Chapter 21 Eating Disorders
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 realize this must be very difficult for you but try to remember I'm not your enemy." B) "I'm not going to take your insults personally but you need to be more respectful." C) "I'm sorry that you are angry but you cannot throw food at me." D) "I'm not the root of your problem."
A) "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. A) "I want things to be the way I want them to be." B) "I consider myself a really laid-back individual." C) "Things being out of order really bothers me." D) "Everything about my school work needs to be perfect." E) "I'll stand up for what I want, regardless of what you say."
A) "I want things to be the way I want them to be." C) "Things being out of order really bothers me." D) "Everything about my school work needs to be perfect."
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? A) "I'll eat small meals and snacks regularly." B) "I'll take my medication when I feel the urge to binge." C) "How I feel about my body has little to do with my binging." D) "I know if I eat pasta, I'll binge."
A) "I'll eat small meals and snacks regularly."
A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder? A) "There are many factors involved with how I developed anorexia ." B) "My strict dieting led to my problem with anorexia." C) "There is a history of obsessive-compulsive disorder in my family." D) "Society told me I needed to be thin and I believed that."
A) "There are many factors involved with how I developed anorexia ."
A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication? A) "What do you think about how much you weigh right now?" B) "Why do you prefer not to eat food?" C) "What do you believe has caused your anorexia?" D) "Is there anything that I can get you to eat right now?"
A) "What do you think about how much you weigh right now?"
Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? A) Antidepressant B) Antimanic C) Antiparkinsonian D) Antianxiety
A) Antidepressant
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
A) Binge eating disorder
A mental health nurse is caring for a client who is obsessed with a blemish on the client's face and states, "I am so ugly." The client has been unable to work for the past 2 days. The client is suffering from which medical problem? A) Body image disturbance B) Conversion disorder C) Hypochondriasis D) Somatization disorder
A) Body image disturbance
A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected? A) Dental erosion and chronic edema B) Bacterial gastrointestinal infections and overhydration C) Respiratory distress and dyspnea D) Metabolic acidosis and constricted colon
A) Dental erosion and chronic edema
Which is the most common disorder found in clients diagnosed with bulimia nervosa? A) Depression B) Psychosis C) Anxiety D) Substance abuse
A) Depression
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) Ziprasidone C) Olanzapine D) Risperidone
A) Fluoxetine
Exacerbation of anorexia nervosa results from the client's effort to do what? A) Gain control of one part of life B) Diminish conflict C) Live up to family expectations D) Manipulate family members
A) Gain control of one part of life
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? A) Imbalanced nutrition: less than body requirements B) Anxiety C) Ineffective coping D) Disturbed body image
A) Imbalanced nutrition: less than body requirements
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? A) Poor communication and enmeshed family dynamics B) The absence of a parent and/or the presence of a stepparent C) Passive parenting and lack of encouragement D) An overemphasis of peer relationships over family relationships
A) Poor communication and enmeshed family dynamics
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? A) Risk for self-directed violence B) Anxiety C) Ineffective individual coping D) Nutrition that is less than body requirements
A) Risk for self-directed violence
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? A) Serotonin B) Norepinephrine C) Acetylcholine D) Dopamine
A) Serotonin
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 ... A) anorexia nervosa. B) binge-eating disorder. C) bulimia nervosa. D) eating disorder not otherwise specified.
A) anorexia nervosa.
What percentage of clients who have fully recovered from bulimia nervosa later experience a relapse? A) 10% B) 30% C) 23% D) 50%
B) 30%
Which area of the brain has been associated with the symptoms of eating disorders? A) Medulla B) Hypothalamus C) Pons D) Cerebellum
B) Hypothalamus
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? A) Monitoring vital signs and weight B) Initiating total parenteral nutrition as ordered C) Initiating cognitive behavioral therapy as ordered D) Addressing the client's low self-esteem
B) Initiating total parenteral nutrition as ordered
Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? A) Maintenance of emotional distance from their children B) Overprotective of their children C) Alternation between loving and rejecting their children D) A history of substance abuse
B) Overprotective of their children
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? A) Music therapy B) Self-monitoring C) Guided imagery D) Distraction
B) Self-monitoring
When working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason? A) To document physical problems the client wants to share with the physician B) To raise self awareness and a sense of control C) To show the family evidence of the client's progress D) For the nurse to be able to document in the client record accurately
B) To raise self awareness and a sense of control
When admitted to the inpatient unit, a client is 5 feet 10 inches tall and weighs 100 pounds. What is the initial goal in the client's care? A) To be on bedrest B) To stop losing weight C) To reduce fluid intake D) To assess for violence potential
B) To stop losing weight
Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? A) Positive self-esteem B) Weight gain C) Mood elevation D) Increased activity
B) Weight gain
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? A) "Using a laxative to purge is not an acceptable way to manage your weight." B) "Why do you want to take a laxative?" C) "Laxatives are not a part of your treatment plan." D) "Using laxatives is bad for you because your electrolytes can become unbalanced."
C) "Laxatives are not a part of your treatment plan."
A college student has been referred to the clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what? A) Oily skin and acne B) Onset of symptoms in early adolescence C) Body weight significantly below ideal for height and age D) Temper tantrums and sleep disturbance
C) Body weight significantly below ideal for height and age
A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment? A) Evidence of injury to skin by cutting B) Complete blood count and differential C) Cardiac assessment and measurement of electrolyte levels D) Psychosocial assessment and determination of coping skills
C) Cardiac assessment and measurement of electrolyte levels
Which intervention has been found to be most effective reducing the initial symptoms of bulimia? A) Behavioral therapy and psychoeducation B) Clearly stated unit rules and a supportive milieu C) Cognitive behavior therapy and pharmacologic interventions D) Daily monitoring of sound dietary principles and meditation sessions
C) Cognitive behavior therapy and pharmacologic interventions
For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? A) One-on-one time with psychiatric staff and antidepressant medication therapy B) Daily reinforcement of sound dietary principles and meditation sessions C) Cognitive-behavioral therapy (CBT) including self-monitoring D) Clearly stated unit rules and a supportive milieu
C) Cognitive-behavioral therapy (CBT) including self-monitoring
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? A) Depression B) Anxiety C) Control D) Dependency
C) Control
Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care? A) Anxiety related to inadequate coping mechanisms B) Hyperactivity related to restlessness C) Deficient fluid volume related to refusal to drink D) Impaired social interaction related to aggressive behavior
C) Deficient fluid volume related to refusal to drink
A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include? A) Emphasis on the need for teachers to focus their prevention efforts on female students B) Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns C) Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders D) Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades
C) Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders
Which statement best describes the biologic theories of the etiology of eating disorders? A) Eating disorders involve dysregulation of multiple neurotransmitter systems and may be influenced by behavioral, cultural, and familial factors. B) Eating disorders result from family dysfunction involving a controlling mother; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. 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 involve dysregulation of the serotonergic system and have a strong genetic component.
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.
The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what? A) Provide the nurse with a tool for evaluating the plan of care B) Provide the therapist with a strategy for client compliance C) Provide the client with a feeling of responsibility and control over the client's behavior D) Allow the client a tool by which to negotiate behavior
C) Provide the client with a feeling of responsibility and control over the client's behavior
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? A) Reinforcing the client's concerns over physical appearance B) Using an abrupt, forceful manner to communicate with the client C) Teaching the client alternative ways to lose weight D) Encouraging the client to suppress feelings regarding obesity
C) Teaching the client alternative ways to lose weight
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? A) Anorexia nervosa B) Eating disorder not otherwise specified C) Binge-eating disorder D) Bulimia nervosa
D) Bulimia nervosa
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) Patterns of activity and rest B) Throat and esophagus C) Condition of mouth and gums D) Heart rate and rhythm
D) Heart rate and rhythm
A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find? A) Panic B) Delusions C) Hyperactivity D) Impulsivity
D) Impulsivity
A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? A) Encouraging client take time away from peers for a time B) Communicating aggressively with the client C) Nurturing the client's need for dependency D) Increasing client's coping skills for anxiety
D) Increasing client's coping skills for anxiety
An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? A) Restrict visits with the family until the client begins to eat B) Provide privacy during meals C) Encourage the client to exercise, which will reduce the client's anxiety D) Set up a strict eating plan for the client
D) Set up a strict eating plan for the client
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? A) The client will acknowledge self-harm thoughts. B) The client will identify alternatives to current coping patterns. C) The client will verbalize fears relating to the client's health needs. D) The client will be free of self-induced vomiting.
D) The client will be free of self-induced vomiting.
The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care? A) The client will demonstrate measures to reduce body mass index. B) The client will demonstrate actions that promote health maintenance. C) The client will experience diminished episodes of delusional thinking. D) The client will verbalize acceptance of appearance.
D) The client will verbalize acceptance of appearance.
A nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa? A) The person has feeling of powerlessness B) The person is preoccupied with body image. C) The person judges worth based on a lack of fat. D) The person engages in episodic binge eating.
D) The person engages in episodic binge eating.
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? A) becoming sexually promiscuous B) compulsively washing his or her hands C) socially withdrawing D) engaging in severe dieting
D) engaging in severe dieting
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) "I don't think you are fat." B) "Has something occurred that caused you to measure your thighs?" C) "You have always been very focused on your thighs. Is that the part of your body you like least?" D) "You are exactly the right weight for your height."
B) "Has something occurred that caused you to measure your thighs?"
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? A) Stimulants B) Antipsychotics C) Mood stabilizers D) Antidepressants
D) Antidepressants
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? A) Drive for thinness B) Interoceptive awareness C) Perfectionism D) Body image disturbance
D) Body image disturbance
Which is a cardiac complication of an eating disorder? A) Thrombocytopenia B) Enlarged heart C) Hypertension D) Bradycardia
D) Bradycardia
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? A) Bupropion B) Lithium C) Haloperidol D) Fluoxetine
D) Fluoxetine
