A nurse is caring for a client who is pregnant.

Exhibits

A nurse is evaluating the client's response to therapy. Which of the following recent assessment findings indicate the client's condition has improved or not changed?
For each recent assessment finding. click to specify if the finding indicates the client’s condition has improved or has not changed. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

Bulimia Nervosa:

Low potassium level (3 mEq/L): Frequent self-induced vomiting leads to significant loss of gastric contents, including potassium. Hypokalemia is a common electrolyte disturbance in bulimia and can contribute to cardiac arrhythmias.

Low sodium level (134 mEq/L): Vomiting and fluid shifts associated with purging behaviors can result in mild hyponatremia. This may also be exacerbated by compensatory water intake or laxative use.

Parotid gland swelling: Repeated vomiting stimulates the salivary glands, particularly the parotids, leading to hypertrophy. This is a hallmark physical finding in bulimia nervosa.

Calluses on index and middle fingers (Russell’s sign): These result from repeated trauma due to self-induced vomiting, where the fingers are used to stimulate the gag reflex. This sign is highly specific to bulimia.

Normal BMI (20.7): Clients with bulimia often maintain a normal or slightly elevated BMI due to cycles of binging and purging. Unlike anorexia, extreme weight loss is not typical.

Anorexia Nervosa:

Low potassium level (3 mEq/L): Although more common in bulimia, hypokalemia can occur in anorexia—especially in the purging subtype or due to severe malnutrition and dehydration.

Low sodium level (134 mEq/L): Hyponatremia may result from dehydration, poor intake, or compensatory behaviors such as excessive water consumption. It’s less common but possible in anorexia.

Parotid enlargement is typically associated with bulimia nervosa, not anorexia. It results from repeated stimulation of the salivary glands due to frequent self-induced vomiting. In anorexia nervosa, especially the restricting subtype, vomiting is not a primary behavior, so parotid swelling is uncommon unless purging is involved.

Calluses on the index and middle fingers are caused by mechanical trauma from inducing vomiting. This physical sign is characteristic of bulimia nervosa, where clients often use their fingers to trigger emesis. In anorexia nervosa, particularly the restricting subtype, this behavior is not typical, making this finding inconsistent.

Anorexia nervosa is defined by significantly low body weight, typically a BMI below 18.5. A BMI of 20.7 falls within the normal range, which is inconsistent with the diagnostic criteria for anorexia. Clients with bulimia nervosa often maintain a normal or slightly elevated BMI due to cycles of binging and purging.

Rationale:

A. The client is doing 30 min of moderate exercise daily: Regular moderate exercise (e.g., walking, swimming) is recommended in pregnancy. It improves circulation, mood, and endurance for labor.

B. The client last visited the dentist 4 months ago: Dental care is encouraged during pregnancy because hormonal changes increase the risk of gingivitis. A dental visit 4 months ago is appropriate.

C. The client started working in a parking garage 3 months ago: Parking garages have poor ventilation and potential exposure to carbon monoxide (CO) from car exhaust, which can cause fetal hypoxia and developmental harm. The nurse should assess environmental safety and possibly recommend reassignment.

D. The client is drinking 2.5 L of water per day: Adequate hydration is essential in pregnancy to maintain amniotic fluid volume and prevent dehydration.