PrepU ED Practice
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?" "You have always been very focused on your thighs. Is that the part of your body you like least?" "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?" (Explanation: The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.)
The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective? "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." "I am getting more comfortable confronting people when I have conflict with them." "I am keeping a record of everything I eat and how I am feeling every day." "I am beginning to understand how my lack of self-control is hurting me."
"I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."
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? "I do diet around my periods; otherwise, I just get so bloated." "I like the way I look. I just need to keep my weight down because I'm a cheerleader." "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."
"I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."
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 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? "Let's talk about your ideas about your body and why you perceive yourself to be fat." "You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." "You only weigh 100 pounds. It is just not true that you are 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." (Explanation: 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.)
A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate? "Let me know when you get back to the dayroom." "I will accompany you to the bathroom." "Thanks for checking in." "I'll stand outside your door to give you privacy."
"I will accompany you to the bathroom." (Explanation: After each meal or snack, clients may be required to remain in view of staff for a period of time to ensure they do not empty the stomach by vomiting. Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. The response, "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the behavior. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.)
Which nursing statement is most effective in communicating a positive expectation of the client? "I'll give you 90 minutes to eat." "I will allow you space to eat in peace." "There are people who would truly appreciate this food." "I will sit here quietly with you while you eat."
"I will sit here quietly with you while you eat."
The nurse has just completed an admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression? "Others are just trying to keep me from looking good." "Those weight charts are for normal people. I am not normal." "I know I have a problem. I need help." "I know my weight is a little below normal."
"Others are just trying to keep me from looking good." (Explanation: Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. An admission of need shows a high level of insight. Acknowledging a low weight does not show insight because the client is more likely to be far below norms. Stating "I am not normal" shows distorted cognition, but this is not necessarily in the domains of judgment and insight.)
The nurse is assisting the client with anorexia nervosa to express feelings more openly. Which response by the nurse would be most likely to encourage expression of feelings? "Are you sad?" "You look anxious." "Tell me what you are feeling right now." "Tell me when you feel bad."
"Tell me what you are feeling right now." (Explanation: Because clients with anorexia have problems with self-awareness, they often have difficulty identifying and expressing feelings. The nurse can help clients begin to recognize emotions by asking them to describe how they are feeling and allowing adequate time for response. The nurse should not ask, "Are you sad?" or "Are you anxious?" because a client may quickly agree rather than struggle for an answer. As well, the nurse is making assumptions about how the client is feeling. Stating, "Tell me when you feel bad" does not encourage dialogue because the client is likely to say "okay" and elaborate no further.)
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?" "What do you believe has caused your anorexia?" "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?" (Explanation: Open-ended questions that are not "loaded" or accusatory are most likely to elicit data from a client who has an eating disorder. Offering food at this early stage of care is likely to inhibit rather than enhance rapport between the nurse and the client.)
A client is diagnosed with mild anorexia nervosa based on body mass index (BMI). Which BMI would the nurse identify as reflecting mild anorexia nervosa? 16.1 kg/m2 15.5 kg/m2 17.3 kg/m2 16.75 kg/m2
17.3 kg/m2
A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? 5 to 10 years old 10 to 14 years old 18 to 22 years old 25 to 35 years old
18 to 22 years old
A client comes to the health clinic for a physical exam. He is complaining that he is not happy with himself about being overweight. He has been depressed for several weeks. When discussing his weight goal, he asks the nurse, "What is a normal or healthy BMI?" The nurse's correct response would include which of the following? 30 to 34.9 35 to 39.9 18 to 24.9 25 to 29
18-24.9
A client with a history of anorexia nervosa comes to the clinic for evaluation. During the visit, the client's body mass index (BMI) is obtained. The nurse determines that treatment has been effective based on which BMI measurement? 17.0 kg/m2 16.5 kg/m2 15.9 kg/m2 19.2 kg/m2
19.2 kg/m2
Which of the following clients 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 magnesium level 1.2 mg/dL A 16-year-old with serum potassium of 3.8 mEq/L and a BP of 98/66 mmHg A 32-year-old with a temperature of 98°F and a pulse rate of 54 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 magnesium level 1.2 mg/dL (Explaination: Criteria for hospitalization include: acute weight loss, <85% below ideal; heart rate near 40 beats/min; temperature,b <36.1°C; blood pressure, <80/50 mm Hg; hypokalemia; hypophosphatemia; hypomagnesemia. The client with a weight 70% of ideal and magnesium level of 1.2 mg/dL (low) fits the criteria.)
The parents of a teenage girl who has just been diagnosed with anorexia nervosa are distraught at this development, stating, "We have no idea where this all came from." The anorexia nervosa client is typically what? Socially withdrawn with below average intelligence The first-degree relative or close friend of a person who is obese Listless and unmotivated A high achiever
A high achiever
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? Eating disorder not otherwise specified Anorexia nervosa, restricting type Bulimia nervosa, nonpurging type. Anorexia nervosa, binge eating, and purging type
Anorexia nervosa, restricting type (Explanation: Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories.")
Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? Antiparkinsonian Antianxiety Antidepressant Antimanic
Antidespressant
A client who has an eating disorder is becoming dependent on the nurse for direction in food choices. Which approach by the nurse would be most therapeutic? Take care of the needs that the client is neglecting. Approach the client with an adult-like objectivity. Give the support and direction that the client is seeking. Give approval for positive changes seen in the client.
Approach the client with an adult-like objectivity. (Explanation: 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. Power struggles overeating are common, and remaining nonreactive is a challenge. During such power struggles, the nurse should always think about his or her own feelings of frustration and need for control. Presenting information factually without chiding the client will obtain more positive results. Be empathetic and nonjudgmental, although this is not easy. Remember the client's perspective and fears about weight and eating. Do not label clients as "good" when they avoid purging or eat an entire meal. Otherwise, clients will believe they are "bad" on days when they purge or fail to eat enough food. Providing the client's neglected needs may promote dependence rather than autonomy. Similarly, the nurse should aim to instill new coping skills so that the client's support and direction are not dependent on others.)
The nurse is helping a client with an eating disorder to accept the client's body image. The client must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? Being able to cope in healthy ways improves the ability to accept a realistic body image. When body image is positive, the client will develop better coping skills. Coping skills are dependent on a supportive upbringing. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills.
Being able to cope in healthy ways improves the ability to accept a realistic body image.
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? Eating disorder not otherwise specified Bulimia nervosa Binge eating disorder Anorexia nervosa
Binge eating disorder (Explanation: Binge eating disorder is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese. The client does not restrict eating so anorexia is not appropriate. Eating disorder not otherwise specified refers to partial syndromes but does not met the criteria for anorexia or bulimia.)
A 15-year-old is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? Body weight less than normal for age, height, and overall physical health Irregular menstrual cycles Absence of hunger feelings Erosion of dental enamel
Body weight less than normal for age, height, and overall physical health (Explanation: Clients with anorexia nervosa have a body weight that is less than the minimum expected weight, considering their age, height, and overall physical health. Physical problems of anorexia nervosa include amenorrhea a characteristic that goes beyond simply having irregular cycles. These clients do not lose their appetites. They still experience hunger but ignore it and signs of physical weakness and fatigue. Dental erosion is characteristic of bulimia nervosa because this disorder involves vomiting of acidic stomach contents.)
Which is a cardiac complication of an eating disorder? Bradycardia Hypertension Enlarged heart Thrombocytopenia
Bradycardia (Explanation: Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.)
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. Loss of cardiac muscle Ventricular tachycardia Enlarged heart Bradycardia Hypertension
Bradycardia Ventricular tachycardia Loss of cardiac muscle (Explanation: Cardiac complications associated with eating disorders include hypotension, bradycardia, loss of cardiac muscle, small heart, and cardiac dysrhythmias, including ventricular tachycardia.)
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 Eating disorder not otherwise specified Binge-eating disorder Anorexia nervosa
Bulimia nervosa (Explanation: Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental cavities from the frequent contact of tooth enamel with food and acidic gastric fluids.)
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 nurse recognizes these as symptoms of what disease? Anorexia nervosa Pica Bulimia nervosa Rumination disorder
Bullimia nervosa (Explanation: The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings cause the client to engage in self-induced vomiting, use laxatives or diuretics, follow a strict diet, or fast to overcome the effects of the binges. Clients with anorexia nervosa manifest an extreme fear of becoming fat and have a distorted body image. They are unable to perceive an accurate body size and shape. Weight loss most often occurs through decreasing food intake. Pica and rumination disorder are considered feeding disorders. The client with pica eats inappropriate items, such as clay. Clients with rumination disorder regurgitate and then rechew food they previously swallowed. This disorder occurs in infants who are emotionally deprived or intellectually disabled and in adults who are intellectually disabled.)
The difference between clients with anorexia nervosa and bulimia nervosa is which of the following? Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior. Bulimia can be life-threatening, whereas anorexia is seldom so. Anorexia has a psychological basis, whereas the cause of bulimia is biologic. There is no real difference between these two types of clients.
Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior.
When working with the family of a client with anorexia nervosa, which issue must be addressed? Control Codependence Self-discipline Sexual identity
Control (Explanation: Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity may be relevant to some clients, but the presence of control issues is relevant in all clients with anorexia nervosa.)
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? Dependency Anxiety Depression Control
Control (Explanation: Often, nurses feel the need to offer control for a client who is helpless in controlling food, anxiety, and life. This client should not evoke feelings of depression any more than any other client should. The client is likely to experience an accompanying depressed state. Although anxiety may arise in the nurse, this is not the best answer. The client is likely to be dependent in this hospital setting. Control or rescue issues are more likely to surface in the nurse.)
When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? Self-discipline Sexual identity Codependence Control issues
Control issues (Explanation: Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity are not pertinent issues to address with the family.)
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 Anxiety related to inadequate coping mechanisms Impaired social interaction related to aggressive behavior Hyperactivity related to restlessness
Deficient fluid volume related to refusal to drink
Which is the most common disorder found in clients diagnosed with bulimia nervosa? Depression Anxiety Substance abuse Psychosis
Depression (Explanation: 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.)
A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? Dieting helps build a positive self-image in children. Dieting at an early age teaches healthy eating habits. Dieting during childhood can promote self-discipline in children who are obese. Dieting at an early age may lead to the development of eating disorders.
Dieting at an early age may lead to the development of eating disorders. (Explanation: A specific cause for eating disorders is unknown. Initially, dieting may be the stimulus that leads to their development. Dieting is also associated with the risk factor of dissatisfaction with body image. Children need well-balanced diets rather than calorie restriction diets. Healthy eating patterns do not require dieting because dieting may instill unhealthy attitudes toward food. Obesity is complex and self-discipline does not address each component of this health problem.)
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 Body image distortion Interoceptive awareness Perfectionism
Drive for thinness (Explanation: Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues.It is the result of body image distortion. Body image distortion occurs when an individual perceives his or her body disparately from how society views it. 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 the consequences for their self-worth and others' opinions. Perfectionism is often involved in a drive for thinness, but it is not the primary physical and emotional process in this disorder.)
The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? Outspoken Eager to please Defiant Careless
Eager to please (Explanation: Family members often describe clients with anorexia nervosa as perfectionists with above-average intelligence, achievement oriented, dependable, eager to please, and seeking approval before their condition began. Parents describe clients as being "good, causing us no trouble" until the onset of anorexia. Likewise, clients with bulimia often are focused on pleasing others and avoiding conflict. These clients are often highly regimented, not careless. Overt defiance is unlikely because they may be eager to please. Clients are often evasive rather than outspoken when they are attempting to avoid ownership of their eating disorder.)
A client meets some (but not all) of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the client's weight is within the normal range. The nurse understands that based on DSM-5 criteria, this client would most likely be diagnosed with which of following? Anorexia nervosa Bulimia nervosa Binge eating disorder Eating disorder not otherwise specified
Eating disorder not otherwise specified (Explanation: Subclinical cases, also called partial syndromes, are usually diagnosed as Eating Disorder Not Otherwise Specified (EDNOS). These individuals still need treatment despite not meeting criteria for anorexia nervosa or bulimia nervosa.)
Which would be most supportive for family and friends of a client with an eating disorder? Emotional support, love, and attention Focus on food intake, calories, and weight Unlimited access to unhealthy foods that the client enjoys Positive reinforcement for weight gain
Emotional support, love, and attention
The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia? Encourage autonomy by allowing the client to have total control over food choices. Insist that the client complete all meals provided. Encourage the entire family to engage in a balanced and regular dietary pattern. Provide the client a diet of mainly vegetables and salads.
Encourage the entire family to engage in a balanced and regular dietary pattern. (Explanation: Clients with eating disorders can benefit when the entire family makes positive changes. This shows solidarity and makes it easier for the client to maintain healthy behaviors. Eating only salads and vegetables during the day may set up clients for later binges as a result of too little dietary fat and carbohydrates. The client with an eating disorder will not make healthy food choices independently. It is also not possible or beneficial for family and friends to force the client to eat.)
Which of the following terms describes a lack of clear role boundaries? Enmeshment Empathy Autonomy Satiety
Enmeshment
Which is a dental complication associated with purging? Elevated blood urea nitrogen (BUN) Erosion of dental enamel Enlarged pancreas Seizures
Erosion of dental enamel
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? Excessive exercise Moist skin Wearing tight-fitting clothing Tachycardia
Excessive exercsie
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? Risperidone Fluoxetine Ziprasidone Olanzapine
Fluoxetine (Explanation: Atypical antipsychotics are often associated with weight gain, while some antidepressants such as fluoxetine tend to induce weight loss.)
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Haloperidol Fluoxetine Bupropion Lithium
Fluoxetine (Explanation: Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Adminstration approval for the treatment of bulimia nervosa.)
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? Patterns of activity and rest Throat and esophagus Condition of mouth and gums Heart rate and rhythm
Heart rate and rhythm (Explanation: Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.)
Assessment of a client reveals a loss of 30 pounds in 3 months. The nurse would be alert for which complication associated with weight loss affecting the client's metabolic function? Amenorrhea Bradycardia Hypothyroidism Leukopenia
Hypothyroidism
A psychiatric-mental health nurse is preparing a presentation for a local adolescent group about eating disorders. Which factor would the nurse most likely include as contributing to the frequency of eating disorders in this age group? Select all that apply. Body image disturbance Seeking to develop a unique identity Media portrayal of slimness as an ideal Body dissatisfaction in adolescent females Stress-free existence of adolescents
Media portrayal of slimness as an ideal Body dissatisfaction in adolescent females Body image disturbance Seeking to develop a unique identity (Explanation: Adolescents are vulnerable because of stressors associated with their development, especially concerns about body image, autonomy, and peer pressure, and their susceptibility to such influences as the media, which extols an ideal body type. Low stress levels would be a protective factor, rather than a risk factor, for eating disorders.)
The nurse is assessing a client with bulimia nervosa. Which symptoms would the nurse expect to find? Select all that apply. Hypotension Cold intolerance Metabolic alkalosis Normal weight for height Dental erosion
Normal weight for height Dental erosion Metabolic alkalosis (Explanation: The weight of clients with bulimia usually is in the normal range, although some clients are overweight or underweight. Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these clients. Metabolic alkalosis often results from vomiting of acidic stomach contents. Cold intolerance and hypotension are symptoms associated with emaciation seen in anorexia nervosa.)
Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? Observe the client for 30 minutes after all meals. Offer liquid protein supplements if the client is unable to complete a meal. Weigh the client weekly in the same clothing at the same time of day. Leave the client alone to relax during meals.
Offer liquid protein supplements if the client is unable to complete a meal. (Explanation: Nursing interventions designed to establish nutritional eating patterns include sitting with the client during meals and snacks, giving a liquid protein supplement to replace any food not eaten to ensure consumption of the total number of prescribed calories, adhering to treatment program guidelines regarding restrictions, observing the client following meals and snacks for 1 to 2 hours, weighing the client daily in uniform clothing, and being alert for attempts to hide or discard food or inflate weight.)
A nurse is reading a journal article about anorexia nervosa and comorbidities. The article describes a strong association between anorexia and obsessive-compulsive disorder. The nurse demonstrates understanding of this information by identifiying which aspect as common to both of these disorders? gender identity body dissatification emotional dysregulation perfectionism
Perfectionism (Explanation: In many individuals with anorexia nervosa, OCD symptoms predate the anorexia nervosa diagnosis by about 5 years, leading many researchers to consider OCD a causative or risk factor for anorexia nervosa (Brady, 2014). In fact, perfectionism is an aspect of both OCD and anorexia nervosa and is considered a risk factor for anorexia nervosa.)
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? An overemphasis of peer relationships over family relationships Poor communication and enmeshed family dynamics Passive parenting and lack of encouragement The absence of a parent and/or the presence of a stepparent
Poor communication and enmeshed family dynamics (Explanation: Family systems theories emphasize the role of the family in the development of eating disorders. Among the characteristics that are thought to contribute are enmeshed patterns of relationship and impaired communication. The absence of a parent and/or the presence of a stepparent has not been emphasized. Passive parenting styles, lack of encouragement, and an overemphasis on peer relationships are not healthy patterns of being, but none has been identified as a specific contributor to eating disorders.)
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 nurse with a tool for evaluating the plan of care Provide the client with a feeling of responsibility and control over the client's behavior Allow the client a tool by which to negotiate behavior Provide the therapist with a strategy for client compliance
Provide the client with a feeling of responsibility and control over the client's behavior (Explanation: Refeeding involves establishing a contract that spells out expected behaviors, rewards, privileges, and consequences of noncompliance. Such a contract may be useful in eliminating power struggles with the client. Even though clients may rebel against contract terms, it reassures them to know that consistent limits are being maintained and that they can trust the staff to help maintain control, and ultimately it enables the client to feel more in control.)
The immediate goal of nursing interventions in the care of a client with anorexia nervosa is which of the following? Establishing a target weight to be achieved by discharge Gaining insight into the effects of anorexia on her physical health Restoring nutritional status to normal Changing her irrational thinking about her body
Restoring nutritional status to normal (Explanation: Physiologic safety and homeostasis are the priority concerns. Changing of thought pattern, establishing a target weight, and gaining insight into the effects of anorexia on her physical health are not immediate goals in the management of anorexia nervosa.)
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? Guided imagery Self-monitoring Distraction Music therapy
Self-monitoring (Explanation: Self-monitoring is a type of behavioral therapy. It is designed to help the client with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.)
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? Develop a contract with the client to stop using laxatives and diuretics. Stabilize electrolyte levels. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. Help build self-esteem.
Stabilize electrolyte levels. (Explanation: Restoring nutritional balance is a priority for clients with severe eating disorders. Clients who are clearly malnourished need to become physiologically stabilized until they are no longer at risk for severe medical complications related to starvation. Refeeding the very low-weight client with anorexia means that nurses must carefully monitor cardiac function; another important intervention is to carefully monitor electrolytes. These clients are at risk for developing a "refeeding syndrome" with accompanying hypokalemia.)
A psychiatric-mental health nurse is preparing a program for parents of a local high school about eating disorders. Which condition would the nurse most likely include as the leading cause of death among clients diagnosed with anorexia nervosa? Myocardial infarction Suicide Respiratory failure Renal failure
Suicide (Explanation: Suicide and cardiopulmonary arrest are the leading causes of death for individuals with anorexia nervosa. These individuals tend to commit suicide with highly lethal means in which rescue is unlikely. Renal failure, respiratory failure, and myocardial infarction are not the leading causes of death.)
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? Encouraging the client to suppress feelings regarding obesity Using an abrupt, forceful manner to communicate with the client Reinforcing the client's concerns over physical appearance Teaching the client alternative ways to lose weight
Teaching the client alternative ways to lose weight
All of the following would be included as interventions for eating disorders to establish nutritional eating patterns except ... Sitting with the client during meals and snacks Being alert for attempts to hide or discard food or inflate weight Observing the client following meals and snack for 1 to 2 hours Weighing the client twice daily
Weighing the client twice daily (Explanation: This statement reflects the nurse's expectation that the client will eat yet the nurse still will provide adequate supervision. Answers A, B, and D are not appropriate means of assuming a positive expectation of the client.)
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? engaging in severe dieting socially withdrawing becoming sexually promiscuous compulsively washing his or her hands
engaging in severe dieting
