Chapter 18 - Eating & Feeding Disorders (Psych) EAQ's

Which statement is least likely to be made by a patient diagnosed with bulimia nervosa during the assessment interview? 1 - "I eat three meals each day and purge every evening." 2 - "I feel as though my eating and purging are out of my control." 3 - "I'm concerned about what others think about my binging and purging." 4 - "When I eat I feel calm, but then I realize I have to make myself vomit or gain weight."

1 - "I eat three meals each day and purge every evening." Most patients with bulimia purge after each meal. Text Reference - p. 341

Bupropion, although seemingly effective, is contraindicated in patients who purge. What is the reason for this? 1 - An increased risk of seizures 2 - Historically poor patient compliance 3 - The potential to cause gastric ulcers 4 - The long-term effects on liver function

1 - An increased risk of seizures Bupropion, although seemingly effective, is contraindicated in patients who purge because of an increased risk of seizures. Text Reference - p. 349, Table 18.7

During assessment of a patient with anorexia nervosa, it is not likely that the nurse would note indications of which of the following? 1 - Introversion 2 - Social isolation 3 - High self-esteem 4 - Obsessive-compulsive tendencies

3 - High self-esteem Most patients with eating disorders have low self-esteem. Text Reference - pp. 337, 338

Which assessment finding can the nurse anticipate for a patient newly diagnosed with binge-eating disorder? 1 - Russell sign 2 - Hypotension 3 - Normal weight 4 - Use of laxatives

3 - Normal weight The nurse may find that the patient newly diagnosed with a binge-eating disorder is of normal weight. Over time, repeated binge eating can result in obesity. Hypotension is more likely to be found with anorexia or bulimia nervosa as the disease state worsens. Russell sign and the use of laxatives are more typical of patients with bulimia nervosa. Text Reference - p. 346

Prioritize these nursing diagnoses from highest to lowest for a patient diagnosed with anorexia nervosa. 1 Chronic low self-esteem 2 Loneliness 3 Imbalanced nutrition: less than body requirements

1 - Imbalanced nutrition: less than body requirements 2 - Loneliness 3 - Chronic low self-esteem Diagnoses are prioritized using Maslow's pyramid. Physiological needs come first: nutritional balance is the priority. The next level of the pyramid is safety and security, but none of the diagnoses relate to that level. The next level is love and belonging, which is jeopardized by loneliness. The next level is self-esteem. Text Reference - p. 337

A patient diagnosed with anorexia nervosa presents to the clinic with a body mass index (BMI) of 15 kg/m2. Based on BMI, which level of severity does the nurse document? 1 - Mild 2 - Severe 3 - Extreme 4 - Moderate

2 - Severe A BMI of 15 to 15.99 kg/m2 is considered severe. A BMI of 16 to 16.99 kg/m2 is moderate. A BMI of less than 15 is extreme. A BMI of 17kg/m2 or more is mild. Text Reference - p. 334

A patient who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meal daily and engages in a rigorous exercise program. What is the nursing diagnosis for this patient? 1 - Death anxiety 2 - Ineffective denial 3 - Disturbed sensory perception 4 - Imbalanced nutrition: less than body requirements

4 - Imbalanced nutrition: less than body requirements A body weight of 80 pounds for a 16-year-old who is 5 foot, 3 inches tall is ample evidence of imbalanced nutrition. Text Reference - p. 337

What should the nurse instruct the patient who is taking Qsymia for the management of binge eating disorder? 1 - "Use birth control." 2 - "Eat at regular intervals." 3 - "Measure your weight weekly." 4 - "Review the nutritional content of foods you consume."

1 - "Use birth control." Qsymia is a combination of two drugs: topiramate and phentermine. It is used in the treatment of binge eating disorder; however, it should be used cautiously because it can cause birth defects. Female patients prescribed this medication should be instructed to use birth control. All patients diagnosed with binge eating disorder are advised to eat at regular intervals because abstinence from food can result in a rebound of binge eating. All patients diagnosed with binge eating disorder are advised to weigh themselves on a weekly basis since there is minimal daily weight loss, which can discourage the patient. In order to eat a balanced diet, any patient diagnosed with binge eating disorder should be advised to review the nutritional content of the foods they consume. Text Reference - p. 349, Table 18.7

The nurse is assessing a patient with binge eating disorder. What diagnosis should the nurse consider when the patient shows feelings of inadequacy? 1 - Anxiety 2 - Ineffective coping 3 - Imbalanced nutrition 4 - Disturbed body image

1 - Anxiety The nursing diagnosis of anxiety is made when the patient shows feelings of discomfort or inadequacy. Ineffective coping is noted if the patient uses eating as a coping method. Imbalanced nutrition is diagnosed when the patient shows irregular eating patterns and is overweight. Disturbed body image is noted when the patient shows embarrassment due to weight gain. Text Reference - p. 348, Table 18.6

An adolescent patient diagnosed with anorexia nervosa currently weighs 97 pounds. The patient's ideal body weight is 127 pounds. Identify the highest priority goal for this patient. 1 - Attain a weight of 114.3 pounds 2 - Verbalize a realistic body image 3 - Demonstrate elevated self-concept 4 - Seek input from others when making decisions

1 - Attain a weight of 114.3 pounds After intervention for any acute symptoms, the patient with anorexia begins a weight restoration program that allows for incremental weight gain. A treatment goal is set at 90% of ideal body weight, the weight at which most women are able to menstruate. Verbalizing a realistic body image and improved self-concept are important goals, but nutritional integrity is a higher priority. The goal of treatment is to achieve independence with decision-making processes. Text Reference - p. 338

A nurse is attending to a patient with bulimia nervosa. What reason does the nurse suspect for the presence of gastric dilation in the patient? 1 - Binge eating 2 - Induced vomiting 3 - Use of laxatives 4 - Ipecac intoxication

1 - Binge eating Binge eating can cause gastric dilation or rupture. Induced vomiting causes reflux of hydrochloric acid over the tooth enamel, causing dental cavities. Ipecac intoxication can cause cardiac failure. Use of laxatives causes electrolyte imbalances. Text Reference - p. 344, Table 18.4

What clinical finding can the nurse anticipate when caring for a patient diagnosed with anorexia? 1 - Bradycardia 2 - Leukocytosis 3 - Hyperkalemia 4 - Hyperthyroidism

1 - Bradycardia The nurse can anticipate bradycardia during the assessment of a patient with anorexia. Hypokalemia (not hyperkalemia), leukopenia (not leukocytosis), and hypothyroidism (not hyperthyroidism) are other clinical findings in an anorexic patient. Text Reference - p. 337

What is a coping mechanism used excessively by patients with anorexia nervosa? 1 - Denial 2 - Humor 3 - Altruism 4 - Projection

1 - Denial Denial of excessive thinness is the mainstay of the patient with anorexia nervosa. Text Reference - p. 338, Table 18.3

What outcome is most important for a patient with bulimia nervosa to reduce the feeling of powerlessness? 1 - Making informed life decisions 2 - Willingness to call others for help 3 - Using a personal support system 4 - Being satisfied with body appearance

1 - Making informed life decisions When the patient makes informed life decisions, there is a sense of control and power over his or her own life. Development of this skill reduces the feeling of powerlessness associated with bulimia nervosa. When the patient is satisfied with body appearance, there is a reduction of disturbed body image and obsession with the body. When the patient is willing to call others for help, it decreases social isolation. By using a personal support system, the patient can develop effective coping mechanisms Text Reference - p. 348, Table 18.6

A patient with anorexia nervosa was discharged from a specialized eating-disorder unit three weeks ago, weighing 123 lb. The patient returns to the outpatient clinic for a follow-up visit. The patient's ideal body weight is 154 lb, but the current body weight is 112 lb. What is the nurse's priority action? 1 - Notify the health provider. 2 - Obtain a 24-hour diet recall. 3 - Request to view the nutrition log. 4 - Proceed with the treatment plan.

1 - Notify the health provider. The nurse's priority action is to notify the healthcare provider. The patient weights 75% below his or her ideal body weight and will require immediate medical stabilization. Obtaining a 24-hour diet recall, requesting to view the nutrition log, and proceeding with the treatment plan are actions that may be taken once the healthcare provider is consulted. Text Reference - p. 338

What is the nurse's initial intervention when beginning the management of care for an individual diagnosed with a maladaptive eating disorder? 1 - Personally reflect on weight-related biases. 2 - Establish a therapeutic patient-focused relationship. 3 - Evaluate the individual's current state of physical and emotional health. 4 - Assure the individual that the treatment plan will be agreed upon mutually.

1 - Personally reflect on weight-related biases. Before working with patients with maladaptive eating regulation responses, nurses must closely examine their own feelings and prejudices about weight and body size. Although establishing a therapeutic patient-focused relationship, evaluating the individual's current state of physical and emotional health, and assuring the individual that the treatment plan will be agreed upon mutually all reflect appropriate interventions, there is a different intervention among the options that has priority in this situation. Text Reference - p. 338

The nurse is assessing a patient with binge-eating disorder. What term is used to document the symptom where the patient shows feelings of shame and guilt? 1 - Powerlessness 2 - Ineffective coping 3 - Imbalanced nutrition 4 - Disturbed body image

1 - Powerlessness If the patient shows feelings of shame and guilt, the nurse documents it as powerlessness. If the patient uses only eating as a coping method, the nurse documents it as ineffective coping. If the patient shows irregular eating patterns and is overweight, the nurse documents it as imbalanced nutrition, more than body requirements. If the patient shows embarrassment due to weight gain, the nurse documents it as disturbed body image. Text Reference - pp. 339-340, 348, Table 18.6

How does the patient with bulimia differ from the patient with anorexia nervosa? 1 - The patient with bulimia maintains a normal weight. 2 - The patient with bulimia exercises more rigorously. 3 - The patient with bulimia purges to keep weight down. 4 - The patient with bulimia holds a distorted body image.

1 - The patient with bulimia maintains a normal weight. Many bulimics are at or near normal weight, whereas patients with anorexia nervosa are underweight Text Reference - p. 344, Table 18.5

A nurse is assessing a patient suffering from bulimia nervosa. For what reason would the nurse assess the patient for the presence of dental caries? 1 - Vomiting 2 - Binge eating 3 - Ipecac intoxication 4 - Excessive caloric intake

1 - Vomiting In bulimia nervosa, induced vomiting causes reflux of hydrochloric acid over the tooth enamel causing dental caries. Binge eating can cause gastric dilation or rupture and not dental caries. Ipecac intoxication can cause cardiac failure and not dental cavities. Excessive caloric intake can lead to the patient having slightly low to normal body weight. Text Reference - pp. 343-344, Table 18.4

Which intervention would be least useful for accurate assessment of the weight of a patient diagnosed with anorexia nervosa? 1 - Weigh fully clothed before breakfast. 2 - Permit no oral intake before weighing. 3 - Do not reweigh patient when patient requests. 4 - Weigh two times daily, then three times weekly.

1 - Weigh fully clothed before breakfast. Patients should be weighed wearing only underwear before ingesting any food or fluids in the morning. Text Reference - p. 340, Case Study 18.1

What is the focus for the acute phase of treatment for anorexia nervosa? 1 - Weight restoration 2 - Improving interpersonal skills 3 - Learning effective coping methods 4 - Changing family interaction patterns

1 - Weight restoration Weight restoration is the priority goal of treatment for the patient with anorexia nervosa because health is threatened seriously by the underweight status. Text Reference - p. 338

Which assessment question should be asked of a patient suspected of demonstrating characteristics of anorexia nervosa? 1 - "Do you find yourself feeling hungry?" 2 - "How would you describe your body?" 3 - "Why do you choose to take laxatives?" 4 - "How often do you force yourself to vomit?"

2 - "How would you describe your body?" The question "How would you describe your body?" will reveal the cognitive distortion consistent with anorexia nervosa. Invariably the patient will describe self as fat despite being excessively underweight. Text Reference - p. 335

Which statement made by a patient diagnosed with bulimia indicates that an appropriate outcome for treatment has been met? 1 - "I purge only once a day now instead of twice." 2 - "I'm both a hard worker and a compassionate person." 3 - "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." 4 - "I always purge when I'm alone so that I'm not a bad role model for my younger sister."

2 - "I'm both a hard worker and a compassionate person." An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is not an appropriate outcome because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging. Text Reference - p. 343

A patient with a history of a binge-eating disorder is prescribed Orlistat to help reduce his or her weight. What statement will the nurse include in the patient teaching? 1 - "The medication may decrease your blood sugar." 2 - "It is important to take a multivitamin with this medication." 3 - "The medication may cause numbness or burning of the skin." 4 - "The medication may cause constipation, so you will need to increase your dietary fiber."

2 - "It is important to take a multivitamin with this medication." The nurse will tell the patient it is important to take a multivitamin with this medication. Orlistat causes steatorrhea, which can result in deficiencies of fat-soluble vitamins. Liraglutide may cause hypoglycemia. Side effects of phentermine and topiramate may include numbness or burning of the skin. A side effect of naltrexone and bupropion is constipation. Text Reference - p. 349

The nurse recognizes bariatric surgery as a treatment for which disorder? 1 - Rumination 2 - Binge eating 3 - Bulimia nervosa 4 - Anorexia nervosa

2 - Binge eating Bariatric surgery is an option to treat binge eating disorder as the patients are obese due to overeating, with no compensatory activities such as exercise. Patients with anorexia nervosa are underweight as they starve themselves due to fear of weight gain. They do not need bariatric surgery. Patients with bulimia nervosa tend to overeat, which is followed by compensatory behaviors, such as excessive exercise or misuse of laxatives. They are usually normal in weight or close to ideal weight and they do not need bariatric surgery. In rumination disorder the patient regurgitates the food, which is followed by rechewing and reswallowing or spitting. It does not cause obesity and bariatric surgery is not necessary. Text Reference - pp. 348-349

A patient presents with decreased cardiac output. The nurse notes that the patient experiences bingeing and then exercises excessively to make up for the calories gained. What should the nurse suspect? 1 - Binge eating 2 - Bulimia nervosa 3 - Anorexia nervosa 4 - Weight management

2 - Bulimia nervosa Bulimia nervosa is having repeated episodes of binge eating followed by inappropriate behaviors to compensate such as exercise, induced vomiting, or purgation. Binge eating is repeated episodes of overindulgence in eating followed by a feeling of guilt and distress but no compensatory behavior. Anorexia nervosa is having intense fear of weight gain and refusing to maintain optimal weight. Weight management has a specific plan of diet and exercise and does not include bingeing followed by excessive exercise. Text Reference - p. 341

The nurse is caring for a patient with bulimia nervosa who overuses laxatives but does not purge. Which drug is known to be effective to treat the patient? 1 - Qsymia 2 - Bupropion 3 - Olanzapine 4 - Lorcaserin

2 - Bupropion Bupropion is known to be effective in patients with bulimia nervosa who do not purge. It is contraindicated in patients who purge as it increases the risk of seizures. Antipsychotic agents such as olanzapine are effective to treat anorexia nervosa. Olanzapine improves the mood, decreases obsessive behaviors, and reduces resistance to weight gain. Lorcaserin and Qsymia are known to be effective to treat patients with binge eating. They block appetite signals and produce feelings of fullness. Text Reference - p. 349, Table 18.7

Which assessment finding is most likely to occur in a patient diagnosed with bulimia nervosa? 1 - Lymphocytosis 2 - Dental erosion 3 - Osteoporosis 4 - Muscle wasting

2 - Dental erosion Dental erosion is most likely to occur in patients diagnosed with bulimia nervosa due to chronic self-induced vomiting. Lymphocytosis, osteoporosis, and muscle wasting are conditions that are more likely to occur as a result of anorexia nervosa, not bulimia nervosa. Text Reference - p. 337

A patient is admitted to the hospital with severe anorexia. Upon assessment, the nurse notes the patient's skin is yellow. Which physiological response may cause this finding? 1 - Hypoalbuminemia 2 - Hypercarotenemia 3 - Hyperbilirubinemia 4 - Estrogen deficiency

2 - Hypercarotenemia Hypercarotenemia causes the skin to appear yellow in patients with severe anorexia. Estrogen deficiency causes decreased bone density. Hypoalbuminemia results in peripheral edema. Hyperbilirubinemia is the result of excessive red blood cell breakdown, not anorexia. Text Reference - p. 272

A patient reveals that he or she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal which of the following? 1 - Tachycardia 2 - Hypokalemia 3 - Hypolipidemia 4 - Hypercalcemia

2 - Hypokalemia Vomiting causes loss of potassium, leading to hypokalemia. Text Reference - p. 344, Table 18.4

A nurse is assessing a patient experiencing anorexia nervosa. What diagnosis should the nurse consider when the patient exhibits destructive behavior towards self? 1 - Powerlessness 2 - Ineffective coping 3 - Imbalanced nutrition 4 - Disturbed body image

2 - Ineffective coping Ineffective coping is presented as destructive behavior toward oneself or inability to meet expectations. Powerlessness is presented by indecisive behavior or a feeling of shame. Imbalanced nutrition is diagnosed when there are signs of emaciation or decreased urine output. Disturbed body image is noted when there is excessive self-monitoring regarding body image. Text Reference - p. 338, Table 18.3

When managing the care of a young adult diagnosed with anorexia, the nurse adds which intervention to the patient's care plan to assist in identifying a likely comorbid psychiatric condition? 1 - Teach stress reduction techniques. 2 - Monitor bathroom use after meals. 3 - Assess for suicidal ideation twice daily. 4 - Set limits to minimize manipulative behaviors.

2 - Monitor bathroom use after meals. Bulimia and anorexia may be present in the same patient. Individuals diagnosed with anorexia have a 50% chance of developing bulimic symptoms. Monitoring the patient for opportunities for vomiting will impact developing that condition. While assisting with stress management may be helpful in preventing suicidal ideations, it has minimal effect on preventing the development of bulimia. The development of bulimia is generally not depression-related. Managing manipulative behavior will have minimal effect on preventing the development of bulimia. Text Reference - p. 339

A nurse cares for a patient recently diagnosed with bulimia nervosa. Which nursing action is most appropriate? 1 - Weigh the patient twice daily. 2 - Monitor the patient's bathroom trips after meals. 3 - Provide snacks whenever the patient requests them. 4 - Encourage the patient to make menu selections independently.

2 - Monitor the patient's bathroom trips after meals. The nurse should monitor the patient's bathroom trips after meals to prevent self-induced vomiting. Weighing the patient twice daily is excessive. Providing snacks whenever the patient requests them reinforces dysfunctional eating patterns. Encouraging the patient to make menu selections independently may occur later but not initially. Text Reference - p. 339

A nurse is educating a patient newly diagnosed with anorexia nervosa about the medication dosage and side effects. The patient becomes upset and tearful, stating, "No! I will not take that medication!" What is the most likely reason for the patient's feelings? 1 - The patient is resistant because of a need to control. 2 - The patient is upset about the possible side effect of weight gain. 3 - The patient feels embarrassed about taking psychiatric medication. 4 - The patient is worried about the common adverse effect of sexual problems.

2 - The patient is upset about the possible side effect of weight gain. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain, but are not well accepted by patients who are frightened by the side effect of weight gain. There is nothing in the scenario to suggest the patient is embarrassed. Sexual side effects are more common with selective serotonin reuptake inhibitor (SRRI) medication than with atypical antipsychotics. The patient may have a need to control, which is typical of patients with anorexia; however, during medication education it is more likely for the patient to be upset over the possibility of a side effect. Text Reference - p. 334

Therapeutic nutrition is initiated for a patient hospitalized with anorexia nervosa. Two days later, the nurse notes that the patient has developed peripheral edema. What is the nurse's correct analysis of this situation? 1 - The patient's electrolyte balance has improved. 2 - The patient may be experiencing refeeding syndrome. 3 - Peripheral edema is the consequence of preexisting low bone density. 4 - The therapeutic nutrition program has improved the patient's hydration.

2 - The patient may be experiencing refeeding syndrome. Refeeding syndrome is a potential complication of initiation of therapeutic nutrition for patients diagnosed with anorexia nervosa. An assessment finding associated with this problem is peripheral edema. Serum electrolytes, particularly sodium and potassium, are likely to be abnormal in this situation. Low bone density is an assessment finding associated with estrogen deficiency or low calcium intake. Peripheral edema is not a finding associated with normal hydration. Text Reference - p. 338

According to current theory, which statement is true regarding eating disorders? 1 - They are frequently misdiagnosed. 2 - They are possibly influenced by sociocultural factors. 3 - They are rarely comorbid with other mental health disorders. 4 - They are psychotic disorders in which patients experience body dysmorphic disorder.

2 - They are possibly influenced by sociocultural factors. The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders. Text Reference - pp. 335-336

The nurse is interviewing a patient with an eating disorder. What statement by the patient indicates the presence of a binge eating disorder? 1 - "I do not want to eat food." 2 - "I overuse diuretics and laxatives." 3 - "I do not exercise to reduce weight." 4 - "I have a tendency to induce vomiting."

3 - "I do not exercise to reduce weight." Patients with binge eating disorder have episodes of uncontrolled eating followed by feelings of guilt. But they show no compensatory behavior, such as exercise to reduce the weight. Patients with anorexia nervosa do not want to eat food due to fear of weight gain and they starve themselves. Patients with bulimia nervosa may use diuretics or laxatives to compensate for overeating. They may induce vomiting to compensate for overeating. Text Reference - p. 346

A nurse assesses a patient diagnosed with an eating disorder. Which comment by the patient is most likely? 1 - "Rules don't apply to me. I just do what's best for me." 2 - "I feel good. I feel just fine. I don't have any problems." 3 - "I have certain ways I like to do things and that takes extra time." 4 - "If I want to do something, I just do it. I don't like to overanalyze things."

3 - "I have certain ways I like to do things and that takes extra time." Patients diagnosed with eating disorders consistently exhibit personality traits of perfectionism and obsessive compulsiveness. Personality disorders occur more often in the eating disordered population than the general population, particularly obsessive-compulsive personality disorder. Believing that the rules do not apply to oneself, that one does not have any problems, or that one does what one wants would be expected from persons with antisocial or narcissistic traits. Text Reference - pp. 335, 337

A nurse assesses personality traits of a patient with an eating disorder. Which comment by the patient indicates bulimia nervosa rather than anorexia nervosa? 1 - "I feel good. I feel just fine. I don't have any problems." 2 - "I try to do what my parents want, but I usually don't get things right." 3 - "If I want to do something, I just do it. I don't like to analyze things too much." 4 - "I don't look as good as most of my friends. That's why I don't have many dates."

3 - "If I want to do something, I just do it. I don't like to analyze things too much." Impulsivity is characteristic of bulimia nervosa. The other options indicate low self-esteem, feelings of ineffectiveness, and alexithymia, which are findings in all eating disorders. Text Reference - p. 343

A patient with a history of anorexia nervosa is currently being treated with fluoxetine for obsessive-compulsive behavior. The patient asks the nurse, "Will this medication help keep my anorexia from worsening?" What is the nurse's best response? 1 - "The medication will prevent a relapse of anorexia." 2 - "You will be taking a different medication to treat your anorexia." 3 - "The medication is being used to treat obsessive-compulsive behavior." 4 - "The medication will treat both the anorexia and obsessive compulsive behavior

3 - "The medication is being used to treat obsessive-compulsive behavior." The nurse's best response is, "The medication is being used to treat obsessive compulsive behavior." Fluoxetine is a selective serotonin reuptake inhibitor that is useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. There are no drugs approved for the treatment of anorexia nervosa, so fluoxetine won't help; there are no drugs that will be prescribed for the anorexia, and fluoxetine cannot treat both. Text Reference - p. 339

The nurse is assessing a patient with low weight, lanugo, and cool extremities. The nurse finds that the patient has a fear of gaining weight. What disorder does the nurse suspect as the cause for the presence of these symptoms? 1 - Bulimia nervosa 2 - Binge eating disorder 3 - Anorexia nervosa 4 - Rumination disorder

3 - Anorexia nervosa Anorexia nervosa is an eating disorder in which the patient has intense fear of weight gain and refuses to maintain optimal weight. The patient is underweight, and presents with lanugo (downy hair on face and back) and cool skin on the extremities due to starvation. In bulimia nervosa, the patient has recurrent episodes of uncontrollable bingeing. This is followed by inappropriate compensatory behaviors, such as excessive exercise, induced vomiting, and misuse of laxatives. In binge eating disorder, the patient has recurrent episodes of uncontrollable bingeing followed by a feeling of distress but the patient shows no compensatory behavior. In rumination disorder, the patient regurgitates the food, which is followed by rechewing and reswallowing or spitting. Text Reference - p. 336, Table 18.1

The nurse is assessing a teenager who is underweight compared to others in a similar age and height category. On interviewing, the nurse finds that the teen has a fear of gaining weight and is refusing to eat. What would the nurse consider this condition? 1 - Binge eating 2 - Bulimia nervosa 3 - Anorexia nervosa 4 - Rumination disorder

3 - Anorexia nervosa Anorexia nervosa refers to intense fear of weight gain and refusal of food to maintain weight. Binge eating is repeated episodes of overindulgence in eating followed by a feeling of guilt and distress but no compensatory behavior. Rumination disorder is characterized by regurgitation, followed by re-chewing, reswallowing, or spitting. Bulimia nervosa involves repeated episodes of binge eating followed by inappropriate behaviors like induced vomiting or purgation to compensate. Text Reference - p. 334

A patient with anorexia nervosa displays indecisive behavior, passivity, and an inability to maintain eye contact. When formulating a plan of care for the patient, what is the most appropriate nursing diagnosis the nurse can make? 1 - Ineffective coping 2 - Disturbed body image 3 - Chronic low self-esteem 4 - Altered health maintenance

3 - Chronic low self-esteem The most appropriate nursing diagnosis based on these characteristics is chronic low self-esteem. Destructive behavior toward the self, poor concentration, inability to meet role expectations, and inadequate problem-solving are signs and symptoms of ineffective coping. The signs and symptoms of a disturbed body image include excessive self-monitoring and describing the self as fat despite emaciation. Altered health maintenance is a change in the ability of an individual's ability to perform the functions necessary to maintain health or wellness. Text Reference - p. 338

What is the nurse's priority while trying to improve the condition of a patient with a binge-eating disorder? 1 - Treat bradycardia 2 - Treat hypotension 3 - Ensure steady weight loss 4 - Restore electrolyte imbalance

3 - Ensure steady weight loss The nurse's priority for a patient with binge-eating disorder is to allow steady and slow weight loss as the patient is obese due to overeating. Bradycardia, hypotension, and electrolyte imbalance are present in patients with anorexia nervosa due to dehydration and starvation. Bradycardia, hypotension, and electrolyte imbalance are also present in patients with bulimia nervosa due to induced vomiting. Treating bradycardia, electrolyte imbalance, and hypotension is the nurse's priority for patients with anorexia nervosa and bulimia nervosa. Text Reference - p. 349

The nurse can determine that inpatient treatment for a patient diagnosed with an eating disorder would be warranted when which criterion is met? 1 - Weighs 10% below ideal body weight 2 - Has a heart rate less than 60 beats/min 3 - Has systolic blood pressure less than 70 mm Hg 4 - Has a serum potassium level of 3 mEq/L or greater

3 - Has systolic blood pressure less than 70 mm Hg Systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a patient with anorexia nervosa. It suggests severe cardiovascular compromise. Text Reference - p. 338

Assessment of a patient suspected of experiencing bulimia nervosa calls for the nurse to perform which of the following? 1 - Body fat analysis 2 - Inspection of body cavities 3 - Inspection of the oral cavity 4 - A range of motion assessment

3 - Inspection of the oral cavity Repeated vomiting often causes dental erosions and caries. Text Reference - p. 343 (?)

Which of the following statements is true of bulimia? 1 - Patients with bulimia have lanugo. 2 - Patients with bulimia severely restrict their food intake. 3 - Patients with bulimia often appear to have a normal weight. 4 - Patients with bulimia binge eat but do not engage in compensatory measures.

3 - Patients with bulimia often appear to have a normal weight. Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. Not engaging in compensatory measures, severely restricting food, and lanugo do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa. Text Reference - p. 344, Table 18.4

Which diagnosis would be given priority for a patient diagnosed with bulimia nervosa? 1 - Disturbed body image 2 - Chronic low self-esteem 3 - Risk for injury: electrolyte imbalance 4 - Ineffective coping: impulsive responses to problems

3 - Risk for injury: electrolyte imbalance The patient who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss. Text Reference - p. 344, Table 18.5

A patient diagnosed with anorexia nervosa and which assessment finding meets the criteria for hospitalization? 1 - Oral temperature 98.1°F 2 - Heart rate 56 beats per minute 3 - Serum potassium level 2.6 mEq/L 4 - Systolic blood pressure 88 mm Hg

3 - Serum potassium level 2.6 mEq/L Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances warrant hospitalization because of risks regarding cardiac regulation. Other criteria for hospitalization include severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute and systolic blood pressure less than 70 mm Hg. Text Reference - p. 338

Which intervention would be removed from the plan of care for a patient diagnosed with bulimia nervosa? 1 - Assist patient to identify trigger foods. 2 - Teach that fasting sets one up to binge eat. 3 - Support importance of avoiding forbidden foods. 4 - Teach patient to plan and eat regularly scheduled meals.

3 - Support importance of avoiding forbidden foods. No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy. Text Reference - p. 339

How can the nurse working with patients diagnosed with eating disorders help families develop effective coping mechanisms? 1 - Stressing the need to suppress overt conflict within the family 2 - Urging the family to demonstrate greater caring for the patient 3 - Teaching the family about the disorder and the patient's behaviors 4 - Encouraging the family to use their usual social behaviors at meals

3 - Teaching the family about the disorder and the patient's behaviors Families need information about specific eating disorders and the behaviors often seen in patients with these disorders. This information can serve as a basis for additional learning about how to support the family member. Text Reference - pp. 339, 345, 349

At a health camp, the nurse is teaching about eating disorders. What statement by a participant indicates a need for further teaching? 1 - "Patients with an eating disorder often have personality disorders." 2 - "Adolescents get social support by viewing 'pro anorexia' websites." 3 - "Psychotherapy is the most effective treatment for bulimia nervosa." 4 - "Anorexia nervosa can be completely cured with adequate treatment."

4 - "Anorexia nervosa can be completely cured with adequate treatment." Anorexia nervosa cannot be completely cured with treatment. Nearly half the patients have a relapse within one year. 'Pro anorexia' websites try to provide rationales for anorexic food choices and reinforcing the adolescents' behaviors and attitudes; in this way, they provide social support to adolescents with anorexia nervosa. Personality disorders are common in those with eating disorders. Obsessive-compulsive personality disorder is seen more often among patients with anorexia nervosa than in the general population. A history of major depression or anxiety is common among those with binge-eating disorders. The most effective treatment for bulimia nervosa is cognitive behavioral therapy, which is a type of psychotherapy. Text Reference - p. 334

A patient tells the nurse, "I eat whenever I'm stressed." What would be the nurse's best response to confirm if the patient has developed ineffective coping when stressed? 1 - "Have you gained any weight recently?" 2 - "How do you feel about your body image?" 3 - "Can I check you for increased blood pressure?" 4 - "Do you continue to eat even after you feel full?"

4 - "Do you continue to eat even after you feel full?" The patient reports eating when stressed, which could indicate ineffective coping. The nurse can confirm that the patient has ineffective coping behaviors if the patient continues to eat after feeling full. Therefore, this statement would be the nurse's best response. Confirming if the patient has gained weight does not necessarily confirm if the patient has ineffective coping skills because weight gain can be related to a number of issues. Increased blood pressure may be a result of obesity from overeating or of stress-related anxiety but it does not confirm ineffective coping skills. A patient with a disturbed body image may be self-conscious about his or her body, but this does not necessarily confirm ineffective coping strategies. Text Reference - p. 348, Table 18.6

A nurse is assessing a child who does not like certain foods in the daily diet. On examination, the nurse notes that the body mass index (BMI) of the child is very low. What should the nurse anticipate the diagnosis to be? 1 - Encopresis 2 - Rumination 3 - Elimination disorder 4 - Avoidant/restrictive food intake disorder

4 - Avoidant/restrictive food intake disorder Avoidant or restrictive food intake is a feeding disorder where the patient avoids or restricts certain foods right from childhood. Encopresis is an elimination disorder in which the child involuntarily or intentionally passes feces. Rumination is a feeding problem where there is regurgitation with chewing again and then swallowing or spitting. Elimination disorder is related to involuntary or intentional passage of urine or feces. Text Reference - p. 352

A patient with bulimia nervosa uses enemas and laxatives to purge to maintain his or her weight. For which imbalance should the nurse assess? 1 - Elevated serum sodium level 2 - Increased red blood cell count 3 - Elevated serum potassium level 4 - Disrupted fluid and electrolyte balance

4 - Disrupted fluid and electrolyte balance Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives. Text Reference - p. 336

What term is used to document the symptom where the patient is underweight but monitors the weight excessively to prevent weight gain? 1 - Powerlessness 2 - Ineffective coping 3 - Imbalanced nutrition 4 - Disturbed body image

4 - Disturbed body image If the patient is underweight but self-monitors weight excessively, the nurse documents it as disturbed body image. If the patient has indecisive behavior or a feeling of shame, the nurse documents it as powerlessness. If the patient has self-destructive behavior, the nurse documents it as ineffective coping. If the patient has signs such as dehydration or decreased urine output or decreased blood pressure, the nurse documents it as imbalanced nutrition. Text Reference - p. 338, Table 18.3

What should the nurse expect to be the cause of edema found next to the ear in a patient diagnosed with bulimia nervosa? 1 - Electrolyte imbalance 2 - Self-induced vomiting 3 - Hydrochloric acid reflux 4 - Increased serum amylase levels

4 - Increased serum amylase levels The patient diagnosed with bulimia nervosa has a parotid swelling, which can be caused by increased serum amylase levels. An electrolyte imbalance can cause many body manifestations, none of which are indicative of swelling in front of the ear. Patients diagnosed with bulimia nervosa generally induce vomiting by sticking their fingers down their throats, causing finger calluses but not swelling by the ear. Dental caries and enamel erosion occur in patients with diagnosed bulimia nervosa due to hydrochloric acid reflux. Text Reference - p. 344, Table 18.4

The nurse learns that Qsymia contains two components, namely topiramate and phentermine. What is the function of phentermine? 1 - It burns calories quickly. 2 - It reduces the taste sensation. 3 - It produces feelings of fullness. 4 - It influences leptin blood levels.

4 - It influences leptin blood levels. Phentermine influences the blood concentration of the appetite-regulating hormone leptin by releasing the neural norepinephrine. Thereby it acts as an appetite suppressant. Topiramate is an antiseizure medication that produces feelings of fullness, reduces the taste sensation, and burns calories quickly. Text Reference - p. 337, Table 18.7

A patient with anorexia nervosa presents with severe dehydration and rapid weight loss in the last week. What appropriate action should the nurse take? 1 - Wait and watch 2 - Prescribe sedatives 3 - Obtain orders for lab work 4 - Suggest hospital admission

4 - Suggest hospital admission A patient with anorexia nervosa showing severe dehydration and rapid weight loss should be admitted beginning with appropriate treatment and observation. If untreated, this condition can become life-threatening. Wait and watch approach is not advisable in this case as it can have life-threatening consequences and needs attention. The appropriate treatment can be decided after the patient is hospitalized for inpatient care. Sedatives may help the patient to sleep but may not be helpful in managing anorexia nervosa. Laboratory investigations can be performed once the patient is hospitalized for inpatient care. Text Reference - p. 338

A nurse is teaching a patient with bulimia nervosa about scheduling healthy, balanced meals. Why does a nurse consider providing this patient education important? 1 - To identify trigger foods 2 - To realize health effects 3 - To include forbidden foods 4 - To avoid binge-purge cycles

4 - To avoid binge-purge cycles Learning about scheduled balanced meals can help the patient to maintain a steady dietary regimen and avoid binge-purge cycles. Identifying trigger foods can be done by encouraging the patient to explore ideas about trigger foods. Including forbidden foods can be achieved by discussing the patient's irrational thoughts regarding those foods. Health effects of purging can be taught by educating the patient about the ill effects of induced vomiting. Text Reference - p. 345

What is a subjective symptom the nurse would expect to note during assessment of a patient with anorexia nervosa? 1 Lanugo 2 Hypotension 3 25-lb weight loss 4 Fear of gaining weight

Correct4 Fear of gaining weight Fear of gaining weight is the only subjective datum listed and is universally true. Text Reference - p. 334