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

Excessive dental caries and enlarged tonsils are more commonly associated with bulimia nervosa due to the erosive effects of recurrent vomiting on tooth enamel and compensatory hypertrophy of lymphoid tissue in the pharynx. While indicative of disordered eating, they are not primary physical markers for anorexia nervosa.

Choice B rationale

A skeletal appearance with lanugo on arms is highly indicative of anorexia nervosa. The emaciation results from severe caloric restriction, leading to significant adipose tissue and muscle loss. Lanugo, fine downy hair, develops as a compensatory mechanism to conserve body heat due to the lack of insulating fat.

Choice C rationale

An irregular heart rate, such as bradycardia, is a common finding in anorexia nervosa due to metabolic slowdown and electrolyte imbalances. However, heavy menstruation (menorrhagia) is not typically associated with anorexia; amenorrhea (absence of menstruation) is a classic sign due to hormonal suppression from malnutrition.

Choice D rationale

Being overweight with a puffy face is inconsistent with the diagnostic criteria for anorexia nervosa, which is characterized by significantly low body weight. A puffy face might suggest fluid retention or salivary gland enlargement, which can occur in bulimia, but not typical for anorexia.

Choice A rationale

Performing fundal massage is indicated for a boggy or displaced fundus, which suggests uterine atony and a risk of hemorrhage. In this scenario, the fundus is described as firm and midline at the umbilicus, indicating appropriate uterine involution and contraction. Therefore, fundal massage is not necessary.

Choice B rationale

Increasing the rate of IV fluids is typically done to expand circulating blood volume in cases of hypovolemia or hemorrhage. Given the small amount of lochia rubra and a firm, midline fundus, there is no indication of excessive blood loss or hypovolemia that would warrant an increase in IV fluid rate.

Choice C rationale

Assisting the client to ambulate is generally encouraged in the postpartum period to promote circulation and prevent complications like deep vein thrombosis. However, in the context of assessing for potential concealed hemorrhage, ambulation is not the most immediate or appropriate action; the priority is to rule out hidden blood loss.

Choice D rationale

A small amount of lochia rubra with a firm, midline fundus is a normal finding. However, checking for blood under the client's buttock is crucial to rule out concealed hemorrhage, as blood can pool unnoticed beneath the client, masking significant blood loss despite a firm fundus. This ensures a comprehensive assessment of blood loss.