Nurse Claire is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is?

Correct Answer: B. Identify anxiety-causing situations

Bulimia disorder generally is a maladaptive coping response to stress and underlying issues. The client should identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Assist the patient to learn strategies other than eating for dealing with feelings. Have the patient keep a diary of feelings, particularly when thinking about food. Feelings are the underlying issue, and the patient often uses food instead of dealing with feelings appropriately. The patient needs to learn to recognize feelings and how to express them clearly.

• Option A: Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. Be alert to choices of low-calorie foods and beverages; hoarding food; disposing of food in various places, such as pockets or wastebaskets. The patient will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating.
• Option C: Provide diet and snacks with substitutions of preferred foods when available. Having a variety of foods available enables the patient to have a choice of potentially enjoyable foods. Provide smaller meals and supplemental snacks, as appropriate. Gastric dilation may occur if refeeding is too rapid following a period of starvation dieting. Note: the patient may feel bloated for 3–6 weeks while the body adjusts to food intake.
• Option D: Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situations while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain.