Chapter 21 Eating Disorders
The diagnosis of ____________________ nervosa includes the symptoms of gross distortion of body image, preoccupation with food, and refusal to eat.
Answer: Anorexia Feedback: Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat.
The nurse is teaching about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia. Which information should the nurse include? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.
Answer: 1 Rationale: 1 The nurse would include that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia usually do not. 2 Clients with anorexia can experience amenorrhea, clients with bulimia do not. 3 Clients with bulimia nervosa typically do not experience these symptoms. Hypotension, edema, and lanugo are experienced by clients with anorexia nervosa. 4 Clients with bulimia often have tooth enamel erosion, as do clients with anorexia nervosa. This is not a distinguishing factor.
The client's altered body image is evidenced by claims of "being obese," even though the client is emaciated. Which outcome criterion is appropriate for this client's problem? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will verbally state a misperception of body image as "fat." 4. The client will not express a preoccupation with food.
Answer: 3 Rationale: 1 Consuming adequate calories to sustain a normal weight may be unrealistic for this client. 2 Ceasing strenuous exercise programs may be unrealistic for this client. 3 The nurse should identify that the appropriate outcome for this client is to verbally state a misperception of body image as "fat." 4 Not expressing a preoccupation with food may be unrealistic for this client.
The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed ____________________.
Answer: binging Feedback: The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed binging. Binging is a classic symptom of the eating disorder defined as bulimia nervosa. The binging episodes often occur in secret and involve high calorie foods with a sweet taste and a soft/smooth texture so that chewing is minimal.
To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in ____________________ behaviors, which include self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Answer: purging Feedback: To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in purging behaviors, which include self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In addition to these behaviors, other inappropriate compensatory behaviors, such as fasting or excessive exercise, may be used.
The nurse is caring for a client diagnosed with binge eating disorder (BED). Which medication should the nurse administer to the client to decrease binging? 1. Lisdexamfetamine (Vyvanse) 2. Chlorpromazine (Thorazine) 3. Haloperidol (Haldol) 4. Diazepam (Valium)
Answer: 1 Rationale: 1 The nurse should administer lisdexamfetamine. Lisdexamfetamine has been FDA-approved specifically for short-term treatment of BED to reduce binge eating and weight gain. 2 Chlorpromazine, an antipsychotic, is ineffective for treatment of BED. 3 Haloperidol, an antipsychotic, is not appropriate treatment for BED. 4 Valium, an antianxiety and benzodiazepine, is not effective for BED.
The nurse is teaching a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide? 1. The emesis is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries.
Answer: 1 Rationale: 1 The nurse should explain to the client diagnosed with bulimia nervosa that his or her teeth will eventually deteriorate, because the emesis produced during purging is acidic from the gastric acid and corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance. 2 While electrolyte imbalances can occur with purging, this does not correlate with tooth enamel deterioration. 3 While food can be rapidly ingested during binging, this does not lead to tooth enamel deterioration. 4 This statement does not educate the client about tooth enamel deterioration caused by vomiting in bulimia. While poor oral hygiene can lead to dental caries, it does not explain the deterioration in bulimia.
The adolescent diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "Since going back to school, I am nervous, get apprehensive, and have a hard time eating food." Which nursing diagnosis would take priority at this time? 1. Imbalanced nutrition: less than body requirements 2. Disturbed body image/Low self-esteem 3. Impaired verbal communication 4. Anxiety
Answer: 4 Rationale: 1 Imbalanced nutrition: less than body requirements is not the priority at this time. The adolescent has been medically cleared. There is no evidence that the client is refusing to eat, abusing laxatives/diuretics, or losing 15% of expected body weight. 2 Disturbed body image/Low self-esteem is not the priority at this time. There is no evidence that the client has a distorted body image, views self as fat, or has difficulty accepting positive reinforcement. 3 Impaired verbal communication is not the priority at this time. There is no evidence that the client has problems communicating verbally. 4 The priority diagnosis is anxiety. The client is exhibiting evidence of anxiety, such as nervousness, apprehension, and increased difficulty taking oral nourishment.
An adolescent is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. Which body mass index (BMI) measurement would the nurse observe upon assessment of this client? 1. 30 2. 24 3. 20 4. 16
Answer: 4 Rationale: 1 Obesity, not anorexia nervosa, is defined as a BMI of 30.0 or greater. 2 A BMI of 24 is in the normal range for BMI. 3 A BMI of 20 is indicative of a normal finding, not anorexia nervosa. 4 Anorexia nervosa is characterized by a BMI of 17 or lower. In extreme anorexia nervosa, the BMI may be less than 15.
The nurse is caring for a client with anorexia nervosa. Which nursing interventions would the nurse add to the plan of care? (Select all that apply.) 1. Minimize the focus on food and eating 2. Limit mealtime to 30 minutes 3. Monitor for 30 minutes after eating 4. Weigh client weekly 5. If weight loss occurs, bargain for restrictions
Answer: 1, 2 Rationale: 1 The nurse would minimize the focus on food and eating because the real issues have little to do with food or eating patterns. Focus on the control issues that have precipitated these behaviors. 2 The nurse would limit mealtimes to 30 minutes since lengthy mealtimes put excessive focus on food and eating and provide the client with attention and reinforcement. 3 The nurse would monitor the client for at least 1 hour (not 30 minutes) after mealtimes to prevent the client from discarding food stashed from the tray or engaging in self-induced vomiting. 4 The nurse would weigh the client daily, not weekly, immediately upon arising and following first voiding, using the same scale. 5 The nurse would enforce restrictions, not bargain, if weight loss occurs. Restrictions and limits must be established and carried out consistently to avoid power struggles.
The family of a teenager diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting to implement the Maudsley approach. Which is the appropriate nursing response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "For the plan to be successful, we need your involvement. The parents establish the rules and guidelines around eating." 3. "While the client is the primary focus, this meeting will provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."
Answer: 2 Rationale: 1 This statement is not therapeutic to the family and gives incorrect information regarding the Maudsley approach. 2 In the Maudsley approach Phase I is focused on weight restoration, and in this phase, the parents are actively engaged in establishing the rules and guidelines around eating. Parents often need a lot of support during this phase because they typically encounter frequent power struggles with their child. 3 This statement is untrue, as the meeting is about more than providing the child with family support. 4 This statement does not describe the Maudsley approach correctly and may cause family members to become defensive.
The nurse is teaching about the DSM-5 criteria for the diagnosis of binge eating disorder. Which statements by the staff indicate successful teaching? (Select all that apply.) 1. "Binge eating occurs exclusively during the course of bulimia nervosa." 2. "Binge eating occurs, on average, at least once a week for three months." 3. "Binge eating occurs because of an intense fear of becoming fat." 4. "Marked distress regarding binge eating is present." 5. "Marked distress regarding purging is present."
Answer: 2, 4 Rationale: 1 This statement does not indicate effective teaching. According to the DSM-5 criteria for the diagnosis of binge-eating disorder, binge eating should not occur exclusively during the course of anorexia nervosa or bulimia nervosa. 2 This statement regarding binge eating is accurate, indicating that teaching has been effective. 3 This statement does not indicate successful teaching. According to the DSM-5, an intense fear of becoming fat is associated with anorexia nervosa, not binge eating disorder. 4 This statement indicates that teaching has been effective because marked distress regarding binge eating is present according to the DSM-5. 5 This statement does not indicate successful teaching. The DSM-5 criteria for binge eating disorder does not include purging. Purging occurs with anorexia nervosa binge-eating/purging type or with bulimia nervosa's inappropriate compensatory behavior of self-induced vomiting.
The client diagnosed with bulimia nervosa has been attending an outpatient mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? 1. Gained two pounds in one week 2. Focused conversations on nutritious food 3. Demonstrated healthy coping mechanisms that decreased anxiety 4. Verbalized an understanding of the etiology of the disorder
Answer: 3 Rationale: 1 Gaining two pounds in one week is not an appropriate indicator of a positive client behavioral change. Most individuals with bulimia are within a normal weight range—some slightly underweight, some slightly overweight. Gaining weight is a positive behavioral change for a client with anorexia nervosa. 2 Focusing conversations on nutritious foods is not an appropriate indicator of a positive client behavioral change. 3 The nurse should identify that a client who demonstrates healthy coping mechanisms to decrease anxiety indicates a positive behavioral change. Stress and anxiety can increase binging, which is followed by inappropriate compensatory behavior, like purging. 4 Verbalizing an understanding of eating disorders is important, but it is not an appropriate indicator of a positive client behavioral change. Verbalizing understanding does not indicate a behavioral change.
Which historical perspective would the nurse include when teaching about the home environment and the development of anorexia nervosa? 1. Maintains loose personal boundaries 2. Places an overemphasis on food 3. Is overprotective with emphasis on perfection 4. Condones corporal punishment
Answer: 3 Rationale: 1 A home environment that maintains loose personal boundaries is not a historical perspective in the development of anorexia nervosa. 2 A home environment that places an overemphasis on food is not a historical perspective in the development of anorexia nervosa. 3 The nurse would include that a home environment that is overprotective and demands perfection is a historical perspective that has been shown to negatively influence care. The American Academy for Eating Disorders (AED) stands firmly against any model of eating disorders in which blame is assigned to the family. The AED recommends that family be included in the recovery process. 4 A home environment that condones corporal punishment does not typically lead to anorexia nervosa and is not a historical perspective in the development of anorexia nervosa.
The nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. What is the priority rationale for this treatment? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's psychotic behaviors. 4. It allows clients to maintain control.
Answer: 4 Rationale: 1 Behavior modification does not help the client correct distorted body image. Behavior modification techniques are helpful for weight restoration only. 2 Behavior modification does not help the client address underlying client anger. Behavior modification techniques are helpful for weight restoration only. 3 Behavior modification does not help the client manage psychotic behaviors. There is no psychosis in eating disorders. Behavior modification techniques are helpful for weight restoration only. 4 Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders, because these programs allow clients to maintain control for weight restoration. Issues of control are central to the etiology of these disorders. The importance of instituting a behavior modification program with these clients is to ensure that the program does not "control" them.
