A nurse is implementing a care plan for a patient with an eating disorder. The patient says, "I don't want to eat. I'm afraid I'll gain weight." Which response by the nurse is appropriate?

Recurrent episodes of binge eating followed by inappropriate compensatory behaviors.

Choice A rationale:

Eating large amounts of food when not feeling physically hungry is not a characteristic of bulimia nervosa. While individuals with bulimia nervosa do experience episodes of binge eating, this behavior is not dependent on physical hunger.

Choice B rationale:

Recurrent episodes of binge eating followed by inappropriate compensatory behaviors are indeed a characteristic of bulimia nervosa. Binge eating involves consuming a large amount of food in a short period, accompanied by a sense of lack of control. The compensatory behaviors, such as vomiting, laxative use, or excessive exercise, are aimed at counteracting the perceived consequences of the binge eating, such as weight gain.

Choice C rationale:

Persistent eating of nonnutritive, nonfood substances, known as pica, is not a characteristic of bulimia nervosa. Pica is a separate eating disorder that involves the consumption of non-food items such as hair, paper, or soil.

Choice D rationale:

Recurrent purging behavior to influence weight or shape is more closely associated with the eating disorder anorexia nervosa. While purging behaviors like vomiting or using laxatives can also occur in bulimia nervosa, they are not specific to it.

Choice A rationale:

Increased levels of cortisol and thyroid hormones. While stress-induced changes in cortisol levels can be seen in individuals with eating disorders, they are not the primary pathophysiological changes associated with these disorders. Cortisol plays a role in the body's response to stress and can contribute to weight gain, but altered levels of other hormones have a more direct impact on eating behaviors in individuals with eating disorders.

Choice B rationale:

Decreased levels of growth hormone and insulin. Growth hormone and insulin do play a role in metabolism and growth, but their levels are not commonly altered in eating disorders in the same way that hormones like leptin and ghrelin are. Altered levels of growth hormone and insulin can lead to metabolic disturbances, but these are not the hallmark changes seen in individuals with eating disorders.

Choice C rationale:

Altered levels of leptin and ghrelin. This is the correct choice. Leptin and ghrelin are two hormones that play a significant role in regulating hunger and satiety. Leptin, produced by adipose tissue, signals to the brain when energy stores are sufficient, thereby reducing appetite. Ghrelin, produced by the stomach, stimulates appetite and promotes food intake. In individuals with eating disorders, these hormones can become dysregulated, leading to disrupted hunger and fullness cues, and contributing to the development and maintenance of the disorder.

Choice D rationale:

Elevated levels of sex hormones and growth hormone. Elevated levels of sex hormones are not a primary pathophysiological change associated with eating disorders. Growth hormone, while important for growth and metabolism, is not a central player in the hormonal changes that drive eating disorder behaviors. Leptin and ghrelin are more directly involved in the dysregulation of eating behaviors seen in these disorders.