The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective?

"I am keeping a record of everything I eat and how I am feeling every day."

"I am getting more comfortable confronting people when I have conflict with them."

"I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."

"I am beginning to understand how my lack of self-control is hurting me."

Answer and Explanation

The Correct Answer is C

Self-monitoring in the context of eating disorders like bulimia nervosa is a cornerstone of Cognitive Behavioral Therapy (CBT). It goes beyond simple food logging; it is a specialized technique designed to help the client identify the antecedents (triggers) of their behavior, the behavior itself (bingeing/purging), and the consequences (emotional or physical) that follow, thereby breaking the cycle of disordered eating.

Rationale:

A. Keeping a record of food intake is a component of self-monitoring, but this statement is incomplete. Monitoring food alone does not address the behavioral connection between emotions and the urge to purge. This answer describes a food diary rather than a comprehensive therapeutic self-monitoring strategy.

B. Confronting conflict relates to interpersonal therapy and assertiveness training. Although improved communication can reduce stress, it is not a direct measure of the effectiveness of self-monitoring techniques, which are specifically focused on tracking the client’s internal and external cues for eating behaviors.

C. It demonstrates that the client has moved beyond passive recording to active analysis. The client identifies the link between emotions (the "why") and the binge (the "what"), and is actively developing healthy alternative responses. This shows the self-monitoring has successfully increased the client's self-awareness and functional coping.

D. This statement is non-therapeutic and reflects a shame-based view of the disorder. Bulimia is not a lack of self-control but a complex psychological illness. Adopting a mindset of self-blame is likely to increase anxiety and trigger further binge-purge cycles rather than foster recovery.

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Correct Answer is C

Explanation

Effective anger management begins with the identification of early warning signs during the triggering or escalation phases. By recognizing these subtle internal and behavioral shifts before they intensify into a loss of control, the client can implement de-escalation strategies and coping mechanisms to maintain safety and emotional stability.

Rationale:

A. Severe muscle tension is typically a manifestation of the escalation or crisis phase. It is a sign of anger, but severe tension usually occurs later in the cycle, whereas early intervention focuses on the very first physiological shifts.

B. A decreased ability to problem-solve occurs as the prefrontal cortex (the rational brain) loses its influence to the amygdala (the emotional center). This cognitive impairment usually characterizes the middle to late stages of escalation, making it difficult for the client to use self-help techniques if they wait until this point to act.

C. Restlessness and irritability are hallmark early signs of the triggering phase. These precursor symptoms, such as pacing, fidgeting, or a short fuse, serve as a biological alert. Teaching the client to identify these specific feelings allows them to exit the situation or use breathing exercises before the anger becomes overwhelming.

D. Remorse is an emotion experienced during the post-crisis phase (the depression or recovery stage) after an aggressive outburst has occurred. It is an important time for reflection, but it is a consequence of the behavior rather than a sign used for the prevention of an episode.

A. None; the serum level is in therapeutic range B. Nausea, diarrhea, and confusion C. Fever, muscle rigidity, and disorientation D. Constipation and postural hypotension

Correct Answer is B

Explanation

Lithium carbonate is a mood-stabilizing salt with a very narrow therapeutic index of 0.6 to 1.2 mEq/L. It mimics sodium in the body, and levels reaching 2.0 mEq/L represent moderate toxicity, leading to severe systemic effects and potential neurological damage if the medication is not immediately discontinued.

Rationale:

A. The therapeutic range for lithium is 0.6 to 1.2 mEq/L, making 2.0 mEq/L a toxic concentration. The nurse must recognize that this level is significantly elevated, requiring urgent intervention to prevent life-threatening complications such as seizures or cardiovascular collapse.

B. At levels of 1.5 to 2.0 mEq/L, clients typically exhibit gastrointestinal distress and CNS changes. Persistent emesis, coarse tremors, and profound confusion are hallmark signs that the lithium has reached dangerous levels in the blood, necessitating gastric lavage or diuresis.

C. Fever and muscle rigidity are associated with neuroleptic malignant syndrome, not lithium toxicity. Although both conditions involve altered mental status, lithium toxicity is specifically characterized by ataxia, tinnitus, and polyuria rather than the lead-pipe rigidity seen with antipsychotics.

D. Lithium toxicity usually causes diarrhea rather than constipation due to its osmotic effects in the gut. Hypotension can occur in late-stage toxicity due to dehydration, but the primary early indicators involve the worsening of initial side effects into overt toxic manifestations.

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The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective?

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