Ch 20 - prepu ED

What percentage of clients who have fully recovered from bulimia nervosa later experience a relapse?

30%

Which client being treated for anorexia displays assessment values that warrant hospitalization?

A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL

The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss?

Anorexia nervosa, purging type

A client is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The client believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this client is what?

Anorexia nervosa, restricting type

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders?

Antidepressants Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms.

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect?

Binge eating disorder

A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment?

Bradycardia

Which is a cardiac complication of an eating disorder?

Bradycardia

A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment?

Cardiac assessment and measurement of electrolyte levels

Which intervention has been found to be most effective reducing the initial symptoms of bulimia?

Cognitive behavior therapy and pharmacologic interventions

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which would the nurse expect to implement in conjunction with pharmacologic therapy?

Cognitive behavioral therapy

When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what?

Control

When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what?

Control Often, nurses feel the need to offer control for a client who is helpless in controlling food, anxiety, and life.

Individuals with anorexia nervosa concentrate on which body cue?

Controlling food intake

Which area of the brain has been associated with the symptoms of eating disorders?

Hypothalamus

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find?

Impulsivity

For clients who purge, what is the most important goal?

Stop the behavior

When working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason?

To raise self awareness and a sense of control

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa?

Weight gain

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting?

engaging in severe dieting

A nurse is discussing the plan of care with a client who has anorexia nervosa. The client's weight is 15% below ideal. The nurse and client are now discussing the client's activity level. The client would like to run 5 miles per day as the client normally does. Which response by the nurse is best?

"Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass." Rigorous aerobic exercise generally is contraindicated when weight gain is a goal. Allowing the client to engage in moderate anaerobic exercise (e.g., weight lifting), however, would increase lean body mass as the client gains weight and minimize the gain in "fat weight," which is a great fear of the client.

A nurse is interviewing a client and suspects an eating disorder. Which client statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply.

"Everything about my school work needs to be perfect." "I want things to be the way I want them to be." "Things being out of order really bothers me." Both anorexia and bulimia are characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder. Depression and obsessive-compulsive disorders are commonly associated with eating disorders. Being self-assured or laid back would be least likely associated with an eating disorder.

During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?

"Has something occurred that caused you to measure your thighs?"

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse?

"I realize this must be very difficult for you but try to remember I'm not your enemy."

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective?

"I'll eat small meals and snacks regularly."

A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder?

"There are many factors involved with how I developed anorexia ."

A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication?

"What do you think about how much you weigh right now?" Open-ended questions that are not "loaded" or accusatory are most likely to elicit data from a client who has an eating disorder.

The client is 16 years old with an identical twin just diagnosed with anorexia nervosa. The client tells the nurse the client is concerned that the client may also develop the disorder. Which response by the nurse is the most appropriate?

"While eating disorders have shown a genetic link, other factors also play a role in its development."

A nurse is initiating a group for adolescent girls diagnosed with anorexia nervosa. Many of the clients in the group are irritable and resent having to attend. One of them comments, "This is a stupid waste of time!" Which response by the nurse would be most appropriate?

"You sound irritated; tell me about what is bothering you."

A group of nurses is reviewing information about the complications associated with eating disorders. The group demonstrates understanding of the information when they identify which as a possible cardiac complication? Select all that apply.

Bradycardia Ventricular tachycardia Loss of cardiac muscle

While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from?

Bulimia nervosa Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental cavities from the frequent contact of tooth enamel with food and acidic gastric fluids.

Which is a family risk factor for bulimia nervosa?

Chaotic family

A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected?

Dental erosion and chronic edema

A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories?

Depression

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.

A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include?

Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders

A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find?

Dry skin Dry skin is a physical problem of anorexia nervosa. Others include hypokalemia, bradycardia, and oversensitivity to cold.

Which statement best describes the biologic theories of the etiology of eating disorders?

Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.

During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication?

Fluoxetine Atypical antipsychotics are often associated with weight gain, while some antidepressants such as fluoxetine tend to induce weight loss.

Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits?

Fluoxetine Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Adminstration approval for the treatment of bulimia nervosa.

Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits?

Fluoxetine Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Adminstration approval for the treatment of bulimia nervosa.

During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication?

Fluoxetine (antidepressant)

The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next?

Heart rate and rhythm

Which is a metabolic complication related to weight loss?

Hypothyroidism

A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis?

Imbalanced nutrition: less than body requirements

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include?

Increasing client's coping skills for anxiety

At the prompting of friends, a 16-year-old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. During the nurse's assessment, the nurse has asked the client to describe the client's family. Which family process and characteristic is thought to contribute to eating disorders?

Poor communication and enmeshed family dynamics

The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what?

Provide the client with a feeling of responsibility and control over the client's behavior

A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client?

Self-monitoring

Which technique is a type of cognitive behavioral therapy implemented for bulimic clients?

Self-monitoring Self-monitoring is a type of cognitive behavioral therapy. It is designed to help clients with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.

People diagnosed with bulimia nervosa have lower levels of which neurotransmitter?

Serotonin

A client with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. Considering the client's unrealistic body image, which intervention should be included in the care plan?

Telling the client of the nurse's concern for the client's health and desire to help the client make decisions to keep the client healthy

After complaining of weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client's nursing care and treatment, which outcome should be prioritized?

The client will be free of self-induced vomiting.

The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care?

The client will verbalize acceptance of appearance.

A nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa?

The person engages in episodic binge eating.

The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks the student to step on the scale. The student asks if the student can go to the bathroom first to empty the student's bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has ...

anorexia nervosa.

When reviewing the documented history of an adult client with anorexia nervosa, what is the nurse most likely to find? (Select all that apply.)

food restriction began at age 15 depression at age 16 lasting one month reported believing that friends were "jealous" of her body