You are most concerned about extrapyramidal symptoms (EPS) if your patient is on which of the following? (Select all that apply.)

Gap 1 (Correct Answer: Emotional status/depression)

The nurse should first address the client’s emotional statusbecause she repeatedly verbalizes hopelessness (“I don’t think I am ever going to be thin,” “I feel so depressed,” “Sometimes I don’t even want to go to work”). According to DSM-5, binge eating disorder is strongly associated with comorbid depression and anxiety. The National Institute of Mental Health (NIMH) highlights that untreated depression worsens binge eating outcomes and adherence to treatment. Maslow’s Hierarchy of Needs places psychological well-being and emotional safety above physiological goals like diet adherence or weight loss. Therefore, prioritizing depression management is essential before other interventions can succeed.

Gap 2 (Correct Answer: Verbalization of hopelessness and depressed mood)

The client’s verbalization of hopelessness is the most urgent indicator. Hopelessness is a red flag for worsening depression and potential risk of suicidality, even if not explicitly stated. Uptodate clinical guidance emphasizes that addressing mood symptoms is critical in patients with binge eating disorder, as untreated depression undermines adherence to diet, medication, and self-monitoring. Thus, the nurse’s first priority is to address the client’s depressed mood.

Incorrect Answers

Gap 1 Incorrect Options

Nutritional intake/diet adherence: While important, the client has already begun making progress (adding snacks, limiting alcohol, losing 2 pounds). However, adherence is secondary to emotional stability. Without addressing depression, diet adherence will remain fragile.

Blood glucose monitoring: The client is compliant with medication and glucose checks, with improved fasting glucose (120 → 112 mg/dL). This shows adequate management, so it is not the most urgent priority.

Weight reduction goals: The client has already lost weight, but focusing on weight reduction without addressing depression risks reinforcing negative body image and hopelessness. Maslow’s framework suggests psychological needs must be met before esteem-related goals like weight loss.

Gap 2 Incorrect Options

Elevated blood pressure readings: The client’s blood pressure was mildly elevated (146/82 mmHg) but not critically high. This is not the most urgent issue compared to hopelessness.

Forgetting to record food diary: This is a minor adherence issue. Forgetting the diary does not pose immediate risk compared to depression and hopelessness.

History of gallstones: This is part of her medical history but not currently symptomatic or urgent. It does not outweigh the need to address her depressed mood.

Choice A reason: Physical health

Good physical health supports resilience and treatment participation. It reduces burden from comorbidities and aligns with Maslow’s foundation of physiological needs, making it a modest protective factor.

Choice B reason: Mental health support

Engagement in therapy and antidepressants is protective. Even if current efficacy feels limited, ongoing care provides structure and monitoring, consistent with NIMH’s emphasis on access to effective treatment.

Choice C reason: Family history

A maternal suicide and estrangement increase risk. Family history is a strong predictor of vulnerability, and loss of belonging undermines Maslow’s social needs, compounding depressive risk.

Choice D reason: Alcohol consumption

Past misuse elevates lifetime risk, but sustained sobriety is protective. Abstinence reduces impulsivity and stabilizes mood, though DSM-5 notes prior substance use remains relevant to risk.

Choice E reason: Access to lethal means

Immediate access to alprazolam with a stated plan is a high-risk factor. NIMH highlights lethal means as critical to restrict, and DailyMed warns of overdose dangers.

Choice F reason: Feelings of self-worth

Worthlessness and hopelessness are classic depressive risk markers. DSM-5 includes these as core symptoms, and NIMH links them directly to suicidal ideation.

Choice G reason: Support systems

Estranged family and reluctance to use friends increase isolation risk. While some friends exist, avoidance weakens this protective factor. Connectedness is central in NIMH’s prevention framework.