Final Exam - Chapter 20
While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from?
Bulimia nervosa
A client's diagnosis of bulimia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.)
Client reports of "being depressed" History of purging "3 times a week for 2 years." Often heard discussing "how hard it is to stay thin" with other clients
A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include?
Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders
Exacerbation of anorexia nervosa results from the client's effort to do what?
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?
Imbalanced nutrition: less than body requirements
The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks the student to step on the scale. The student asks if the student can go to the bathroom first to empty the student's bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has ...
anorexia nervosa.
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."
A nurse is interviewing a client and suspects an eating disorder. Which client statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply.
"Everything about my school work needs to be perfect." "I want things to be the way I want them to be." "Things being out of order really bothers me."
A nurse is interviewing a client and suspects an eating disorder. Which client statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply.
"Everything about my school work needs to be perfect." "Things being out of order really bothers me." "I want things to be the way I want them to be."
During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?
"Has something occurred that caused you to measure your thighs?"
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 guess it's probably safe to say that anorexia runs in my family."
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?
"I see. Do you ever feel as though you cannot control your eating?"
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective?
"I'll eat small meals and snacks regularly."
While caring for a client with anorexia nervosa, a nurse anticipates that the client would have difficulty making which comment?
"I'm mad at you because you won't let me go on a pass unless I gain weight!"
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."
A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder?
"There are many factors involved with how I developed anorexia ."
A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication?
"What do you think about how much you weigh right now?"
The client is 16 years old with an identical twin just diagnosed with anorexia nervosa. The client tells the nurse the client is concerned that the client may also develop the disorder. Which response by the nurse is the most appropriate?
"While eating disorders have shown a genetic link, other factors also play a role in its development."
Which percentage accurately reflects the prevalence of anorexia and bulimia in the United States?
2% to 4%
What percentage of clients who have fully recovered from bulimia nervosa later experience a relapse?
30%
Which client being treated for anorexia displays assessment values that warrant hospitalization?
A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL
A client is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The client believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this client is what?
Anorexia nervosa, restricting type
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders?
Antidepressants
The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first?
Ask the client directly about thoughts of suicide or self-harm
A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect?
Binge eating disorder
A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply.
Body dissatisfaction Obsessiveness Cognitive distortions
A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment?
Bradycardia
Which is a cardiac complication of an eating disorder?
Bradycardia
A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment?
Cardiac assessment and measurement of electrolyte levels
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?
Chronic low self-esteem related to unrealistic self-expectations
Which intervention has been found to be most effective reducing the initial symptoms of bulimia?
Cognitive behavior therapy and pharmacologic interventions
A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which would the nurse expect to implement in conjunction with pharmacologic therapy?
Cognitive behavioral therapy
For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions?
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?
Control
Individuals with anorexia nervosa concentrate on which body cue?
Controlling food intake
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?
Deficient fluid volume related to refusal to drink
A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected?
Dental erosion and chronic edema
A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories?
Depression
Which is the most common disorder found in clients diagnosed with bulimia nervosa?
Depression
A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find?
Dry skin
Which statement best describes the biologic theories of the etiology of eating disorders?
Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.
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.
Electrocardiogram (ECG) Serum glucose Serum amylase Serum cortisol
Which is a dental complication associated with purging?
Erosion of dental enamel
For a client diagnosed with anorexia nervosa, which goal takes priority?
Establishing adequate daily nutritional intake
During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication?
Fluoxetine
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits?
Fluoxetine
The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next?
Heart rate and rhythm
Which area of the brain has been associated with the symptoms of eating disorders?
Hypothalamus
A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find?
Impulsivity
A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include?
Increasing client's coping skills for anxiety
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
Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa?
Overprotective of their children
At the prompting of friends, a 16-year-old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. During the nurse's assessment, the nurse has asked the client to describe the client's family. Which family process and characteristic is thought to contribute to eating disorders?
Poor communication and enmeshed family dynamics
The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what?
Provide the client with a feeling of responsibility and control over the client's behavior
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
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client?
Self-monitoring
Which technique is a type of cognitive behavioral therapy implemented for bulimic clients?
Self-monitoring
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter?
Serotonin
An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care?
Set up a strict eating plan for the client
A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which would the nurse include in the education plan?
Setting realistic goals
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.
For clients who purge, what is the most important goal?
Stop the 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?
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?
Telling the client of the nurse's concern for the client's health and desire to help the client make decisions to keep the client healthy
After complaining of weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client's nursing care and treatment, which outcome should be prioritized?
The client will be free of self-induced vomiting.
The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care?
The client will verbalize acceptance of appearance.
A nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa?
The person engages in episodic binge eating.
When working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason?
To raise self awareness and a sense of control
Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa?
Weight gain
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 ...
eating disorder not otherwise specified.
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting?
engaging in severe dieting
