Nurse is caring for a client diagnosed with bulimia nervosa. The most appropriate initial goal for a client diagnosed with bulimia nervosa is?

1. A

   Encourage to avoid foods

2. B

   Identify anxiety causing situations

3. C

   Electrolytes imbalances

4. D

   Avoid shopping plenty of groceries

Appeared in: SJH Nursing Officer - 2019

Explanation

• The initial and most critical goal in managing bulimia nervosa is correcting fluid and electrolyte imbalances to ensure physiological stability.
• Purging behaviors (vomiting, laxative/diuretic abuse) lead to significant loss of potassium, chloride, and fluids.
• This can cause severe hypokalemia, a life-threatening condition that can trigger cardiac dysrhythmias and sudden death.
• According to nursing principles (like Maslow's hierarchy), physiological needs must be met before psychological or behavioral interventions can be effective.

Why Other Options Were Wrong

• Option A: Encouraging food avoidance is counterproductive and reinforces the disordered eating pattern. It can increase the urge to binge.
• Option B: Identifying anxiety triggers is a key component of psychotherapy (e.g., CBT), which is a later stage of treatment. It is not the initial priority when a client's life is at risk due to physiological instability.
• Option D: This is a practical behavioral strategy to help manage binge urges, but it does not address the immediate, life-threatening medical complications of the disorder.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Prioritization of nursing care for clients with bulimia nervosa to guide bedside assessment, documentation, and the next nursing action.
• A nurse's primary responsibility in the initial care of a client with bulimia is to assess for, monitor, and manage life-threatening physiological complications. This includes checking vital signs, monitoring lab values (especially potassium), and potentially initiating cardiac monitoring.
• Failure to prioritize medical stabilization can have fatal consequences. The nurse acts as a critical safety net during this vulnerable period.
• What if the client refuses to have their blood drawn for electrolyte monitoring? The nurse must explain the life-saving importance of the test in a calm, firm manner. If refusal persists, the nurse must document the refusal, inform the primary healthcare provider immediately, and increase monitoring of vital signs and cardiac status, as this is a high-risk situation.

How to Approach the Question

• First, identify the core of the question: it asks for the 'initial' and 'most appropriate' goal. This signals a prioritization question.
• Recall Maslow's Hierarchy of Needs or the ABCs (Airway, Breathing, Circulation) of nursing. Physiological needs are always the top priority over psychological or behavioral needs.
• Analyze the options in this context. 'Electrolyte imbalances' directly relates to a critical physiological need (circulation, cardiac function).
• Evaluate the other options: 'Avoiding foods' is a harmful action. 'Identifying anxiety' is a psychological goal. 'Avoiding grocery shopping' is a behavioral strategy.
• Conclude that correcting electrolyte imbalances is the only option that addresses an immediate, life-threatening physiological risk, making it the highest priority initial goal.

Concept Tested & Keywords

• Concept Tested: Prioritization of nursing care for clients with bulimia nervosa.
• Stem keywords: bulimia nervosa, initial goal, nurse, caring
• Lead-in keywords: most appropriate, initial

Question ID

Qk30iHqz2KBNbxfrL90aHS

Copy ID

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) pp. 60-62, 61-63