A nurse is caring for a client who has bulimia nervosa and has a new prescription for a selective serotonin reuptake inhibitor (SSRI). Which of the following medications should the nurse anticipate administering?

Choice A rationale Valproate is an anticonvulsant and mood stabilizer primarily used in the treatment of bipolar disorder and seizure disorders. Its mechanism involves enhancing GABAergic neurotransmission and modulating voltage-gated ion channels. While it can be used for mood stabilization, it is not a first-line treatment for bulimia nervosa. Its side effect profile also differs significantly from SSRIs. Choice B rationale Naltrexone is an opioid antagonist used primarily for alcohol and opioid dependence. It blocks opioid receptors, reducing cravings and the euphoric effects of these substances. It has no direct pharmacological action on the neurochemical pathways associated with appetite regulation or mood disturbances characteristic of bulimia nervosa. Choice C rationale Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is the only FDA-approved medication for the treatment of bulimia nervosa. It increases serotonin availability in the synaptic cleft by inhibiting its reuptake, thereby modulating mood, impulse control, and satiety, which are often dysregulated in this disorder. Choice D rationale Olanzapine is an atypical antipsychotic primarily used for schizophrenia and bipolar disorder. It blocks dopamine and serotonin receptors. While it can cause weight gain, which might seem counterintuitive in bulimia, its primary therapeutic indications and extensive side effect profile make it an inappropriate first-line choice for bulimia nervosa.