Ch. 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?"

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 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."

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."

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

The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss?

Anorexia nervosa, purging type

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

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 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 client's diagnosis of anorexia nervosa is supported when the psychiatric nurse documents assessment data that includes which finding? Select all that apply.

Client reports "being depressed." Client claims that she "hasn't had a menstrual period in over 2 years." Client is overheard telling other clients "I weigh myself three times a day when I'm home." Client consistently denies that she "has a problem with the way she looks."

Which intervention has been found to be most effective reducing the initial symptoms of bulimia?

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?

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 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

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

For clients who purge, what is the most important goal?

For clients who purge, what is the most important goal?

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

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

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

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

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.

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

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