A nurse is collecting data from a female client who has bulimia nervosa.
Which of the following manifestations should the nurse expect?

Choice A rationale

Consuming red wine before bed, even in small amounts, can disrupt sleep architecture. While alcohol might initially induce drowsiness, it often leads to fragmented sleep later in the night as the body metabolizes it, resulting in poor sleep quality and reduced restorative sleep.

Choice B rationale

Staying in bed for prolonged periods when unable to sleep can create a negative association between the bed and wakefulness. This can increase anxiety about sleep and perpetuate insomnia. It is generally recommended to get out of bed and engage in a relaxing activity until feeling sleepy.

Choice C rationale

Exercising vigorously close to bedtime can be stimulating and raise core body temperature, making it harder to fall asleep. The body needs time to cool down for optimal sleep initiation. It is generally recommended to avoid intense exercise at least a few hours before bed.

Choice D rationale

Caffeine is a stimulant that can interfere with sleep initiation and maintenance. Limiting caffeine intake, especially in the afternoon and evening, can significantly improve sleep quality by reducing its stimulating effects on the central nervous system. Normal caffeine intake should be limited, and eliminating it closer to bedtime is beneficial for sleep.

Choice A rationale

Reaction formation involves behaving in a way that is the opposite of one's true feelings. The client's statement focuses on delaying health concerns rather than expressing the opposite of their anxiety about their diagnosis.

Choice B rationale

Splitting is a defense mechanism where individuals view themselves or others as all good or all bad. The client's statement does not demonstrate this polarized thinking; instead, it shows a postponement of addressing their health.

Choice C rationale

Projection involves attributing one's own unacceptable thoughts or feelings onto another person. The client is not attributing their feelings about their cancer diagnosis to someone else; they are simply putting off thinking about it.

Choice D rationale

Suppression is a conscious or semiconscious effort to avoid thinking about disturbing thoughts or feelings. The client is consciously stating their intention to not think about their cancer diagnosis until after their son's wedding, indicating a deliberate avoidance of the topic.