CHAPTER 20 PREPU

A nurse is assessing a client for an eating disorder. Which screening question made by the nurse would assess for a possible eating disorder in the client?

"Do thoughts about food, weight, dieting, or eating dominate your life?"

During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?

"Has something occurred that caused you to measure your thighs?"

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse?

"I realize this must be very difficult for you but try to remember I'm not your enemy."

A client diagnosed with anorexia nervosa has regained weight and is being discharged to an outpatient program. Which statement made by the client would indicate the need for further teaching?

"I will go to all my support groups so that I don't need to go to therapy."

Which nursing statement is most effective in communicating a positive expectation of the client?

"I will sit here quietly with you while you eat."

A psychiatric-mental health nurse is presenting to community members about eating disorders, including cultural considerations. Which statement made by a community member would indicate a need for further education?

"Immigrants from cultures in which eating disorders are rare will not develop an eating disorder as they assimilate into other cultures."

The nurse has conducted a community health fair about eating disorders. After the teaching, a community resident approaches the nurse and states that they are concerned about a family member having a possible eating disorder. Which advisement made by the nurse to the resident would be appropriate?

"Tell your family member that you are concerned and would like to help."

An outpatient client diagnosed with anxiety, depression, and anorexia nervosa is receiving treatment to develop healthy coping skills. The client has recently lost more weight. Which statement made by the nurse would be appropriate?

"What stressors are you currently experiencing?"

A counselor is conducting a psychotherapy session with a client diagnosed with depression and anorexia nervosa. Which statement made by the counselor would assess the client's personal strengths?

"When you are successful in your life, how do you reward yourself?"

A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which characteristic would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply.

- Body dissatisfaction - Obsessiveness - Cognitive distortions

The nurse is assessing a client with bulimia nervosa. Which finding(s) supports this diagnosis? Select all that apply.

- erosion of dental enamel - callous on the dorsal hand surface - poor skin turgor - electrocardiogram changes

When reviewing the documented history of an adult client with anorexia nervosa, what is the nurse most likely to find? (Select all that apply.)

- food restriction began at age 15 - depression at age 16 lasting one month - reported believing that friends were "jealous" of her body

The nurse is assessing a client with anorexia nervosa. Which statement(s) by the client will likely support this diagnosis? Select all that apply.

-"I don't know what the fuss is about, I'm too fat to be a model." -"I know some friends; I just don't hang out or talk to them."

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect?

Binge eating disorder

A college student has been referred to the clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what?

Body weight significantly below ideal for height and age

Which is a cardiac complication of an eating disorder?

Bradycardia

The dentist of a client noticed that the client's teeth were losing enamel. The client is of average weight. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with enamel loss?

Bulimia nervosa, purging type

A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment?

Cardiac assessment and measurement of electrolyte levels

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

Cognitive behavior therapy and pharmacologic interventions

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions?

Cognitive-behavioral therapy (CBT) including self-monitoring

Individuals with anorexia nervosa concentrate on which body cue?

Controlling food intake

A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected?

Dental erosion and chronic edema

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression

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?

Encourage the entire family to engage in a balanced and regular dietary pattern.

For a client diagnosed with anorexia nervosa, which goal takes priority?

Establishing adequate daily nutritional intake

Exacerbation of anorexia nervosa results from the client's effort to do what?

Gain control of one part of life

The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next?

Heart rate and rhythm

Which area of the brain has been associated with the symptoms of eating disorders?

Hypothalamus

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find?

Impulsivity

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include?

Increasing client's coping skills for anxiety

A psychiatric-mental health nurse is self-reflecting on their own feelings while caring for clients diagnosed with an eating disorder. Which point is important to consider when self-reflecting as a health care professional?

Keep in mind the client's perspective and fears while gaining weight.

A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client?

Self-monitoring

Which technique is a type of cognitive behavioral therapy implemented for bulimic clients?

Self-monitoring

An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care?

Set up a strict eating plan for the client

A hospitalized client weighs 72% of their ideal body weight. What is the priority consideration for the nurse in the planning process?

Slowly introduce calories.

A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. The client doesn't want to feel fat in a bathing suit on vacation. The client's sodium level is 150 mEq/L; potassium level is 3.2 mEq/L. The client is 5 feet tall, weighs 100 pounds, and has lost 15 pounds in 3 weeks. Which goal is a priority at this time?

Stabilize electrolyte levels.

A client with bulimia is being discharged from care. The nurse considers which indicator most important when evaluating the effectiveness of the care plan?

The client eats six small meals per day.

A nurse is reviewing the medical records of several clients being treated for eating disorders at the community mental health center. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa?

The client is of normal body weight.

The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care?

The client will verbalize acceptance of appearance.

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa?

Weight gain

An adult client diagnosed with anorexia nervosa weighs in at the outpatient clinic as underweight according to their height. The client has not gained any weight for the last two weight checks and is currently being treated with psychotherapy sessions. Which medication will the nurse anticipate being ordered for the client to promote weight gain?

amitriptyline

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting?

engaging in severe dieting

A client diagnosed with anorexia nervosa is being prescribed a medication. Which medication would the nurse prepare for the client?

fluoxetine

The nurse provides care to an adolescent client who presents to the emergency department (ED) after losing consciousness during a marching band performance. A differential diagnosis of anorexia nervosa is documented by the practitioner. Which finding noted when reviewing the client's laboratory data indicates a need for hospitalization?

hypokalemia

A nurse has conducted an education session for parents with children at risk for eating disorders. Which topic would be included in the education session for the parents?

identifying signs and symptoms of eating disorders

An adolescent client is diagnosed with an eating disorder. The client has been restricting intake for 4 months, and the client does not binge and purge. The parents are agreeable to family therapy. Which type of treatment setting is most appropriate for the client?

outpatient therapy

When working with a client with bulimia, the nurse should encourage the client to keep a diary or journal for what reason?

to improve coping through behavioral changes