A nurse is caring for a 24-year-old female client with anorexia nervosa on an inpatient eating disorder unit.

A nurse on an inpatient eating disorder unit is assessing a 24-year-old female client with anorexia nervosa. Which of the following assessment findings indicate a therapeutic response to the treatment plan? Select all that apply.

Choice A rationale

Amenorrhea, the absence of menstruation, can occur in individuals with bulimia nervosa, but it is more commonly associated with anorexia nervosa due to severe caloric restriction and low body fat leading to hypothalamic dysfunction and disruption of the pulsatile release of GnRH, impacting ovarian function. While possible, dental decay is a more direct and frequent consequence of recurrent self-induced vomiting.

Choice B rationale

Frequent self-induced vomiting exposes dental enamel to highly acidic gastric contents. This repeated exposure leads to the erosion of tooth enamel, increasing susceptibility to cavities, discoloration, and potential loss of teeth. The acid decalcifies the enamel, a process known as perimylolysis, which is a hallmark sign.

Choice C rationale

Clients with bulimia nervosa often maintain a body weight that is within or even above the normal expected reference range. Unlike anorexia nervosa, bulimia involves cycles of binging and compensatory behaviors, which may not always result in significant weight loss. Therefore, lower than normal expected body weight is not a defining characteristic.

Choice D rationale

Self-induced vomiting causes a significant loss of gastric acid, which primarily contains hydrogen chloride. To compensate for this loss, the kidneys excrete potassium to conserve hydrogen ions, leading to hypokalemia. The normal reference range for potassium is 3.5-5.0 mEq/L. Therefore, hyperkalemia, an elevated potassium level, is not an expected finding.

Choice A rationale

The absence of delusions or hallucinations is characteristic of a period of remission or residual phase in psychotic disorders, not the active phase of schizoaffective disorder. During an active phase, both psychotic symptoms and mood symptoms are prominent and co-occur.

Choice B rationale

While negative symptoms can be present in both schizophrenia and schizoaffective disorder, they are typically more severe and enduring in schizophrenia. The active phase of schizoaffective disorder is defined by the co-occurrence of prominent mood symptoms alongside psychotic features.

Choice C rationale

The defining characteristic of the active phase of schizoaffective disorder is the simultaneous presence of symptoms meeting criteria for a major mood episode (major depression or mania) and symptoms of schizophrenia (e.g., delusions, hallucinations, disorganized speech), with the psychotic symptoms also present for at least two weeks in the absence of prominent mood symptoms.

Choice D rationale

Anosognosia, a lack of insight into one's illness, can occur in both schizophrenia and schizoaffective disorder. However, there is no scientific basis to suggest that anosognosia is inherently more severe during the active phase of schizoaffective disorder compared to schizophrenia. Its severity varies individually.