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 feature of bulimia nervosa is binge eating followed by inappropriate compensatory behaviors to prevent weight gain.
• If a patient is eating but not gaining weight, the highest priority is to suspect and prevent hidden purging behaviors, such as self-induced vomiting.
• Observing the patient for 1-2 hours after meals, particularly by restricting access to bathrooms, is a standard and necessary intervention to interrupt the binge-purge cycle.
• This action allows the nurse to ensure that the consumed nutrients are not being eliminated, which is essential for nutritional rehabilitation and weight restoration.

Why Other Options Were Wrong

• Option B: The problem is not the composition of the diet but the patient's behavior after eating. The stem states the diet is 'proper,' so changing it does not address the suspected purging.
• Option C: Adding palatable foods, especially those the patient may consider 'forbidden' or high-calorie, can act as a trigger for binge eating and subsequent purging. It does not address the immediate problem of stopping the purging behavior.
• Option D: Making a patient NPO (nothing by mouth) is contraindicated and harmful. It would exacerbate malnutrition, increase anxiety about food, and go against the primary treatment goal of establishing regular, healthy eating patterns.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nursing management of a patient with bulimia nervosa exhibiting signs of purging to guide bedside assessment, documentation, and the next nursing action.
• Nurses must maintain a non-judgmental, empathetic, yet firm and consistent approach when managing patients with eating disorders.
• Patient safety is paramount. Purging can lead to severe electrolyte imbalances (especially hypokalemia), which can cause life-threatening cardiac arrhythmias. Regular monitoring of lab values and vital signs is essential.
• What if the patient becomes hostile when told they must be observed? The nurse should calmly and firmly reiterate the treatment goal: 'I understand this is difficult, but my primary concern is your safety. We need to ensure you are getting the nutrition you need to heal. I will be staying with you for a while.' This maintains boundaries while being supportive.

How to Approach the Question

• First, identify the key information in the scenario: The patient has bulimia nervosa, is on a 'proper diet,' but is not gaining weight.
• Recall the pathophysiology of bulimia nervosa. The defining characteristic is binge eating followed by compensatory behaviors (purging) to prevent weight gain.
• Connect the patient's lack of weight gain to the disease process. The most logical conclusion is that the patient is secretly purging after meals.
• Evaluate the options based on this conclusion. Which action directly addresses and interrupts the suspected purging behavior?
• Option A (observation) directly targets the problem. Options B and C (diet changes) fail to address the behavior. Option D (NPO) is harmful and counter-therapeutic.
• Therefore, select the option that involves monitoring and intervention to prevent the compensatory behavior.

Concept Tested & Keywords

• Concept Tested: Nursing management of a patient with bulimia nervosa exhibiting signs of purging.
• Stem keywords: bulimia nervosa, proper diet, weight not gaining
• Lead-in keywords: appropriate nursing action
• Clinical cues: Lack of weight gain despite reported dietary adherence is a red flag for purging behaviors.

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