# A nurse is caring for a client with bulimia nervosa in an outpatient clinic. The client reports feeling overwhelmed and states, "I can't control my eating anymore." The nurse observes that the client appears anxious and is pacing around the room after discussing their eating patterns. Which nursing intervention should the nurse implement first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543404  
> language: ko  
> subject: Mental Health

## 문제

A nurse is caring for a client with bulimia nervosa in an outpatient clinic. The client reports feeling overwhelmed and states, "I can't control my eating anymore." The nurse observes that the client appears anxious and is pacing around the room after discussing their eating patterns. Which nursing intervention should the nurse implement first?

## 보기

1. Encourage the client to keep a detailed food diary to track eating patterns and triggers
2. Establish a therapeutic relationship by actively listening and validating the client's feelings **✔ 정답**
3. Provide education about the physical complications of bulimia nervosa
4. Implement a structured meal plan with supervised eating times

**정답: 2**

## 해설

Establishing a therapeutic relationship through active listening and validation is the priority to build trust before other interventions. This addresses the client's immediate emotional distress and anxiety, creating a foundation for effective treatment.

## 심화 해설

Clinical Judgment
This question tests the **Recognize Cues** and **Prioritize Hypotheses** stages of the Clinical Judgment Measurement Model (CJMM). The key cue is the patient's behavior of feeling "overwhelmed," being anxious, and pacing around the room. This indicates emotional distress and a crisis state. At the root of eating disorders like bulimia nervosa lies difficulty with emotional regulation, and eating behaviors often serve as a coping mechanism for dealing with uncomfortable feelings. Therefore, the most urgent nursing intervention is to address the patient's emotional state and build a therapeutic relationship to provide a sense of safety and support. While all other interventions are important, they may be ineffective or even provoke resistance if implemented before trust and rapport are established.

Memory Tip
For patients with eating disorders, the first intervention is **R**apport (therapeutic relationship). **E**ducation, **D**iary, and **P**lan are all possible only after the relationship (R) is built. Remember **R** first.

KR vs US
In Korea, the treatment of eating disorders may tend to focus on a family-centered approach and medical management (e.g., nutritional support). In contrast, the US NGN/NCLEX, following mental health nursing principles, emphasizes addressing the patient's emotional state and forming a therapeutic alliance as the highest-priority foundational intervention. A person-centered care approach that respects the patient's autonomy and internal motivation is key.

## 임상 시나리오

Clinical Practice Guide
When caring for patients with bulimia nervosa, continuous monitoring for physical complications (electrolyte imbalances, esophageal damage, etc.) must be combined with emotional support. The initial approach always begins with a non-judgmental attitude and empathetic listening.

Caution
In SATA (Select All That Apply) questions asking for the "first/initial/priority intervention," specific 'action' interventions such as education, journaling, or structured plans may appear as tempting incorrect options. Always remember that the patient's 'emotional state' and 'establishing a therapeutic relationship' form the foundation for all other specific interventions. "Validate feelings" is a very high-frequency correct answer in priority questions.

## 핵심 개념

- **Bulimia Nervosa** — Bulimia nervosa. An eating disorder characterized by recurrent binge eating episodes (consuming large amounts of food with a sense of loss of control) followed by inappropriate compensatory behaviors to prevent weight gain (such as vomiting, substance abuse, fasting, excessive exercise, etc.).
- **Therapeutic Relationship** — Therapeutic relationship. A professional relationship formed between a nurse and patient based on trust, respect, empathy, and collaboration. It is the core of psychiatric nursing, providing the foundation for effective treatment and change.
- **Validation** — Validation. The process of understanding and acknowledging the patient's thoughts, feelings, and experiences. Without trying to judge or correct them, it reduces the patient's emotional distress and builds trust through responses such as "I understand that you are feeling that way right now."
- **Active Listening** — Active listening. A communication technique in which one fully concentrates on the speaker, strives to understand both the content and emotions, observes nonverbal cues, and conveys understanding through appropriate verbal responses (summarizing, reflecting).
- **Coping Mechanism** — Coping mechanisms. Conscious or unconscious patterns of thought and behavior used when facing difficult situations such as stress, anxiety, or distress. Binge eating and purging behaviors in bulimia nervosa are examples of maladaptive coping mechanisms.

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