Chapter 20 Eating Disorders, ch 20 NCLEX questions, Mental Health Final Ch 20, Ch 20 PrepUs: Eating Disorders, Ch. 20 Eating Disorders M.C., Mental Health, Eating disorders prepU, Chapter 20 Mental, Chapter 20: Eating Disorders

A client with anorexia weighs less than 85% of the client's normal body weight. The client says, "I'm so fat, I can't even get through this doorway, much less fit into any of my clothes." Which is the nurse's most therapeutic response? "I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about." "You only weigh 100 pounds. It is just not true that you are fat." "You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." "Let's talk about your ideas about your body and why you perceive yourself to be fat."

"I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about."

Which is the most common disorder found in clients diagnosed with bulimia nervosa? Anxiety Substance abuse Psychosis Depression

Depression

Which is the most common disorder found in clients diagnosed with bulimia nervosa? Psychosis Anxiety Depression Substance abuse

Depression Rationale: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.

Exacerbation of anorexia nervosa results from the client's effort to do what? Gain control of one part of life Manipulate family members Live up to family expectations Diminish conflict

Gain control of one part of life

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. The client is 5 feet 5 inches tall and weighs 75 pounds. Which is the priority nursing intervention? Initiating total parenteral nutrition as ordered Initiating cognitive behavioral therapy as ordered Monitoring vital signs and weight Addressing the client's low self-esteem

Initiating total parenteral nutrition as ordered Rationale:Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. Medical management focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalance.

Which behaviors are associated with purging? Select all that apply. Self-induced vomiting Use of enemas Consuming large amounts of food Misuse of diuretics Use of laxatives

Self-induced vomiting Use of enemas Misuse of diuretics Use of laxatives Rationale:Purging means the compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics. Binge eating means consuming a large amount of food in a discrete period of usually 2 hours or less.

Which technique is a type of cognitive behavioral therapy implemented for bulimic clients? Self-monitoring Distraction Music therapy Guided imagery

Self-monitoring Rationale: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? Dopamine Serotonin Norepinephrine Acetylcholine

Serotonin

When a 27-year-old is admitted for treatment of anorexia nervosa, the nurse prepares the client for diagnostic testing that includes what? Select all that apply. Serum amylase Serum uric acid Serum glucose Serum cortisol Electrocardiogram (ECG)

Serum glucose Serum cortisol Serum amylase Electrocardiogram (ECG)

An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? Encourage the client to exercise, which will reduce the client's anxiety Provide privacy during meals Restrict visits with the family until the client begins to eat Set up a strict eating plan for the client

Set up a strict eating plan for the client Rationale:Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals—not given privacy. Exercise must be limited and supervised.

A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which would the nurse include in the education plan? Knowing the calorie content of numerous foods Setting realistic goals Describing physiologic consequences of anorexia nervosa Learning strategies to control impulses

Setting realistic goals

For clients who purge, what is the most important goal? Understand that purging is an ineffective means of weight control Recognize that purging promotes binge eating Stop the behavior Develop the technique of distraction

Stop the behavior

For clients who purge, what is the most important goal? Develop the technique of distraction Stop the behavior Understand that purging is an ineffective means of weight control Recognize that purging promotes binge eating

Stop the behavior Rationale:The most important goal for a client who purges is to stop the behavior. All other options would not be the most important goal.

An obese client is admitted to the facility for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client? Teaching the client alternative ways to lose weight Reinforcing the client's concerns over physical appearance Using an abrupt, forceful manner to communicate with the client Encouraging the client to suppress feelings regarding obesity

Teaching the client alternative ways to lose weight

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? Confronting the client about the client's actual appearance during one-on-one sessions, scheduled during each shift 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 Assigning the client to group therapy in which participants provide realistic feedback about the client's weight Asking the client to compare the client's figure with magazine photographs of women the client's age

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 Rationale: 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 the client healthy.

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which comment indicates that the client may be suffering from anorexia nervosa? a. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." b. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." c. "I do diet around my periods; otherwise, I just get so bloated." d. "I like the way I look, but I just need to keep my weight down because I'm a cheerleader."

a. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." (Rationale: Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Most clients with anorexia nervosa do not like the way they look, and their self-perception may be distorted. Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.)

A client is receiving treatment for anorexia nervosa, and the nurse observes that the client has consumed a healthy meal without providing any resistance. How should the nurse respond? a. Directly acknowledge the client's positive behavior. b. Challenge the client to double his food intake the following day. c. Ask the client why he has not previously been eating this way. d. Document the client's apparent recovery in the electronic health record.

a. Directly acknowledge the client's positive behavior. (Rationale: The nurse should give the client positive support and honest praise for accomplishments. A single meal does not constitute recovery, and it is likely unrealistic to expect the client to double his food intake the following day.)

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. She is 5'5" tall and weighs 75 pounds. Which of the following is the highest priority nursing intervention? a. Initiating total parenteral nutrition as ordered b. Assessing the client's food preferences c. Initiating cognitive-behavioral therapy as ordered d. Addressing the client's low self-esteem

a. Initiating total parenteral nutrition as ordered (Rationale: Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. Medical management focuses on weight restoration, nutritional rehabilitation, and correction of electrolyte imbalance. This acute physiologic need is prioritized over psychosocial assessments, even though these are important. Identifying food preferences is unlikely to change the client's eating patterns.)

A client has been diagnosed with anorexia nervosa. To assist the client to cope with her disease process, the client will complete which of the following actions? a. Keeping a journal and discussing it with the nurse b. Temporarily withdrawing from social contact c. Drinking 4 L of fluid per day d. Avoiding mirrors and reflective surfaces

a. Keeping a journal and discussing it with the nurse (Rationale: Recording and discussing feelings are a constructive way to manage stress. Increasing fluid intake may be an attempt to artificially increase her weight. Withdrawal from social contact is not normally necessary, and the client is not required to avoid looking at her body.)

Which of the following is a typical characteristic of parents of clients diagnosed with anorexia nervosa? a. Maintenance of emotional distance from their children b. A tendency to overprotect their children c. Alternation between loving and rejecting their children d. A history of substance abuse

b. A tendency to overprotect their children (Rationale: 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. This family characteristic is known to be a risk factor for anorexia nervosa.)

The nurse is planning the care for a client with an eating disorder. Which of the following should not be included in the client's care plan? a. Sitting with the client during meals and snacks b. Weighing the client after each meal c. Being alert for attempts to hide or discard food or to inflate weight d. Observing the client following meals and snack for 1 to 2 hours

b. Weighing the client after each meal (Rationale: Weighing the client frequently 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 to inflate weight.)

A client is being seen in the health clinic. During the nursing assessment, the client states that she has had amenorrhea for the last 6 months. She weighs 80 pounds and is 5'2" tall. She states that she usually eats salads so that she does not gain weight. The nurse suspects that the client most likely has what health problem? a. Anxiety disorder b. Bulimia nervosa c. Anorexia nervosa d. Depression

c. Anorexia nervosa (Rationale: Anorexia nervosa is a life-threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal bodyweight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain such as purging, fasting, or excessively exercising. Although depression and anxiety may accompany eating disorders, this particular situation is indicative of anorexia.)

An adolescent client is being admitted to the psychiatric unit for treatment of an eating disorder. Her admission interview reveals a history of recurrent episodes of binge eating and self-induced vomiting. The client states that she wants to go to the store "just to grab a quick snack." How should the nurse respond to the client's statement? a. Set a specific time for the client to return. b. Distract the client. c. Deny the client's request. d. Insist that the client choose a healthy snack.

c. Deny the client's request. (Rationale: Clients with bulimia nervosa require firm limits around the content and setting of food intake. It would be inappropriate for the client to independently purchase food while receiving inpatient care.)

The nurse is caring for a client who has been diagnosed with bulimia nervosa. All of the following behaviors are associated with purging in this disease process except which of the following? a. Misuse of diuretics b. Overuse of laxatives c. Excessive exercise d. Self-induced vomiting

c. Excessive exercise (Rationale: Purging means the compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics. Exercise may be a compensatory behavior, but is not an example of purging.)

The nurse is planning the care for a client with anorexia nervosa. The nurse should recognize that the client's behavior most likely has what motivation? a. Manipulating her family members or friends b. Diminishing the likelihood of conflict c. Gaining control of one part of her life d. Living up to her family's expectations

c. Gaining control of one part of her life (Rationale: A client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. The eating disorder carries with it a high incidence in families that emphasize achievement.)

Which of the following goals should guide the nursing care for a client with anorexia nervosa? a. The client will interact frequently with other clients. b. The client will acknowledge the pathophysiology of her disease. c. The client will acknowledge areas of personal strength. d. The client will demonstrate an ability to cook healthy meals.

c. The client will acknowledge areas of personal strength. (Rationale: Nurses can assist in recovery from eating disorders by helping clients to recognize and acknowledge their positive qualities apart from body image and food. Cooking healthy meals does not necessarily equate to consuming healthy meals. Pathophysiology and frequent social interaction are not high priorities.)

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? Ziprasidone Fluoxetine Risperidone Olanzapine

Fluoxetine

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

Fluoxetine

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." "Five miles per day is too much. How about 3 miles per day?" "No, exercise is not allowed until your weight is closer to normal." "That's fine as long as you adhere to your eating program and do not use laxatives or purging."

"Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass."

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

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

Following a series of visits to the primary care provider and the hospital, a 22-year-old retail clerk has been diagnosed with anorexia nervosa. Which of the client's statements demonstrate an accurate understanding of the diagnosis? "I know that if I could lose this last 10 pounds I'd feel completely different about things." "What you don't understand is that it's way healthier to be skinny than fat, and it looks better." "What no one seems to understand is that I'm concerned about my health, not ignoring it." "I guess it's probably safe to say that anorexia runs in my family."

"I guess it's probably safe to say that anorexia runs in my family."

Which client being treated for anorexia displays assessment values that warrant hospitalization? A 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL

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

The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first? Control the eating responses Ask the client directly about thoughts of suicide or self-harm Identify the cues related to binging Provide small regular meals and snacks

Ask the client directly about thoughts of suicide or self-harm

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? Binge-eating disorder Eating disorder not otherwise specified Anorexia nervosa Bulimia nervosa

Bulimia nervosa

A 30-year-old client is in therapy for bulimia, depression, and anxiety. The client relates that the client feels unable to cope with the demands of the client's job and that the client's partner recently ended their long-term relationship. The client states that the client frequently binges when stress levels are high. The client denies feeling suicidal but states, "I'm a mess. I'm just not smart enough to figure out how to run my life!" Which nursing diagnosis would best identify the client's problems? Social isolation related to recent loss of significant relationship Risk for impulse control related to unidentified triggers Anxiety related to job stressors Chronic low self-esteem related to unrealistic self-expectations

Chronic low self-esteem related to unrealistic self-expectations

A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge eating disorder (BED). The students demonstrate understanding when they identify which characteristics as specific to BED? Select all that apply. Feelings of guilt do not occur after binging. Clients refrain from purging behaviors. Clients engage in overexercising. Binge eating periods are shorter. Clients typically are obese.

Clients typically are obese. Clients refrain from purging behaviors.

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

Cognitive behavior therapy and pharmacologic interventions

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 Depression Dependency Anxiety

Control

The nurse is providing care to a client diagnosed with anorexia and notes that the client demonstrates behaviors that reflect an intense physical and emotional process that overrides all physiologic body cues. Which term would the nurse use to document this finding? Perfectionism Drive for thinness Body image distortion Interoceptive awareness

Drive for thinness

A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find? Dry skin Oversensitivity to heat Tachycardia Hyperkalemia

Dry skin

A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find? Oversensitivity to heat Hyperkalemia Dry skin Tachycardia

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

A nurse is planning to explain the purpose of the behavioral therapy technique of self-monitoring to a client with bulimia nervosa. The nurse would emphasize keeping a diary to record what? Efforts at distraction Rigid rules about eating Feelings of hunger Environmental cues

Environmental cues

Which is a dental complication associated with purging? Elevated blood urea nitrogen (BUN) Enlarged pancreas Seizures Erosion of dental enamel

Erosion of dental enamel Rationale:Erosion of dental enamel is a dental complication associated with purging. Seizures, elevated BUN, and enlarged pancreas are not dental complications associated with purging, but are overall complications.

For a client diagnosed with anorexia nervosa, which goal takes priority? Identifying self-perceptions about body size as unrealistic Developing a contract with the nurse that sets a target weight Verbalizing the possible physiologic consequences of self-starvation Establishing adequate daily nutritional intake

Establishing adequate daily nutritional intake Rationale:According to Maslow's hierarchy of needs, physiologic needs are the most basic. Adequate daily intake of food and fluids would be of the highest priority for this client.

Exacerbation of anorexia nervosa results from the client's effort to do what? Live up to family expectations Manipulate family members Gain control of one part of life Diminish conflict

Gain control of one part of life Rationale:A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client's life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.

A client's diagnosis of bulimia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.) Lanugo observed on forearms and face Serum potassium of 3.8 mEq/L History of purging "3 times a week for 2 years." Client reports of "being depressed" Often heard discussing "how hard it is to stay thin" with other clients

History of purging "3 times a week for 2 years." Client reports of "being depressed" Often heard discussing "how hard it is to stay thin" with other clients

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. The client is 5 feet 5 inches tall and weighs 75 pounds. Which is the priority nursing intervention? Initiating cognitive behavioral therapy as ordered Initiating total parenteral nutrition as ordered Addressing the client's low self-esteem Monitoring vital signs and weight

Initiating total parenteral nutrition as ordered

A client is diagnosed with anorexia nervosa. The client's body mass index is 16.75 kg/m2. The nurse interprets this as indicating which level of severity of the condtion? Mild Severe Moderate Extreme

Moderate

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? Maintenance of emotional distance from their children A history of substance abuse Alternation between loving and rejecting their children Overprotective of their children

Overprotective of their children Rationale: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 old. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.

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? The absence of a parent and/or the presence of a stepparent An overemphasis of peer relationships over family relationships Passive parenting and lack of encouragement Poor communication and enmeshed family dynamics

Poor communication and enmeshed family dynamics

Which technique is a type of cognitive behavioral therapy implemented for bulimic clients? Distraction Guided imagery Self-monitoring Music therapy

Self-monitoring

A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. The client doesn't want to feel fat in a bathing suit on vacation. The client's sodium level is 150 mEq/L; potassium level is 3.2 mEq/L. The client is 5 feet tall, weighs 100 pounds, and has lost 15 pounds in 3 weeks. Which goal is a priority at this time? Stabilize electrolyte levels. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. Develop a contract with the client to stop using laxatives and diuretics. Help build self-esteem.

Stabilize electrolyte levels.

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 experience diminished episodes of delusional thinking. The client will demonstrate measures to reduce body mass index. The client will verbalize acceptance of appearance. The client will demonstrate actions that promote health maintenance.

The client will verbalize acceptance of appearance.

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

Weight gain Rationale:Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.

A client is being assessed for suspected bulimia nervosa and admits to a pattern of binge eating. What further assessment finding would confirm a diagnosis of bulimia? a. A weight loss of more than 40 pounds over the previous 6 months b. Inappropriate behaviors aimed at avoiding weight gain c. Frequent physical exercise d. Persistent fluid and electrolyte imbalances

b. Inappropriate behaviors aimed at avoiding weight gain (Rationale: Bulimia is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain. Exercise is not necessarily considered to be an inappropriate compensatory behavior. Weight loss and electrolyte imbalances can have many causes apart from bulimia.)

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. The client is tachycardic. b. The client has moist skin. c. The client often performs excessive exercise. d. The client wears tight-fitting clothing.

c. The client often performs excessive exercise. (Rationale: 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 typically wear loose-fitting clothes to hide his or her body.)

When working with a client who has bulimia nervosa, the nurse should recognize that the client likely has what comorbid diagnosis? a. Borderline personality disorder b. Psychosis c. Avoidant personality disorder d. Depression

d. Depression (Rationale: 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.)

All but which of the following characteristics are associated with both bulimia and anorexia? a. Perfectionism b. Obsessive-compulsiveness c. Harm avoidance d. High impulsivity

d. High impulsivity (Rationale: Clients with bulimia often have a history of impulsive behavior, such as substance abuse and shoplifting, as well as anxiety, depression, and personality disorders. Perfectionism, harm avoidance, and obsessive-compulsiveness are associated with both eating disorders. Clients with anorexia tend to be self-disciplined and methodical rather than impulsive.)

The emergency department nurse is assessing a client who has a recent history of bulimia nervosa. What objective assessment should the nurse prioritize? a. Oxygen saturation b. Temperature c. White blood cell count d. Potassium level

d. Potassium level (Rationale: Purging can result in severe electrolyte imbalances, which would be evidenced by hypokalemia. The client's oxygen levels, white cells, and temperature are less likely to be affected.)

What is the percentage of clients who had been diagnosed with bulimia nervosa but who have fully recovered later relapse? a. 50% b. 23% c. 33% d. 10%

c. 33% (Rationale: One third of fully recovered clients with bulimia nervosa eventually relapse.)

What percentage of clients who have fully recovered from bulimia nervosa later experience a relapse? 0.23 0.5 0.3 0.1

0.3 Rationale:Thirty percent of clients have fully recovered from bulimia nervosa later experience a relapse.

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? Overprotective of their children A history of substance abuse Alternation between loving and rejecting their children Maintenance of emotional distance from their children

Overprotective of their children

Following a series of visits to the primary care provider and the hospital, a 22-year-old retail clerk has been diagnosed with anorexia nervosa. Which of the client's statements demonstrate an accurate understanding of the diagnosis? "What no one seems to understand is that I'm concerned about my health, not ignoring it." "I guess it's probably safe to say that anorexia runs in my family." "What you don't understand is that it's way healthier to be skinny than fat, and it looks better." "I know that if I could lose this last 10 pounds I'd feel completely different about things."

"I guess it's probably safe to say that anorexia runs in my family." Rationale:There are known to be both familial and genetic contributors to eating disorders. Weight loss does not relieve the thinking or behaviors that characterize the disorders, and there are serious health consequences to being underweight.

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

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

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. "I'll stand up for what I want, regardless of what you say." "I consider myself a really laid-back individual." "I want things to be the way I want them to be." "Everything about my school work needs to be perfect." "Things being out of order really bothers me."

"I want things to be the way I want them to be." "Everything about my school work needs to be perfect." "Things being out of order really bothers me."

An adolescent diagnosed with anorexia nervosa is insistent on being allowed to take a laxative. Which response by the nurse best demonstrates the management of this client request? "Laxatives are not a part of your treatment plan." "Why do you want to take a laxative?" "Using a laxative to purge is not an acceptable way to manage your weight." "Using laxatives is bad for you because your electrolytes can become unbalanced."

"Laxatives are not a part of your treatment plan." Rationale:The nurse should avoid sounding parental when teaching about nutrition or why laxative use is harmful. Presenting information factually without chiding the client will obtain more positive results. A firm, accepting, and patient approach is important in working with these individuals. Providing a rationale for all interventions helps build trust, as does a consistent, nonreactive approach.

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

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

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

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

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. "Things being out of order really bothers me." "I'll stand up for what I want, regardless of what you say." "I want things to be the way I want them to be." "Everything about my school work needs to be perfect." "I consider myself a really laid-back individual."

"Things being out of order really bothers me." "I want things to be the way I want them to be." "Everything about my school work needs to be perfect." Rationale: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.

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

"What do you think about how much you weigh right now?"

Which percentage accurately reflects the prevalence of anorexia and bulimia in the United States? 6% to 9% 10% to 12% 4% to 6% 2% to 4%

2% to 4% Rationale:Estimates of the prevalence of anorexia nervosa and bulimia nervosa range from 1% to 4% of the U.S. general population.

Approximately what percentage of clients who have fully recovered from bulimia nervosa later experience a relapse? 50% 10% 23% 30%

30%

Which area of the brain has been associated with the symptoms of eating disorders? Cerebellum Pons Medulla Hypothalamus

Hypothalamus

Which area of the brain has been associated with the symptoms of eating disorders? Pons Hypothalamus Medulla Cerebellum

Hypothalamus Rationale:The hypothalamus has been associated with the symptoms of eating disorders.

Which is a metabolic complication related to weight loss? Hypothyroidism Leukopenia Amenorrhea Bradycardia

Hypothyroidism

Which is a metabolic complication related to weight loss? Hypothyroidism Leukopenia Amenorrhea Bradycardia

Hypothyroidism Rationale:Hypothyroidism is a metabolic complication related to weight loss. Bradycardia, amenorrhea, and leukopenia are not metabolic complications of weight loss.

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 Disturbed body image Anxiety Ineffective coping

Imbalanced nutrition: less than body requirements

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 Panic Delusions Hyperactivity

Impulsivity

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

Increasing client's coping skills for anxiety

The client with bulimia reports feeling helpless and says, "What's the use?" As the nurse plans the client's care, the priority diagnosis is which? Risk for self-directed violence Ineffective individual coping Anxiety Nutrition that is less than body requirements

Risk for self-directed violence

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? Confronting the client about the client's actual appearance during one-on-one sessions, scheduled during each shift 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 Assigning the client to group therapy in which participants provide realistic feedback about the client's weight Asking the client to compare the client's figure with magazine photographs of women the client's age

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 identify alternatives to current coping patterns. The client will verbalize fears relating to the client's health needs. The client will be free of self-induced vomiting. The client will acknowledge self-harm thoughts.

The client will be free of self-induced vomiting.

For a client with anorexia nervosa, which goal takes the highest priority? a. Verbalizing the possible physiologic consequences of self-starvation b. Developing a contract with the nurse that sets a target weight c. Establishing adequate daily nutritional intake d. Identifying self-perceptions about body size as unrealistic

a. Establishing adequate daily nutritional intake (Rationale: According to Maslow's hierarchy of needs, physiologic needs are the most basic. Adequate daily intake of food and fluids would be the highest priority for this client.)

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 pounds. Considering the client's unrealistic body image, which intervention should be included in the care plan? a. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy. b. Asking the client to compare her figure with magazine photographs of women of her age. c. Assigning the client to group therapy in which participants provide realistic feedback about her weight. d. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift.

a. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy. (Rationale: The client needs assistance with making decisions about nutritious foods to keep her healthy. Attempts to help the client view her body realistically and rationally are frequently unsuccessful.)

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 ... bulimia nervosa. eating disorder not otherwise specified. binge-eating disorder. anorexia nervosa.

anorexia nervosa.

Which of the following is a metabolic complication related to excessive weight loss? a. Leukopenia b. Hypothyroidism c. Bradycardia d. Amenorrhea

b. Hypothyroidism (Rationale: Hypothyroidism is a metabolic complication related to weight loss. Bradycardia, amenorrhea, and leukopenia are not metabolic complications of weight loss.)

An adolescent female has been diagnosed with anorexia nervosa. Which of the following interventions should be included in the client's plan of care? a. Encourage the client to exercise in order to reduce anxiety. b. Provide frequent feedback to the client on her behaviors. c. Restrict visits with the family until the client begins to eat. d. Provide privacy during meals.

b. Provide frequent feedback to the client on her behaviors. (Rationale: The client should be given frequent feedback on her behaviors. The family should be included in the client's care. The client should be monitored during meals and not given privacy. Exercise must be limited and supervised.)

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

b. Weight gain (Rationale: Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.)

The nurse is caring for a client diagnosed with bulimia. What is the most appropriate initial goal for a client diagnosed with bulimia? a. Avoid shopping for large amounts of food. b. Control eating impulses. c. Eat several small meals each day. d. Identify anxiety-causing situations.

d. Identify anxiety-causing situations. (Rationale: Clients with eating disorders seem sad, anxious, and worried. Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping patterns is not a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the care plan after initially addressing stress and underlying issues. Eating frequent, small meals is not a component of treatment.)

A client has been admitted to the psychiatry unit for the treatment of anorexia nervosa. How should the nurse best organize the client's initial nursing care? a. Ask the client which nurse she would prefer. b. Assign two nurses to the client for the first 3 to 4 days of treatment. c. Arrange for a different nurse to care for the client each day. d. Limit the number of staff assigned to and interacting with the client.

d. Limit the number of staff assigned to and interacting with the client. (Rationale: Initially, limit the number of staff assigned to and interacting with the client, and then gradually increase the variety of staff interacting with the client. The client would not be invited to choose a nurse, and multiple nurses are not needed.)

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? engaging in severe dieting compulsively washing his or her hands socially withdrawing becoming sexually promiscuous

engaging in severe dieting Rationale:Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. 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. While the remaining options may demonstrative reactive behaviors, they are not generally associated with over-productive parenting.

When reviewing the documented history of an adult client with anorexia nervosa, what is the nurse most likely to find? (Select all that apply.) reported believing that friends were "jealous" of her body food restriction began at age 15 depression at age 16 lasting one month had successful outpatient treatment one year after onset of disorder reports strong relationship with parents

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

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

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

The nurse is interviewing an 18-year-old client about eating behaviors. The client's parents have brought the client to treatment because the client's mother suspects that the client has been binge eating and vomiting. The nurse asks the client if the client ever feels that the client cannot control the client's eating. The client's mother states, "I know the client can't control it; the client ate an entire cake last night!" Which comment by the nurse is best? " Is what your mother said true?" "Do you often have to answer for your child?" "I see. Do you ever feel as though you cannot control your eating?" "I see. What are your thoughts on what your mother has said?"

"I see. Do you ever feel as though you cannot control your eating?"

A client with anorexia weighs less than 85% of the client's normal body weight. The client says, "I'm so fat, I can't even get through this doorway, much less fit into any of my clothes." Which is the nurse's most therapeutic response? "You only weigh 100 pounds. It is just not true that you are fat." "You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." "Let's talk about your ideas about your body and why you perceive yourself to be fat." "I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about."

"I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about." Rationale:People with eating disorders tend to have perfectionistic personalities and to think in all-or-nothing terms. The nurse communicates caring to the client through a kind, firm, matter-of-fact approach, acknowledging the client's statement and at the same time, being honest and factual about the client's condition without being condescending or punitive.

The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first? Provide small regular meals and snacks Control the eating responses Ask the client directly about thoughts of suicide or self-harm Identify the cues related to binging

Ask the client directly about thoughts of suicide or self-harm Rationale:The client's safety is a priority. The nurse must ask questions about suicide and related thoughts in order to determine the level of monitoring the client may need to ensure safety during treatment.

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. The nurse identifies this as reflecting what? Perfectionism Body image disturbance Drive for thinness Interoceptive awareness

Body image disturbance Rationale:Body image disturbance occurs when the individual perceives his or her body disparately from how the world or society views it. Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues. Interoceptive awareness is a term used to describe the sensory response to emotional and visceral cues, such as hunger. Perfectionism consists of personal standards (the extent to which the individual sets and tries to achieve high standards for oneself) and concern over mistakes and their consequences for their self-worth and others' opinions.

Which is a family risk factor for bulimia nervosa? Chaotic family Self-perception of being overweight Inability to deal with conflict Lack of emotional support

Chaotic family Rationale:A chaotic family life is a risk factor for bulimia nervosa. Lack of emotional support, self-perception of being overweight, and inability to deal with conflict are family risk factors for anorexia nervosa.

Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to have only bites of food and small sips of fluids. Which of the following nursing diagnoses is paramount in this client's care? Imbalanced nutrition less than body requirements related to refusal to eat Anxiety related to inadequate coping mechanisms Impaired social interaction related to aggressive behavior Deficient fluid volume related to inability to meet bodily fluid requirements

Deficient fluid volume related to inability to meet bodily fluid requirements

During a family meeting for a client with an eating disorder, it becomes apparent that the family lacks clear role boundaries. The nurse should recognize what phenomenon? a. Potential abuse b. Autonomy c. Enmeshment d. Satiety

c. Enmeshment (Rationale: Enmeshment is a lack of clear role boundaries. Autonomy is exerting control over oneself. Satiety is satisfaction of appetite. Unclear boundaries do no necessarily suggest the presence of abuse.)