Chapter18
A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate? "You and I will have to sit down and discuss this problem." "It bothers me to see you exercising. I am afraid you will lose more weight." "Let's discuss the relationship between exercise, weight loss, and the effects on your body." "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."
"According to our agreement, no exercising is permitted until you have a gained a specific amount of weight."
A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? "What are your feelings about not eating foods that you prepare?" "You seem to feel much better about yourself when you eat something." "It must be difficult to talk about private matters to someone you just met." "Being thin doesn't seem to solve your problems. You are thin now but still unhappy."
"Being thin doesn't seem to solve your problems. You are thin now but still unhappy."
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months and lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis? "I am fat and ugly." "What I think about myself is my business." "I'm grossly underweight, but that's what I want." "I'm a few pounds overweight, but I can live with it."
"I am fat and ugly."
A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient: "Do you often feel fat?" "Who plans the family means?" "What do you eat in a typical day?" "What do you think about your present weight?"
"What do you eat in a typical day?"
One bed is available on the inpatient eating disorders unit. Which patient should be admitted to this bed? The patient whose weight decreased from: 150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9 C; pulse, 38 beats/min; blood pressures 60/40 mm Hg. 120 to 90 pounds over a 3-month period. Vital signs are temperature, 36 C; pulse, 50 beats/min; blood pressure 70/50 mm Hg 110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5 C; pulse, 60 beats/min; blood pressure 80/66 mm Hg 90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7 C; pulse, 62 beats/min; blood pressure 74/48 mm Hg
150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9 C; pulse, 38 beats/min; blood pressure 60/40 mm Hg
A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? SELECT ALL THAT APPLY. Flexible mealtimes Unscheduled weight checks Adherence to a selected menu Observation during and after meals Monitoring during bathroom trips Privileges correlated with emotional expression.
Adherence to a selected menu Observation during and after meals. Monitoring during bathroom trips
Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? Binge eating Bulimia nervosa Anorexia nervosa Eating disorder not otherwise specified
Anorexia nervosa
An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: Assess lung sounds and extremities. Suggest use of an aerobic exercise program. Positively reinforce the patient for the weight gain. Establish a higher goal for weight gain the next week.
Assess lung sounds and extremities.
Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? Assist the patient to identify triggers to binge eating. Provide corrective consequences for weight loss. Assess for signs of impulsive eating. Explore needs for health teaching.
Assist the patient to identify triggers to binge eating.
The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction? Renal Endocrine Integumentary Cardiovascular
Cardiovascular
Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosed Imbalanced nutrition: less than body requirements. Within 1 week, the patient will: Weigh self accurately using balanced scales. Limit exercise to less than 2 hours daily. Select clothing that fits properly. Gain 1 to 2 pounds.
Gain 1 to 2 pounds
Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130- pound patient diagnosed with bulimia nervosa who purges? Powerlessness Ineffective coping Disturbed body image Imbalanced nutrition: less than body requirements
Imbalanced nutrition: less than body requirements
A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies? Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia.
Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia.
A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, "I won't eat until I look thin." Select the priority initial nursing diagnosis. Anxiety related to fear of weight gain. Disturbed body image related to weight loss. Ineffective coping related to lack of conflict resolution skills. Imbalanced nutrition: less than body requirements related to self-starvation
Imbalanced nutrition: less than body requirements related to self-starvation.
As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weights 70 pounds and is 5 feet 4 inches tall. Which term should be documented? Amenorrhea Alopecia Lanugo Stupor
Lanugo
Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight? Assess for depression and anxiety. Observe for adverse effects of refeeding. Communicate empathy for the patient's feelings. Help the patient balance energy expenditures with caloric intake.
Observe for adverse effects of refeeding.
Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? Weight, muscle, and fat congruence with height, frame, age and sex. Calorie intake is within required parameters of treatment plan. Weight reaches established normal range for the patient. Patient expresses satisfaction with body appearance.
Patient expresses satisfaction with body appearance.
A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable. Patient involvement in decision making increases sense of control and promotes compliance with treatment. Because of increased risk of physical problems with refeeding, the patient's permission is needed. A team approach to planning the diet ensures that physical and emotional needs will be met.
Patient involvement in decision making increases sense of control and promotes compliance with treatment.
A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? SELECT ALL THAT APPLY. Peripheral edema Parotid swelling Constipation Hypotension Dental caries Lanugo
Peripheral edema Constipation Hypotension Lanugo
Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? Carefree flexibility Rigidity, perfectionism Open displays of emotion High spirits and optimism
Rigidity, perfectionism
Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization? Urine output 40 mL/hr Pulse rate 58 beats/min Serum potassium 3.4 mEq/L Systolic blood pressure 62 mm Hg
Systolic blood pressure 62 mm Hg
A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed? The nurse interacts with the patient in a protective fashion. The nurse's comments to the patient are compassionate and nonjudgmental. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. The nurse refers the patient to a self-help group for individuals with eating disorders.
The nurse interacts with the patient in a protective fashion.
A 5- year-old child was diagnosed with encopresis. Which assessment finding would the nurse expect associated with this diagnosis? The child: frequently smears feces on clothing and toys. experiences frequent nocturnal episodes of bedwetting. has accidents of defecation at kindergarten three three times a week. has occasional episodes of voiding accidents at the day care center.
has accidents of defecation at kindergarten three times a week.
A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to: self-monitoring of daily food and fluid intake. establishing the desired daily weight gain. how to recognize hypokalemia. self-esteem maintenance.
how to recognize hypokalemia
A nursing diagnosis for a patient diagnosed with bulimia nervosa is ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will: appropriately express angry feelings. verbalize two positive things about self. verbalize the importance of eating a balanced diet. identify two alternative methods of coping with loneliness.
identify two alternative methods of coping with loneliness.
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient: to eat a small meal after purging. not to skip meals or restrict food. to increase oral intake after 4 PM daily the value of reading journal entries aloud to others.
not to skip meals or restrict food.
Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach? The patient: Now weighs 196 pounds says, "I am using contraceptives." says, "I feel full after eating a small meal." reports problems with dry mouth and constipation.
now weighs 196 pounds.
Physical assessment of a patient diagnosed with bulimia often reveals: prominent parotid glands. peripheral edema. thin, brittle hair. 25% underweight.
prominent parotid glands.
A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: maintaining patients' concentration and attention. shifting the patient's focus from food to psychotherapy. promoting processing of anxiety associated with eating. focusing on weight control mechanisms and food preparation.
promoting processing of anxiety associated with eating.