CHAPTER 10 EATING DISORDERS

25. A 16-year-old female with anorexia nervosa is admitted to the unit. Which is the most appropriate short-term outcome? A) The client will accept herself as having value and worth. B) The client will admit she has a fear of gaining weight. C) The client will follow a nutritionally balanced diet for her age. D) The client will identify her problems and potential alternative coping strategies.

Ans: B Feedback: Admitting her fears is an initial step in recovery. Accepting herself as having value and worth, following a nutritionally balanced diet, and identifying problems and potential alternative coping strategies are examples of long-term outcomes.

30. The nurse has been teaching a client about bulimia. Which statement by the client indicates that the teaching has been effective? A) "I know if I eat pasta, I'll binge." B) "I'll eat small meals and snacks regularly." C) "I'll take my medication when I feel the urge to binge." D) "I'll limit my intake of carbohydrates and fats."

Ans: B Feedback: Teaching is effective when the client recognizes the need to return to nutritious eating patterns. Answer choices A, C, and D would not be appropriate responses to teaching regarding bulimia nervosa.

21. Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa? A) Imbalanced nutritionóless than body requirements B) Disturbed body image C) Deficient knowledge (nutritious eating patterns) D) Social isolation

Ans: B Feedback: The client's dissatisfaction with body image is an enduring belief pattern that is firmly ingrained and, therefore, very difficult to change. Imbalanced nutritionóless than body requirements, deficient knowledge (nutritious eating patterns), and social isolation are nursing diagnoses that can be worked through with education and support more easily than the diagnosis of disturbed body image.

10. Several medications are prescribed for a client who has anorexia. Which medication may be prescribed to help treat the client's distorted body image? A) Amitriptyline (Elavil) B) Cyproheptadine (Periactin) C) Olanzapine (Zyprexa) D) Fluoxetine (Prozac)

Ans: C Feedback: Several classes of drugs have been studied, but few have shown clinical success. Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses (up to 28 mg/day) can promote weight gain in clients with anorexia nervosa. Olanzapine (Zyprexa) has been used with success because of its antipsychotic effect (on bizarre body image distortions) and associated weight gain. Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has been partially or completely restored. However, close monitoring is needed because weight loss can be a side effect.

5. During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which would indicate to the nurse that this client might have anorexia nervosa? A) Episodes of overeating and excessive weight gain B) Expressions of a positive self-concept C) Flexible thought patterns and spontaneity D) Severe weight loss due to self-imposed dieting

Ans: D Feedback: Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.

3. Which etiology for anorexia nervosa is from a neuroendocrine perspective? 1. Anorexia nervosa is more common among sisters and mothers of clients with the disorder than among the general population. 2. Dysfunction of the thalamus is implicated in the diagnosis of anorexia nervosa. 3. There is a higher than expected frequency of mood disorders among first-degree relatives of clients diagnosed with anorexia nervosa. 4. Clients diagnosed with anorexia nervosa have elevated cerebrospinal fluid cortisol levels and possible alterations in the regulation of dopamine.

1. Anorexia nervosa is more common among sis- ters and mothers of clients with the disorder than among the general population. However, this is an etiological implication from a genetic, not neuroendocrine, perspective. 2. A dysfunction of the hypothalamus, not thala- mus, is implicated in the diagnosis anorexia nervosa. This would support a physiological, not neuroendocrine, etiological perspective. ✅3. There is a higher than expected frequency of mood disorders among first-degree relatives of clients diagnosed with anorexia nervosa. However, this is an etiological implication from a genetic, not neuroendocrine, perspective. 4. Research has shown that clients diagnosed with anorexia nervosa have elevated cere- brospinal fluid cortisol levels and possible alterations in the regulation of dopamine. This is an etiological implication from a neuroendocrine perspective. TEST-TAKING HINT: To answer this question cor- rectly, the test taker should note the perspective required in the question. All answers except "2" are correct etiological implications for the diag- nosis of anorexia nervosa; however, only "4" is from a neuroendocrine perspective.

22. A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? 1. "I'm Italian, so I really enjoy a large plate of spaghetti." 2. "I'll weigh you after your meal." 3. "Let's focus on your continued improvement. You ate 80% of your lunch." 4. "Why do you always talk about food? Let's talk about swimming."

1. Because clients diagnosed with anorexia ner- vosa are obsessed with food, the nurse should not discuss food or eating behaviors. Discussion of food or eating behaviors can provide unintended positive reinforcement for negative behaviors. This statement by the nurse also focuses on the nurse and not the client. 2. The nurse should weigh the client daily, immediately on arising, following first voiding, and not after a meal. ✅3. It is important to offer support and posi- tive reinforcement for improvements in eating behaviors. Because clients diag- nosed with anorexia nervosa are obsessed with food, discussion of food can provide unintended positive reinforcement for negative behaviors. In this answer choice, the nurse is redirecting the client. 4. When the nurse requests an explanation that the client cannot give, the client may feel defensive. "Why" questions are blocks to therapeutic communication. TEST-TAKING HINT: The test taker must under- stand the underlying obsession and preoccupa- tion with food that clients diagnosed with eating disorders experience. When this is understood, it is easy to choose an answer that does not support this maladaptive behavior.

25. A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements R/T altered body perception AEB client's being 5 feet 4 inches tall and weighing 75 pounds. Which nursing intervention would address this client's problem? 1. Encourage the client to keep a diary of food intake. 2. Plan exercise tailored to individual choice. 3. Help the client to identify triggers to self-induced purging. 4. Monitor physician-ordered nasogastric tube feedings.

1. Clients diagnosed with anorexia nervosa have a preoccupation with food. Focusing on food by encouraging the client to keep a food diary only reinforces maladaptive behaviors. Encouraging a food diary is an appropriate nursing intervention for clients designated as obese. 2. Clients diagnosed with anorexia nervosa are critically ill. They are not meeting their nutritional needs because of poor caloric intake. Exercise would increase the client's metabolic requirements further and exacer- bate the client's problem. 3. Self-induced purging is typical of bulimia nervosa, not anorexia nervosa. Also, identify- ing triggers does not directly address the nursing diagnosis of imbalanced nutrition: less than body requirements. ✅4. If clients are unable or unwilling to maintain adequate oral intake, the physician may order a liquid diet to be administered via nasogastric tube. This treatment is initiated because without adequate nutri- tion a life-threatening situation exists for these clients. Nursing care of a client receiving tube feedings should be admin- istered according to established hospital procedures. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the nursing intervention that addresses this problem. Only "4" correlates with the client problem of imbalanced nutrition: less than body requirements.

13. After a routine dental examination on an adolescent, the dentist reports to the parents that bulimia nervosa is suspected. On which of the following assessment data would the dentist base this determination? Select all that apply. 1. Extreme weight loss. 2. Amenorrhea. 3. Discoloration of dental enamel. 4. Bruises of the palate and posterior pharynx. 5. Dental enamel dysplasia.

1. Clients with bulimia nervosa can maintain a normal weight. Extreme weight loss would be a symptom of anorexia nervosa, not bulimia nervosa. 2. Amenorrhea is a symptom of anorexia ner- vosa, not bulimia nervosa, that is due to estrogen deficiency. A dentist would not be in a position to evaluate this symptom during a routine dental examination. ✅3. Discoloration of dental enamel occurs because of the presence of gastric juices in the mouth from continual vomiting owing to purging behaviors by clients diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia should be suspected. ✅4. Bruises of the palate and posterior phar- ynx occur because of continual vomiting owing to purging behaviors by clients diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected. ✅5. Dental enamel dysplasia occurs because of the presence of gastric juices in the mouth from continual vomiting owing to purging behaviors by the client diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected. TEST-TAKING HINT: The test taker should consid- er the situation presented in the question to gain clues to the correct answer. What assessment data would a dentist gather? A dentist would not gather assessment information related to men- struation, and so "2" can be eliminated quickly.

30. Which medication is used most often in the treatment of clients diagnosed with anorexia nervosa? 1. Fluphenazine decanoate (Prolixin Decanoate). 2. Clozapine (Clozaril). 3. Fluoxetine (Prozac). 4. Methylphenidate (Ritalin).

1. Fluphenazine decanoate (Prolixin Decanoate) is an antipsychotic medication prescribed for thought disorders and is rarely used in the treatment of anorexia nervosa. 2. Clozapine (Clozaril) is an antipsychotic med- ication prescribed for thought disorders and is rarely used in the treatment of anorexia nervosa. ✅3. Fluoxetine (Prozac) is an antidepressant medication. Feelings of depression and anxiety often accompany anorexia nervosa, making antianxiety and antidepressant medications the treatments of choice for the diagnosis. 4. Methylphenidate (Ritalin) is a stimulant med- ication prescribed for attention deficit hyper- activity disorder, not anorexia nervosa. TEST-TAKING HINT: The test taker must note key- words in the question, such as "most often," to answer this question correctly. Although antipsy- chotic medications can be used to treat selected clients diagnosed with anorexia nervosa, the most frequently used medications are antidepressants and antianxiety agents.

19. A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which intervention takes priority? 1. Assessment of family issues and health concerns. 2. Assessment of early disturbances in mother-infant interactions. 3. Assessment of the client's knowledge of selective serotonin reuptake inhibitors used in treatment. 4. Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems.

1. It is important to assess family issues and health concerns, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 2. It is important to assess early disturbances in mother-infant interactions, but because of the critical nature of physical problems experi- enced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 3. It is important to assess the client's previous knowledge of selective serotonin reuptake inhibitors before any teaching, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. ✅4. The immediate priority of nursing interventions in eating disorders is to restore the client's nutritional status. Complications of emaciation, dehydration, and electrolyte imbalance can lead to death. When the physical condition is no longer life-threatening, other treatment modalities may be initiated. The assessment and monitoring of vital signs and lab values to recognize and anticipate these medical problems must take priority TEST-TAKING HINT: To answer this question cor- rectly, the test taker must note that the question requires a "priority" intervention. Physical needs that threaten life always take priority over psychological needs.

7. A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous mem- branes. Which is most likely the cause of this client's symptoms? 1. Mood disorders, which often accompany the diagnosis of bulimia nervosa. 2. Nutritional deficits, which are characteristic of bulimia nervosa. 3. Vomiting, which may lead to dehydration and electrolyte imbalance. 4. Binging, which causes abdominal discomfort.

1. Mood disorders often accompany the diagno- sis of bulimia nervosa, but the client symp- toms described in the question do not reflect a mood disorder. 2. Nutritional deficits are characteristic of bulimia nervosa, but the client symptoms described in the question do not reflect a nutritional deficit. ✅3. Purging behaviors, such as vomiting, may lead to dehydration and electrolyte imbal- ance. Hallucinations and restlessness are signs of electrolyte imbalance. Dry mucous membranes indicate dehydration. 4. Binging large quantities of food can cause abdominal discomfort, but the client symp- toms described in the question do not reflect abdominal discomfort. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must recognize common signs and symptoms of electrolyte imbalance and dehydration.

12. Using the DSM-IV-TR, which statement is true as it relates to the diagnosis of obesity? 1. Obesity is a diagnosis classified on Axis I similar to other eating disorders. 2. Obesity is not classified as an eating disorder because medical diagnoses are not clas- sified in the DSM-IV-TR. 3. Obesity is currently evaluated for all clients as a "psychological factor affecting medical conditions." 4. Obesity is not classified as an eating disorder, but can be placed on Axis III as a med- ical condition.

1. Obesity is not classified as a psychiatric disorder in the DSM-IV-TR, but because of the strong emotional factors associated with the condition, it may be considered under "psychological factors affecting medical conditions." 2. Medical diagnoses are classified in the DSM-IV-TR under Axis III. Obesity is not classified as a psychiatric disorder in the DSM-IV-TR, but would be placed on Axis III. 3. Because of the strong emotional factors asso- ciated with obesity, it may be considered under "psychological factors affecting medical conditions"; however, this evaluation does not apply to "all clients." ✅4. Obesity is not classified as an eating dis- order. It can be placed on Axis III as a medical condition, or it may be considered under "psychological factors affecting medical conditions." TEST-TAKING HINT: Note the words "all clients" in "3." Superlatives that are all-inclusive or exclu- sive, such as "all," "always," and "never," usually indicate that the answer choice is incorrect.

14. A client diagnosed with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that this outcome addresses? 1. Ineffective coping R/T lack of control. 2. Altered nutrition: less than body requirements R/T decreased intake. 3. Self-care deficit: feeding R/T fatigue. 4. Anxiety R/T feelings of helplessness.

1. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of ineffective coping. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, or inability to use available resources. An appropriate outcome for ineffec- tive coping for clients diagnosed with eating disorders would be to use healthy coping strategies effectively to deal with anxiety or lack of control without resorting to self-starvation. ✅2. The outcome of gaining 2 pounds in 1 week is directly related to the nursing diagnosis of altered nutrition: less than body requirements. Altered nutrition: less than body requirements is defined as the state in which an individual experiences an intake of nutrients insufficient to meet metabolic needs. Weight loss is character- istic of the diagnosis of anorexia nervosa, with weight gain being a critical outcome. 3. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of self-care deficit: feeding R/T fatigue. Self-care deficit is related to the inability of the client to perform the acts of self-care; in this case feeding. Clients diagnosed with anorexia nervosa have the ability to feed themselves, but choose not to because of impaired body image. 4. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of anxiety R/T feelings of helplessness. Feelings of depression and anxiety often accompany the diagnosis of anorexia nervosa, but in the short-term, weight gain would increase, not decrease, the anxiety experi- enced by the client. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the nursing outcome presented in the question with the cor- rect nursing diagnosis. There always must be a correlation between the stated outcome and the problem statement.

28. Which outcome indicates that the client's problem of impaired body image has improved? 1. The client has gained up to 80% of body weight for age and size. 2. The client is free of symptoms of malnutrition and dehydration. 3. The client has not attempted to self-induce vomiting. 4. The client has acknowledged that perception of being "fat" is incorrect.

1. The outcome of gaining 80% of body weight for age and size indicates that the nursing diagnosis of imbalanced nutrition: less than body requirements, not impaired body image, has been resolved. Normal body weight is an indication of improved nutritional status. 2. Being free of symptoms of malnutrition and dehydration is an outcome that indicates that the nursing diagnosis of imbalanced nutrition: less than body requirement, not impaired body image, has been resolved. Nutritional status has improved when there are no signs of malnutrition and dehydration. 3. Not attempting self-induced vomiting is an outcome that indicates that the nursing diag- nosis of altered coping, not impaired body image, has been resolved. Not resorting to the maladaptive coping mechanism of self-induced vomiting indicates improvement in the client's ability to cope effectively with stressors. ✅4. When clients can acknowledge that their perception of being "fat" is incorrect, they perceive a body image that is realistic and not distorted. This is evidence that the client's impaired body image has improved. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the out- come that indicates improvement of this prob- lem. All outcomes presented may be appropriate for the client, but only "4" correlates with the client problem of impaired body image.

1. Which structure of the brain contains the appetite regulation center? 1. Thalamus. 2. Amygdala. 3. Hypothalamus. 4. Medulla

1. The thalamus integrates all sensory input (except smell) on its way to the cortex and is involved with emotions and mood. It does not regulate appetite. 2. The amygdala is located in the temporal lobe of the brain and may play a major role in memory processing and "learned fear." It does not regulate appetite. ✅3. The hypothalamus exerts control over the actions of the autonomic nervous system and regulates appetite and temperature. 4. The medulla of the brain contains vital cen- ters that regulate heart rate; blood pressure; respiration; and reflex centers for swallowing, sneezing, coughing, and vomiting. It does not regulate appetite TEST-TAKING HINT: The test taker must be famil- iar with the structure and function of the various areas of the brain to recognize the hypothalamus as the appetite regulation center.

21. When using a behavioral modification approach to the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? 1. A matter-of-fact, directive approach with the input of the entire treatment team. 2. Clients should perceive that they are in control of clearly communicated treatment choices. 3. Appropriate treatment choices are presented to the client's family for consideration. 4. The treatment team develops a system of rewards and privileges that can be earned by the client.

1.A behavior modification program should be instituted with client input and involvement. A directive approach would not give the client the needed and sought-after control over behaviors. Typically, control issues are the underlying problem precipitating eating disorders. ✅2. A behavior modification program for clients diagnosed with eating disorders should ensure that the client does not feel "controlled" by the program. Issues of control are central to the etiology of these disorders, and for a program to succeed the client must perceive that the client is in control of behavioral choices. This is accomplished by contracting with the client for privileges based on weight gain. 3. A behavior modification program should be instituted with client input and involvement. Focusing on the family and excluding the client from treatment choices has been shown to be ineffective. 4. It is important for staff members and client to work jointly to develop a system to contract for rewards and privileges that can be earned by the client. The client should have ultimate control over behavior choices, including whether to abide by the contract. TEST-TAKING HINT: To select the correct answer, the test taker must understand that issues of control are central to the etiology of eating dis- orders. Effective nursing interventions are client focused. Only "2" involves the client in develop- ing the plan of care.

16. A client is leaving the in-patient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? 1. Client will accept refeeding as part of a daily routine. 2. Client will perform nasogastric tube feeding independently. 3. Client will verbalize recognition of "fat" body misperception. 4. Client will discuss importance of monitoring weights daily.

1.Accepting refeeding as part of a daily routine is an outcome that would be appropriate early in treatment and should have been accom- plished before consideration for discharge planning. 2. Performing nasogastric tube feeding inde- pendently is an outcome that would be appropriate early in treatment and should have been accomplished before consideration for discharge planning. ✅3. The outcome of verbalizing recognition of misperception involving "fat" body image is a long-term outcome, appropriate for discharge planning for a client diagnosed with anorexia nervosa. 4. Monitoring weight on a daily basis is an inap- propriate outcome for a client diagnosed with anorexia nervosa. Obsession about food and weight gain is a characteristic symptom of the disease, and this outcome would reinforce this problem. TEST-TAKING HINT: An outcome that is appropri- ate for discharge planning must be a long-term outcome. Answer choices "1" and "2" are short-term in nature and should occur early in treatment. Answer "4" would be excessive and inappropriate. Answers "1," "2," and "4" can be eliminated immediately.

4. Which etiological implication for obesity is from a physiological perspective? 1. Eighty percent of offspring of two obese parents become obese. 2. Individuals who are obese have unresolved dependency needs and are fixed in the oral stage of development. 3. Hyperthyroidism interferes with metabolism and may lead to obesity. 4. Lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity.

1.Eighty percent of offspring of two obese parents become obese. However, this etiological implication is from a genetic, not physiological, perspective. 2. The psychoanalytic, not physiological, view of obesity proposes that obese individuals have unresolved dependency needs and are fixed in the oral stage of development 3. Hypothyroidism, not hyperthyroidism, decreases metabolism and may lead to obesity. Hyperthyroidism, because of increased meta- bolic rates, may lead to weight loss. ✅4. A theory of obesity from a physiological perspective is that lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must look for a potential obesity cause from a physiological, or "physical," perspective. Answer "3" is physiologically based,but contains inaccurate information and so can be eliminated.

8. An 18-year-old female client weighs 95 pounds and is 70 inches tall. She has not had a period in 4 months and states, "I am so fat!" Which statement is reflective of this client's symptoms? 1. The client meets the criteria for an Axis I diagnosis of bulimia nervosa. 2. The client meets the criteria for an Axis I diagnosis of anorexia nervosa. 3. The client needs further assessment to be diagnosed using the DSM-IV-TR. 4. The client is exhibiting normal developmental tasks according to Erikson.

1.Included in the diagnostic criteria for bulimia nervosa are binge eating, self-induced vomit- ing, abuse of laxatives, and poor self-evaluation. This client is not experiencing any binge eat- ing, purging, or inappropriate use of laxatives. Although weight may fluctuate, clients diag- nosed with bulimia nervosa can maintain weight within a normal range. This client does not meet the criteria for an Axis I diagnosis of bulimia nervosa. ✅2. Weight loss leading to maintenance of less than 85% of normal body weight is a criterion for the diagnosis of anorexia nervosa. Disturbance in the way the client views her body and amenorrhea for at least three consecutive menstrual cycles also must be present to validate the diag- nosis. This client meets the criteria for an Axis I diagnosis of anorexia nervosa. 3. Because the client meets the diagnostic crite- ria for an Axis I diagnosis of anorexia nervosa, additional assessments are unnecessary. 4.Extreme weight loss, disturbed body image, and amenorrhea are not normal developmental tasks according to Erikson for an 18-year-old client. Erikson identified the development of a secure sense of self as the task of the adolescent (12 to 20 years) stage of psychosocial development. TEST-TAKING HINT: To answer this question correctly, the test taker must remember the DSM-IV-TR criteria for the diagnosis of anorexia nervosa and differentiate these from the criteria for bulimia nervosa.

18. Which nursing intervention would directly assist a hospitalized client diagnosed with bulimia nervosa to avoid the urge to purge after discharge? 1. Locking the door to the client's bathroom. 2. Holding a mandatory group after mealtime to assist in exploration of feelings. 3. Discussing preplanned meals to decrease anxiety around eating. 4. Educating the family to recognize purging side effects.

1.Locking the client's door would be an appro- priate behavioral approach to prevent purging in an in-patient setting, but would not assist the client to avoid the urge to purge when discharged. ✅2. Holding a mandatory group after meal- time to assist in exploration of feelings is an appropriate intervention to assist the hospitalized client diagnosed with bulimia nervosa to avoid the urge to purge after discharge. If the client can become aware of feelings that may trigger purging, future purging may be avoided. 3. Discussing preplanned meals to decrease anx- iety around eating is an intervention focused on binging, not purging. 4. Educating the family to recognize purging side effects would not directly assist the client to avoid purging after discharge. This inter- vention is focused on providing the family tools to use if purging behaviors continue, not on assisting the client to avoid these behaviors. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must note the timeframe presented in the question. The client must be present on the unit for "1" to be a possible inter- vention. Although "2" occurs on the unit, the information presented in group therapy would assist the client to avoid purging behaviors after discharge. Answer "4" can be eliminated because it focuses on the family instead of the client.

23. 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 nursing response is most appropriate? 1. "Thanks for checking in." 2. "I will accompany you to the bathroom." 3. "Let me know when you get back to the day room." 4. "I'll stand outside your door to give you privacy."

1.The response, "Thanks for checking in," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. ✅2.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. 3. The response, "Let me know when you get back to the day room," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. 4. The response, "I'll stand outside your door to give you privacy," does not address the nurse's responsibility to deter the self-induced vomit- ing done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits. TEST-TAKING HINT: The test taker must under- stand that sometimes all client needs cannot be met. Although privacy is a client need, in this case the nurse must put aside the client's need for privacy to intervene to prevent further nutritional deficits resulting from self-induced vomiting.

31. A client is exhibiting signs and symptoms of anorexia nervosa. Identify the anatomical structure of the brain in which alteration in biological function may contribute to these symptoms. 1. Thalamus. 2. Amygdala. 3. Hypothalamus. 4. Hippocampus.

1.The thalamus integrates all sensory input except smell. The thalamus also is involved in emotions and mood, but not appetite regulation. 2. The amygdala, located in the anterior portion of the temporal lobe, plays an important role in arousal, not appetite regulation. ✅3. The hypothalamus regulates the anterior and posterior lobes of the pituitary gland, controls the auditory nervous system, and regulates appetite and temperature. A client diagnosed with anorexia nervosa may be experiencing alterations in this area of the brain. 4. The hippocampus is part of the limbic system, which is associated with fear and anxiety, anger and aggression, love, joy, hope, sexuality, and social behavior, not appetite regulation. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be familiar with the location and function of various structures of the brain.

9. Which factors may contribute to the frequency of eating disorders in adolescents? Select all that apply. A) Media portrayal of slimness as an ideal B) Body dissatisfaction in adolescent females C) Stress-free existence of adolescents D) Body image disturbance E) Seeking autonomy F) Seeking to develop a unique identity

ANS: A, B, D, E, F Feedback: Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. In families in which enmeshment exists, adolescents begin to control their eating through severe dieting and thus gain control over their weight. Adolescent girls who express body dissatisfaction are most likely to experience adverse outcomes. The need to develop a unique identity, or a sense of who one is as a person, is another essential task of adolescence. It coincides with the onset of puberty, which initiates many emotional and physiologic changes. Self-doubt and confusion can result if the adolescent does not measure up to the person she or he wants to be. Advertisements, magazines, and movies that feature thin models reinforce the cultural belief that slimness is attractive. Body image disturbance occurs when there is an extreme discrepancy between one's body image and the perceptions of others and extreme dissatisfaction with one's body image.

31. A client who has an eating disorder is becoming dependent on the nurse for direction in food choices. Which approach by the nurse would demonstrate the nurse's self- awareness? A) Approach the client with an adult-like objectivity. B) Give the support and direction that the client is seeking. C) Give approval for positive changes seen in the client. D) Take care of the needs that the client is neglecting.

Ans: A Feedback: Avoid sounding parental when teaching about nutrition or why laxative use is harmful. 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 ìgoodî when they avoid purging or eat an entire meal. Otherwise, clients will believe they are ìbadî on days when they purge or fail to eat enough food

18. The nurse is teaching a client with bulimia to use self-monitoring techniques. Which client statement would let the nurse know that this has been effective? A) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." B) "I am beginning to understand how my lack of self-control is hurting me." C) "I am keeping a record of everything I eat and how I am feeling every day" D) "I am getting more comfortable confronting people when I have conflict with them."

Ans: A Feedback: Self-monitoring is a cognitiveñbehavioral technique designed to help clients with bulimia. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions, thoughts, circumstances, and interactions surrounding eating and binging or purging episodes. In this way, clients begin to see connections between emotions and situations and eating behaviors. The nurse can then help clients to develop ways to manage emotions such as anxiety by using relaxation techniques or distraction with music or another activity.

28. Which of the following would be most supportive for family and friends of a client with an eating disorder? A) Emotional support, love, and attention B) Focus on food intake, calories, and weight C)Unlimited access to unhealthy foods that the client enjoys D) Positive reinforcement for weight gain

Ans: A Feedback: The nurse explains to family and friends that they can be most helpful by providing emotional support, love, and attention. They can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight. Eating disorders can be viewed on a continuum with clients with anorexia eating too little or starving themselves, clients with bulimia eating chaotically, and clients with obesity eating too much.

11. The nurse uses cognitiveñbehavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach? A) "Is there any way you can look at that sandwich as fuel for your body?" B) "You have to eat in moderation for good nutrition." C) "You seem to have a really hard time controlling your eating patterns." D) "Is this your way of showing your family that you can make decisions?"

Ans: A Feedback: CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual to guide treatment. Strategies designed to change the client's thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept.

1. A 15-year-old female is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? A) Body weight less than normal for age, height, and overall physical health B) Amenorrhea for at least two cycles C) Absence of hunger feelings D) Erosion of dental enamel

Ans: A Feedback: Anorexia nervosa is a life-threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. Clients with anorexia have a body weight that is less than the minimum expected weight, considering their age, height, and overall physical health. In addition, clients have a preoccupation with food and food-related activities and can have a variety of physical manifestations. Physical problems or anorexia nervosa include amenorrhea, constipation, overly sensitive to cold, lanugo hair on body, hair loss, dry skin, dental caries, pedal edema, bradycardia, enlarged parotid glands, hypothermia, and electrolyte imbalance. 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.

8. The nurse understands that which biologic factors may influence the development of an eating disorder? Select all that apply. A) Family history of eating disorders B) Dysfunction of the hypothalamus C) Norepinephrine imbalances D) First-degree relatives with psychotic disorder E) Decreased serotonin levels

Ans: A, B, C, E Feedback: Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families, or it may directly involve a dysfunction of the hypothalamus. A family history of mood or anxiety disorders (e.g., obsessiveñcompulsive disorder) places a person at risk for an eating disorder. Low norepinephrine levels are seen in clients during periods of restricted food intake. Also, low epinephrine levels are related to the decreased heart rate and blood pressure seen in clients with anorexia. Low levels of serotonin as well as low platelet levels of monoamine oxidase have been found in clients with bulimia and the binge and purge subtype of anorexia nervosa.

3. Which eating disorder is characterized by consuming an amount of food much larger than a person would normally eat and of near-normal weight? Afterward, the client may purge the food or exercise excessively, and between binges, the client may eat low- calorie foods or fast. A) Anorexia nervosa B) Bulimia nervosa C) Pica D) Rumination

Ans: B Feedback: Bulimia nervosa, often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. The amount of food consumed during a binge episode is much larger than a person would normally eat. Between binges, the client may eat low-calorie foods or fast. Anorexia nervosa is a life- threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. The weight of clients with bulimia usually is in the normal range. Pica is persistent ingestion of nonfood substances. Rumination is repeated regurgitation of food that is then rechewed, reswallowed, or spit out.

14. When documenting the mental status exam findings in the chart of a client with anorexia, the nurse notes poor judgment and insight. Which client statement would support this impression? A) "I know I have a problem. I need help." B) "Others are just trying to keep me from looking good." C) "I know my weight is a little below normal" D) "Those weight charts are for normal people. I am not normal."

Ans: B Feedback: 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. Facts about failing health status are not enough to convince these clients of their true problems.

6. What is the primary difference between anorexia nervosa and bulimia nervosa? A) Anorexia has a psychological basis, whereas the cause of bulimia is biologic. B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. C) Bulimia can be life threatening, whereas anorexia is seldom so. D) There is no real difference between these two types of disorders.

Ans: B Feedback: Clients with bulimia know their behavior is pathologic and are ashamed of it; clients with anorexia think they are fine and see no problem with their weight-control efforts. Anorexia nervosa is a life-threatening eating disorder. Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families.

12. Which may help a person to overcome an eating disorder that causes weight gain? A) Being ashamed of his or her body image B) Believing that gaining weight is a side effect of unhealthy lifestyle behaviors and losing weight is a side effect of healthy lifestyle behaviors C) Being reminded that every morsel of food he or she consumes will make him or her fat D) Knowing that his or her current weight is abnormal

Ans: B Feedback: Cognitiveñbehavioral therapy has been found to be the most effective treatment for bulimia. Strategies designed to change the client's thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept. All of the other statements are factors that may reinforce the continuing cycle of an eating disorder.

29. The nurse has been teaching the client's family about the client's eating disorder, anorexia nervosa. Which statement would indicate that teaching was effective? A) "We will eat our evening meals together with no exceptions." B) "We will negotiate resolutions to family conflicts." C) "We will spend less time discussing troublesome family members." D) "We will give her frequent encouragement for eating well and maintaining her weight."

Ans: B Feedback: Families of clients with eating disorders typically put too much emphasis on food and are less skilled at discussing family conflicts and allowing the client to begin gaining independence. ìWe will eat our evening meals together with no exception,î allows little or no compromise; the client needs to be able to make decisions for him or herself. ìWe will spend less time discussing troublesome family members,î indicates that the client is a problem to the family. ìWe will give her frequent encouragement for eating well and maintaining her weightî indicates that family members can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight.

16. Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? A) Leave the client alone to relax during meals. B) Offer liquid protein supplements if the client is unable to complete meal. C) Observe the client for 30 minutes after all meals. D) Weigh the client weekly in the same clothing at the same time of day.

Ans: B Feedback: 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 client daily in uniform clothing, and being alert for attempts to hide or discard food or inflate weight.

27. 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? A) Provide the client a diet of mainly vegetables and salads. B) Encourage the entire family to engage in a balanced and regular dietary pattern. C) Encourage autonomy by allowing the client to have total control over food choices. D) Insist that the client complete all meals provided.

Ans: B Feedback: The nurse provides extensive teaching about basic nutritional needs and the effects of restrictive eating, dieting, and the binge and purge cycle. Clients need encouragement to set realistic goals for eating throughout the day. 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 for family and friends to force the client to eat.

4. When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? A) Codependence B) Control issues C) Self-discipline D) Sexual identity

Ans: B Feedback: 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.

2. The nurse is assessing a client with bulimia nervosa. Which of the following symptoms would the nurse expect to find? Select all that apply. A) Cold intolerance B) Normal weight for height C) Dental erosion D) Hypotension E) Metabolic alkalosis

Ans: B, C, E Feedback: 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. Cold intolerance and hypotension are symptoms associated with emaciation seen in anorexia nervosa.

22. Which of the following interventions would be appropriate for a client with anorexia nervosa? A) Allowing the client to eat whenever she feels hungry B) Insisting that the client sit in the dining room until all food is eaten C) Having the client in view of staff for 90 minutes after each meal D) Permitting the client to eat any food she chooses, as long as she is eating

Ans: C Feedback: Many clients with anorexia also have purging behavior; even those who have not purged previously may begin to do so when they are unable to restrict their eating. Answer choices A, B, and D do not promote healthy eating behaviors.

23. Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa? A) Changing her irrational thinking about her body B) Establishing a target weight to be achieved by discharge C) Restoring nutritional status to normal D) Gaining insight into the effects of anorexia on her physical health

Ans: C Feedback: 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.

24. Which nursing statement is most effective in communicating a positive expectation of the client? A) "I'll give you 90 minutes to eat." B) "I will allow you space to eat in peace." C) "I will sit here quietly with you while you eat." D) "There are people who would truly appreciate this food."

Ans: C Feedback: This statement reflects the nurse's expectation that the client will eat, yet the nurse still will provide adequate supervision. The other choices are not appropriate means of assuming a positive expectation of the client.

19. The nurse understands that before a client with an eating disorder can accept their body image, he or she must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? A) Coping skills are dependent on a supportive upbringing. B) When body image is positive, the client will develop better coping skills. C) Being able to cope in healthy ways improves the ability to accept a realistic body image. D) Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills.

Ans: C Feedback: When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image.

17. The nurse is assisting the client with anorexia to express feelings more openly. Which response by the nurse would be most likely to encourage expression of feelings? A) "Are you sad?" B) "You look anxious." C) "Tell me what you are feeling right now." D) "Tell me when you feel bad."

Ans: C Feedback: Because clients with anorexia have problems with self-awareness, they often have difficulty identifying and expressing feelings. Therefore, they often express these feelings in terms of somatic complaints such as feeling fat or bloated. 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, ìAre you sad?î or ìAre you anxious?î because a client may quickly agree rather than struggle for an answer. The nurse encourages the client to describe her or his feelings. This approach can eventually help clients to recognize their emotions and to connect them to their eating behaviors.

26. 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? A) Dieting helps build a positive self-image in children. B) Dieting during childhood restricts essential nutrients needed for normal growth. C) Dieting at an early age teaches healthy eating habits. D) Dieting at an early age may lead to the development of eating disorders.

Ans: D Feedback: 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. Eating patterns during childhood are often carried into adulthood.

13. The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? A) Careless B) Outspoken C) Defiance D) Eager to please

Ans: D Feedback: 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 ìgood, causing us no troubleî until the onset of anorexia. Likewise, clients with bulimia often are focused on pleasing others and avoiding conflict.

15. All of the following nursing diagnoses are appropriate for the care of a client with anorexia. Which nursing diagnosis has the highest priority? A) Activity intolerance B) Ineffective coping C) Chronic low self-esteem D) Imbalanced nutrition: less than body requirements

Ans: D Feedback: Nursing diagnoses for clients with eating disorders include imbalanced nutritionóless than/more than body requirements, activity intolerance, ineffective coping, and chronic low self-esteem. When prioritizing nursing diagnoses, physical needs must be met before psychosocial needs (apply Maslow's hierarchy of needs). Of the physical needs, nutritional imbalances pose a more acute threat than decreased activity levels. When addressing psychosocial needs, improving coping skills will eventually lead to rise in self-esteem.

7. While assessing the family dynamics of a client with an eating disorder, which of the following does the nurse most likely discover? A) Multiple siblings B) Lack of interest in the client by other family members C) Supportive and encouraging relationships D) Over controlling parents

Ans: D Feedback: Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: by continuing to lose, these clients exert control over one aspect of their lives.

20. When preparing a client with bulimia for discharge, the nurse suggests that the client and family continue with family therapy on an outpatient basis. Which of the following is the rationale for this suggestion? A) Family members often need to learn role independence and autonomy. B) Family members need to learn to monitor for signs of client relapse. C) Family relationships need to be strengthened due to a lifetime of disengagement. D) Family members often feel jealous of the attention the client has been receiving in treatment.

Ans:A Feedback: Dysfunctional relationships with significant others often are a primary issue for clients with eating disorders. In addition, support groups in the community or via the internet can offer support, education, and resources to clients and their families or significant others.

15. A client with cachexia states, "I don't care what you say, I am horribly fat and will con- tinue to diet." The client is experiencing arrhythmias and bradycardia. Based on this client's symptoms, which nursing diagnosis takes priority? 1. Ineffective denial. 2. Imbalanced nutrition: less than body requirements. 3. Disturbed body image. 4. Ineffective coping.

Cachexia is a state of ill health, malnutrition, and wasting. 1. When clients diagnosed with eating disorders are unable to admit the effect of maladaptive eating behaviors on life patterns, they are experiencing ineffective denial. This is a valid nursing diagnosis for this client because there is an inability to admit emaciation. This diag- nosis should be considered, however, only after resolution of life-threatening nutritional status. ✅2. The immediate and priority problem that this client faces is imbalanced nutrition: less than body requirements. Impaired nutrition causes complications of emacia- tion, dehydration, and electrolyte imbal- ance that can lead to death. When the physical condition is no longer life- threatening, other problems may be addressed. 3. When emaciated clients diagnosed with eating disorders are negative about their appearance and see themselves as overweight, they are experiencing disturbed body image. This is a valid nursing diagnosis for this client because the client views the body as "horribly fat" when in reality the client is critically thin. This diagnosis should be considered, however, only after resolution of life-threatening nutritional status. 4. Clients diagnosed with eating disorders cope ineffectively with stress and anxiety by mal- adaptive eating patterns. This is a valid nursing diagnosis because this client is choosing not to eat to deal with unconscious stressors. This diagnosis should be consid- ered, however, only after resolution of life- threatening nutritional status. TEST-TAKING HINT: To answer this question cor- rectly, the test taker first must understand the terms used in the question, such as "cachexia." Physiological needs must take priority over psy- chological needs. If physiological needs are not addressed, the client is at risk for life-threatening complications.

29. A client diagnosed with bulimia nervosa has responded well to citalopram (Celexa). Which is the possible cause for this response? 1. There is an association between bulimia nervosa and dilated blood vessels and inac- tive alpha-adrenergic and serotoninergic receptors. 2. There is an association between bulimia nervosa and the neurotransmitter dopamine. 3. There is an association between bulimia nervosa and the neurotransmitters sero- tonin and norepinephrine. 4. There is an association between bulimia nervosa and a malfunction of the thalamus.

Citalopram (Celexa) is a selective serotonin reuptake inhibitor and affects the neurotransmit- ter serotonin. 1. Vascular headaches, not bulimia nervosa, are caused by dilated blood vessels in the brain. Drugs such as ergotamine (Ergostat) are used to treat vascular headaches by stimulating alpha-adrenergic and serotoninergic receptors. 2. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine, not dopamine. ✅3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. Because citalopram (Celexa) is a selective serotonin reuptake inhibitor, it would be useful in the treatment of bulimia nervosa and responsible for a positive client response. 4. There is an association between bulimia ner- vosa and a malfunction of the hypothalamus, not thalamus. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must recognize citalopram (Celexa) as a selective serotonin reuptake inhibitor.

9. The nurse is assessing a client with a body mass index of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. 1. Hypoglycemia. 2. Rheumatoid arthritis. 3. Angina. 4. Respiratory insufficiency. 5. Hyperlipidemia.

Clients with a body mass index (BMI) of 30 or greater are classified as obese. It is important to learn the complications of obesity because, based on the World Health Organization guidelines, half of all Americans are obese. 1. Obese clients commonly have hyperglycemia, not hypoglycemia, and are at risk for developing diabetes mellitus. 2. Osteoarthritis, not rheumatoid arthritis, results from trauma to weight-bearing joints and is commonly seen in obese clients. ✅3. Workload on the heart is increased in obese clients, and this often leads to symptoms of angina . ✅4. Workload on the lungs is increased in obese clients, and this often leads to symptoms of respiratory insufficiency. ✅5. Obese clients often present with hyper- lipidemia, particularly elevated triglyc- eride and cholesterol levels TEST-TAKING HINT: To answer this question cor- rectly, the test taker first must recognize that this client is obese as reflected by the BMI men- tioned in the question.

10. The family of a client diagnosed with anorexia nervosa has canceled the last two family counseling sessions. Which of the following could be reasons for this noncompliance? Select all that apply. 1. The family is fearful of the social stigma of having a family member with emotional problems. 2. The family is dealing with feelings of guilt because of the perception that they have contributed to the disorder. 3. There may be a pattern of conflict avoidance, and the family fears conflict would surface in the sessions. 4. The family may be attempting to maintain family equilibrium by keeping the client in the sick role. 5. The client is now maintaining adequate nutrition, and the sessions are no longer necessary

Eating disorders are considered "family" disor- ders, and resolution of the disease cannot be achieved until dynamics within the family have improved. ✅1. Support is given through family counsel- ing as families deal with the existing social stigma of having a family member with emotional problems. This stigma also may discourage compliance with therapies, as the family copes with the stress by deny- ing the illness. ✅2. Families who are experiencing feelings of guilt associated with the perception that they have contributed to the onset of the disorder may avoid dealing with this guilt by being noncompliant with family therapy. ✅3. Dysfunctional family dynamics may lead the family to avoid conflict by avoiding highly charged family sessions. ✅4. Dysfunctional family systems often focus conflicts and stress on a scapegoat family member. These families balance their family system by maintaining this member in a dependent, sick role. Because of disruption in the dysfunctional family system, there is little interest shown in changing the role of this "sick" member. 5. Anorexia nervosa is a disease that requires long-term treatment for successful change to occur. It would be improbable that the client would begin eating spontaneously, maintain adequate nutrition, and no longer require treatment TEST-TAKING HINT: To select the correct answer, the test taker must recognize the deterrents to active participation in family therapy. It is vital to understand these deterrents to be able to encourage effective compliance with family therapy.

24. A client diagnosed with an eating disorder has a nursing diagnosis of low self-esteem. Which nursing intervention would address this client's problem? 1. Offer independent decision-making opportunities. 2. Review previously successful coping strategies. 3. Provide a quiet environment with decreased stimulation. 4. Allow the client to remain in a dependent role throughout treatment.

✅ 1. Offering independent decision-making opportunities promotes feelings of con- trol. Making decisions and dealing with the consequences of these decisions should increase independence and improve the client's self-esteem. 2. Reviewing previously successful coping strategies is an effective nursing intervention for clients experiencing altered coping, not low self-esteem. Altered coping is a common problem for clients diagnosed with eating disorders, but this diagnosis is not stated in the question. 3. Providing a quiet environment with decreased stimulation is an effective nursing intervention for clients experiencing anxiety, not low self-esteem. Anxiety is a common problem for clients diagnosed with eating dis- orders, but this diagnosis is not stated in the question. 4. Allowing the client to remain in a dependent role throughout treatment would decrease, rather than increase, self-esteem. There is little opportunity for successful experiences and increased self-esteem when a client has decisions and choices made for him or her. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the nurs- ing intervention that addresses this problem. Answers "2" and "3" may be appropriate inter- ventions for clients diagnosed with an eating dis- order, but only "1" correlates with the client problem of low self-esteem.

11. Which anorexia nervosa symptom is physical in nature? 1. Dry, yellow skin. 2. Perfectionism. 3. Frequent weighing. 4. Preoccupation with food.

✅ 1.Dry, yellow skin is a physical symptom of anorexia nervosa. This is due to the release of carotenes as fat stores are burned for energy. 2. Perfectionism is experienced by clients with a diagnosis of anorexia nervosa, but it is a behavioral, not physical, symptom. 3. Frequent weighing is a behavioral, not physical, symptom of anorexia nervosa. 4. Preoccupation with food is a cognitive, not physical, symptom of anorexia. TEST-TAKING HINT: To select the correct answer, the test taker first must determine if the symp- tom presented is a symptom of anorexia nervosa, then be able to categorize this symptom accu- rately as physical.

17. A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which long-term outcome indicates that the client's problem has improved? 1. The client's body mass index will be 20 by the 6-month follow-up appointment. 2. The client will be free of signs and symptoms of malnutrition and dehydration. 3. The client will use one healthy coping mechanism during a time of stress by discharge. 4. The client will state an understanding of a previous dependency role by the 3-month follow-up appointment.

✅1. A normal body mass index (BMI) range is 20 to 25. The client's BMI of 20 documents attainment of a successful long-term outcome for the stated nursing diagnosis of imbalanced nutrition: less than body requirements. 2. Experiencing no signs and symptoms of mal- nutrition and dehydration is an outcome related to the nursing diagnosis of imbalanced nutrition. This outcome does not contain a timeframe, however, and cannot be measured. 3. Improving the ability to demonstrate healthy coping mechanisms by discharge is a shortterm outcome related to the nursing diagnosis of ineffective coping, not imbalanced nutrition . 4. Stating understanding of a previous dependency role by 3-month follow-up appointment is a longterm outcome related to the nursing diagnosis of low self-esteem, not imbalanced nutrition. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the measurable outcome that is a realistic expecta- tion for the client. Answers "3" and "4" may be appropriate outcomes for clients diagnosed with eating disorders, but only "1" correlates with the client problem of imbalanced nutrition: less than body requirements.

26. The instructor is teaching nursing students about the psychodynamic influences of eating disorders. Which statement indicates that more teaching is necessary? 1. "Eating disorders result from very early and profound disturbances in father-infant interactions." 2. "Disturbances in mother-infant interactions result in retarded ego development." 3. "When the mother responds to the physical and emotional needs of the child by pro- viding food, it contributes to ego development alterations." 4. "Poor self-image contributes to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating.

✅1.Eating disorders result from very early and profound disturbances in mother- infant, not father-infant, interactions. This statement would indicate that more teaching is necessary. 2. Disturbances in mother-infant interactions result in retarded ego development, which contributes to the development of an eating disorder. This is a correct statement and fur- ther teaching is not necessary. 3. Ego development alterations can be attrib- uted to the mother's responding to the physical and emotional needs of the child by providing food. This is a correct statement and further teaching is not necessary. 4. Poor self-image contributes to a perceived lack of control. The client compensates for this perceived lack of control by controlling behav- iors related to eating. This is a correct state- ment and further teaching is not necessary. TEST-TAKING HINT: The question is asking for an incorrect statement about eating disorders, which would indicate that "more teaching is necessary."

6. Which individual would be at highest risk for obesity? 1. A poor black woman. 2. A rich white woman. 3. A rich white man. 4. A well-educated black man.

✅1.Obesity is more common in black women than in white women, and the prevalence among lower socioeconomic classes is six times greater than among upper socioeco- nomic classes. Because of these data, this individual is at highest risk for obesity compared with the others described. 2. Obesity is less common in white women than in black women, and the prevalence among lower socioeconomic classes is six times greater than among upper socioeconomic classes. These data reflect a lower risk for obesity for this individual. 3. Obesity is more common in white men than in black men, but because the prevalence among lower socioeconomic classes is six times higher than among upper socioeco- nomic classes, this individual's risk is lowered. 4. Obesity is more common in white men than in black men, and there is an inverse relation- ship between obesity and education level. These data reflect a lower risk for obesity for this individual. TEST-TAKING HINT: The test taker must be aware of the epidemiological factors that influence the prevalence rate of obesity to determine which of the individuals described is at highest risk for becoming obese.

20. A client diagnosed with anorexia nervosa has a nursing diagnosis of disturbed body image. Which nursing intervention addresses this problem? 1. Help client to realize that perfection is unrealistic. 2. Stay with client during mealtime and for at least 1 hour after meals. 3. Help the client to identify and set weight loss goals. 4. Explain to client that privileges and restrictions will be based on weight gain

✅1.When the nurse helps the client to realize that perfection is unrealistic, the nurse is intervening to address a disturbed body image problem. If the client begins to accept certain personal inadequacies, the need for unrealistic achievement and per- fectionism should diminish. 2. Staying with the client during mealtime and for at least 1 hour after meals addresses an imbalanced nutrition, not a disturbed body image, problem. Adequate intake must be encouraged and the amount of intake moni- tored. The client may use time after meals to discard uneaten food, and the presence of the nurse would discourage this behavior. 3. Helping the client to identify and set weight loss goals is inappropriate for a client diag- nosed with anorexia nervosa. It is appropriate to set weight gain goals with these clients. 4. Explaining to clients that privileges and restrictions will be based on weight gain is an appropriate intervention to address an imbal- anced nutrition, not disturbed body image, problem. Applying privileges and restrictions based on compliance with treatment and weight gain is a behavioral approach to encourage increased nutritional intake. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the nursing diagnosis presented in the question with the cor- rect nursing intervention. There always must be a correlation between the stated problem and nursing actions to correct this problem.

27. Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? Select all that apply. 1. The client participates in individual therapy. 2. The client has a body mass index of 16. 3. The client consumes adequate calories as determined by the dietitian. 4. The client is dependent on mother for most basic needs. 5. The client states, "I realize that I can't be perfect."

✅1.Willingness to participate in individual therapy is an indication that this client meets discharge criteria. Individual therapy encourages the client to explore unresolved conflicts and to recognize maladaptive eating behaviors as defense mechanisms used to ease emotional pain. 2. The body mass index (BMI) for normal weight is 20 to 25. Because this client's BMI is lower than the normal range, consideration for discharge may be inappropriate at this time. ✅3. It is significant when a client diagnosed with anorexia nervosa consumes adequate calories to maintain metabolic needs. This assessment information would indicate that the client should be considered for discharge. 4. Families of clients diagnosed with anorexia nervosa often consist of a passive father, a domineering mother, and an overly dependent child. This client's continued dependence on the mother may indicate that considera- tion for discharge is inappropriate at this time. ✅5. A high value is placed on perfectionism in families of clients diagnosed with anorexia nervosa. These clients feel that they must satisfy these unrealistic standards, and when this is found to be impossible, helplessness results. Because this client shows insight into this problem by the recognition that perfection is impossible, consideration for discharge is appropriate. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must have an understanding of the basic problems underlying the diagnosis of anorexia nervosa. Remembering the BMI value for normal weight eliminates "2."

2. The nurse is teaching about factors that influence eating patterns. Which statements indicate that learning has occurred? Select all that apply. 1. "Factors such as taste and texture can affect appetite." 2. "The function of my digestive organs affects my eating behaviors." 3. "High socioeconomic status determines nutritious eating patterns." 4. "Social interaction contributes little to eating patterns." 5. "Society and culture influence eating patterns."

Providing a social setting can improve eating patterns, whereas societal pressures may be detrimental. ✅1. Environmental factors, such as taste, tex- ture, temperature, and stress, affect eating behaviors. ✅2. The function of the gastrointestinal tract affects eating behaviors and appetite. Physiological variables include the balance of neuropeptides and neurotransmitters, metabolic rate, the structure and function of the gastrointestinal tract, and the abili- ty to taste and smell. 3. A high socioeconomic status does not deter- mine healthy eating patterns. Many people in affluent cultures in the United States and all over the world have poor nutritional status because of poor eating choices. 4. Social interactions do contribute to eating patterns. Eating is a social activity. Most spe- cial events revolve around the presence of food. Providing a social setting can improve appetite and eating behaviors. ✅5. Society and culture have a great deal of influence on eating behaviors and percep- tions of ideal weight. Eating patterns are developed based on attempts to meet these societal norms. TEST-TAKING HINT: The test taker must recognize the impact of the social activity of eating and the effect society has on eating patterns to answer this question correctly.

5. 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? 1. 5 to 10 years old. 2. 10 to 14 years old. 3. 18 to 22 years old. 4. 40 to 45 years old.

The onset of bulimia nervosa commonly occurs in late adolescence or early adulthood. Bulimia nervosa is more prevalent than anorex- ia nervosa. Research suggests that bulimia occurs primarily in societies that place empha- sis on thinness as the model of attractiveness for women and where an abundance of food is available. 1. These ages are not within the range of late adolescence to early adulthood. 2. These ages are not within the range of late adolescence to early adulthood. Age 14 would be considered early, not late, adolescence. ✅3. These ages are within the range of late adolescence to early adulthood, in which the onset of bulimia nervosa commonly occurs. 4. These ages are not within the range of late adolescence to early adulthood. Age 40 falls in the category of late, not early, adulthood. TEST-TAKING HINT: The test taker must recognize the age ranges for onset of bulimia nervosa to answer this question correctly.