Chapter 26: Eating Disorders: Nursing Care of Persons with Eating and Weight-Related Disorders

The nurse is educating a client with bulimia to use self-monitoring techniques. Which statement by the client would indicate that the education provided is effective? "I am keeping a record of everything I eat and how I am feeling every day." "I am beginning to understand how my lack of self-control is hurting me." "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." "I am getting more comfortable confronting people when I have conflict with them."

"I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." Explanation: Self-monitoring is a cognitive-behavioral technique designed to help clients with bulimia. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions and triggers. In this way, clients begin to see connections between emotions and situations and eating behaviors. The nurse can then help clients to develop ways to manage emotions such as anxiety by using relaxation techniques or distraction with music or another activity. Keeping a record of feelings and food intake is helpful, but not if it is unaccompanied by healthy responses and changes in behavior. Managing conflict is important but this is not an example of self-monitoring. Stating a lack of self-control is not therapeutic because self-control is not the key to recovery from eating disorders. Efforts that focus solely on self-control are rarely successful or sustainable.

Which of the following clients being treated for anorexia displays assessment values that warrant hospitalization? A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL A 32-year-old with a temperature of 98°F and a pulse rate of 54 A 16-year-old with serum potassium of 3.8 mEq/L and a BP of 98/66 mmHg A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt SUBMIT ANSWER

A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL Explanation: 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 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? A. "Do thoughts about food, weight, dieting, or eating dominate your life?" B. "How often do you weigh yourself?" C. "What do you love about your body?" D. "Do your friends say that you need to lose weight?"

A. "Do thoughts about food, weight, dieting, or eating dominate your life?" Explanation: Screening questions for eating disorders assess for unhealthy eating and thought patterns that are present in the client's life. Sample screening questions include, "How often do you feel dissatisfied with your body shape and size?", "Do you think you are overweight or need to lose weight, even when others say you are thin?", "Do thoughts about food, weight, dieting, or eating dominate your life?", and "Do you eat to make yourself feel better emotionally and then feel guilty about it?" The questions, "How often do you weigh yourself?", "What do you love about your body?", and "Do your friends say that you need to lose weight?" do not directly screen for eating disorders in the client.

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. "Has something occurred that caused you to measure your thighs?" B. "You have always been very focused on your thighs. Is that the part of your body you like least?" C. "I don't think you are fat." D. "You are exactly the right weight for your height."

A. "Has something occurred that caused you to measure your thighs?" Explanation: The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.

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? A. "Talk to your family member about calories consumed and offer to seek professional help for them." B. "Tell your family member that you are concerned and would like to help." C. "Try making the family member meals and limit their exercise ability." D. "Start the conversation with making comments about their appearance and see what they say."

A. "Tell your family member that you are concerned and would like to help." Explanation: Approaching a family member with a possible eating disorder can be a sensitive situation. The nurse should advise the family to be supportive, not controlling, toward the client. The nurse's statement to the resident, "Tell your family member that you are concerned and would like to help" is appropriate advisement. The nurse's statements, "Talk to your family member about calories consumed and offer to seek professional help for them", "Start the conversation with making comments about their appearance and see what they say", and "Try making the family member meals and limit their exercise ability" are inappropriate advisement.

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. 1500 B. 2000 C. 2500 D. 1000

A. 1500 Explanation: 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.

Which is a cardiac complication of an eating disorder? A. Bradycardia B. Hypertension C. Thrombocytopenia D. Enlarged heart

A. Bradycardia Explanation: Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.

Which intervention has been found to be most effective reducing the initial symptoms of bulimia? A. Cognitive behavior therapy and pharmacologic interventions B. Daily monitoring of sound dietary principles and meditation sessions C. Behavioral therapy and psychoeducation D. Clearly stated unit rules and a supportive milieu

A. Cognitive behavior therapy and pharmacologic interventions Explanation: The combination of cognitive behavior therapy and pharmacologic interventions is best for producing an initial decrease in symptoms.

A client diagnosed with anorexia nervosa weighs 78% of their ideal body weight and continues to state that they are "fat." Which symptom does the nurse identify? A. body image distortion B. drive for thinness C. low self-esteem D. negative self-concept

A. body image distortion Explanation: Clients diagnosed with anorexia nervosa have a distorted body image. The clients can be very thin and still perceive that they are heavy and need to lose weight. The drive for thinness prompts the client in an urgent way to "undo" or frantically work toward weight loss. Negative self-concept is the negative idea of the self, created from the beliefs someone holds about themselves and the responses of others. Low self-esteem is the negative perception of one's own worth or abilities.

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. The client weighs 80 pounds and is 5 feet 2 inches tall. The client states that she usually eats salads to not gain weight. These data supports which diagnosis? Anorexia nervosa Depression Bulimia nervosa Anxiety disorder

Anorexia nervosa Explanation: Anorexia nervosa is a life-threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal body weight, 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.

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 Eating disorder not otherwise specified Anorexia nervosa Bulimia nervosa

Binge eating disorder Explanation: Binge eating disorder is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese. The client does not restrict eating so anorexia is not appropriate. Eating disorder not otherwise specified refers to partial syndromes but does not met the criteria for anorexia or bulimia.

The nurse provides care for a client who is diagnosed with anorexia nervosa. Which question should the nurse ask to assess the client for neuropsychiatric complications associated with the diagnosed eating disorder? A. "Is your skin dry and your nails brittle?" B. "Do you experience constipation or diarrhea?" C. "Do you experience abnormal taste sensations?" D. "How often do you menstruate?"

C. "Do you experience abnormal taste sensations?" Explanation: There are many complications associated with eating disorders, including anorexia nervosa. The neuropsychiatric complications include abnormal taste sensations, often due to zinc deficiency. Other neuropsychiatric complications include apathetic depression, fatigue, mild organic mental symptoms, and sleep disturbances. Abnormal menstrual cycles and/or amenorrhea are reproductive complications associated with anorexia nervosa. Dermatologic complications include dry skin and brittle nails. Constipation and/or diarrhea are both gastrointestinal complications associated with anorexia nervosa.

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. "You only weigh 100 pounds. It is just not true that you are 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. "Let's talk about your ideas about your body and why you perceive yourself to be fat."

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." Explanation: 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 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? A. "I will use my breathing techniques when I feel anxious." B. "I can engage in physical activity within my schedule when I feel anxious or restless." C. "I will go to all my support groups so that I don't need to go to therapy." D. "I will reach out to my friends to develop connection."

C. "I will go to all my support groups so that I don't need to go to therapy." Explanation: After discharge, support groups are helpful for the client but cannot replace therapy sessions. Therefore, the client's statement, "I will go to all my support groups so that I don't need to go to therapy" would indicate a need for further teaching. The client's statements, "I will use my breathing techniques when I feel anxious", "I can engage in physical activity within my schedule when I feel anxious or restless", and "I will reach out to my friends to develop connection" are demonstrating that the teaching was effective.

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? A. "Why are you losing more weight?" B. "Are you using the coping skills that you learned in our last session?" C. "What stressors are you currently experiencing?" D. "Who can you reach out to in times of crisis?"

C. "What stressors are you currently experiencing?" Explanation: Clients with an eating disorder often cope with stress and anxiety through controlling eating. In times of perceived stressful events, the dysfunctional eating pattern often becomes worse. Therefore, the nurse should assess for current stressors by asking the client, "What stressors are you currently experiencing?" The nurse's question, "Who can you reach out to in times of crisis?" assesses the client's support system, not addressing the cause of the recent weight loss. The nurse's questions, "Why are you losing more weight?", and "Are you using the coping skills that you learned in our last session?" are not therapeutic and do not address the current stressors in the client.

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? A. "What are your feelings when you eat a meal?" B. "What substances do you use when you are stressed?" C. "When you are successful in your life, how do you reward yourself?" D. "Who do you reach out to when you are feeling really depressed?"

C. "When you are successful in your life, how do you reward yourself?" Explanation: Health care professionals can elicit motivation through a client strength assessment. The counselor's question, "When you are successful in your life, how do you reward yourself?" would assess the client's personal strengths. The counselor's questions, "What substances do you use when you are stressed?", "Who do you reach out to when you are feeling really depressed?", and "What are your feelings when you eat a meal?" do not assess the client's personal strengths.

A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. When creating the plan of care, which nursing intervention takes priority? A. Assess family issues and health concerns. B. Assess knowledge of selective serotonin reuptake inhibitors used in treatment. C. Assess and monitor vital signs and lab values. D. Assess early disturbances in parent-child interactions.

C. Assess and monitor vital signs and lab values. Explanation: The immediate priority of nursing interventions in eating disorders is to restore the client's nutritional status. Major life-threatening complications that indicate the need for hospital admission include severe fluid, electrolyte, and metabolic imbalances; cardiovascular complications; severe weight loss and its consequences. The assessment and monitoring of vital signs and lab values to recognize and anticipate these medical problems must take priority. When the physical condition is no longer life threatening, other treatment modalities may be initiated.

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. Eating disorder not otherwise specified D. Binge eating disorder

C. Eating disorder not otherwise specified Explanation: 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.

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. 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

C. Overprotect their children Explanation: 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. Family therapy may be beneficial for families of clients younger than 18 years. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.

The nurse is performing an assessment of the family dynamics for a client with an eating disorder. Which issue observed by the nurse is an indicator of why the client may be experiencing an eating disorder? A. The family appears to lack interest in the client. B. The client has supportive and encouraging relationships. C. The client has overprotective parents. D. There are multiple siblings in the household.

C. The client has overprotective parents. Explanation: 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 adolescents 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.

A community health nurse is conducting an educational session for a group of high-school community members. The community health nurse is educating the community about positive body image. Which statement made by a community member would indicate the need for further education? A. "I will wear ill-fitting clothes to remind me about my health goals." B. "No particular diet, weight, or body size will automatically lead to happiness." C. "I will regularly reflect and appreciate all the things that my body can do." D. "I will surround myself with supportive, positive, and real people."

Correct response: A. "I will wear ill-fitting clothes to remind me about my health goals." Explanation: The National Eating Disorders Association provides the following suggestions to promote positive body image including eliminating the idea that a particular diet, weight, or body size will automatically lead to happiness and fulfillment; appreciating all the things that your body can do; keeping a list of the top 10 things that the individual likes about themselves; doing something nice for yourself; surrounding yourself with positive people; wearing comfortable clothes that make you feel good about your body; not judging yourself and others based on body weight or shape; limiting time on social media and surrounding yourself with positive, supportive, and real people; and filtering through the media and its messages about self-esteem and body image. Therefore, the statement, "I will wear ill-fitting clothes to remind me about my health goals" would require further teaching from the nurse.

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? A. Bulimia nervosa, purging type B. Binge eating disorder C. Anorexia nervosa, purging type D. Anorexia nervosa, restricting type

Correct response: A. Bulimia nervosa, purging type Explanation: The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests bulimia nervosa, purging type. Individuals with bulimia typically maintain normal weight. Binge eating disorder does not involve purging.

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? A. engaging in severe dieting B. socially withdrawing C. becoming sexually promiscuous D. compulsively washing his or her hands

Correct response: A. engaging in severe dieting Explanation: Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. 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. While the remaining options may demonstrative reactive behaviors, they are not generally associated with over-productive parenting.

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? A. identifying signs and symptoms of eating disorders B. adapting and coping with problems C. peer pressure regarding weight and eating habits D. how puberty affects weight

Correct response: A. identifying signs and symptoms of eating disorders Explanation: Education is important for parents with children at risk for developing eating disorders. The topic to be included in the education session includes identifying signs and symptoms of eating disorders, so that the parent can safely intervene and support the child. Education topics such as peer pressure regarding weight and eating habits, how puberty affects weight, and adapting and coping with problems are topics that should be taught to the children at risk for eating disorders.

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. Bulimia nervosa, nonpurging type. B. Eating disorder not otherwise specified C. Anorexia nervosa, restricting type D. Anorexia nervosa, binge eating, and purging type

Correct response: Anorexia nervosa, restricting type Explanation: Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories."

When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? A. Sexual identity B. Control issues C. Codependence D. Self-discipline

Correct response: B. Control issues Explanation: 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.

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? A. Act as the client's authority figure when educating the client. B. Keep in mind the client's perspective and fears while gaining weight. C. Become upset when the client does not take the nurse's advice on a situation. D. Praise the client for being good after the client resists purging.

Correct response: B. Keep in mind the client's perspective and fears while gaining weight Explanation: There are important points to consider when working with clients with eating disorders including being empathetic and nonjudgmental and remembering the client's perspective and fears about weight and eating; avoiding sounding parental when teaching about nutrition or behaviors, instead present information as factual; and avoiding labeling clients as "good" when they avoid unacceptable behavior. Praising the client for being good after the client resists purging, becoming upset when the client does not take the nurse's advice on a situation, and acting as the client's authority figure when educating the client are not therapeutic and do not promote a therapeutic relationship. Therefore, the nurse should keep in mind the client's perspective and fears while gaining weight.

During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which of the following would indicate to the nurse that this client might have anorexia nervosa? A. Episodes of overeating and excessive weight gain B. Severe weight loss due to self-imposed dieting C. Expressions of a positive self-concept D. Flexible thought patterns and spontaneity

Correct response: B. Severe weight loss due to self-imposed dieting Explanation: Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.

The nurse is talking with family members of a client with an eating disorder that state, "What is the best way for us to show support during this time?" Which will the nurse inform the family as the most supportive action they can take? A. Give the client unlimited access to foods that the client enjoys. B. Give positive reinforcement for weight gain. C. Give the client emotional support. D. Focus on food intake, calories, and weight.

Correct response: C. Give the client emotional support. Explanation: The nurse explains to family and friends that they can be most helpful by providing emotional support, love, and attention. They can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight. Structure around eating is more therapeutic than providing constant, unlimited access to food. Positive reinforcement can be beneficial but this must be framed in a context of support, love, and attention in order for the client to accept it.

A client diagnosed with anorexia nervosa is being prescribed a medication. Which medication would the nurse prepare for the client? A. olanzapine B. lorazepam C. fluoxetine D. haloperidol

Correct response: C. fluoxetine Explanation: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is Food and Drug Administration (FDA) approved for anorexia nervosa. Olanzapine and haloperidol are antipsychotics, and lorazepam is a benzodiazepine, none of which are FDA approved for the treatment of anorexia nervosa.

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? A. partial hospitalization B. long inpatient stay C. outpatient therapy D. short hospital stay

Correct response: C. outpatient therapy Explanation: Treatment settings include inpatient specialty eating disorder units, partial hospitalization or day treatment programs, and outpatient therapy. Major life-threatening complications that indicate the need for hospital admission include severe fluid, electrolyte, and metabolic imbalances; cardiovascular complications; severe weight loss and its consequences; and risk for suicide. Short hospital stays are most effective for clients who are amenable to weight gain and who gain weight rapidly while hospitalized. Longer inpatient stays are required for those who gain weight more slowly and are more resistant to gaining additional weight. Outpatient therapy has the best success with clients who have been ill for less than 6 months, are not binging and purging, and have parents likely to participate effectively in family therapy. Partial hospitalization is for clients who need a structured setting to stay compliant with the treatment plan. The client in the scenario would best be served in an outpatient setting.

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. Eating disorder not otherwise specified B. Binge-eating disorder C. Anorexia nervosa D. Bulimia nervosa

Correct response: D. Bulimia nervosa Explanation: Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental cavities from the frequent contact of tooth enamel with food and acidic gastric fluids.

Individuals with anorexia nervosa concentrate on which body cue? A. Anxiety B. Weakness C. Hunger D. Controlling food intake

Correct response: D. Controlling food intake Explanation: Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.

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.

Correct response: 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. Explanation: 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.

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? A. Maintenance of emotional distance from their children B. A history of substance abuse C. Alternation between loving and rejecting their children D. Overprotective of their children

Correct response: D. Overprotective of their children Explanation: 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. Family therapy may be beneficial for families of clients younger than 18 years old. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.

The nurse is caring for a client admitted with anorexia nervosa. When creating the nursing interventions for the plan of care, which is the primary objective? A. Establishing a target weight to be achieved by discharge B. Gaining insight into the effects of anorexia on the client's physical health C. Changing the client's irrational thinking about the client's body D. Restoring nutritional status to normal

Correct response: D. Restoring nutritional status to normal Explanation: Physiologic safety and homeostasis are the priority concerns. Changing of thought patterns and gaining insight into the effects of anorexia on the client's physical health are not immediate goals in the management of anorexia nervosa because these are psychosocial, not physiologic, aspects of care. Achieving a client's target weight requires a lengthy process that is unlikely to be completed during inpatient care.

A 45-year-old client is being treated for an eating disorder. Upon assessment, the client reveals that they eat as much as they can in secret within 45 minutes at a time, about three to four times a week. They state that they do not purge afterward. Which eating disorder would the nurse document in the client's health record? A. bulimia nervosa B. pica C. anorexia nervosa D. binge eating disorder

Correct response: D. binge eating disorder Explanation: Anorexia nervosa is a life-threatening eating disorder characterized by the client's restriction of nutritional intake necessary to maintain a minimally normal bodyweight, intense fear of gaining weight, 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 its very existence. Binge eating disorder is characterized by recurrent episodes of binge eating, with no regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives. Pica is the persistent ingestion of nonfood substances. Bulimia nervosa, often simply called bulimia, 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. Based on the presenting symptoms of the client, binge eating disorder will be documented.

A psychiatric-mental health nurse has learned about how eating disorders develop in clients. Which theories emphasize the importance of the media, fashion industry, and peer pressure causing eating disorders? A. psychological theories B. genetic theories C. biological theories D. social theories

Correct response: D. social theories Explanation: Social theories focus on the societal role in the formation of eating disorders, particularly how the media, fashion industry, and peer pressure influence the client's eating behaviors, which is described in the scenario. Biological theories emphasize brain changes in clients with anorexia nervosa, which is not mentioned in the scenario. Genetic theories emphasize that eating disorders run in families, which is not present in the scenario. Psychological theories focus on the client's struggles with identity and role, body image formation, and sexuality, which is not present in the scenario.

The nurse is assisting a client with an eating disorder to accept their body image and use effective coping skills. Which will the nurse discuss with the client in relation to body acceptance and coping skills? A. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills. B. When body image is positive, you will develop better coping skills. C. In order for you to develop coping skills, it is important to have had a supportive upbringing. D. Being able to cope in healthy ways improves the ability to accept a realistic body image.

D. Being able to cope in healthy ways improves the ability to accept a realistic body image. Explanation: When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image. Coping skills can be learned and honed even if the client's upbringing was less than supportive. Changes in body image result from enhanced coping; they do not cause enhanced coping. Eating disorders have biologic elements to their etiology, but this does not rule out the development of positive coping.

A client 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. Complaints of heartburn C. Heat intolerance D. Bradycardia

D. Bradycardia Explanation: Associated physical exam findings include cold intolerance, complaints of constipation and abdominal pain, hypotension, and bradycardia.

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? A. Nurturing the client's need for dependency B. Communicating aggressively with the client C. Encouraging client take time away from peers for a time D. Increasing client's coping skills for anxiety

D. Increasing client's coping skills for anxiety Explanation: Since clients with bulimia experience high anxiety levels and may use the binge-purge cycle as a coping mechanism, increasing coping skills for anxiety is a high priority nursing intervention. A perception of lack of control and helplessness is at the source of eating disorders. . A firm, accepting, and patient approach is important in working with these individual, not an aggressive approach, which could render the nurse-client relationship ineffective. Since the client already tends to isolate when bingeing and purging, increasing involvement with others would be a positive treatment modality. Meeting dependency needs is nontherapeutic; the nurse does not need to rescue the client but rather to teach the client to be less helpless.

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. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift B. Assigning the client to group therapy in which participants provide realistic feedback about her weight C. Asking the client to compare her figure with magazine photographs of women her age D. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy

D. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy Explanation: 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.

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 Respiratory distress and dyspnea Bacterial gastrointestinal infections and overhydration Metabolic acidosis and constricted colon

Dental erosion and chronic edema Explanation: 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.

When working with a client with anorexia nervosa, which of the following nursing diagnoses is most difficult to resolve successfully? Disturbed body image Social isolation Deficient knowledge (nutritious eating patterns) Imbalanced nutrition: less than body requirements

Disturbed body image Explanation: 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.

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 Patterns of activity and rest Condition of mouth and gums Throat and esophagus

Heart rate and rhythm Explanation: Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.

The nurse provides care to a client who is diagnosed with an eating disorder. Which strategy should the nurse include in the client's plan of care to increase the client's self-concept? Keep a list of accomplishments. Practice meditation. Increase social contact. Limit physical activity to a reasonable schedule.

Keep a list of accomplishments. Explanation: Wellness challenges must be addressed by the nurse when providing care to a client who is diagnosed with an eating disorder. Interventions that support increasing the client's self-concept include keeping a list of accomplishments, helping others, keeping busy, and counseling or therapy. Practicing meditation is a strategy that address stress management. Increasing social contact is a strategy for developing a sense of connection, belonging, and a support system. Limiting physical activity to a reasonable schedule addresses the recognition for the need for moderate physical activity.