Choice A reason:

Tremors are not typically associated with Cushing’s syndrome. Cushing’s syndrome is characterized by an excess of cortisol, which leads to various symptoms, but tremors are not commonly among them. Tremors are more often associated with conditions affecting the nervous system, such as Parkinson’s disease or essential tremor.

Choice B reason:

A buffalo hump, which is a fat deposit on the back of the neck and upper back, is a common manifestation of Cushing’s syndrome. This occurs due to the redistribution of fat caused by prolonged exposure to high levels of cortisol. The buffalo hump is a distinctive physical sign that helps in diagnosing Cushing’s syndrome.

Choice C reason:

Moon face, characterized by a rounded, puffy face, is another hallmark of Cushing’s syndrome. This symptom results from fat deposits accumulating in the facial area due to elevated cortisol levels. The moon face is often one of the first noticeable signs of Cushing’s syndrome.

Choice D reason:

Hypertension, or high blood pressure, is a common symptom of Cushing’s syndrome. Cortisol increases blood pressure by enhancing the sensitivity of blood vessels to catecholamines and by promoting sodium and water retention. This leads to an increase in blood volume and, consequently, higher blood pressure.

Choice E reason:

Purple striae, or stretch marks, are also indicative of Cushing’s syndrome. These marks typically appear on the abdomen, thighs, breasts, and arms and are caused by the thinning of the skin and weakening of connective tissue due to excessive cortisol. The striae are often wide and have a purplish hue, distinguishing them from regular stretch marks.

Choice A: Potassium Level

Reason: Monitoring potassium levels is crucial in clients with bulimia nervosa due to the risk of hypokalemia (low potassium levels), which can result from frequent vomiting and laxative abuse. Hypokalemia can lead to serious complications, including cardiac arrhythmias. In this case, the client’s potassium level improved from 3.2 mEq/L (below the normal range of 3.5 to 5 mEq/L) on June 1 to 3.7 mEq/L (within the normal range) on June 15. This improvement indicates a positive response to treatment, as it suggests that the client is experiencing fewer episodes of vomiting or laxative abuse, leading to better electrolyte balance.

Choice B: ECG Report

Reason: While the ECG report is important for assessing cardiac health, it is not a direct indicator of therapeutic response to bulimia nervosa treatment. The presence of premature ventricular contractions (PVCs) on the ECG can be related to electrolyte imbalances, particularly hypokalemia. However, the ECG itself does not provide information about the client’s behaviors or coping mechanisms, which are more directly related to the treatment of bulimia

nervosa. Therefore, while the ECG report is useful for monitoring cardiac health, it is not one of the primary indicators of therapeutic response in this context.

Choice C: BUN Level

Reason: Blood Urea Nitrogen (BUN) levels can indicate kidney function and hydration status. Elevated BUN levels, as seen in this client (28 mg/dL on June 1 and 26 mg/dL on June 15, with a normal range of 10 to 20 mg/dL), may suggest dehydration or impaired kidney function. However, BUN levels are not specific indicators of therapeutic

response to bulimia nervosa treatment. They do not directly reflect changes in the client’s eating behaviors, purging habits, or coping skills. Therefore, while monitoring BUN levels is important for overall health, it is not a primary indicator of therapeutic response in this case.

Choice D: Laxative Usage

Reason: Reducing or eliminating laxative usage is a significant indicator of therapeutic response in clients with bulimia nervosa. Laxative abuse is a common purging behavior in bulimia nervosa, and its reduction indicates progress in treatment. The client’s report of laxative usage provides direct insight into their purging behaviors. A

decrease in laxative use suggests that the client is gaining better control over their eating disorder and is adhering to the treatment plan. This behavioral change is a critical component of recovery and indicates a positive therapeutic response.

Choice E: Overeating Cycle/Purging

Reason: Assessing changes in the client’s overeating and purging cycle is essential for evaluating therapeutic response. Bulimia nervosa is characterized by cycles of binge eating followed by purging behaviors such as vomiting or laxative abuse. A reduction in the frequency or severity of these cycles indicates that the client is responding well to treatment. The client’s self-reported behaviors regarding overeating and purging provide valuable information about their progress. A decrease in these behaviors suggests that the client is developing healthier eating patterns and coping mechanisms, which are key goals of treatment.

Choice F: Coping Skills

Reason: Developing effective coping skills is a crucial aspect of treatment for bulimia nervosa. Clients often use disordered eating behaviors as a way to cope with emotional distress. By learning and implementing healthier coping strategies, clients can reduce their reliance on harmful behaviors such as binge eating and purging. Assessing the client’s coping skills involves evaluating their ability to manage stress, emotions, and triggers in a healthy manner. Improvement in coping skills indicates that the client is making progress in their recovery and is better equipped to handle challenges without resorting to disordered eating behaviors.