NUR 1511 Mental Health Chapter 20 Eating Disorders

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."

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

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

The nurse 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?"

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."

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

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

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

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

A nurse 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 want things to be the way I want them to be." "Everything about my school work needs to be perfect."

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 and has an identical twin just diagnosed with anorexia nervosa. The client shares with the nurse a concern about also developing the disorder. Which response by the nurse is the most appropriate?

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

Approximately 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

Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification?

Antidepressant

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

Antidepressants

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 college student has been referred to the clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what?

Body weight significantly below ideal for height and age

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

Bradycardia Ventricular tachycardia Loss of cardiac muscle

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

Bulimia nervosa

The dentist of a client noticed that the client's teeth were losing enamel. The client is of average weight. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with enamel loss?

Bulimia nervosa, purging type

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

Cardiac assessment and measurement of electrolyte levels

Which is a family risk factor for bulimia nervosa?

Chaotic family

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 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

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?

Drive for thinness

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 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.

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?

Environmental cues

A client diagnosed with anorexia nervosa is being treated in an outpatient setting in the community. Which activity would be the priority?

Establishing a therapeutic relationship

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

Exacerbation of anorexia nervosa results from the client's effort to do what?

Gain control of one part of life

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

Imbalanced nutrition: less than body requirements

A 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

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

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

A client with bulimia is being discharged from care. The nurse considers which indicator most important when evaluating the effectiveness of the care plan?

The client eats six small meals per day.

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.

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.

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

engaging in severe dieting