What are the main features of anorexia nervosa and a key nursing concern during refeeding?

• A. High BMI and fear of weight loss; refeeding has no complications
• B. Low BMI, intense fear of weight gain, distorted body image; refeeding carries risk of electrolyte shifts and refeeding syndrome requiring careful monitoring
• C. Normal BMI with no body image distortion; refeeding is not necessary
• D. Binge eating with purging; electrolyte disturbances are uncommon

Answer: (B)

The main concept here is recognizing what anorexia nervosa looks like and understanding the serious risk that can occur when feeding is resumed. Anorexia nervosa typically presents with a very low body weight or BMI, an intense fear of gaining weight, and a distorted perception of body shape or size that drives ongoing restriction and dieting. These features reflect both the behavioral patterns of under-eating and the powerful cognitive distortions around weight.

When refeeding someone with anorexia nervosa, the key nursing concern is preventing refeeding syndrome. Restoring nutrition after a period of malnutrition can cause rapid shifts in fluids and electrolytes, especially phosphate, potassium, and magnesium. These shifts can lead to dangerous problems such as heart rhythm disturbances, respiratory failure, edema, and neurological issues. Therefore the approach is cautious and collaborative: begin with a slow, supervised reintroduction of calories, provide thiamine and other necessary vitamins before and during feeding, and monitor vital signs and laboratory values closely—electrolytes (phosphate, potassium, magnesium), glucose, and fluid status. Adjust the refeeding plan based on tolerance and lab trends, and engage the broader healthcare team to prevent complications.

Descriptions that cite high or normal BMI with no body image disturbance, or patterns like binge eating with purging, do not fit the typical presentation or the associated refeeding risk, and the idea that refeeding has no complications is inaccurate.