A widow, aged 72 years, lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the son visited today, he found his mother confused and disoriented, with an unsteady gait. The nurse assessed the patient as having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms that the patient's symptoms developed:

Correct Answer: A

Rationale: The correct answer is A: Over the past few days. The sudden onset of confusion, disorientation, and cognitive deficits in the elderly patient suggests an acute change in her condition. This acute change is more indicative of a recent event or medication-related issue rather than a gradual decline over weeks or months. The sudden onset could be due to factors such as medication interactions, overdose, or underlying medical conditions. It is crucial to investigate recent changes in medications, lab results, or any other potential triggers that might have led to this acute cognitive decline. Choices B, C, and D are incorrect because they imply a gradual decline over weeks, months, or no specific timeframe, which does not align with the sudden onset observed in the patient.

Correct Answer: A

Rationale: Step-by-step rationale: 1. A: Not skipping meals or restricting food promotes regular eating patterns, helps stabilize blood sugar levels, and reduces the urge to binge. 2. B: Eating a small meal after purging could reinforce the binge-purge cycle and is not a healthy approach. 3. C: Eating a large breakfast but skipping lunch can lead to imbalanced eating habits and is not recommended for treating bulimia nervosa. 4. D: None of the above options provide a comprehensive and effective approach to managing bulimia nervosa symptoms.

Correct Answer: A

Rationale: Step 1: Individuals with bulimia often engage in episodes of binge eating followed by purging behaviors. Step 2: Choice A, a person who is significantly overweight, is more likely to engage in binge eating behavior. Step 3: Being overweight can be a risk factor for bulimia due to body image concerns. Step 4: Choices B and C do not provide as strong indicators for bulimia as choice A. Summary: Choice A is correct as being significantly overweight is a common characteristic of individuals with bulimia. Choices B and C lack the same level of risk factors for engaging in eating behaviors characteristic of bulimia.

Correct Answer: C

Rationale: The correct answer is C because anorexia nervosa is characterized by restricting food intake and having an intense fear of gaining weight. This behavior leads to severe weight loss and malnutrition. Choice A is typically associated with bulimia nervosa, where binge eating is followed by purging. Choice B also aligns with bulimia, as self-induced vomiting is a common purging behavior. Choice D describes behaviors more typical of binge eating disorder, where individuals consume large quantities of food followed by excessive exercise. In anorexia nervosa, the primary focus is on severe food restriction and the fear of weight gain, leading to significantly low body weight.

Correct Answer: A

Rationale: The correct answer is A: Provide a structured mealtime environment with supervision. This is the most important initial intervention for a patient with bulimia nervosa because it addresses the immediate health concern of disordered eating behavior. By providing a structured mealtime environment with supervision, the patient can establish regular eating patterns, learn healthier eating habits, and reduce the risk of purging behaviors. This intervention also helps in restoring proper nutrition and addressing any underlying issues related to food and eating. Choice B is incorrect because support groups may be beneficial but are not the most critical initial intervention. Choice C is incorrect as antianxiety medications do not directly address the disordered eating behavior. Choice D is also incorrect as assessing family dynamics and home environment is important but not as crucial as addressing the immediate eating disorder symptoms.