Chapter 22 Eating Disorders
Which of the following terms describes a lack of clear role boundaries? A) Satiety B) Enmeshment C) Empathy D) Autonomy
Answer: B Enmeshment
The nurse is helping a patient with an eating disorder to accept the patient's body image. The patient must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? A) Being able to cope in healthy ways improves the ability to accept a realistic body image. B) Neurotransmitters that are deficient in patients with eating disorders prohibit the development of effective coping skills. C) When body image is positive, the patient will develop better coping skills. D) Coping skills are dependent on a supportive upbringing.
Answer: A Being able to cope in healthy ways improves the ability to accept a realistic body image.
Which intervention has been found to be most effective reducing the initial symptoms of bulimia? A) Cognitive behavior therapy and pharmacologic interventions B) Behavioral therapy and psychoeducation C) Clearly stated unit rules and a supportive milieu D) Daily monitoring of sound dietary practices and meditation sessions
Answer: A Cognitive behavior therapy and pharmacologic interventions
A patient with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the patient is 5' 8" tall and weighs only 90 lb. When considering the patient's unrealistic body image, which intervention should be included in the care plan? A) Compare specific measurement of the patient's body size with patient's perceived calculations B) Confronting the patient about her actual appearance during one-on-one sessions C) Asking the patient to compare her figure with magazine photographs of women her age D) Assigning the patient to group therapy in which participants provide realistic feedback about her weight
Answer: A Compare specific measurement of the patient's body size with patient's perceived calculations
A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? A) Dieting at an early age may lead to the development of eating disorders. B) Dieting during childhood can promote self-discipline in children who are obese. C) Dieting helps build a positive self-image in children. D) Dieting at an early age teaches healthy eating habits.
Answer: A Dieting at an early age may lead to the development of eating disorders.
During the assessment of a 16-year-old client suspected of having an eating disorder, the nurse asks the client to describe the her family. Which family process and characteristic is thought to contribute to eating disorders? A) Poor communication and enmeshed family dynamics B) Absence of a parent and/or the presence of a stepparent C) Passive parenting and lack of encouragement D) Emphasis of peer relationships over family relationships
Answer: A Poor communication and enmeshed family dynamics
A patient has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the patient? A) Self-monitoring B) Distraction C) Music therapy D) Guided imagery
Answer: A Self-monitoring
Fluoxetine includes a black box warning concerning which of the following? A) Suicidality in children and adolescents B) Stroke C) Renal failure D) Myocardial infarction
Answer: A Suicidality in children and adolescents
People diagnosed with bulimia nervosa may have lower levels of which neurotransmitter? A) serotonin B) gamma-amino- butyric acid (GABA) C) acetylcholine D) dopamine
Answer: A serotonin
A patient's diagnosis of anorexia nervosa is supported when the psychiatric nurse documents assessment data that includes which finding? Select all that apply. A) Patient is overheard telling other patients "I weigh myself three times a day when I'm home." B) Patient reports "being depressed." C) Patient has a history of "sleeping 9 hours a night and taking frequent naps." D) Patient reports that she "hasn't had a menstrual period in over 2 years."
Answer: A, B, D Patient is overheard telling other patients "I weigh myself three times a day when I'm home." Patient reports "being depressed." Patient reports that she "hasn't had a menstrual period in over 2 years."
Which behaviors are associated with purging? Select all that apply. A) Use of laxatives B) Self-induced vomiting C) Consuming large amounts of food D) Misuse of diuretics
Answer: A, B, D Use of laxatives, Self-induced vomiting, Misuse of diuretics
A nurse is developing a teaching plan for a patient with bulimia nervosa. Which topic(s) would the nurse include in this plan? Select all that apply. A) Limit setting B) Isometric exercise C) Realistic goal setting D) Hydration E) Assertiveness
Answer: A, C, D, E A) Limit setting, C) Realistic goal setting D) Hydration E) Assertiveness
A nurse is interviewing a patient and suspects an eating disorder. Which patient statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply. A) "Things being out of order really bothers me." B) "I consider myself a really laid-back individual." C) "I'll stand up for what I want, regardless of what you say." D) "Everything about my school work needs to be perfect." E) "I want things to be the way that I want them to be."
Answer: A, D, E "Things being out of order really bothers me." "Everything about my school work needs to be perfect." "I want things to be the way that I want them to be."
The nurse is teaching a patient with bulimia to use self-monitoring techniques. Which statement by the patient would let the nurse know that this has been effective? A) "I am keeping a record of everything I eat and how I am feeling every day." B) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." C) "I am beginning to understand how my lack of self-control is hurting me." D) "I am getting more comfortable confronting people when I have conflict with them."
Answer: B "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."
Which is a cardiac complication of an eating disorder? A) Hypertension B) Bradycardia C) Thrombocytopenia D) Enlarged heart
Answer: B Bradycardia
When working with the family of a patient with anorexia nervosa, which issue must be addressed? A) Self-discipline B) Control C) Sexual identity D) Codependence
Answer: B Control
Individuals with anorexia nervosa concentrate their efforts on what? A) Anxiety B) Controlling food intake C) Hunger D) Weakness
Answer: B Controlling food intake
A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find? A) Hyperkalemia B) Dry skin C) Tachycardia D) Over-sensitivity to heat
Answer: B Dry skin
A nurse is developing the plan of care for a patient with bulimia. Which intervention would the nurse most likely include? A) Encouraging patient take some time away from peers B) Increasing patient's coping skills for anxiety C) Communicating aggressively with the patient D) Nurturing the patient's need for dependency
Answer: B Increasing patient's coping skills for anxiety
The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks the student to step on the scale. The student asks if she can go to the bathroom first to empty her bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has: A) binge-eating disorder B) anorexia nervosa C) bulimia nervosa
Answer: B anorexia nervosa
During a therapy session, a patient 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? A) "I don't think that you are fat." B) "Has something occurred that caused you to measure your thighs?" C) "You have always been very focused on your thighs. Is that the part of your body that you like least?" D) "You need to look in the mirror. You thighs are smaller than my arms."
Answer: B "Has something occurred that caused you to measure your thighs?"
The nurse is performing the history and physical examination on a patient who is being admitted for anorexia nervosa. The patient is 5 feet 2 inches and weighs 88 pounds. The nurse assesses the patient'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? A) Condition of mouth and gums B) Heart rate and rhythm C) Throat and esophagus D) Patterns of activity and rest
Answer: B Heart rate and rhythm
During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a patient who is being treated with which medication? A) risperidone B) fluoxetine C) olanzapine D) ziprasidone
Answer: B fluoxetine
Individuals with anorexia nervosa often experience comorbid conditions. Which of the following would be most common? Select all that apply. A) Factitious disorder B) Obsessive compulsive disorder C) Panic disorder D) Depression E) Somatic symptom disorder
Answer: B, C, D Obsessive, compulsive disorder, Panic disorder, Depression
The nurse has been teaching a patient with bulimia about healthier eating patterns. Which statement by the patient indicates that the teaching has been effective? A) "I'll take my medication when I feel the urge to binge." B) "I know if I eat pasta, I'll binge." C) "I'll eat small meals and healthy snacks." D) "I'll limit my intake of carbohydrates and fats."
Answer: C "I'll eat small meals and healthy snacks."
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which class of medications can be used to treat eating disorders? A) Mood stablizers B) Antipsychotics C) Antidepressants D) Stimulants
Answer: C Antidepressants
A patient with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the patient is 5 feet 8 inches tall and weighs only 90 pounds. The nurse identifies this as reflecting what? A) Drive for thinness B) Interoceptive awareness C) Body image disturbance D) Perfectionism
Answer: C Body image disturbance
The mother of a 15-year-old patient expresses concern over the patient's eating and exercise habits. The mother says that as soon as the patient comes home from school, she exercises for 2 to 3 hours every day. She says the patient eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The patient was complaining of tooth pain, and when the mother took the patient to the dentist, the patient had over 10 cavities. Which disorder is the patient most likely suffering from? A) Binge eating disorder B) Anorexia nervosa C) Bulimia nervosa
Answer: C Bulimia nervosa
A patient meets some (but not all) of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the patient's weight is within the normal range. The nurse understands that based on DSM-5 criteria, this patient would most likely be diagnosed with which of following? A) Bulimia nervosa B) Anorexia nervosa C) Eating disorder not otherwise specified D) Binge eating disorder
Answer: C Eating disorder not otherwise specified
All of the following nursing diagnoses are appropriate for the care of a patient with anorexia nervosa. Which nursing diagnosis has the priority? A) Ineffective coping B) Chronic low self-esteem C) Imbalanced nutrition: less than body requirements D) Activity intolerance
Answer: C Imbalanced nutrition: less than body requirements
A mental health nurse is completing an initial assessment on a patient diagnosed with anorexia nervosa. Which of the following is a typical characteristic of parents of patients diagnosed with anorexia nervosa? A) A history of substance abuse B) Alternate between loving and rejecting their children C) Overprotect their children D) Maintain an emotional distance from their children
Answer: C Overprotect their children
The patient with bulimia reports feeling helpless and says, "What's the use?" As the nurse plans the client's care, the priority diagnosis is which? A) Nutrition: less than body requirements B) Ineffective individual coping C) Risk for self-directed violence D) Anxiety
Answer: C Risk for self-directed violence
A nurse is reviewing the medical records of several patients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa? A) The person is preoccupied with body image. B) The person judges worth based on a lack of fat. C) The person engages in episodic binge eating. D) The person has feeling of powerlessness.
Answer: C The person engages in episodic binge eating.
Which is most often the criterion for determining the effectiveness of treatment in the patient diagnosed with anorexia nervosa? A) Increased activity B) Mood elevation C) Weight gain D) Positive self-esteem
Answer: C Weight gain
What behavior is likely a result of an adolescent's attempt to manage the effects of over-controlling parenting? A) compulsively washing his or her hands B) becoming sexually promiscuous C) engaging in severe dieting D) socially withdrawing
Answer: C engaging in severe dieting
A patient with a long history of bulimia nervosa is seen in the emergency department. The patient is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this patient's symptoms? A) binging, which causes abdominal discomfort B) mood disorders, which often accompany the diagnosis of bulimia nervosa C) vomiting, which may lead to dehydration and electrolyte imbalance D) nutritional deficits, which are characteristic of bulimia nervosa
Answer: C vomiting, which may lead to dehydration and electrolyte imbalance
A patient on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The patient states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate? A) "I'll stand outside your door to give you privacy." B) "Thanks for checking in." C) "Let me know when you get back to the dayroom." D) "I will accompany you to the bathroom."
Answer: D "I will accompany you to the bathroom."
The nurse is sitting with the patient at mealtime. The nurse uses cognitive-behavioral approaches to assist the patient with bulimia toward recovery. Which statement by the nurse would be consistent with this approach? A) "Is this your way of showing your family that you can make decisions?" B) "You have to eat in moderation for good nutrition." C) "You seem to have a really hard time controlling your eating patterns." D) "Is there any way you can look at that sandwich as fuel for your body?"
Answer: D "Is there any way you can look at that sandwich as fuel for your body?"
A patient is diagnosed with mild anorexia nervosa based on body mass index (BMI). Which BMI would the nurse identify as reflecting mild anorexia nervosa? A) 16.75 kg/m2 B) 15.5 kg/m2 C) 16.1 kg/m2 D) 17.3 kg/m2
Answer: D 17.3 kg/m2
A patient is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this patient to fall within which age range? A) 5 to 10 years old B) 30 - 35 years old C) 10 to 14 years old D) 18 to 22 years old
Answer: D 18 to 22 years old
Which of the following patients being treated for anorexia nervosa displays assessment values that warrant hospitalization? A) A 10 - year-old whose weight has remained unchanged in spite of a 3 - inch growth spurt. B) A 32-year-old with a temperature of 98 F and a pulse rate of 54. C) A 16-year-old with a serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg. D) A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level of 1.2 mg/dL.
Answer: D A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level of 1.2 mg/dL.
A patient is an overweight 32-year-old who regularly binges on large amounts of food. After the patient binges, the patient feels guilty and ashamed about eating the food. Despite the bad feelings, the patient binges almost daily. Which would the nurse most likely suspect? A) Bulimia nervosa B) Eating disorder not otherwise specified C) Anorexia nervosa D) Binge eating disorder
Answer: D Binge eating disorder
A patient is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment? A) Hypertension B) Heat intolerance C) Complaints of heartburn D) Bradycardia
Answer: D Bradycardia
A patient has an eating disorder characterized by consuming an amount of food much larger than a person would normally eat. Afterward, the patient often purges the food or exercises excessively. Between binges, the patient often eats low-calorie foods or fasts. What is the patient's most likely diagnosis? A) Pica B) Rumination C) Anorexia nervosa D) Bulimia nervosa
Answer: D Bulimia nervosa
Which statement best describes the etiology of eating disorders? A) Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component. B) Eating disorders result from family dysfunction involving a controlling mother; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. C) Eating disorders involve a weak ego, resulting from a individual's unfulfilled sense of separation-individuation in early childhood. D) Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.
Answer: D Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.
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) Moist skin B) Tachycardia C) Wearing tight-fitting clothing D) Excessive exercise
Answer: D Excessive exercise
Exacerbation of anorexia nervosa results from the patient's effort to do what? A) Diminish conflict B) Manipulate family members C) Live up to family expectations D) Gain control of one part of life
Answer: D Gain control of one part of life
While assessing the family dynamics of a patient with an eating disorder, which does the nurse most likely discover? A) Supportive and encouraging relationships B) Lack of interest in the patient by other family members C) Multiple siblings D) Overcontrolling parents
Answer: D Overcontrolling parents
A 16-year-old with anorexia nervosa is admitted to the unit. Which is the most appropriate short-term outcome? A) The patient will identify problems and potential alternative coping strategies. B) The patient will accept the self as having value and worth. C) The patient will follow a nutritionally balanced diet for the patient's age. D) The patient will admit a fear of gaining weight.
Answer: D The patient will admit a fear of gaining weight.
After complaining of weakness and confusion while at school, a 16-year-old patient with bulimia was admitted to the hospital where admission assessments revealed hypokalemia. In planning the patient's nursing care and treatment, which outcome should be prioritized? A) The patient will identify alternatives to current coping patterns. B) The patient will acknowledge self-harm thoughts. C) The patient will verbalize fears relating to his health needs. D) The patient will be free of self-induced vomiting.
Answer: D The patient will be free of self-induced vomiting.
A patient is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The patient believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this patient is: A) eating disorder not otherwise specified B) anorexia nervosa, binge eating, and purging type C) bulimia nervosa, nonpurging type D) anorexia nervosa, restricting type
Answer: D Anorexia nervosa, restricting type
Family-based theories of causality propose that eating disorders develop how? A) Due to the socialization of girls to evaluate themselves against certain "idealized" standards of appearance B) As an attempt for the child to get attention from disinterested parents C) In response to pressure by the parents to have a thin, attractive daughter D) As a way for the child to feel a sense of control in response to controlling parents
Answer: D As a way for the child to feel a sense of control in response to controlling parents
The immediate goal of nursing interventions in the care of a patient with anorexia nervosa is which of the following? A) Gaining insight into the effects of anorexia on her physical health B) Establishing a target weight to be achieved by discharge C) Changing her irrational thinking about her body D) Restoring nutritional status to normal
Answer: D Restoring nutritional status to normal