The nurse is providing care to a client diagnosed with schizophrenia and is experiencing anticholinergic side effects from long-term use of typical antipsychotics. Which of the following symptoms would the nurse expect to see during an assessment?

Choice A reason: Russell’s sign, calluses on the knuckles from self-induced vomiting, is a hallmark of bulimia nervosa. Repeated purging causes skin abrasions, making this a common physical finding, so this is the correct expected observation.

Choice B reason: Hyperkalemia is not typical in bulimia; hypokalemia is more common due to vomiting or laxative abuse. Electrolyte imbalances occur, but high potassium is unrelated, making this incorrect for bulimia findings.

Choice C reason: Lanugo, fine body hair, is associated with anorexia nervosa, not bulimia. Bulimia patients often maintain normal weight, lacking severe starvation signs, making this incorrect for the expected findings.

Choice D reason: Sunken parotid glands are not a bulimia feature; enlarged parotids occur due to frequent vomiting. Sunken glands are unrelated, making this incorrect compared to Russell’s sign as a bulimia indicator.

Choice A reason: Wearing an eye patch at all times for diplopia in multiple sclerosis is inappropriate, as it may not address the underlying demyelination causing visual disturbances. Alternating eye patches or consulting a neurologist is preferred, as constant patching could strain vision or mask worsening symptoms, reducing quality of life.

Choice B reason: Relaxing in a hot tub daily is not advisable for multiple sclerosis, as heat can exacerbate symptoms (Uhthoff’s phenomenon) by slowing nerve conduction in demyelinated areas. This could worsen fatigue, sensory changes, or motor symptoms, making it an unsafe recommendation for managing MS symptoms.

Choice C reason: Implementing a rest schedule is appropriate for multiple sclerosis, as fatigue is a common symptom due to immune-mediated demyelination and central nervous system dysfunction. Rest periods help conserve energy, reduce symptom exacerbation, and improve daily functioning, making this a critical strategy for managing MS effectively.

Choice D reason: A vigorous exercise program is inappropriate for MS clients with active symptoms like diplopia and sensory changes, as overexertion can worsen fatigue and neurological symptoms. Gentle, tailored exercise may be beneficial, but vigorous activity risks exacerbating demyelination-related impairments, making this an unsuitable recommendation.