(Question from external source) What is the first priority in the treatment of anorexia nervosa?

Choice A rationale:

Ineffective Coping is the most appropriate nursing diagnosis for a client with binge eating disorder who reports feeling guilty and depressed after episodes of binge eating. Binge eating disorder is characterized by recurrent episodes of consuming large amounts of food within a discrete period, accompanied by a sense of loss of control. The guilt and depression reported by the client are emotional responses to these episodes. Ineffective Coping reflects the client's inability to manage and adapt to these negative emotions in a healthy manner. It addresses the psychological distress that often accompanies binge eating behaviors.

Choice B rationale:

Disturbed Body Image is not the most appropriate nursing diagnosis for this client. While individuals with binge eating disorder may experience body dissatisfaction due to weight gain resulting from their binge episodes, the primary focus of this client's distress is on feelings of guilt and depression, which are better captured by the Ineffective Coping diagnosis.

Choice C rationale:

Imbalanced Nutrition: More Than Body Requirements is not the most suitable nursing diagnosis for this client. While binge eating disorder involves excessive food consumption during episodes, the diagnosis of Imbalanced Nutrition is usually reserved for clients who have issues with nutrient intake that lead to alterations in physical health, such as obesity or malnutrition.

Choice D rationale:

Risk for Impaired Skin Integrity related to dental erosion is not the most relevant nursing diagnosis for this client. While binge eating may lead to dental erosion over time due to frequent exposure to stomach acid during episodes, this choice does not address the primary psychological concerns of guilt and depression.

Choice A rationale:

Bradycardia and tachycardia. While these cardiovascular symptoms can occur in eating disorders, they are more commonly associated with anorexia nervosa rather than bulimia nervosa. Bradycardia (slow heart rate) is often seen in individuals with severe anorexia due to the body's adaptive response to conserve energy. Tachycardia (rapid heart rate) can occur as a compensatory mechanism in response to dehydration and electrolyte imbalances, particularly in those with anorexia. However, in bulimia nervosa, the rapid cycle of binge eating and purging is more likely to lead to electrolyte imbalances that cause other symptoms.

Choice B rationale:

Hypertension and mitral valve prolapse. Hypertension (high blood pressure) is not a common cardiovascular symptom of bulimia nervosa. Mitral valve prolapse, which involves the improper closing of the heart's mitral valve, is also not a typical cardiovascular manifestation of bulimia nervosa. Eating disorders primarily affect the electrical conduction system of the heart and can lead to rhythm disturbances.

Choice C rationale:

Orthostatic hypotension and arrhythmias. This is the correct choice. Orthostatic hypotension, which is a drop in blood pressure upon standing, is a common cardiovascular symptom of bulimia nervosa. It is often a result of dehydration and electrolyte imbalances caused by frequent vomiting and laxative use. Arrhythmias (irregular heart rhythms) can also occur due to electrolyte imbalances, particularly low levels of potassium, which can disrupt the heart's electrical activity.

Choice D rationale:

Pericardial effusion and cardiomyopathy. While pericardial effusion (accumulation of fluid around the heart) and cardiomyopathy (disease of the heart muscle) can occur in individuals with eating disorders, they are not the most common cardiovascular symptoms. These conditions usually result from prolonged malnutrition and severe electrolyte imbalances, which can occur in both anorexia nervosa and bulimia nervosa. However, orthostatic hypotension and arrhythmias are more characteristic of bulimia nervosa.