Chapter 20 Eating Disorders

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which comment indicates that the client may be suffering from anorexia nervosa? a. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." b. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." c. "I do diet around my periods; otherwise, I just get so bloated." d. "I like the way I look, but I just need to keep my weight down because I'm a cheerleader."

a. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." (Rationale: Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Most clients with anorexia nervosa do not like the way they look, and their self-perception may be distorted. Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.)

A client is receiving treatment for anorexia nervosa, and the nurse observes that the client has consumed a healthy meal without providing any resistance. How should the nurse respond? a. Directly acknowledge the client's positive behavior. b. Challenge the client to double his food intake the following day. c. Ask the client why he has not previously been eating this way. d. Document the client's apparent recovery in the electronic health record.

a. Directly acknowledge the client's positive behavior. (Rationale: The nurse should give the client positive support and honest praise for accomplishments. A single meal does not constitute recovery, and it is likely unrealistic to expect the client to double his food intake the following day.)

For a client with anorexia nervosa, which goal takes the highest priority? a. Verbalizing the possible physiologic consequences of self-starvation b. Developing a contract with the nurse that sets a target weight c. Establishing adequate daily nutritional intake d. Identifying self-perceptions about body size as unrealistic

a. Establishing adequate daily nutritional intake (Rationale: According to Maslow's hierarchy of needs, physiologic needs are the most basic. Adequate daily intake of food and fluids would be the highest priority for this client.)

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. She is 5'5" tall and weighs 75 pounds. Which of the following is the highest priority nursing intervention? a. Initiating total parenteral nutrition as ordered b. Assessing the client's food preferences c. Initiating cognitive-behavioral therapy as ordered d. Addressing the client's low self-esteem

a. Initiating total parenteral nutrition as ordered (Rationale: Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. Medical management focuses on weight restoration, nutritional rehabilitation, and correction of electrolyte imbalance. This acute physiologic need is prioritized over psychosocial assessments, even though these are important. Identifying food preferences is unlikely to change the client's eating patterns.)

A client has been diagnosed with anorexia nervosa. To assist the client to cope with her disease process, the client will complete which of the following actions? a. Keeping a journal and discussing it with the nurse b. Temporarily withdrawing from social contact c. Drinking 4 L of fluid per day d. Avoiding mirrors and reflective surfaces

a. Keeping a journal and discussing it with the nurse (Rationale: Recording and discussing feelings are a constructive way to manage stress. Increasing fluid intake may be an attempt to artificially increase her weight. Withdrawal from social contact is not normally necessary, and the client is not required to avoid looking at her body.)

A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5'8" tall and weighs only 90 pounds. Considering the client's unrealistic body image, which intervention should be included in the care plan? a. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy. b. Asking the client to compare her figure with magazine photographs of women of her age. c. Assigning the client to group therapy in which participants provide realistic feedback about her weight. d. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift.

a. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy. (Rationale: The client needs assistance with making decisions about nutritious foods to keep her healthy. Attempts to help the client view her body realistically and rationally are frequently unsuccessful.)

Which of the following is a typical characteristic of parents of clients diagnosed with anorexia nervosa? a. Maintenance of emotional distance from their children b. A tendency to overprotect their children c. Alternation between loving and rejecting their children d. A history of substance abuse

b. A tendency to overprotect their children (Rationale: Some families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. This family characteristic is known to be a risk factor for anorexia nervosa.)

Which of the following is a metabolic complication related to excessive weight loss? a. Leukopenia b. Hypothyroidism c. Bradycardia d. Amenorrhea

b. Hypothyroidism (Rationale: Hypothyroidism is a metabolic complication related to weight loss. Bradycardia, amenorrhea, and leukopenia are not metabolic complications of weight loss.)

A client is being assessed for suspected bulimia nervosa and admits to a pattern of binge eating. What further assessment finding would confirm a diagnosis of bulimia? a. A weight loss of more than 40 pounds over the previous 6 months b. Inappropriate behaviors aimed at avoiding weight gain c. Frequent physical exercise d. Persistent fluid and electrolyte imbalances

b. Inappropriate behaviors aimed at avoiding weight gain (Rationale: Bulimia is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain. Exercise is not necessarily considered to be an inappropriate compensatory behavior. Weight loss and electrolyte imbalances can have many causes apart from bulimia.)

An adolescent female has been diagnosed with anorexia nervosa. Which of the following interventions should be included in the client's plan of care? a. Encourage the client to exercise in order to reduce anxiety. b. Provide frequent feedback to the client on her behaviors. c. Restrict visits with the family until the client begins to eat. d. Provide privacy during meals.

b. Provide frequent feedback to the client on her behaviors. (Rationale: The client should be given frequent feedback on her behaviors. The family should be included in the client's care. The client should be monitored during meals and not given privacy. Exercise must be limited and supervised.)

The nurse is planning the care for a client with an eating disorder. Which of the following should not be included in the client's care plan? a. Sitting with the client during meals and snacks b. Weighing the client after each meal c. Being alert for attempts to hide or discard food or to inflate weight d. Observing the client following meals and snack for 1 to 2 hours

b. Weighing the client after each meal (Rationale: Weighing the client frequently puts emphasis on weight and should not be included as an intervention for a client with an eating disorder. Interventions that should be implemented include sitting with the client during meals and snacks, observing the client following meals and snack for 1 to 2 hours, and being alert for attempts to hide or discard food or to inflate weight.)

Which of the following is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? a. Mood elevation b. Weight gain c. Increased activity d. Positive self-esteem

b. Weight gain (Rationale: Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.)

What is the percentage of clients who had been diagnosed with bulimia nervosa but who have fully recovered later relapse? a. 50% b. 23% c. 33% d. 10%

c. 33% (Rationale: One third of fully recovered clients with bulimia nervosa eventually relapse.)

A client is being seen in the health clinic. During the nursing assessment, the client states that she has had amenorrhea for the last 6 months. She weighs 80 pounds and is 5'2" tall. She states that she usually eats salads so that she does not gain weight. The nurse suspects that the client most likely has what health problem? a. Anxiety disorder b. Bulimia nervosa c. Anorexia nervosa d. Depression

c. Anorexia nervosa (Rationale: Anorexia nervosa is a life-threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal bodyweight, 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. Bulimia nervosa 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. Although depression and anxiety may accompany eating disorders, this particular situation is indicative of anorexia.)

An adolescent client is being admitted to the psychiatric unit for treatment of an eating disorder. Her admission interview reveals a history of recurrent episodes of binge eating and self-induced vomiting. The client states that she wants to go to the store "just to grab a quick snack." How should the nurse respond to the client's statement? a. Set a specific time for the client to return. b. Distract the client. c. Deny the client's request. d. Insist that the client choose a healthy snack.

c. Deny the client's request. (Rationale: Clients with bulimia nervosa require firm limits around the content and setting of food intake. It would be inappropriate for the client to independently purchase food while receiving inpatient care.)

During a family meeting for a client with an eating disorder, it becomes apparent that the family lacks clear role boundaries. The nurse should recognize what phenomenon? a. Potential abuse b. Autonomy c. Enmeshment d. Satiety

c. Enmeshment (Rationale: Enmeshment is a lack of clear role boundaries. Autonomy is exerting control over oneself. Satiety is satisfaction of appetite. Unclear boundaries do no necessarily suggest the presence of abuse.)

The nurse is caring for a client who has been diagnosed with bulimia nervosa. All of the following behaviors are associated with purging in this disease process except which of the following? a. Misuse of diuretics b. Overuse of laxatives c. Excessive exercise d. Self-induced vomiting

c. Excessive exercise (Rationale: Purging means the compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics. Exercise may be a compensatory behavior, but is not an example of purging.)

The nurse is planning the care for a client with anorexia nervosa. The nurse should recognize that the client's behavior most likely has what motivation? a. Manipulating her family members or friends b. Diminishing the likelihood of conflict c. Gaining control of one part of her life d. Living up to her family's expectations

c. Gaining control of one part of her life (Rationale: A client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. The eating disorder carries with it a high incidence in families that emphasize achievement.)

The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder? a. The client is tachycardic. b. The client has moist skin. c. The client often performs excessive exercise. d. The client wears tight-fitting clothing.

c. The client often performs excessive exercise. (Rationale: Clients with eating disorders utilize excessive exercise to burn as many calories as possible. Medical complications of eating disorders include bradycardia; hypotension; and dry, cracking skin due to dehydration. The client will typically wear loose-fitting clothes to hide his or her body.)

Which of the following goals should guide the nursing care for a client with anorexia nervosa? a. The client will interact frequently with other clients. b. The client will acknowledge the pathophysiology of her disease. c. The client will acknowledge areas of personal strength. d. The client will demonstrate an ability to cook healthy meals.

c. The client will acknowledge areas of personal strength. (Rationale: Nurses can assist in recovery from eating disorders by helping clients to recognize and acknowledge their positive qualities apart from body image and food. Cooking healthy meals does not necessarily equate to consuming healthy meals. Pathophysiology and frequent social interaction are not high priorities.)

When working with a client who has bulimia nervosa, the nurse should recognize that the client likely has what comorbid diagnosis? a. Borderline personality disorder b. Psychosis c. Avoidant personality disorder d. Depression

d. Depression (Rationale: Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.)

All but which of the following characteristics are associated with both bulimia and anorexia? a. Perfectionism b. Obsessive-compulsiveness c. Harm avoidance d. High impulsivity

d. High impulsivity (Rationale: Clients with bulimia often have a history of impulsive behavior, such as substance abuse and shoplifting, as well as anxiety, depression, and personality disorders. Perfectionism, harm avoidance, and obsessive-compulsiveness are associated with both eating disorders. Clients with anorexia tend to be self-disciplined and methodical rather than impulsive.)

The nurse is caring for a client diagnosed with bulimia. What is the most appropriate initial goal for a client diagnosed with bulimia? a. Avoid shopping for large amounts of food. b. Control eating impulses. c. Eat several small meals each day. d. Identify anxiety-causing situations.

d. Identify anxiety-causing situations. (Rationale: Clients with eating disorders seem sad, anxious, and worried. Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping patterns is not a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the care plan after initially addressing stress and underlying issues. Eating frequent, small meals is not a component of treatment.)

A client has been admitted to the psychiatry unit for the treatment of anorexia nervosa. How should the nurse best organize the client's initial nursing care? a. Ask the client which nurse she would prefer. b. Assign two nurses to the client for the first 3 to 4 days of treatment. c. Arrange for a different nurse to care for the client each day. d. Limit the number of staff assigned to and interacting with the client.

d. Limit the number of staff assigned to and interacting with the client. (Rationale: Initially, limit the number of staff assigned to and interacting with the client, and then gradually increase the variety of staff interacting with the client. The client would not be invited to choose a nurse, and multiple nurses are not needed.)

The emergency department nurse is assessing a client who has a recent history of bulimia nervosa. What objective assessment should the nurse prioritize? a. Oxygen saturation b. Temperature c. White blood cell count d. Potassium level

d. Potassium level (Rationale: Purging can result in severe electrolyte imbalances, which would be evidenced by hypokalemia. The client's oxygen levels, white cells, and temperature are less likely to be affected.)