A pediatric nurse at the clinic interviews a 14-year-old client who is dressed in baggy clothes and two sweaters on a warm day. The client admits to not having had her period for 4 months. The nurse notes fine downy hair along the client's cheeks. Vital signs are T, 36.6; P, 64; and BP, 84/50. Which additional objective sign would best support the nurse's assessment that the client has anorexia nervosa?

Correct Answer: A

Rationale: The correct answer is A: Weight 15% below normal for her height. In anorexia nervosa, individuals have a fear of gaining weight leading to severe weight loss. A weight 15% below normal for her height indicates significant weight loss, a hallmark feature of anorexia nervosa. This is supported by the client's baggy clothes, two sweaters on a warm day, and absence of menstrual periods, which are common signs of anorexia nervosa. Choice B: Eroded dental enamel is a sign of bulimia nervosa, not anorexia nervosa. Choice C: Parotid gland enlargement is seen in bulimia nervosa due to frequent vomiting, not anorexia nervosa. Choice D: Dehydration is a general sign and not specific to anorexia nervosa.

Correct Answer: A

Rationale: The correct answer is A: denial. Patients with anorexia nervosa often deny the seriousness of their low weight, distorted body image, or the potential health consequences of their eating behaviors. This denial helps them avoid facing their underlying issues and enables them to continue harmful behaviors. Choice B (projection) involves attributing one's own thoughts or feelings onto others, not relevant to anorexia. Choice C (introjection) involves internalizing external beliefs or values, not a common maladaptive coping mechanism in anorexia. Choice D (rationalization) involves creating logical explanations to justify inappropriate behaviors, not the primary defense mechanism in anorexia.

Correct Answer: B

Rationale: The correct answer is B because it demonstrates that parents are actively engaged and interested in learning about healthier eating patterns for their children, aligning with the objective of preventing childhood eating problems. This outcome indicates a willingness to make positive changes in the family's approach to nutrition. A: While providing structured meal times and snacks is important, this choice does not necessarily reflect an understanding of healthier eating patterns or prevention of eating problems. C: Using food as a reward can actually contribute to unhealthy eating habits and does not align with the goal of preventing childhood eating problems. D: Keeping a diary to record signs of hunger is useful, but it does not directly address the objective of learning about healthier eating patterns.

Correct Answer: D

Rationale: The correct answer is D) 9 months, 18 months, and 30 months for developmental screening according to AAP guidelines. This timing aligns with critical periods in a child's development when significant milestones should be observed. At 9 months, infants are typically reaching important milestones such as sitting without support, babbling, and beginning to crawl. Screening at this age allows for early detection of any developmental delays or concerns. At 18 months, toddlers should be demonstrating more advanced skills like walking independently, using simple words, and engaging in pretend play. Screening at this stage helps identify any delays that may require intervention. Finally, at 30 months, children are expected to show more advanced language skills, social interactions, and motor coordination. Screening at this age ensures that any developmental issues are addressed promptly to support the child's overall development. The incorrect options can be ruled out based on the fact that they do not align with the critical developmental milestones expected at each age. Options A) and C) miss the 30-month screening, which is crucial for detecting delays before a child enters preschool. Option B) skips the 9-month screening, which is essential for early intervention. Understanding the recommended ages for developmental screening is vital for healthcare providers, educators, and parents to ensure children receive timely support if needed. Early detection and intervention can significantly impact a child's long-term outcomes and overall well-being.

Correct Answer: C

Rationale: In Avoidant/Restrictive Food Intake Disorder (ARFID), individuals do not have weight concerns, which is why option C is the correct answer. This characteristic distinguishes ARFID from other eating disorders like anorexia nervosa or bulimia nervosa where weight concerns are typically present. Option A, not preferring foods with strong smells, is not a defining characteristic of ARFID. While sensory issues can contribute to food aversions in ARFID, this alone is not a clinical feature that defines the disorder. Option B, not preferring bland foods, is also not a characteristic feature of ARFID. Individuals with ARFID may have a limited range of preferred foods due to sensory sensitivities or fear of negative consequences associated with eating, but this is not specific to bland foods. Option D, not preferring solid foods, is not a defining characteristic of ARFID either. While some individuals with ARFID may have specific aversions to certain textures or consistencies of food, the preference for solid foods is not a universal feature of the disorder. Educationally, understanding the clinical features of ARFID is crucial for healthcare professionals working with individuals who may be struggling with this disorder. Recognizing the absence of weight concerns in ARFID can help in early identification and appropriate intervention to support those affected. It is important to differentiate ARFID from other eating disorders to provide tailored and effective treatment strategies.