Ch 32: Eating Disorders

a) 18 to 24.9 Pg. 605-608 A "healthy" BMI ranges from 18 to 24.9. An individual with a BMI of 25 to 29 is considered to be moderately overweight or preobese. A BMI of 30 to 34.9 is considered moderately obese. A BMI of 35 to 39 is deemed to be severely obese.

11. A client comes to the health clinic for a physical exam. He is complaining that he is not happy with himself about being overweight. He has been depressed for several weeks. When discussing his weight goal, he asks the nurse, "What is a normal or healthy BMI?" The nurse's correct response would include which of the following? a) 18 to 24.9 b) 25 to 29 c) 30 to 34.9 d) 35 to 39.9

b) "I'll eat small meals and snacks regularly" Pg. 615-616 Teaching is effective when the client recognizes the need to return to nutritious eating patterns, such as frequent intake of healthy types and quantities of food. Recognizing triggers, such as particular foods, can help reduce the incidence of binges but does not necessarily cause the development of healthy habits. Food restriction (limiting fats and carbohydrates) is a superficial approach that does not address the root causes of eating disorders. Similarly, reliance on medication as the key to recovery does not address these issues.

23. The nurse has been teaching a client about bulimia. Which statement by the client indicates that the teaching has been effective? a) "I'll limit my intake of carbohydrates and fats" b) "I'll eat small meals and snacks regularly" c) "I know if I eat pasta, I'll binge" d) "I'll take my medication when I feel the urge to binge"

a) "Has something occurred that caused you to measure your thighs?" Pg. 616-617 The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.

28. 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? a) "Has something occurred that caused you to measure your thighs?" b) "You have always been very focused on your thighs. Is that the part of your body you like least?" c) "You are exactly the right weight for your height" d) "I don't think you are fat"

b) 17.3 kg/m2 Pg. 605, 608 A BMI greater than or equal to 17 kg/m2 would characterize mild anorexia. Moderate anorexia is characterize by a BMI between 16 and 16.99 kg/m2. Severe anorexia would be characterized by a BMI between 15.0 to 15.99 kg/m2.

29. A client is diagnosed with mild anorexia nervosa based on body mass index (BMI). Which BMI would the nurse identify as reflecting mild anorexia nervosa? a) 16.1 kg/m2 b) 17.3 kg/m2 c) 15.5 kg/m2 d) 16.75 kg/m2

d) Being able to cope in healthy ways improves the ability to accept a realistic body image Pg. 612 When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image. Coping skills can be learned and honed even if the client's upbringing was less than supportive. Changes in body image result from enhanced coping; they do not cause enhanced coping. Eating disorders have biologic elements to their etiology, but this does not rule out the development of positive coping.

3. The nurse is helping a client with an eating disorder to accept the client's body image. The client must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? a) When body image is positive, the client will develop better coping skills b) Coping skills are dependent on a supportive upbringing c) Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills d) Being able to cope in healthy ways improves the ability to accept a realistic body image

a) Dieting e) Exercising Pg. 605, 608 Anorexia nervosa is categorized into two major types: restricting (dieting and exercising with no binge eating or misuse of laxatives, diuretics, or enemas) and binge eating and purging (binge eating and misuse of laxatives, diuretics, or enemas).

43. A client is diagnosed with anorexia nervosa, restricting type. The nurse interprets this as indicating the use of which of the following? Select all that apply. a) Dieting b) Laxatives c) Enemas d) Diuretics e) Exercising

a) Depression Pg. 620-621 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.

45. Which is the most common disorder found in clients diagnosed with bulimia nervosa? a) Depression b) Substance abuse c) Anxiety d) Psychosis

b) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging" Pg. 626-627 Self-monitoring is a cognitive-behavioral technique designed to help clients with bulimia. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions and triggers. In this way, clients begin to see connections between emotions and situations and eating behaviors. The nurse can then help clients to develop ways to manage emotions such as anxiety by using relaxation techniques or distraction with music or another activity. Keeping a record of feelings and food intake is helpful, but not if it is unaccompanied by healthy responses and changes in behavior. Managing conflict is important but this is not an example of self-monitoring. Stating a lack of self-control is not therapeutic because self-control is not the key to recovery from eating disorders. Efforts that focus solely on self-control are rarely successful or sustainable.

1. The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective? a) "I am getting more comfortable confronting people when I have conflict with them" b) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging" c) "I am beginning to understand how my lack of self-control is hurting me" d) "I am keeping a record of everything I eat and how I am feeling every day"

c) A 16-year-old with serum potassium of 3.8 mEq/L and a BP of 98/66 mmHg Pg. 616 Criteria for hospitalization include: acute weight loss, <85% below ideal; heart rate near 40 beats/min; temperature,b <36.1°C; blood pressure, <80/50 mm Hg; hypokalemia; hypophosphatemia; hypomagnesemia. The client with a weight 70% of ideal and magnesium level of 1.2 mg/dL (low) fits the criteria.

10. Which of the following clients being treated for anorexia displays assessment values that warrant hospitalization? a) A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt b) A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL c) A 16-year-old with serum potassium of 3.8 mEq/L and a BP of 98/66 mmHg d) A 32-year-old with a temperature of 98°F and a pulse rate of 54

d) Dichotomous thinking Pg. 627 The client's statement reflects dichotomous, or all-or-nothing, thinking. Magnification would be reflected in a statement such as "I binged last night, so I can't go out with anyone." Selective abstraction would be reflected in a statement such as "I can only be happy 10 pounds lighter." Catastrophizing would be reflected in a statement such as "I purged last night for the first time in 4 month; now I'll never recover."

12. A client with an eating disorder states, "I've gained 2 pounds, so soon I'll be up by 100 pounds." The nurse interprets this as which of the following? a) Selective abstraction b) Catastrophizing c) Magnification d) Dichotomous thinking

c) Excessive exercise Pg. 606-608 Clients with eating disorders utilize excessive exercise to burn as many calories as possible. Medical complications of eating disorders include bradycardia, hypotension, and dry, cracking skin due to dehydration. The client will wear loose-fitting clothes to hide his or her body.

13. The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder? a) Tachycardia b) Moist skin c) Excessive exercise d) Wearing tight-fitting clothing

b) Weighing the client twice daily Pg. Weighing the client twice daily puts emphasis on weight and should not be included as an intervention for a client with an eating disorder. Interventions that should be implemented include sitting with the client during meals and snacks, observing the client following meals and snack for 1 to 2 hours, and being alert for attempts to hide or discard food or inflate weight.

14. All of the following would be included as interventions for eating disorders to establish nutritional eating patterns except... a) Observing the client following meals and snack for 1 to 2 hours b) Weighing the client twice daily c) Sitting with the client during meals and snacks d) Being alert for attempts to hide or discard food or inflate weight

c) "Let's focus on your continued improvement. You ate 80 percent of your lunch" Pg. 605 Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. It is important to offer support and positive reinforcement for improvements in eating behaviors. Because clients diagnosed with anorexia nervosa are obsessed with food, discussion of food can provide unintended positive reinforcement for negative behaviors. In this answer choice, the nurse is appropriately redirecting the client. When the nurse requests an explanation that the client cannot give, the client may feel defensive. "Why" questions are blocks to therapeutic communication.

15. A nurse, sitting with a client diagnosed with anorexia nervosa, notices that the client has eaten 80 percent of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? a) "I'll weigh you after your meal" b) "I really enjoy a large plate of spaghetti" c) "Let's focus on your continued improvement. You ate 80 percent of your lunch" d) "I like hamburgers a lot but why do you always talk about food?"

c) Self-monitoring Pg. 626-627 Self-monitoring is a type of behavioral therapy. It is designed to help the client with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.

16. A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? a) Guided imagery b) Music therapy c) Self-monitoring d) Distraction

c) Weight gain Pg. 613 Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.

17. Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? a) Increased activity b) Positive self-esteem c) Weight gain d) Mood elevation

b) "I realize this must be very difficult for you but try to remember I'm not your enemy" Pg. 607 The client initially may view the nurse, who is responsible for making the client eat, as the enemy. The client may hide or throw away food or become overtly hostile as anxiety about eating increases. The nurse must remember that the client's behavior is a symptom of anxiety and fear about gaining weight and not personally directed toward the nurse. The other options are nurse rather than client focused.

18. 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? a) "I'm not the root of your problem" b) "I realize this must be very difficult for you but try to remember I'm not your enemy" c) "I'm not going to take your insults personally but you need to be more respectful" d) "I'm sorry that you are angry but you cannot throw food at me"

b) Bradycardia Pg. 612 Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.

19. Which is a cardiac complication of an eating disorder? a) Hypertension b) Bradycardia c) Thrombocytopenia d) Enlarged heart

b) Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior Pg. 625 Clients with bulimia know their behavior is pathologic and are ashamed of it; clients with anorexia think they are fine and see no problem with their weight-control efforts. Anorexia nervosa is a life-threatening eating disorder. Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families.

2. The difference between clients with anorexia nervosa and bulimia nervosa is which of the following? a) Bulimia can be life threatening, whereas anorexia is seldom so b) Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior c) There is no real difference between these two types of clients d) Anorexia has a psychological basis, whereas the cause of bulimia is biologic

a) Binge eating disorder Pg. 628 Binge eating disorder is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese. The client does not restrict eating so anorexia is not appropriate. Eating disorder not otherwise specified refers to partial syndromes but does not met the criteria for anorexia or bulimia.

20. 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? a) Binge eating disorder b) Eating disorder not otherwise specified c) Bulimia nervosa d) Anorexia nervosa

d) Overcontrolling parents Pg. 605, 609 Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Interest in the client is often excessive, rather than deficient. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: by continuing to lose, these clients exert control over one aspect of their lives. There is no demonstrated relationship between the number of siblings and an individual's risk for eating disorders.

21. While assessing the family dynamics of a client with an eating disorder, which does the nurse most likely discover? a) Lack of interest in the client by other family members b) Multiple siblings c) Supportive and encouraging relationships d) Overcontrolling parents

a) Body weight less than normal for age, height, and overall physical health Pg. 605-606 Clients with anorexia nervosa have a body weight that is less than the minimum expected weight, considering their age, height, and overall physical health. Physical problems of anorexia nervosa include amenorrhea a characteristic that goes beyond simply having irregular cycles. These clients do not lose their appetites. They still experience hunger but ignore it and signs of physical weakness and fatigue. Dental erosion is characteristic of bulimia nervosa because this disorder involves vomiting of acidic stomach contents.

22. A 15-year-old is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? a) Body weight less than normal for age, height, and overall physical health b) Absence of hunger feelings c) Erosion of dental enamel d) Irregular menstrual cycles

a) Anorexia nervosa, restricting type Pg. 605-608 Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories."

24. 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? a) Anorexia nervosa, restricting type b) Anorexia nervosa, binge eating, and purging type c) Bulimia nervosa, nonpurging type d) Eating disorder not otherwise specified

d) Controlling food intake Pg. 606 Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.

25. Individuals with anorexia nervosa concentrate on which body cue? a) Anxiety b) Hunger c) Weakness d) Controlling food intake

d) Heart rate and rhythm Pg. 612-613 Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.

26. 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? a) Condition of mouth and gums b) Throat and esophagus c) Patterns of activity and rest d) Heart rate and rhythm

d) Disturbed body image Pg. 605-606 The client's dissatisfaction with body image is an enduring belief pattern that is firmly ingrained and, therefore, very difficult to change. Imbalanced nutrition—less than body requirements, deficient knowledge (nutritious eating patterns), and social isolation are nursing diagnoses that can be worked through with education and support more easily than the diagnosis of disturbed body image.

27. Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa? a) Deficient knowledge (nutritious eating patterns) b) Social isolation c) Imbalanced nutrition—less than body requirements d) Disturbed body image

a) Genetic vulnerability b) Alterations in brain structures e) Decreased serotonin levels Pg. 609-610 Biologic theories address the following: altered brain structure in the medial orbitofrontal cortex and striatum suggesting there is also altered brain circuitry; genetic research showing a genetic vulnerability to anorexia nervosa, especially in females; and neuroendocrine and neurotransmitter changes, such as an increase in endogenous opioids (through exercise) contributing to denial of hunger and a blunting of serotonergic functioning. Norepinephrine imbalances have not be identified as playing a role.

30. A nurse is reviewing a journal article about the etiology and risk factors associated with the development of eating disorders. The nurse demonstrates understanding of the information by identifying which factor as being reflective of biologic theories? Select all that apply. a) Genetic vulnerability b) Alterations in brain structures c) Decreased levels of endogenous opioids d) Norepinephrine imbalances e) Decreased serotonin levels

c) "I will accompany you to the bathroom" Pg. 620-621 After each meal or snack, clients may be required to remain in view of staff for a period of time to ensure they do not empty the stomach by vomiting. Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. The response, "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the behavior. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.

31. A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate? a) "Let me know when you get back to the dayroom" b) "I'll stand outside your door to give you privacy" c) "I will accompany you to the bathroom" d) "Thanks for checking in"

d) Eager to please Pg. 605-607 Family members often describe clients with anorexia nervosa as perfectionists with above-average intelligence, achievement oriented, dependable, eager to please, and seeking approval before their condition began. Parents describe clients as being "good, causing us no trouble" until the onset of anorexia. Likewise, clients with bulimia often are focused on pleasing others and avoiding conflict. These clients are often highly regimented, not careless. Overt defiance is unlikely because they may be eager to please. Clients are often evasive rather than outspoken when they are attempting to avoid ownership of their eating disorder.

32. The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? a) Outspoken b) Defiant c) Careless d) Eager to please

c) Suicide Pg. 605, 609 Suicide and cardiopulmonary arrest are the leading causes of death for individuals with anorexia nervosa. These individuals tend to commit suicide with highly lethal means in which rescue is unlikely. Renal failure, respiratory failure, and myocardial infarction are not the leading causes of death.

33. A psychiatric-mental health nurse is preparing a program for parents of a local high school about eating disorders. Which condition would the nurse most likely include as the leading cause of death among clients diagnosed with anorexia nervosa? a) Myocardial infarction b) Renal failure c) Suicide d) Respiratory failure

b) Cognitive behavior therapy and pharmacologic interventions Pg. 622-623 The combination of cognitive behavior therapy and pharmacologic interventions is best for producing an initial decrease in symptoms.

34. Which intervention has been found to be most effective reducing the initial symptoms of bulimia? a) Behavioral therapy and psychoeducation b) Cognitive behavior therapy and pharmacologic interventions c) Clearly stated unit rules and a supportive milieu d) Daily monitoring of sound dietary principles and meditation sessions

b) Perfectionism Pg. 605-606 In many individuals with anorexia nervosa, OCD symptoms predate the anorexia nervosa diagnosis by about 5 years, leading many researchers to consider OCD a causative or risk factor for anorexia nervosa (Brady, 2014). In fact, perfectionism is an aspect of both OCD and anorexia nervosa and is considered a risk factor for anorexia nervosa.

35. A nurse is reading a journal article about anorexia nervosa and comorbidities. The article describes a strong association between anorexia and obsessive-compulsive disorder. The nurse demonstrates understanding of this information by identifying which aspect as common to both of these disorders? a) Body dissatification b) Perfectionism c) Gender identity d) Emotional dysregulation

a) 19.2 kg/m2 Pg. 605-608 An acceptable BMI is between about 19 and 25. Therefore a BMI of 19.2kg/m2 would be considered effective for the client. A BMI of 17 kg/m2 suggest mild anorexia. A BMI of 16.5 kg/m2 suggests moderate anorexia. A BMI of 15.9 suggests severe anorexia.

36. A client with a history of anorexia nervosa comes to the clinic for evaluation. During the visit, the client's body mass index (BMI) is obtained. The nurse determines that treatment has been effective based on which BMI measurement? a) 19.2 kg/m2 b) 15.9 kg/m2 c) 17.0 kg/m2 d) 16.5 kg/m2

b) Restoring nutritional status to normal Pg. 612 Physiologic safety and homeostasis are the priority concerns. Changing of thought pattern, establishing a target weight, and gaining insight into the effects of anorexia on her physical health are not immediate goals in the management of anorexia nervosa.

37. The immediate goal of nursing interventions in the care of a client with anorexia nervosa is which of the following? a) Changing her irrational thinking about her body b) Restoring nutritional status to normal c) Establishing a target weight to be achieved by discharge d) Gaining insight into the effects of anorexia on her physical health

a) Fluoxetine Pg. 615-616 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.

38. Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? a) Fluoxetine b) Haloperidol c) Lithium d) Bupropion

b) Overprotect their children Pg. 611 Some families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. Family therapy may be beneficial for families of clients younger than 18 years. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.

39. A mental health nurse is completing an initial assessment on a client diagnosed with anorexia nervosa. Which of the following is a typical characteristic of parents of clients diagnosed with anorexia nervosa? a) Alternate between loving and rejecting their children b) Overprotect their children c) Maintain an emotional distance from their children d) A history of substance abuse

a) Control Pg. 605 Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity may be relevant to some clients, but the presence of control issues is relevant in all clients with anorexia nervosa.

4. When working with the family of a client with anorexia nervosa, which issue must be addressed? a) Control b) Sexual identity c) Self-discipline d) Codependence

b) "What do you think about how much you weigh right now?" Pg. 614 Open-ended questions that are not "loaded" or accusatory are most likely to elicit data from a client who has an eating disorder. Offering food at this early stage of care is likely to inhibit rather than enhance rapport between the nurse and the client.

40. 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? a) "Is there anything that I can get you to eat right now?" b) "What do you think about how much you weigh right now?" c) "Why do you prefer not to eat food?" d) "What do you believe has caused your anorexia?"

b) "Others are just trying to keep me from looking good" Pg. 613 Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. An admission of need shows a high level of insight. Acknowledging a low weight does not show insight because the client is more likely to be far below norms. Stating "I am not normal" shows distorted cognition, but this is not necessarily in the domains of judgment and insight.

41. The nurse has just completed an admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression? a) "I know my weight is a little below normal" b) "Others are just trying to keep me from looking good" c) "I know I have a problem. I need help" d) "Those weight charts are for normal people. I am not normal"

d) Being free of self-inflicted harm Pg. 605, 608 Purging is a form of self-inflicted harm and can lead to significant medical complications and therefore should be stopped as soon as possible. Understanding that purging is ineffective for weight control and recognizing that purging promotes binge eating are appropriate goals for later in treatment. Distraction also may help but this is something that would occur later.

42. A client has been purging to maintain weight loss. Which would be an important goal for this client? a) Recognizing that purging promotes binge eating b) Using distraction to stop the urge to purge c) Understanding that purging is an ineffective means of weight control d) Being free of self-inflicted harm

b) "Do you experience abnormal taste sensations?" Pg. 612 There are many complications associated with eating disorders, including anorexia nervosa. The neuropsychiatric complications include abnormal taste sensations, often due to zinc deficiency. Other neuropsychiatric complications include apathetic depression, fatigue, mild organic mental symptoms, and sleep disturbances. Abnormal menstrual cycles and/or amenorrhea are reproductive complications associated with anorexia nervosa. Dermatologic complications include dry skin and brittle nails. Constipation and/or diarrhea are both gastrointestinal complications associated with anorexia nervosa.

44. The nurse provides care for a client who is diagnosed with anorexia nervosa. Which question should the nurse ask to assess the client for neuropsychiatric complications associated with the diagnosed eating disorder? a) "Is your skin dry and your nails brittle?" b) "Do you experience abnormal taste sensations?" c) "Do you experience constipation or diarrhea?" d) "How often do you menstruate?"

a) Fluoxetine Pg. 615-616 Atypical antipsychotics are often associated with weight gain, while some antidepressants such as fluoxetine tend to induce weight loss.

46. 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? a) Fluoxetine b) Olanzapine c) Ziprasidone d) Risperidone

c) Emotional support, love, and attention Pg. The nurse explains to family and friends that they can be most helpful by providing emotional support, love, and attention. They can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight. Structure around eating is more therapeutic than providing constant, unlimited access to food. Positive reinforcement can be beneficial but this must be framed in a context of support, love and attention in order for the client to accept it.

47. Which would be most supportive for family and friends of a client with an eating disorder? a) Unlimited access to unhealthy foods that the client enjoys b) Positive reinforcement for weight gain c) Emotional support, love, and attention d) Focus on food intake, calories, and weight

d) Increasing client's coping skills for anxiety Pg. 613-614 Since clients with bulimia experience high anxiety levels and may use the binge-purge cycle as a coping mechanism, increasing coping skills for anxiety is a high priority nursing intervention. A perception of lack of control and helplessness is at the source of eating disorders. A firm, accepting, and patient approach is important in working with these individual, not an aggressive approach, which could render the nurse-client relationship ineffective. Since the client already tends to isolate when bingeing and purging, increasing involvement with others would be a positive treatment modality. Meeting dependency needs is nontherapeutic; the nurse does not need to rescue the client but rather to teach the client to be less helpless.

48. A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? a) Nurturing the client's need for dependency b) Communicating aggressively with the client c) Encouraging the client to take time away from peers for a time d) Increasing client's coping skills for anxiety

b) Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy Pg. 605-606 A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about nutritious foods to keep her healthy.

49. A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5' 8" tall and weighs only 90 lb. When considering the client's unrealistic body image, which intervention should be included in the care plan? a) Assigning the client to group therapy in which participants provide realistic feedback about her weight b) Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy c) Asking the client to compare her figure with magazine photographs of women her age d) Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift

a) Keep a list of accomplishments Pg. Wellness challenges must be addressed by the nurse when providing care to a client who is diagnosed with an eating disorder. Interventions that support increasing the client's self-concept include keeping a list of accomplishments, helping others, keeping busy, and counseling or therapy. Practicing meditation is a strategy that address stress management. Increasing social contact is a strategy for developing a sense of connection, belonging, and a support system. Limiting physical activity to a reasonable schedule addresses the recognition for the need for moderate physical activity.

5. The nurse provides care to a client who is diagnosed with an eating disorder. Which strategy should the nurse include in the client's plan of care to increase the client's self-concept? a) Keep a list of accomplishments b) Limit physical activity to a reasonable schedule c) Increase social contact d) Practice meditation

c) 1500 Pg. 614 The refeeding protocol typically starts with 1,500 calories a day and is increased slowly until the client is consuming about 3,500 calories a day in several meals. The usual plan for clients with very low weights is a weight gain of between 1 to 2 pounds a week.

50. A nurse is providing care to a client with anorexia who is beginning a refeeding protocol. Based on the nurse's understanding of these protocols, the nurse would expect the client to start with how many calories per day? a) 1000 b) 2000 c) 1500 d) 2500

d) Severe weight loss due to self-imposed dieting Pg. 606 Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.

51. During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which of the following would indicate to the nurse that this client might have anorexia nervosa? a) Flexible thought patterns and spontaneity b) Expressions of a positive self-concept c) Episodes of overeating and excessive weight gain d) Severe weight loss due to self-imposed dieting

c) Serotonin Pg. 615-616 The most frequently studied biochemical theory in bulimia nervosa relates to lowered brain serotonin neurotransmission. People with bulimia nervosa are believed to have altered modulation of central serotonin neuronal systems.

52. People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? a) Acetylcholine b) Norepinephrine c) Serotonin d) Dopamine

a) "There are many factors involved with how I developed anorexia " Pg. 605, 609 The etiology of anorexia nervosa is multidimensional. Some of the risk factors (discussed later) and the etiologic factors overlap. Initially, dieting may be the stimulus that leads to their development. Biologic vulnerability, developmental problems, and both family and social influences can be associated. However, the statement about many factors reflects the multidimensional nature of the disorder.

53. 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? a) "There are many factors involved with how I developed anorexia " b) "There is a history of obsessive-compulsive disorder in my family" c) "Society told me I needed to be thin and I believed that" d) "My strict dieting led to my problem with anorexia"

a) "Is there any way you can look at that sandwich as fuel for your body?" Pg. 622-623 CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual to guide treatment. CBT strategiesfocus on the client's thinking (cognition) and actions (behavior) about food. Cautioning the client to eat in moderation is non-therapeutic because it does not give the client tools to achieve this outcome. The nurse's statement about lack of control of eating patterns is similar in that it does not give the client cognitive and behavioral tools to effect change. The question "Is this your way of showing your family that you can make decisions?" does not exemplify a CBT approach because it requires the client to spontaneously identify the underlying motivation; it does not provide tools to address the client's thinking.

54. The nurse is sitting with the client at mealtime. The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach? a) "Is there any way you can look at that sandwich as fuel for your body?" b) "You seem to have a really hard time controlling your eating patterns" c) "Is this your way of showing your family that you can make decisions?" d) "You have to eat in moderation for good nutrition"

a) Believing that gaining weight is an effect of unhealthy lifestyle behaviors and losing weight is an effect of healthy lifestyle behaviors Pg. 605 Cognitive-behavioral therapy has been found to be the most effective treatment for bulimia. Strategies designed to change the client's thinking (cognition) and actions (behavior) are most effective, such as helping the client link body weight and lifestyle behaviors in a healthy way. It is ineffective and inappropriate for the nurse to promote shame. Emphasizing the potential harm of every morsel of food is likely to cause hopelessness and despair. Emphasizing the abnormality of the client's weight will likely have a similar effect and will not motivate the client to change his or her thinking and behavior.

55. Which may help a person to overcome an eating disorder that causes weight gain? a) Believing that gaining weight is an effect of unhealthy lifestyle behaviors and losing weight is an effect of healthy lifestyle behaviors b) Being reminded that every morsel of food he or she consumes will make him or her fat c) Knowing that his or her current weight is abnormal d) Being ashamed of his or her body image

a) "I will sit here quietly with you while you eat" Pg. 614 This statement reflects the nurse's expectation that the client will eat, yet the nurse still will provide adequate supervision. Setting a deadline establishes a conflictual, rules-based dynamic between the nurse and client which is not likely to be therapeutic. The nurse should be present, both to supervise and promote therapeutic relationship; it would be inappropriate to leave the client alone during a meal. Instilling guilt about how others would like the food is inappropriate because guilt does not lead to a positive self-concept.

6. Which nursing statement is most effective in communicating a positive expectation of the client? a) "I will sit here quietly with you while you eat" b) "I'll give you 90 minutes to eat" c) "I will allow you space to eat in peace" d) "There are people who would truly appreciate this food"

c) 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 Pg. 605-606 Eating disorders can be best understood in terms of a multifactorial etiology. Most experts agree that anorexia and bulimia develop from a complex interaction of individual, family, and sociocultural factors. Research strongly suggests that eating disorders may originate in part from hypothalamic, hormonal, neurotransmitter, or biochemical disturbances. Whether the biologic abnormalities seen in clients with eating disorders contribute to the disorders or are secondary to the dysregulation in the eating behavior remains unclear.

7. Which statement best describes the theories of the etiology of eating disorders? a) Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component b) Eating disorders are caused by dysregulation of multiple neurotransmitter systems that predispose a dysfunctional response to certain environmental factors c) 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 d) Eating disorders result from family dysfunction; neurotransmitter dysfunction is a result, not a cause, of the eating disorder

c) "Others are just trying to keep me from looking good" Pg. 613 Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. An admission of need shows a high level of insight. Acknowledging a low weight does not show insight because the client is more likely to be far below norms. Stating "I am not normal" shows distorted cognition, but this is not necessarily in the domains of judgment and insight.

8. The nurse has just completed an admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression? a) "I know I have a problem. I need help" b) "Those weight charts are for normal people. I am not normal" c) "Others are just trying to keep me from looking good" d) "I know my weight is a little below normal"

b) Encourage the entire family to engage in a balanced and regular dietary pattern Pg. 611 Clients with eating disorders can benefit when the entire family makes positive changes. This shows solidarity and makes it easier for the client to maintain healthy behaviors. Eating only salads and vegetables during the day may set up clients for later binges as a result of too little dietary fat and carbohydrates. The client with an eating disorder will not make healthy food choices independently. It is also not possible or beneficial for family and friends to force the client to eat.

9. The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia? a) Provide the client a diet of mainly vegetables and salads b) Encourage the entire family to engage in a balanced and regular dietary pattern c) Encourage autonomy by allowing the client to have total control over food choices d) Insist that the client complete all meals provided