A nurse is caring for a female client in an outpatient clinic.

The nurse is reviewing the newly added information in the client’s medication record. For each potential provider’s prescription, specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Recommend client sign up for a diet program (Anticipated): 
This is anticipated because structured programs (such as ADA-approved or medically supervised diet programs) provide accountability, education, and peer support. For a client with binge eating disorder, external reinforcement can help reduce feelings of isolation and shame. It also aligns with the provider’s initial prescription of an 1800-calorie ADA diet, giving the client more tools to succeed.

Hold glipizide medication (Contraindicated): 
Glipizide is an oral hypoglycemic agent prescribed for type 2 diabetes. The client’s fasting blood glucose improved from 120 mg/dL to 112 mg/dL after starting the medication, showing therapeutic benefit. Holding the medication would risk hyperglycemia and poor glycemic control, especially since the client is obese and has a history of binge eating. There is no evidence of adverse effects or contraindications in this case, so discontinuing it would be unsafe.

Encourage client to plan meals ahead of time (Anticipated): 
Meal planning is a cornerstone of managing binge eating disorder and diabetes. It reduces impulsive food choices, helps the client adhere to calorie restrictions, and minimizes anxiety around food. Planning also allows the inclusion of healthy snacks, which the client already found helpful in preventing hunger-driven binges. This intervention directly supports both weight loss and glycemic control goals.

Decrease client’s number of daily calories (Nonessential): 
The client is already prescribed an 1800-calorie ADA diet. Further restriction could increase hunger, frustration, and risk of binge episodes. Since the client has demonstrated weight loss (2 lb per week, meeting the provider’s goal), additional calorie reduction is not necessary at this stage. It could undermine adherence and worsen psychological distress, making it nonessential rather than beneficial.

Discuss adherence to diet plan (Anticipated): 
Ongoing discussion of adherence is essential for reinforcing positive behaviors, identifying barriers, and providing emotional support. The client has expressed embarrassment about eating differently at work and struggles with cravings for foods like pizza and ice cream. Addressing adherence helps normalize these feelings, encourages problem-solving, and strengthens motivation. This is a critical part of behavioral therapy for binge eating disorder and diabetes management.