A nurse is assessing a patient diagnosed with bulimia nervosa. The patient reports engaging in binge eating followed by self-induced vomiting. Which of the following is the priority concern for the nurse?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Nutritional deficiencies and electrolyte imbalances. This is the priority concern for the nurse because individuals with bulimia nervosa often engage in binge eating followed by purging behaviors like self-induced vomiting, which can lead to severe consequences such as electrolyte imbalances (e.g., hypokalemia) and nutritional deficiencies (e.g., low levels of vitamins and minerals). These complications can have serious implications on the patient's physical health, potentially leading to cardiac arrhythmias, muscle weakness, and other life-threatening conditions. Option B) Impulsivity and emotional dysregulation, while important factors in understanding and treating bulimia nervosa, are not the immediate priority in this case. Addressing nutritional deficiencies and electrolyte imbalances takes precedence due to their acute and potentially life-threatening nature. Option C) Distorted body image and low self-esteem are common psychosocial issues in individuals with bulimia nervosa but do not pose an immediate threat to the patient's physical health compared to the risks associated with electrolyte imbalances and nutritional deficiencies. Option D) Excessive exercise and weight loss are more commonly associated with anorexia nervosa rather than bulimia nervosa. While these behaviors can co-occur in some cases, they are not the primary concern in a patient presenting with binge eating and purging behaviors. Educationally, it is crucial for nurses and healthcare providers to prioritize the management of acute physical health concerns in individuals with eating disorders to prevent serious complications. Understanding the hierarchy of concerns allows for appropriate triaging and intervention to address the most critical issues first, ensuring the safety and well-being of the patient.

Correct Answer: D

Rationale: The correct answer is D) Differing values are reflected in the two statements. In this scenario, it is essential to understand that both the patient and the nurse are expressing their personal values and beliefs regarding the sensitive topic of suicide. The patient's perspective advocates for autonomy and individual choice over one's life, while the nurse's response reflects a perspective that values life preservation and intervention to prevent harm. The patient's viewpoint emphasizes the importance of respecting an individual's autonomy and right to make decisions about their own life, even in situations as complex as suicide. On the other hand, the nurse's response reflects a duty to uphold the sanctity of life and intervene to prevent harm, aligning with the ethical principle of beneficence in nursing. This interchange highlights the significance of recognizing and respecting diverse perspectives and values in healthcare settings. Nurses must navigate these differences with empathy, respect, and understanding while upholding professional ethics and standards of care. It also underscores the importance of effective communication and active listening in addressing sensitive and challenging topics with patients to provide holistic and patient-centered care.

Correct Answer: B

Rationale: In this scenario, the correct priority nursing intervention is option B: Assess the patient for suicidal thoughts and ideation. This is the most critical action because the patient's expression of hopelessness raises concerns about their safety and risk of harm to themselves. Suicidal ideation is a serious symptom in major depressive disorder that requires immediate attention to ensure the patient's safety. Option A is incorrect because encouraging the patient to engage in mood-improving activities may not be effective or safe if the patient is experiencing suicidal thoughts. Option C, providing positive affirmations, though supportive, does not address the immediate safety concerns raised by the patient's statement. Option D, suggesting medication, may be part of the treatment plan but is not the most urgent intervention in this situation. From an educational perspective, it is crucial for nurses to prioritize safety in mental health assessments. Assessing for suicidal ideation is a fundamental skill in psychiatric nursing to ensure that appropriate interventions are implemented promptly. Understanding the hierarchy of nursing interventions based on the patient's presenting symptoms is essential for providing quality care in behavioral health settings.

Correct Answer: A

Rationale: In this scenario, option A, "I notice you keep looking toward the door," is the best comment by the nurse regarding the patient's nonverbal communication. This response shows empathy and active listening, acknowledging the patient's behavior without making assumptions or judgments. By addressing the patient's nonverbal cues, the nurse opens the door for the patient to express their concerns or feelings, fostering a therapeutic relationship. Option B, "This is our time together. No one is going to interrupt us," dismisses the patient's feelings and may come across as invalidating. It does not address the underlying issue causing the patient to look toward the door. Option C, "It looks as if you are eager to end our discussion for today," makes an assumption about the patient's intentions without seeking clarification, which can lead to miscommunication and misunderstanding. Option D, "If you are uncomfortable in this room, we can move someplace else," jumps to a solution without first exploring the patient's concerns. It does not demonstrate active listening or empathy towards the patient's nonverbal cues. Educationally, this question highlights the importance of nonverbal communication in nursing practice and the significance of addressing patients' nonverbal cues to provide patient-centered care. It emphasizes the need for nurses to be attentive, empathetic, and responsive to patients' verbal and nonverbal expressions to establish trust and promote effective therapeutic communication.

Correct Answer: A

Rationale: In this scenario, the correct priority nursing action is option A: Ask the patient about their suicidal thoughts and plans. This is crucial because the patient's statement indicates a significant level of hopelessness and lack of interest in life, which are concerning red flags for suicidal ideation. As a nurse, it is paramount to assess the patient's risk of harm to themselves. Option B, providing reassurance, is incorrect because it overlooks the seriousness of the patient's statement and does not address the potential risk of harm. Option C, encouraging activities to improve mood, is inappropriate as the patient's situation requires immediate attention due to the risk of self-harm. Option D, encouraging the patient to express feelings and explore hopelessness, is not the priority when there is a direct concern for the patient's safety. Educationally, this question highlights the importance of recognizing and responding to suicidal ideation in patients with major depressive disorder. Nurses must prioritize safety and risk assessment in such situations to provide appropriate care and intervention. Understanding the urgency of addressing suicidal thoughts is essential in behavioral nursing practice to ensure patient safety and well-being.