During postprandial monitoring, a client with bulimia nervosa tells the nurse, “You can sit with me, but you’re just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice.” What is the nurse’s best response?

“I trust you not to purge.”“How are you purging and when do you do it?”“Don’t worry. I won’t allow you to purge today.” “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.

Explanation.

This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives. Because their therapeutic relationships with caregivers are less important than their need to purge, they don’t fear betraying the nurse’s trust by engaging in the activity. They commonly plot purging and rarely share their secrets about it. An authoritarian or challenging response may trigger a power struggle between the nurse and client.