COMPREHENSIVE PROFESSIONAL NURSING
EXAMINATION
CLIENT CARE: ANOREXIA NERVOSA & EATING
DISORDERS
200 Clinical Practice Questions, Options, Answers, and Comprehensive
Rationales
Focusing on Physical Findings, Behavioral Characteristics,
Complications, and Nursing Interventions
Module 1: Physical Manifestations & Physiological Alterations
(Questions 1 - 50)
Question 1: A nurse is assessing an adolescent with severe anorexia
nervosa. Which of the following cardiovascular findings should the
nurse expect?
A) Tachycardia with bounding peripheral pulses
B) Bradycardia and orthostatic hypotension
C) Hypertension and widened pulse pressure
D) Irregular pulse with hyperactive heart sounds
Correct Answer: B
Rationale: Chronic starvation and malnutrition in anorexia nervosa
lead to myocardial atrophy, decreased cardiac output, and
parasympathetic dominance, resulting in resting bradycardia,
hypotension, and orthostatic changes.
Question 2: Which of the following dermatological manifestations is
commonly observed in an adolescent client with prolonged anorexia
nervosa?
A) Flushing and hot, moist skin
B) Lanugo hair and dry, yellowed skin
, C) Jaundiced sclera and petechiae
D) Hyperpigmentation over pressure points
Correct Answer: B
Rationale: Clients with anorexia nervosa frequently develop fine,
downy hair known as lanugo across the body as a thermoregulatory
response to severe weight loss and subcutaneous fat depletion. Skin
often becomes dry and carotenemic (yellowish) due to
hypercarotenemia.
Question 3: An adolescent with anorexia nervosa is admitted with
profound electrolyte imbalances. Which laboratory abnormality is most
characteristic of purging behaviors (e.g., self-induced vomiting)?
A) Hyperkalemia and metabolic acidosis
B) Hypokalemic metabolic alkalosis
C) Hypernatremia and respiratory alkalosis
D) Hyponatremic metabolic acidosis
Correct Answer: B
Rationale: Loss of gastric hydrochloric acid through vomiting results
in metabolic alkalosis, while renal potassium wasting and GI loss
lead to hypokalemia. Chloride levels are also frequently depressed.
Question 4: A nurse evaluates an adolescent female with anorexia
nervosa regarding her menstrual history. Which finding is expected?
A) Menorrhagia
B) Dysmenorrhea
C) Amenorrhea
D) Polymenorrhea
Correct Answer: C
Rationale: Secondary amenorrhea is a hallmark diagnostic criterion
for adolescent females with anorexia nervosa, caused by suppression
, of the hypothalamic-pituitary-ovarian (HPO) axis due to low body fat
and leptin deficiency.
Question 5: When reviewing laboratory results for an adolescent client
with severe anorexia nervosa, which endocrine finding is typical?
A) Hyperinsulinemia and elevated thyroid hormones
B) Euthyroid sick syndrome (low T3, normal/low T4 and TSH)
C) Elevated estrogen and progesterone levels
D) Increased cortisol clearance and low basal cortisol
Correct Answer: B
Rationale: To conserve energy during starvation, the body
downregulates metabolic rate, manifesting as low triiodothyronine
(T3) levels in the presence of normal or mildly decreased TSH and
T4, known as euthyroid sick syndrome or low T3 syndrome.
Question 6: An adolescent client with anorexia nervosa is at high risk
for osteoporosis and pathological fractures. Which pathophysiological
mechanism explains this risk?
A) Increased osteoblast activity due to high cortisol
B) Estrogen deficiency and decreased bone mineral density
C) Excessive calcium absorption in the renal tubules
D) Hyperparathyroidism secondary to vitamin D excess
Correct Answer: B
Rationale: Hypoestrogenemia resulting from hypothalamic
amenorrhea leads to uncoupled bone remodeling, where bone
resorption outpaces formation, drastically reducing bone mineral
density and predisposing adolescents to early osteopenia and
osteoporosis.
Question 7: Which gastrointestinal complication is frequently reported
by adolescents undergoing treatment for anorexia nervosa?
, A) Rapid gastric emptying and dumping syndrome
B) Severe constipation and delayed gastric emptying
C) Pancreatic insufficiency and steatorrhea
D) Hyperacidity and peptic ulcer disease
Correct Answer: B
Rationale: Starvation and decreased caloric intake slow intestinal
motility, leading to chronic, severe constipation, delayed gastric
emptying (gastroparesis), and early satiety.
Question 8: A nurse performs a physical assessment on an adolescent
with anorexia nervosa. Which oral and dental finding is indicative of
frequent purging behaviors?
A) Gingival hyperplasia
B) Dental erosion and enamel demineralization
C) Macroglossia and angular cheilitis
D) Sublingual hematomas
Correct Answer: B
Rationale: Repeated exposure of teeth to acidic gastric contents
during self-induced vomiting causes dental erosion, particularly on
the lingual surfaces of the teeth, as well as caries and salivary gland
hypertrophy (sialadenosis).
Question 9: An adolescent with anorexia nervosa presents with
peripheral edema upon initiation of refeeding. What is the primary
physiological mechanism for this finding?
A) Acute renal failure due to dehydration
B) Sodium and water retention mediated by secondary
hyperaldosteronism
C) Allergic reaction to enteral formulas
D) Hepatic congestion from fat accumulation
EXAMINATION
CLIENT CARE: ANOREXIA NERVOSA & EATING
DISORDERS
200 Clinical Practice Questions, Options, Answers, and Comprehensive
Rationales
Focusing on Physical Findings, Behavioral Characteristics,
Complications, and Nursing Interventions
Module 1: Physical Manifestations & Physiological Alterations
(Questions 1 - 50)
Question 1: A nurse is assessing an adolescent with severe anorexia
nervosa. Which of the following cardiovascular findings should the
nurse expect?
A) Tachycardia with bounding peripheral pulses
B) Bradycardia and orthostatic hypotension
C) Hypertension and widened pulse pressure
D) Irregular pulse with hyperactive heart sounds
Correct Answer: B
Rationale: Chronic starvation and malnutrition in anorexia nervosa
lead to myocardial atrophy, decreased cardiac output, and
parasympathetic dominance, resulting in resting bradycardia,
hypotension, and orthostatic changes.
Question 2: Which of the following dermatological manifestations is
commonly observed in an adolescent client with prolonged anorexia
nervosa?
A) Flushing and hot, moist skin
B) Lanugo hair and dry, yellowed skin
, C) Jaundiced sclera and petechiae
D) Hyperpigmentation over pressure points
Correct Answer: B
Rationale: Clients with anorexia nervosa frequently develop fine,
downy hair known as lanugo across the body as a thermoregulatory
response to severe weight loss and subcutaneous fat depletion. Skin
often becomes dry and carotenemic (yellowish) due to
hypercarotenemia.
Question 3: An adolescent with anorexia nervosa is admitted with
profound electrolyte imbalances. Which laboratory abnormality is most
characteristic of purging behaviors (e.g., self-induced vomiting)?
A) Hyperkalemia and metabolic acidosis
B) Hypokalemic metabolic alkalosis
C) Hypernatremia and respiratory alkalosis
D) Hyponatremic metabolic acidosis
Correct Answer: B
Rationale: Loss of gastric hydrochloric acid through vomiting results
in metabolic alkalosis, while renal potassium wasting and GI loss
lead to hypokalemia. Chloride levels are also frequently depressed.
Question 4: A nurse evaluates an adolescent female with anorexia
nervosa regarding her menstrual history. Which finding is expected?
A) Menorrhagia
B) Dysmenorrhea
C) Amenorrhea
D) Polymenorrhea
Correct Answer: C
Rationale: Secondary amenorrhea is a hallmark diagnostic criterion
for adolescent females with anorexia nervosa, caused by suppression
, of the hypothalamic-pituitary-ovarian (HPO) axis due to low body fat
and leptin deficiency.
Question 5: When reviewing laboratory results for an adolescent client
with severe anorexia nervosa, which endocrine finding is typical?
A) Hyperinsulinemia and elevated thyroid hormones
B) Euthyroid sick syndrome (low T3, normal/low T4 and TSH)
C) Elevated estrogen and progesterone levels
D) Increased cortisol clearance and low basal cortisol
Correct Answer: B
Rationale: To conserve energy during starvation, the body
downregulates metabolic rate, manifesting as low triiodothyronine
(T3) levels in the presence of normal or mildly decreased TSH and
T4, known as euthyroid sick syndrome or low T3 syndrome.
Question 6: An adolescent client with anorexia nervosa is at high risk
for osteoporosis and pathological fractures. Which pathophysiological
mechanism explains this risk?
A) Increased osteoblast activity due to high cortisol
B) Estrogen deficiency and decreased bone mineral density
C) Excessive calcium absorption in the renal tubules
D) Hyperparathyroidism secondary to vitamin D excess
Correct Answer: B
Rationale: Hypoestrogenemia resulting from hypothalamic
amenorrhea leads to uncoupled bone remodeling, where bone
resorption outpaces formation, drastically reducing bone mineral
density and predisposing adolescents to early osteopenia and
osteoporosis.
Question 7: Which gastrointestinal complication is frequently reported
by adolescents undergoing treatment for anorexia nervosa?
, A) Rapid gastric emptying and dumping syndrome
B) Severe constipation and delayed gastric emptying
C) Pancreatic insufficiency and steatorrhea
D) Hyperacidity and peptic ulcer disease
Correct Answer: B
Rationale: Starvation and decreased caloric intake slow intestinal
motility, leading to chronic, severe constipation, delayed gastric
emptying (gastroparesis), and early satiety.
Question 8: A nurse performs a physical assessment on an adolescent
with anorexia nervosa. Which oral and dental finding is indicative of
frequent purging behaviors?
A) Gingival hyperplasia
B) Dental erosion and enamel demineralization
C) Macroglossia and angular cheilitis
D) Sublingual hematomas
Correct Answer: B
Rationale: Repeated exposure of teeth to acidic gastric contents
during self-induced vomiting causes dental erosion, particularly on
the lingual surfaces of the teeth, as well as caries and salivary gland
hypertrophy (sialadenosis).
Question 9: An adolescent with anorexia nervosa presents with
peripheral edema upon initiation of refeeding. What is the primary
physiological mechanism for this finding?
A) Acute renal failure due to dehydration
B) Sodium and water retention mediated by secondary
hyperaldosteronism
C) Allergic reaction to enteral formulas
D) Hepatic congestion from fat accumulation
