Chapter 26: Eating Disorders: Nursing Care of Persons with Eating and Weight-Related Disorders
A client is diagnosed with anorexia nervosa, restricting type. The nurse interprets this as indicating the use of which of the following? Select all that apply. - Dieting - Exercising - Laxatives - Diuretics - Enemas
Answer: - Dieting - Exercising
Assessment of a client with an eating disorder reveals the need for hospitalization. Which finding would support this need? Select all that apply. - Heart rate near 40 beats/min - Hypokalemia - Blood pressure less than 80/50 mm Hg - Poor motivation to recover - Hypomagnesemia
Answer: - Heart rate near 40 beats/min - Hypokalemia - Blood pressure less than 80/50 mm Hg - Poor motivation to recover - Hypomagnesemia
Individuals with anorexia nervosa often experience comorbid conditions. Which of the following would be most common? Select all that apply. - Panic disorder - Obsessive compulsive disorder - Depression - Somatic symptom disorder - Factitious disorder
Answer: - Panic disorder - Obsessive compulsive disorder - Depression
The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective? A.) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." B.) "I am beginning to understand how my lack of self-control is hurting me." C.) "I am keeping a record of everything I eat and how I am feeling every day." D.) "I am getting more comfortable confronting people when I have conflict with them."
Answer: A.) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."
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 like the way I look. I just need to keep my weight down because I'm a cheerleader." C.) "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." D.) "I do diet around my periods; otherwise, I just get so bloated."
Answer: A.) "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."
The nurse is sitting with the client at mealtime. The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach? A.) "Is there any way you can look at that sandwich as fuel for your body?" 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 this your way of showing your family that you can make decisions?"
Answer: A.) "Is there any way you can look at that sandwich as fuel for your body?" Rationale: CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual to guide treatment. CBT strategies focus on the client's thinking (cognition) and actions (behavior) about food. Cautioning the client to eat in moderation is non-therapeutic because it does not give the client tools to achieve this outcome. The nurse's statement about lack of control of eating patterns is similar in that it does not give the client cognitive and behavioral tools to effect change. The question "Is this your way of showing your family that you can make decisions?" does not exemplify a CBT approach because it requires the client to spontaneously identify the underlying motivation; it does not provide tools to address the client's thinking.
A client with a history of anorexia nervosa comes to the clinic for evaluation. During the visit, the client's body mass index (BMI) is obtained. The nurse determines that treatment has been effective based on which BMI measurement? A.) 19.2 kg/m2 B.) 17.0 kg/m2 C.) 16.5 kg/m2 D.) 15.9 kg/m2
Answer: A.) 19.2 kg/m2
Which of the following clients being treated for anorexia displays assessment values that warrant hospitalization? A.) A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL B.) A 32-year-old with a temperature of 98°F and a pulse rate of 54 C.) A 16-year-old with serum potassium of 3.8 mEq/L and a BP of 98/66 mmHg D.) A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt
Answer: A.) A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL Rationale: Criteria for hospitalization include: acute weight loss, <85% below ideal; heart rate near 40 beats/min; temperature,b <36.1°C; blood pressure, <80/50 mm Hg; hypokalemia; hypophosphatemia; hypomagnesemia. The client with a weight 70% of ideal and magnesium level of 1.2 mg/dL (low) fits the criteria.
A client is being seen in the health clinic. During the nursing assessment, the client states that she has 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 ... A.) Anorexia nervosa B.) Bulimia nervosa C.) Depression D.) Anxiety disorder
Answer: A.) Anorexia nervosa
A client 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 client 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 client is what? A.) Anorexia nervosa, binge eating, and purging type B.) Anorexia nervosa, restricting type C.) Bulimia nervosa, nonpurging type. D.) Eating disorder not otherwise specified
Answer: A.) Anorexia nervosa, binge eating, and purging type
A 15-year-old is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? A.) Body weight less than normal for age, height, and overall physical health B.) Irregular menstrual cycles C.) Absence of hunger feelings D.) Erosion of dental enamel
Answer: A.) Body weight less than normal for age, height, and overall physical health Rationale: Clients with anorexia nervosa have a body weight that is less than the minimum expected weight, considering their age, height, and overall physical health. Physical problems of anorexia nervosa include amenorrhea a characteristic that goes beyond simply having irregular cycles. These clients do not lose their appetites. They still experience hunger but ignore it and signs of physical weakness and fatigue. Dental erosion is characteristic of bulimia nervosa because this disorder involves vomiting of acidic stomach contents.
Which is a cardiac complication of an eating disorder? A.) Bradycardia B.) Hypertension C.) Enlarged heart D.) Thrombocytopenia
Answer: A.) Bradycardia
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.) Daily monitoring of sound dietary principles and meditation sessions D.) Clearly stated unit rules and a supportive milieu
Answer: A.) Cognitive behavior therapy and pharmacologic interventions
Individuals with anorexia nervosa concentrate on which body cue? A.) Controlling food intake B.) Hunger C.) Weakness D.) Anxiety
Answer: A.) Controlling food intake
A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? A.) Increasing client's coping skills for anxiety B.) Communicating aggressively with the client C.) Encouraging client take time away from peers for a time D.) Nurturing the client's need for dependency
Answer: A.) Increasing client's coping skills for anxiety
A mental health nurse is completing an initial assessment on a client diagnosed with anorexia nervosa. Which of the following is a typical characteristic of parents of clients diagnosed with anorexia nervosa? A.) Overprotect their children B.) A history of substance abuse C.) Maintain an emotional distance from their children D.) Alternate between loving and rejecting their children
Answer: A.) Overprotect their children
At the prompting of friends, a 16-year-old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. During the nurse's assessment, the nurse has asked the client to describe the client's family. Which family process and characteristic is thought to contribute to eating disorders? A.) Poor communication and enmeshed family dynamics B.) The absence of a parent and/or the presence of a stepparent C.) Passive parenting and lack of encouragement D.) An overemphasis of peer relationships over family relationships
Answer: A.) Poor communication and enmeshed family dynamics Rationale: Family systems theories emphasize the role of the family in the development of eating disorders. Among the characteristics that are thought to contribute are enmeshed patterns of relationship and impaired communication. The absence of a parent and/or the presence of a stepparent has not been emphasized. Passive parenting styles, lack of encouragement, and an overemphasis on peer relationships are not healthy patterns of being, but none has been identified as a specific contributor to eating disorders.
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? A.) Serotonin B.) Norepinephrine C.) Dopamine D.) Acetylcholine
Answer: A.) Serotonin
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 lb. When 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 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
Answer: A.) Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy Rationale: A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about nutritious foods to keep her healthy.
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 the student can go to the bathroom first to empty the student's bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has ... A.) anorexia nervosa. B.) binge-eating disorder. C.) bulimia nervosa. D.) eating disorder not otherwise specified.
Answer: A.) anorexia nervosa.
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? A.) "I don't think you are fat." B.) "Has something occurred that caused you to measure your thighs?" C.) "You are exactly the right weight for your height." D.) "You have always been very focused on your thighs. Is that the part of your body you like least?"
Answer: B.) "Has something occurred that caused you to measure your thighs?"
A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate? A.) "Thanks for checking in." B.) "I will accompany you to the bathroom." C.) "Let me know when you get back to the dayroom." D.) "I'll stand outside your door to give you privacy."
Answer: B.) "I will accompany you to the bathroom." Rationale: After each meal or snack, clients may be required to remain in view of staff for a period of time to ensure they do not empty the stomach by vomiting. Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. The response, "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the behavior. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.
The nurse has been teaching the client's family about the client's eating disorder, anorexia nervosa. Which statement would indicate that teaching was effective? A.) "We will eat our evening meals together with no exceptions." B.) "We will negotiate resolutions to family conflicts." C.) "We will spend less time discussing troublesome family members." D.) "We will give the client frequent encouragement for eating well and maintaining the client's weight."
Answer: B.) "We will negotiate resolutions to family conflicts." Rationale: Families of clients with eating disorders typically put too much emphasis on food and are less skilled at discussing family conflicts and allowing the client to begin gaining independence. "We will eat our evening meals together with no exception" allows little or no compromise; the client needs to be able to make decisions for himself or herself. "We will spend less time discussing troublesome family members" indicates that the client is a problem to the family. "We will give her frequent encouragement for eating well and maintaining her weight" indicates that family members can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight.
A nurse is providing care to a client with anorexia who is beginning a refeeding protocol. Based on the nurse's understanding of these protocols, the nurse would expect the client to start with how many calories per day? A.) 1000 B.) 1500 C.) 2000 D.) 2500
Answer: B.) 1500 Rationale: The refeeding protocol typically starts with 1,500 calories a day and is increased slowly until the client is consuming about 3,500 calories a day in several meals. The usual plan for clients with very low weights is a weight gain of between 1 to 2 pounds a week.
Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? A.) Antianxiety B.) Antidepressant C.) Antiparkinsonian D.) Antimanic
Answer: B.) Antidepressant
A client has an eating disorder characterized by consuming an amount of food much larger than a person would normally eat. Afterward, the client often purges the food or exercises excessively. Between binges, the client often eats low-calorie foods or fasts. What is the client's most likely diagnosis? A.) Anorexia nervosa B.) Bulimia nervosa C.) Pica D.) Rumination
Answer: B.) Bulimia nervosa
When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? A.) Codependence B.) Control issues C.) Self-discipline D.) Sexual identity
Answer: B.) Control issues Rationale: Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity are not pertinent issues to address with the family.
Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa? A.) Imbalanced nutrition—less than body requirements B.) Disturbed body image C.) Deficient knowledge (nutritious eating patterns) D.) Social isolation
Answer: B.) Disturbed body image Rationale: The client's dissatisfaction with body image is an enduring belief pattern that is firmly ingrained and, therefore, very difficult to change. Imbalanced nutrition—less than body requirements, deficient knowledge (nutritious eating patterns), and social isolation are nursing diagnoses that can be worked through with education and support more easily than the diagnosis of disturbed body image.
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.) Oversensitivity to heat
Answer: B.) Dry skin
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? A.) socially withdrawing B.) engaging in severe dieting C.) compulsively washing his or her hands D.) becoming sexually promiscuous
Answer: B.) engaging in severe dieting
A client with anorexia weighs less than 85% of the client's normal body weight. The client says, "I'm so fat, I can't even get through this doorway, much less fit into any of my clothes." Which is the nurse's most therapeutic response? A.) "Let's talk about your ideas about your body and why you perceive yourself to be fat." B.) "You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." C.) "I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about." D.) "You only weigh 100 pounds. It is just not true that you are fat."
Answer: C.) "I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about." Rationale: People with eating disorders tend to have perfectionistic personalities and to think in all-or-nothing terms. The nurse communicates caring to the client through a kind, firm, matter-of-fact approach, acknowledging the client's statement and at the same time, being honest and factual about the client's condition without being condescending or punitive.
A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? A.) 5 to 10 years old B.) 10 to 14 years old C.) 18 to 22 years old D.) 25 to 35 years old
Answer: C.) 18 to 22 years old
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? A.) Anorexia nervosa B.) Bulimia nervosa C.) Binge eating disorder D.) Eating disorder not otherwise specified
Answer: C.) Binge eating disorder
While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from? A.) Anorexia nervosa B.) Binge-eating disorder C.) Bulimia nervosa D.) Eating disorder not otherwise specified
Answer: C.) Bulimia nervosa
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? A.) Throat and esophagus B.) Condition of mouth and gums C.) Heart rate and rhythm D.) Patterns of activity and rest
Answer: C.) Heart rate and rhythm
The immediate goal of nursing interventions in the care of a client with anorexia nervosa is which of the following? A.) Changing her irrational thinking about her body B.) Establishing a target weight to be achieved by discharge C.) Restoring nutritional status to normal D.) Gaining insight into the effects of anorexia on her physical health
Answer: C.) Restoring nutritional status to normal Rationale: Physiologic safety and homeostasis are the priority concerns. Changing of thought pattern, establishing a target weight, and gaining insight into the effects of anorexia on her physical health are not immediate goals in the management of anorexia nervosa.
A client is diagnosed with mild anorexia nervosa based on body mass index (BMI). Which BMI would the nurse identify as reflecting mild anorexia nervosa? A.) 15.5 kg/m2 B.) 16.1 kg/m2 C.) 16.75 kg/m2 D.) 17.3 kg/m2
Answer: D.) 17.3 kg/m2 Rationale: A BMI greater than or equal to 17 kg/m2 would characterize mild anorexia. Moderate anorexia is characterize by a BMI between 16 and 16.99 kg/m2. Severe anorexia would be characterized by a BMI between 15.0 to 15.99 kg/m2.
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? A.) Antipsychotics B.) Stimulants C.) Mood stabilizers D.) Antidepressants
Answer: D.) Antidepressants Rationale: Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms.
Family-based theories of causality propose that eating disorders develop how? A.) In response to pressure by the parents to have a thin, attractive daughter B.) As an attempt for the child to get attention from disinterested parents C.) Due to the socialization of girls to evaluate themselves against certain "idealized" standards of appearance 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
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? A.) Respiratory distress and dyspnea B.) Bacterial gastrointestinal infections and overhydration C.) Metabolic acidosis and constricted colon D.) Dental erosion and chronic edema
Answer: D.) Dental erosion and chronic edema Rationale: In bulimia, dental erosion (from frequent vomiting) and chronic edema (from fluid imbalances) are common. Dyspnea, bacterial gastrointestinal infections, and metabolic acidosis are not characteristics of bulimia.
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 helps build a positive self-image in children. B.) Dieting during childhood can promote self-discipline in children who are obese. C.) Dieting at an early age teaches healthy eating habits. D.) Dieting at an early age may lead to the development of eating disorders.
Answer: D.) Dieting at an early age may lead to the development of eating disorders.
A client meets some (but not all) of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the client's weight is within the normal range. The nurse understands that based on DSM-5 criteria, this client would most likely be diagnosed with which of following? A.) Anorexia nervosa B.) Bulimia nervosa C.) Binge eating disorder D.) Eating disorder not otherwise specified
Answer: D.) Eating disorder not otherwise specified Rationale: Subclinical cases, also called partial syndromes, are usually diagnosed as Eating Disorder Not Otherwise Specified (EDNOS). These individuals still need treatment despite not meeting criteria for anorexia nervosa or bulimia nervosa.
Which statement best describes the theories of the etiology of eating disorders? A.) Eating disorders are caused by dysregulation of multiple neurotransmitter systems that predispose a dysfunctional response to certain environmental factors. B.) Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component. C.) Eating disorders result from family dysfunction; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. 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. Rationale: Eating disorders can be best understood in terms of a multifactorial etiology. Most experts agree that anorexia and bulimia develop from a complex interaction of individual, family, and sociocultural factors. Research strongly suggests that eating disorders may originate in part from hypothalamic, hormonal, neurotransmitter, or biochemical disturbances. Whether the biologic abnormalities seen in clients with eating disorders contribute to the disorders or are secondary to the dysregulation in the eating behavior remains unclear.
During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication? A.) Olanzapine B.) Ziprasidone C.) Risperidone D.) Fluoxetine
Answer: D.) Fluoxetine
While assessing the family dynamics of a client with an eating disorder, which does the nurse most likely discover? A.) Multiple siblings B.) Lack of interest in the client by other family members C.) Supportive and encouraging relationships D.) Overcontrolling parents
Answer: D.) Overcontrolling parents Rationale: Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Interest in the client is often excessive, rather than deficient. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: by continuing to lose, these clients exert control over one aspect of their lives. There is no demonstrated relationship between the number of siblings and an individual's risk for eating disorders.
The client 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.) Ineffective individual coping B.) Anxiety C.) Nutrition that is less than body requirements D.) Risk for self-directed violence
Answer: D.) Risk for self-directed violence
During an initial interview at a clinic, a young client states that there is nothing wrong with the client. Which would indicate to the nurse that this client might have anorexia nervosa? A.) Episodes of overeating and excessive weight gain B.) Expressions of a positive self-concept C.) Flexible thought patterns and spontaneity D.) Severe weight loss due to self-imposed dieting
Answer: D.) Severe weight loss due to self-imposed dieting
A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? A.) mood disorders, which often accompany the diagnosis of bulimia nervosa B.) nutritional deficits, which are characteristic of bulimia nervosa C.) binging, which causes abdominal discomfort D.) vomiting, which may lead to dehydration and electrolyte imbalance
Answer: D.) vomiting, which may lead to dehydration and electrolyte imbalance Rationale: People who frequently vomit have many dental problems, such as loss of tooth enamel, chipped and ragged teeth, and dental caries. Frequent vomiting may also result in mouth sores. Purging behaviors, such as vomiting, may lead to dehydration and electrolyte imbalance. Hallucinations and restlessness can be signs of electrolyte imbalance. Dry mucous membranes indicate dehydration.
