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Clients with bulimia nervosa typically maintain a normal body weight or may be slightly above or below normal. Unlike anorexia nervosa, bulimia does not usually present with significantly low body weight. Therefore, a lower than normal expected reference range of body weight is not the most expected finding.

Frequent self-induced vomiting leads to loss of gastric acid and potassium, resulting in hypokalemia, not hyperkalemia. Hypokalemia can cause muscle weakness, cardiac dysrhythmias, and fatigue.

Amenorrhea is more commonly associated with anorexia nervosa, especially in clients with significantly low body fat and malnutrition. Although menstrual irregularities can occur in bulimia, they are not as consistently present as in anorexia.

This response is not fully therapeutic because it implies hopelessness by stating there is no cure and offers vague reassurance (“I am sure you will feel better someday”). False reassurance does not validate the client’s feelings or promote active coping strategies.

Focusing solely on the physical symptoms reinforces the client’s preoccupation with somatic complaints. In somatic symptom disorder, the goal is not to validate the illness as medically unexplained in a way that increases symptom focus, but to help the client manage distress and improve functioning.

This response is confrontational and may make the client feel defensive or judged. Asking whether the client lacks confidence in the medical team shifts the focus away from therapeutic support and may damage rapport.

Dissociative amnesia involves an inability to recall important personal information, usually related to trauma or stress. It affects memory, not motor or sensory function. Numbness of the hands would not be explained by dissociative amnesia.

Factitious disorder involves the intentional falsification or induction of physical or psychological symptoms to assume the sick role. There is no indication in this scenario that the client is intentionally producing symptoms.

Depersonalization/derealization disorder involves persistent or recurrent feelings of being detached from oneself (depersonalization) or experiencing the environment as unreal (derealization). It does not typically cause focal neurological symptoms such as hand numbness.

Reinforcing teaching about the eating disorder is more appropriate during the working phase of the nurse–client relationship. In the orientation phase, the priority is establishing trust and defining the structure of the relationship—not delivering extensive education. Teaching is most effective once rapport is established and the client feels safe and supported.

Self-reflection is an internal process the nurse engages in to ensure therapeutic communication and professional behavior. While important, it is not a direct action taken with the client during the orientation phase.

Identifying specific life problems, triggers, and maladaptive behaviors occurs during the working phase, when the nurse and client begin actively addressing issues and implementing strategies for change.

Determining whether the client has entered an alter personality is relevant to dissociative identity disorder, not factitious disorder. In factitious disorder, the client intentionally produces or feigns symptoms, often for attention or care, but they do not have distinct personalities that take control. When a client expresses suicidal thoughts, focusing on diagnostic differentiation is secondary to immediate safety.

Encouraging relaxation techniques, such as deep breathing or mindfulness, may be helpful in managing anxiety or stress in the long term, but it is not the priority when a client expresses suicidal ideation. Focusing on relaxation first could delay critical safety interventions.

While group therapy can be a valuable component of long-term psychiatric treatment, it is not an immediate intervention when a client expresses potential suicidal thoughts. The nurse must first ensure the client’s safety and stabilize risk before moving on to therapy or skill-building activities.

While the nurse may face disciplinary action at work, being fired immediately is not always the first step. Many state boards of nursing follow a structured process that often includes investigation and the opportunity for rehabilitation before termination.

Losing a nursing license immediately is uncommon. The board typically conducts an investigation, may place the license on probation, or require treatment before revocation. Immediate license loss usually occurs only in severe or repeated offenses.

A transfer to another unit is not an appropriate or standard response to drug diversion. The issue involves professional misconduct, not merely unit placement, and requires formal reporting and intervention.

A statement like “I know I am skinny” reflects awareness of being underweight, but it does not indicate the behaviors or preoccupation typical of anorexia nervosa. Some clients with anorexia may actually perceive themselves as overweight, even when underweight.

Enjoying form-fitting clothes to show off the body suggests body confidence rather than the body image distortion seen in anorexia nervosa. Anorexia is usually associated with fear of weight gain and dissatisfaction with body shape, not pride in appearance.

Having “so much energy” is not a defining characteristic of anorexia nervosa. In fact, clients often experience fatigue, weakness, or lethargy due to malnutrition.

Hanging out with friends who serve as a support system is a positive coping mechanism and does not indicate problematic alcohol use. Social interaction alone is not a criterion for substance use disorder.

Engaging in art lessons to relieve stress is a healthy coping strategy and does not indicate substance misuse. It shows the client is trying to manage stress without substances.

Being focused and having goals may reflect motivation or ambition and does not suggest impairment or dysfunction from alcohol use. Substance use disorder is characterized by loss of control over substance intake, neglect of responsibilities, and physical or psychological harm, not goal-directed behavior.

While somatic symptom disorder can be challenging to treat, saying there are “limited effective treatment options” is misleading and may discourage families. Evidence-based treatments, including cognitive-behavioral therapy (CBT), stress management, and coordinated care, can improve outcomes.

Somatic symptom disorder is not primarily characterized by suicidal ideation or thoughts of death. While comorbid depression may occur in some cases, suicide is not a defining feature of the disorder.

Factitious disorder involves intentional fabrication of symptoms, but in somatic symptom disorder, symptoms are unintentional and not consciously produced. Individuals genuinely experience distressing physical effects.