Identifying Neural Conditions - NCLEX-PN

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Question

You are the nurse assessing a 16-year old girl who is the star of her high school's gymanstics team who is admitted to the hospital for fatigue and weakness. You examine her and notice that she appears hypovolemic, her hair appears thin and brittle, her parotid glands appear swollen, her knuckles have excoriations, and her teeth appear slightly yellow. You suspect that she most likely suffers from which of the following?

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Answer

The correct answer is bulimia nervosa.

Bulimia nervosa is an eating disorder in which a patient classically consumes large amounts of food (binge eating) and then induces vomiting (purge behavior) to expel the food prior to absorption in the gastrointestinal tract. As such, the patient restricts their ability to gain weight. Patients with bulimia nervosa are frequently successful, high-achieving individuals under a great deal of stress, and often may be adolescent athletes, as patients in this population frequently have specific weight cutoffs that they must achieve for their respective sports/activities. Some signs of bulimia nervosa, as exhibited by this patient, are thin, brittle hair, a hypovolemic appearance (due to frequent vomiting), excoriations on the knuckles (from self-inducing vomiting with their hands), yellow discoloration of the teeth (from the acidity of vomitus), and swelling of the parotid glands (colloquially known as "chipmunk cheeks") as a response to the frequent vomiting. Patients with bulimia may also use other methods to purge themselves of food and drinks including diuretic use, and/or laxative use.

A key distinction between bulimia nervosa and anorexia nervosa is that in bulimia the patient exhibits a form of purge behavior following binge eating, whereas in anorexia, classically, the patient simply restricts eating rather than binging and purging.

Hypothyroidism is not a correct answer choice because while this patient is exhibiting lethargy, weakness, and brittle hair, given the constellation of her other symptoms and exam findings, it is less consistent with her presentation than bulimia nervosa. If these symptoms persisted following treatment for bulimia, then hypothyroidism could be considered as a concurrent finding.

Exogenous use of testosterone would not account for the symptoms seen in this patient.

Marfan's syndrome would also not account for the symptoms seen in this patient.

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