A pediatric nurse is assessing a 10-year-old girl with signs of anorexia nervosa.
Which physical assessment finding would support the diagnosis?

Choice A rationale

A possible sign of pregnancy typically refers to a cluster of symptoms or physical changes that *could* suggest pregnancy but are not definitive, such as missed menses or breast tenderness. Feeling fetal movement is more specific and falls into a more advanced category of signs.

Choice B rationale

A presumptive sign of pregnancy refers to subjective changes experienced by the woman that suggest pregnancy but could be caused by other conditions. Examples include nausea, fatigue, and amenorrhea. While fetal movement *could* be subjective, a woman feeling it is generally considered a strong indicator.

Choice C rationale

A probable sign of pregnancy refers to objective signs noted by an examiner that strongly suggest pregnancy but are still not definitive. Examples include a positive pregnancy test (detects hCG, which can be elevated in other conditions), Hegar's sign (softening of the lower uterine segment), and Chadwick's sign (bluish discoloration of the cervix).

Choice D rationale

A positive sign of pregnancy refers to objective evidence that can only be attributed to the presence of a fetus. Feeling the baby move, known as quickening when felt by the mother, is a strong indicator. However, *actual* positive signs include fetal heart tones detected by an examiner, visualization of the fetus by ultrasound, or palpation of fetal parts by an examiner. The mother feeling movement is considered a positive sign because it's highly specific to fetal presence.

Choice A rationale

Immediately initiating urological testing without first assessing for psychological factors is premature. While organic causes of enuresis exist, a sudden onset in a 12-year-old following a significant stressor like parental divorce strongly suggests a psychological etiology. Unnecessary invasive testing can be distressing for the child.

Choice B rationale

Punishing a child for bedwetting is detrimental and ineffective. Enuresis, especially stress-induced, is an involuntary act; punishment increases anxiety and shame, exacerbating the problem rather than resolving it. This approach can damage the child's self-esteem and the parent-child relationship.

Choice C rationale

Informing the child they are too old for bedwetting shames them and ignores the underlying emotional distress. This approach fosters guilt and inadequacy, reinforcing negative self-perceptions rather than addressing the root cause. Empathy and support are crucial for managing stress-related symptoms.

Choice D rationale

Providing emotional support and assessing for enuresis as a stress response is the most appropriate initial intervention. The sudden onset of bedwetting after parental divorce strongly suggests a psychological component. Addressing the emotional impact and providing coping strategies can alleviate the stress, leading to resolution of the enuresis.