Chapter 18 Feeding, Eating, and Elimination Disorders

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?

Anorexia Nervosa

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa?

Assist the patient to identify triggers to binge eating.

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction?

Cardiovacular

Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa ?

Risk for injury: electrolyte imbalance

Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of

an increased risk of seizures.

One bed is available on the inpatient eating disorders unit. Which patient should be admitted to this bed? The patient whose weight decreased from:

150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9 C; pulse, 38 beats/min; blood pressure 60/40 mm Hg

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate?

According to our agreement, no exercising is permitted until you have gained a specific amount of weight.

A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply.

Peripheral edema Constipation Hypotension Lanugo

Physical assessment of a patient diagnosed with bulimia often reveals:

Prominent parotid glands

A coping mechanism used excessively by clients with anorexia nervosa is

denial

Assessment of a client suspected of experiencing bulimia nervosa calls for the nurse to perform

inspection of the oral cavity.

The client with bulimia differs from the client with anorexia nervosa by

maintaining a normal weight.

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements.Within 1 week, the patient will:

Gain 1 to 2 pounds

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, Describe what you think about your present weight and how you look. Which response by the patient is most consistent with the diagnosis?

I am fat and ugly.

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges?

Imbalanced nutrition: less than body requirements

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?

Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, I wont eat until I look thin. Select the priority initial nursing diagnosis.

Imbalanced nutrition: less than body requirements related to self-starvation

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet 4 inches tall. Which term should be documented?

Lanugo

Brittany is caring for a patient with bulimia. She recognizes which of the following nursing interventions as being most appropriate?

Monitor the patient on bathroom trips after eating.

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient:

Not to skip meals or restrict food

Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight?

Observe for adverse effects or refeeding

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?

Patient expresses satisfaction with body appearance

A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain?

Patient involvement in decision making increases sense of control and promotes compliance with treatment.

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed?

The nurse interacts with the patient in a protective fashion.

Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa?

Weigh fully clothed before breakfast.

The nurse is planning care for a patient with a binge eating disorder. What outcomes are appropriate? Select all that apply.

a. the patient will identify stressors that lead to binge eating. b. the patient will identify four alternative coping skills.

Which of the following are true regarding feeding disorders in children? Select all that apply.

b. Feeding disorders are often manifested in children with developmental delays. d. In many cases, toddler mealtime difficulties spontaneously resolve with no intervention. e. Behaviors modification has been found to be effective in treating feeding disorders.

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply.

c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips

A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is a(n)

disruption of the fluid and electrolyte balance.

A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is

fear of gaining weight

In contrast to the client diagnosed with anorexia nervosa, the client diagnosed with bulimia usually

fits more easily into the family.

A client has been hospitalized with anorexia nervosa. The client's weight is 65% of normal. For this client, a realistic short-term goal for the first week of hospitalization would be: By the end of week 1, the client will

gain a maximum of 3 lb

A 5-year-old child was diagnosed with encopresis. Which assessment finding would the nurse expect associated with this diagnosis? The child:

has accidents of defecation at kindergarten three times a week.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when the client

has systolic blood pressure less than 70 mm Hg.

During assessment of a client with anorexia nervosa, it is not likely that the nurse would note indications of

high self-esteem

A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal

hypokalemia

A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will:

identify two alternative methods of coping with loneliness.

A client 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. The nursing diagnosis for this client would be

imbalanced nutrition: less than body requirements.

Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach? The patient:

now weighs 196 pounds.

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of:

promoting processing of anxiety associated with eating.

Biological theorists suggest that the cause of eating disorders may be

serotonin imbalance

The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by

teaching the family about the disorder and the client's behaviors.

A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient

"what do you eat in a typical day?"

Which assessment question should be asked of a client suspected of demonstrating characteristics of anorexia nervosa?

"How would you describe your body?"

Which statement is least likely to be made by a client diagnosed with bulimia nervosa during the assessment interview?

"I eat three meals each day and purge every evening."

While on an inpatient unit, you are caring for newly admitted Alyssa, a 16-year-old diagnosed with anorexia nervosa. Number the following nursing interventions in order of priority:

1. Initiate a therapeutic relationship 2. Assess for suicidal ideation 3. Promote caloric consumption 4. Explore feelings of underlying anxiety and low self-esteem 5. Review accomplishments made during treatment

An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should:

Assess lung sounds and extremities

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa?

Rigidity, perfectionism

Which intervention would be removed from the plan of care for a client diagnosed with bulimia nervosa?

Support importance of avoiding forbidden foods.

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?

Systolic blood pressure 62 mm Hg

A focus for the acute phase of treatment for anorexia nervosa would be

weight restoration.

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?

Being thin doesnt seem to solve your problems. You are thin now but still unhappy.

A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to:

How to recognize hypokalemia