A patient with anorexia nervosa begins to refuse food. The nurse should first:

Correct Answer: D

Rationale: The correct answer is D because encouraging the patient to eat a small, manageable portion of food is the most immediate and vital intervention in addressing the patient's refusal to eat. This step is crucial in preventing further complications associated with anorexia nervosa, such as malnutrition and dehydration. By starting with a small portion, the patient can gradually reintroduce food and begin the process of recovery. A: Speaking with the family may be important but not the first step in addressing the patient's refusal to eat. B: Focusing on emotional distress is important but addressing the physical need for food should take priority. C: Redirecting the patient to a different activity may temporarily distract them but does not address the underlying issue of malnutrition.

Correct Answer: D

Rationale: The correct answer is D: Denial of hunger at all times. In anorexia nervosa without bingeing or purging, patients typically deny hunger despite severe weight loss. This is due to their distorted body image and fear of gaining weight. Assessing for denial of hunger helps in understanding their mindset and severity of the disorder. Explanation of why other choices are incorrect: A: Extroverted personality traits - Anorexia nervosa is often associated with introverted personality traits, not extroverted. B: Abuse of diuretics and laxatives - This behavior is more characteristic of bulimia nervosa, not anorexia nervosa without bingeing or purging. C: Claims of sexual activity - This choice is unrelated to the typical features of anorexia nervosa without bingeing or purging.

Correct Answer: A

Rationale: The correct answer is A because journal writing can help individuals with personality disorders recognize and better understand their emotions, leading to improved self-awareness and emotional regulation. This can be a useful tool in therapy and self-management. Choice B is incorrect because individuals with personality disorders often struggle with interpersonal relationships and might benefit from seeking support or guidance rather than attempting to solve problems independently. Choice C is incorrect because avoidance does not address the underlying issues and can lead to isolation and maladaptive coping mechanisms. Choice D is incorrect because simply trying to alleviate problematic behaviors without addressing the underlying emotional issues may not lead to long-term improvement in relationships.

Correct Answer: A

Rationale: The correct answer is A: Severe dehydration and electrolyte imbalances. Untreated bulimia nervosa involves recurrent episodes of binge-eating followed by compensatory behaviors like purging. Purging can lead to fluid loss and electrolyte imbalances, causing dehydration. This can result in serious health complications such as cardiac arrhythmias and kidney damage. Rapid weight gain and fluid retention (B) are more associated with binge-eating disorder, not bulimia nervosa. Chronic constipation and digestive issues (C) are more commonly seen in anorexia nervosa. Severe malnutrition and organ failure (D) are potential complications of anorexia nervosa rather than bulimia nervosa.

Correct Answer: B

Rationale: The correct answer is B because long-term purging in patients with bulimia nervosa can lead to increased risk of dehydration and electrolyte imbalances. Purging behaviors such as vomiting or laxative abuse can disrupt the body's fluid and electrolyte balance, potentially causing dehydration and electrolyte imbalances. These imbalances can have serious health consequences, including cardiac arrhythmias, muscle weakness, and kidney damage. Incorrect choices: A: Improved digestive health and better nutrient absorption - Purging does not improve digestive health or nutrient absorption; rather, it can lead to nutrient deficiencies. C: Improved self-esteem and body image - Purging behaviors are harmful and do not lead to improved self-esteem or body image. D: Decreased risk of cardiovascular problems and hypertension - Purging behaviors can actually increase the risk of cardiovascular problems due to electrolyte imbalances and dehydration.