A patient is taking a proper diet as prescribed for bulimia nervosa, but the patient's weight is not gaining. Which nursing action is appropriate?

1. A

   Observe the patient for two hours after a meal.

2. B

   Change the diet

3. C

   Add palatable food items to the diet

4. D

   Keep NPO until further order

Appeared in: AIIMS Delhi NO - 2018

Explanation

• The core issue in the scenario is the discrepancy between the patient's reported dietary compliance and the lack of expected weight gain.
• In bulimia nervosa, this clinical picture strongly suggests the patient is engaging in compensatory purging behaviors after meals to prevent weight gain.
• The primary nursing intervention is to interrupt this behavior. Observing the patient for 1-2 hours after meals, often by restricting access to bathrooms, is a standard and effective strategy.
• This observation is not punitive but therapeutic; it prevents the immediate purging action and allows the nurse to help the patient manage the intense anxiety and guilt that can follow eating.

Why Other Options Were Wrong

• Option B: The question states the patient is on a 'proper diet as prescribed.' Changing the diet is inappropriate without first investigating why the current plan is not resulting in weight gain. The problem is likely behavioral, not the composition of the diet.
• Option C: While making food palatable is important for overall adherence, the patient is reportedly eating the food. Adding more palatable items does not address the suspected underlying issue of purging after the meal is consumed.
• Option D: Making the patient NPO (nothing by mouth) is counterproductive and potentially harmful. It would worsen the patient's nutritional status and reinforce the disordered eating cycle of restriction and potential binging. The goal of treatment is to normalize eating patterns, not to withhold food.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nursing management of bulimia nervosa and compensatory behaviors to guide bedside assessment, documentation, and the next nursing action.
• The nurse's primary role in treating bulimia nervosa is to establish a safe, structured, and therapeutic environment that interrupts the cycle of disordered eating.
• Monitoring for purging is a critical patient safety intervention, as behaviors like vomiting and laxative abuse can lead to life-threatening electrolyte imbalances (hypokalemia), cardiac arrhythmias, and esophageal tears.
• What if? If the patient admits to purging but refuses observation, the nurse should respond with empathy, acknowledge the difficulty of the situation, and reinforce the treatment goals. The nurse would then need to discuss the non-negotiable aspects of the safety plan with the patient and the treatment team, potentially escalating to a higher level of care if the patient cannot contract for safety.

How to Approach the Question

• First, identify the patient's diagnosis: Bulimia Nervosa.
• Next, recall the key features of this disorder: episodes of binge eating followed by inappropriate compensatory behaviors (purging) to prevent weight gain.
• Analyze the clinical problem presented in the stem: The patient is eating a prescribed diet but not gaining weight.
• Synthesize this information: The most logical conclusion is that the patient is secretly purging after meals.
• Evaluate the options to find the one that directly addresses this suspected behavior. Observing the patient after meals is the only option that serves to interrupt the purging cycle.
• Eliminate the other options: Changing the diet or adding foods doesn't address purging, and making the patient NPO is therapeutically contraindicated.

Concept Tested & Keywords

• Concept Tested: Nursing management of bulimia nervosa and compensatory behaviors.
• Stem keywords: bulimia nervosa, proper diet, not gaining weight
• Lead-in keywords: appropriate nursing action
• Clinical cues: Discrepancy between reported food intake and weight status.

Question ID

Qwetqd75dhepRDZPKvrhq6

Copy ID

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 60-62