A nurse is working with a patient diagnosed with bulimia nervosa. The patient says, 'I can't stop eating even when I feel full.' Which of the following is the most appropriate nursing diagnosis?

Correct Answer: C

Rationale: The most appropriate nursing diagnosis for a patient diagnosed with bulimia nervosa who says, 'I can't stop eating even when I feel full' is option C: Ineffective coping related to lack of emotional regulation. In bulimia nervosa, individuals often engage in episodes of binge eating followed by compensatory behaviors like purging or fasting. The patient's statement indicates a lack of effective coping mechanisms to manage emotional triggers that lead to overeating even when full. This points to the core issue of inadequate coping skills in response to emotional distress, making option C the most suitable diagnosis. Option A (Imbalanced nutrition: Less than body requirements) may not be the best choice as the patient's statement does not directly indicate a deficiency in food intake, but rather a struggle with stopping eating once full. Option B (Disturbed body image related to distorted perception of self) is less appropriate because the patient's statement does not directly address body image concerns but rather focuses on the inability to control eating behaviors. Option D (Risk for self-directed violence related to impulsive behavior) is not the most suitable diagnosis based on the patient's statement. While individuals with bulimia nervosa may engage in harmful behaviors, the statement provided does not specifically suggest a risk for self-directed violence at this moment. Educationally, understanding the rationale behind selecting the most appropriate nursing diagnosis is crucial for nurses to provide effective care tailored to the patient's needs. By accurately identifying the underlying issue of ineffective coping in this case, nurses can develop targeted interventions to support the patient in developing healthier coping strategies to manage their eating behaviors and emotional challenges.

Correct Answer: B

Rationale: The most appropriate response by the nurse in this scenario is option B: "It sounds like you're feeling very concerned about your body image." This response demonstrates empathy and active listening, acknowledging the patient's feelings without judgment. It opens up the opportunity for the patient to express their emotions and concerns further, fostering a therapeutic nurse-patient relationship. Option A is incorrect because it dismisses the patient's feelings and can be perceived as invalidating. It does not address the underlying issue of body image distortion in anorexia nervosa. Option C is inappropriate as it is directive and does not consider the complexity of the patient's psychological condition. Option D is also not the best response as it focuses solely on the physical aspect of weight gain without addressing the patient's emotional distress. In an educational context, it is essential for nurses to develop strong communication skills to effectively support patients with mental health disorders like anorexia nervosa. By responding empathetically and non-judgmentally, nurses can create a safe space for patients to express their thoughts and feelings, which is crucial for building trust and promoting positive health outcomes.

Correct Answer: B

Rationale: In this scenario, option B is the most appropriate intervention for the nurse to implement. This option focuses on offering nonjudgmental support and exploring the patient's feelings about their eating behaviors. This approach is crucial in building trust and establishing a therapeutic relationship with the patient. By actively listening and empathizing with the patient, the nurse can help the patient feel understood and supported, which is essential in addressing the underlying issues contributing to their bulimia nervosa. Options A, C, and D are incorrect for several reasons. Option A, encouraging the patient to restrict their food intake, can exacerbate the patient's feelings of lack of control and may reinforce disordered eating behaviors. Option C, telling the patient to stop purging and eating excessively, is too directive and ignores the complex psychological factors contributing to the patient's condition. Option D, focusing on improving body image, may not address the root causes of the patient's bulimia nervosa. Educationally, it is important for nurses to understand the principles of therapeutic communication and person-centered care when working with patients with eating disorders. Building a supportive and nonjudgmental environment is key to fostering trust and promoting open communication, which are essential for effective assessment and intervention in these cases. By prioritizing empathy and active listening, nurses can better support patients in their recovery journey.

Correct Answer: C

Rationale: The best response for the nurse in this scenario is option C: "I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope." This response is appropriate because it acknowledges the patient's gratitude while also maintaining professional boundaries. Accepting gifts can create ethical dilemmas, blur boundaries, and potentially influence care decisions. By politely declining the gift and emphasizing the nurse's satisfaction in seeing the patient's progress, it reinforces the therapeutic nurse-patient relationship. Option A is incorrect as it comes off as rigid and dismissive of the patient's gesture, failing to acknowledge the emotional significance of the gift-giving. Option B, though appreciative, doesn't address the issue of accepting gifts in a healthcare setting. Option D, while highlighting the rewarding aspects of nursing, fails to address the potential ethical implications of accepting a gift from a patient. In an educational context, this scenario teaches students the importance of maintaining professional boundaries, ethical considerations in healthcare, and the significance of therapeutic communication in nursing practice. It underscores the need for nurses to navigate situations involving patient gratitude while upholding professional standards.

Correct Answer: C

Rationale: In this scenario, the most appropriate nursing diagnosis for a patient with generalized anxiety disorder who expresses feeling constantly anxious and unable to calm down is option C) Anxiety. The correct answer, "Anxiety," aligns with the patient's presenting symptoms and the nursing assessment findings. Generalized anxiety disorder is characterized by persistent and excessive worry or anxiety about various aspects of life. The patient's statement directly reflects this symptom, indicating a high level of anxiety. Option A) Risk for suicide is incorrect because the patient did not express any suicidal ideation or intent in the given scenario. This option would be more appropriate if the patient had mentioned thoughts of self-harm. Option B) Ineffective coping is not the best choice as it does not capture the primary issue of anxiety that the patient is experiencing. While anxiety may lead to ineffective coping mechanisms, the primary focus in this case should be on addressing the underlying anxiety. Option D) Disturbed thought processes is also not the most appropriate choice as the patient's statement does not suggest any cognitive deficits or disorganized thinking. This diagnosis is more relevant in cases involving hallucinations, delusions, or severe cognitive impairments. Educationally, understanding the rationale behind selecting the most appropriate nursing diagnosis is crucial for providing effective patient care. By accurately identifying the patient's primary issue of anxiety, nurses can develop targeted interventions to help the patient manage their symptoms and improve their overall well-being. This exercise highlights the importance of clinical reasoning and the significance of selecting the most relevant nursing diagnosis based on the patient's presentation.