# A nurse is caring for a client with bulimia nervosa who has been admitted to the psychiatric unit. The client has been engaging in binge-eating episodes followed by compensatory behaviors. Which nursing intervention should be the priority during the initial phase of treatment?

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> subject: Mental Health

## 문제

A nurse is caring for a client with bulimia nervosa who has been admitted to the psychiatric unit. The client has been engaging in binge-eating episodes followed by compensatory behaviors. Which nursing intervention should be the priority during the initial phase of treatment?

## 보기

1. Encourage the client to keep a detailed food diary to track eating patterns and triggers
2. Establish a structured meal plan with supervised eating to prevent binge-purge cycles **✔ 정답**
3. Provide individual psychotherapy sessions focused on body image distortion
4. Implement a behavioral contract that includes consequences for purging behaviors

**정답: 2**

## 해설

The priority is establishing a structured meal plan with supervised eating to prevent binge-purge cycles, addressing immediate physical safety. Other interventions like food diaries or psychotherapy are important but secondary once medical stability is achieved.

## 심화 해설

Clinical Judgment
The core of this problem is prioritization. In the initial treatment phase for a patient with Bulimia Nervosa, the most important thing is to interrupt the immediate and dangerous behavioral pattern (the binge-purge cycle) to ensure the patient's physical safety. A structured meal plan and supervised eating are interventions that directly align with this goal. This lays the foundation for the patient to re-establish a healthy relationship with food and reduces the immediate physical risks from purging, such as electrolyte imbalances, esophageal damage, and dental erosion. While the other interventions are all important parts of treatment, they focus on **exploring causes and long-term recovery** rather than the initial goal of **ensuring safety**.

Memory Tip
Remember the goal of initial treatment: **S**top the **C**ycle, **S**tart **S**afety (**S**CSS). That is, the priority is to **S**top the **C**ycle of dangerous behavior and **S**tart a foundation of **S**afety. Structured meals correspond directly to this.

KR vs US
In Korea, eating disorder treatment may emphasize a family-centered approach, or meal supervision in an inpatient setting might be less structured. In contrast, the US NGN/NCLEX strongly emphasizes behavior modification through a Structured Setting and Supervision. This is because preventing immediate physical harm is prioritized over respecting patient autonomy.

## 임상 시나리오

Clinical Practice Guide
When caring for patients with bulimia nervosa, the standard protocol is to supervise them for at least one hour after meals to prevent vomiting attempts. Bathroom access may also be restricted. This should be accompanied by weight monitoring, checking electrolyte levels (especially potassium), and assessing for complications from vomiting (edema, dental issues).

Caution
In SATA (Select All That Apply) questions, pay attention to the phrase "initial phase (Priority/Initial phase)." Options such as "keeping a food diary," "starting cognitive behavioral therapy," and "exploring body image distortion" are essential components of treatment, but they are lower priority than **blocking behaviors and ensuring safety**. "Imposing consequences for vomiting behavior" may be punitive and can damage the therapeutic relationship, so it is not appropriate in the initial phase.

## 핵심 개념

- **Bulimia Nervosa** — Bulimia nervosa. An eating disorder characterized by recurrent episodes of binge eating and inappropriate compensatory behaviors (vomiting, substance abuse, fasting, excessive exercise) to prevent weight gain.
- **Binge-Purge Cycle** — Binge-purge cycle. The core pathology of bulimia nervosa, a repeated pattern of consuming large amounts of food in a short time (binge eating) followed by elimination (purging) through methods such as vomiting or medication use.
- **Structured Meal Plan** — Structured meal plan. A dietary guide designed to provide appropriate amounts of nutrition at regular times. Essential in eating disorder treatment for reducing anxiety around food and restoring normal eating patterns.
- **Supervised Eating** — Supervised meals. A therapeutic intervention where a nurse or treatment team member observes the patient during and immediately after meals to promote normal eating and prevent maladaptive behaviors such as vomiting.
- **Compensatory Behaviors** — Compensatory behaviors. Inappropriate actions taken to prevent weight gain after binge eating. These include self-induced vomiting, misuse of diuretics/laxatives/enemas, fasting, and excessive exercise.

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