Eating Disorders Practice Questions (Test #2, Fall 2020)

A client diagnosed with an eating disorder has a nursing diagnosis of low self-esteem. Which nursing intervention would address this client's problem? 1. Offer independent decision-making opportunities. 2. Review previously successful coping strategies. 3. Provide a quiet environment with decreased stimulation. 4. Allow the client to remain in a dependent role throughout treatment

1 . 1. Offering independent decision-making opportunities promotes feelings of control. Making decisions and dealing with the consequences of these decisions should increase independence and improve the client's self-esteem. 2. Reviewing previously successful coping strategies is an effective nursing intervention for clients experiencing altered coping, not low self-esteem. Altered coping is a common problem for clients diagnosed with eating disorders, but this diagnosis is not stated in the question. 3. Providing a quiet environment with decreased stimulation is an effective nursing intervention for clients experiencing anxiety, not low self-esteem. Anxiety is a common problem for clients diagnosed with eating disorders, but this diagnosis is not stated in the question. 4. Allowing the client to remain in a dependent role throughout treatment would decrease, rather than increase, self-esteem. There is little opportunity for successful experiences and increased self-esteem when a client has decisions and choices made for him or her. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the nursing intervention that addresses this problem. Answers "2" and "3" may be appropriate interventions for clients diagnosed with an eating disorder, but only "1" correlates with the client problem of low self-esteem.

A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which long-term outcome indicates that the client's problem has improved? 1. The client's body mass index will be 20 by the 6-month follow-up appointment. 2. The client will be free of signs and symptoms of malnutrition and dehydration. 3. The client will use one healthy coping mechanism during a time of stress by discharge. 4. The client will state an understanding of a previous dependency role by the 3-month follow-up appointment.

1 1. A normal body mass index (BMI) range is 20 to 25. The client's BMI of 20 documents attainment of a successful long-term outcome for the stated nursing diagnosis of imbalanced nutrition: less than body requirements. 2. Experiencing no signs and symptoms of malnutrition and dehydration is an outcome related to the nursing diagnosis of imbalanced nutrition. This outcome does not contain a timeframe, however, and cannot be measured. 3. Improving the ability to demonstrate healthy coping mechanisms by discharge is a shortterm outcome related to the nursing diagnosis of ineffective coping, not imbalanced nutrition. 4. Stating understanding of a previous dependency role by 3-month follow-up appointment is a long-term outcome related to the nursing diagnosis of low self-esteem, not imbalanced nutrition. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the measurable outcome that is a realistic expectation for the client. Answers "3" and "4" may be appropriate outcomes for clients diagnosed with eating disorders, but only "1" correlates with the client problem of imbalanced nutrition: less than body requirements.

Which anorexia nervosa symptom is physical in nature? 1. Dry, yellow skin. 2. Perfectionism. 3. Frequent weighing. 4. Preoccupation with food.

1 1. Dry, yellow skin is a physical symptom of anorexia nervosa. This is due to the release of carotenes as fat stores are burned for energy. 2. Perfectionism is experienced by clients with a diagnosis of anorexia nervosa, but it is a behavioral, not physical, symptom. 3. Frequent weighing is a behavioral, not physical, symptom of anorexia nervosa. 4. Preoccupation with food is a cognitive, not physical, symptom of anorexia. TEST-TAKING HINT: To select the correct answer, the test taker first must determine if the symptom presented is a symptom of anorexia nervosa, then be able to categorize this symptom accurately as physical.

Which individual would be at highest risk for obesity? 1. A poor black woman. 2. A rich white woman. 3. A rich white man. 4. A well-educated black man

1 1. Obesity is more common in black women than in white women, and the prevalence among lower socioeconomic classes is six times greater than among upper socioeconomic classes. Because of these data, this individual is at highest risk for obesity compared with the others described. 2. Obesity is less common in white women than in black women, and the prevalence among lower socioeconomic classes is six times greater than among upper socioeconomic classes. These data reflect a lower risk for obesity for this individual. 3. Obesity is more common in white men than in black men, but because the prevalence among lower socioeconomic classes is six times higher than among upper socioeconomic classes, this individual's risk is lowered. 4. Obesity is more common in white men than in black men, and there is an inverse relationship between obesity and education level. These data reflect a lower risk for obesity for this individual. TEST-TAKING HINT: The test taker must be aware of the epidemiological factors that influence the prevalence rate of obesity to determine which of the individuals described is at highest risk for becoming obese

A client diagnosed with anorexia nervosa has a nursing diagnosis of disturbed body image. Which nursing intervention addresses this problem? 1. Help client to realize that perfection is unrealistic. 2. Stay with client during mealtime and for at least 1 hour after meals. 3. Help the client to identify and set weight loss goals. 4. Explain to client that privileges and restrictions will be based on weight gain.

1 1. When the nurse helps the client to realize that perfection is unrealistic, the nurse is intervening to address a disturbed body image problem. If the client begins to accept certain personal inadequacies, the need for unrealistic achievement and perfectionism should diminish. 2. Staying with the client during mealtime and for at least 1 hour after meals addresses an imbalanced nutrition, not a disturbed body image, problem. Adequate intake must be encouraged and the amount of intake monitored. The client may use time after meals to discard uneaten food, and the presence of the nurse would discourage this behavior. 3. Helping the client to identify and set weight loss goals is inappropriate for a client diagnosed with anorexia nervosa. It is appropriate to set weight gain goals with these clients. 4. Explaining to clients that privileges and restrictions will be based on weight gain is an appropriate intervention to address an imbalanced nutrition, not disturbed body image, problem. Applying privileges and restrictions based on compliance with treatment and weight gain is a behavioral approach to encourage increased nutritional intake. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the nursing diagnosis presented in the question with the correct nursing intervention. There always must be a correlation between the stated problem and nursing actions to correct this problem

The family of a client diagnosed with anorexia nervosa has canceled the last two family counseling sessions. Which of the following could be reasons for this noncompliance? Select all that apply. 1. The family is fearful of the social stigma of having a family member with emotional problems. 2. The family is dealing with feelings of guilt because of the perception that they have contributed to the disorder. 3. There may be a pattern of conflict avoidance, and the family fears conflict would surface in the sessions. 4. The family may be attempting to maintain family equilibrium by keeping the client in the sick role. 5. The client is now maintaining adequate nutrition, and the sessions are no longer necessary

1,2,3,4 Eating disorders are considered "family" disorders, and resolution of the disease cannot be achieved until dynamics within the family have improved. 1. Support is given through family counseling as families deal with the existing social stigma of having a family member with emotional problems. This stigma also may discourage compliance with therapies, as the family copes with the stress by denying the illness. 2. Families who are experiencing feelings of guilt associated with the perception that they have contributed to the onset of the disorder may avoid dealing with this guilt by being noncompliant with family therapy. 3. Dysfunctional family dynamics may lead the family to avoid conflict by avoiding highly charged family sessions. 4. Dysfunctional family systems often focus conflicts and stress on a scapegoat family member. These families balance their family system by maintaining this member in a dependent, sick role. Because of disruption in the dysfunctional family system, there is little interest shown in changing the role of this "sick" member. 5. Anorexia nervosa is a disease that requires long-term treatment for successful change to occur. It would be improbable that the client would begin eating spontaneously, maintain adequate nutrition, and no longer require treatment. TEST-TAKING HINT: To select the correct answer, the test taker must recognize the deterrents to active participation in family therapy. It is vital to understand these deterrents to be able to encourage effective compliance with family therapy.

Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? Select all that apply. 1. The client participates in individual therapy. 2. The client has a body mass index of 16. 3. The client consumes adequate calories as determined by the dietitian. 4. The client is dependent on mother for most basic needs. 5. The client states, "I realize that I can't be perfect."

1,3,5 1. Willingness to participate in individual therapy is an indication that this client meets discharge criteria. Individual therapy encourages the client to explore unresolved conflicts and to recognize maladaptive eating behaviors as defense mechanisms used to ease emotional pain. 2. The body mass index (BMI) for normal weight is 20 to 25. Because this client's BMI is lower than the normal range, consideration for discharge may be inappropriate at this time. 3. It is significant when a client diagnosed with anorexia nervosa consumes adequate calories to maintain metabolic needs. This assessment information would indicate that the client should be considered for discharge. 4. Families of clients diagnosed with anorexia nervosa often consist of a passive father, a domineering mother, and an overly dependent child. This client's continued dependence on the mother may indicate that consideration for discharge is inappropriate at this time. 5. A high value is placed on perfectionism in families of clients diagnosed with anorexia nervosa. These clients feel that they must satisfy these unrealistic standards, and when this is found to be impossible, helplessness results. Because this client shows insight into this problem by the recognition that perfection is impossible, consideration for discharge is appropriate. TEST-TAKING HINT: To answer this question correctly, the test taker must have an understanding of the basic problems underlying the diagnosis of anorexia nervosa. Remembering the BMI value for normal weight eliminates "2."

After a routine dental examination on an adolescent, the dentist reports to the parents that bulimia nervosa is suspected. On which of the following assessment data would the dentist base this determination? Select all that apply. 1. Extreme weight loss. 2. Amenorrhea. 3. Discoloration of dental enamel. 4. Bruises of the palate and posterior pharynx. 5. Dental enamel dysplasia.

1. Clients with bulimia nervosa can maintain a normal weight. Extreme weight loss would be a symptom of anorexia nervosa, not bulimia nervosa 2. Amenorrhea is a symptom of anorexia nervosa, not bulimia nervosa, that is due to estrogen deficiency. A dentist would not be in a position to evaluate this symptom during a routine dental examination. 3. Discoloration of dental enamel occurs because of the presence of gastric juices in the mouth from continual vomiting owing to purging behaviors by clients diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia should be suspected. 4. Bruises of the palate and posterior pharynx occur because of continual vomiting owing to purging behaviors by clients diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected. 5. Dental enamel dysplasia occurs because of the presence of gastric juices in the mouth from continual vomiting owing to purging behaviors by the client diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected. TEST-TAKING HINT: The test taker should consider the situation presented in the question to gain clues to the correct answer. What assessment data would a dentist gather? A dentist would not gather assessment information related to menstruation, and so "2" can be eliminated quickly

Which nursing intervention would directly assist a hospitalized client diagnosed with bulimia nervosa to avoid the urge to purge after discharge? 1. Locking the door to the client's bathroom. 2. Holding a mandatory group after mealtime to assist in exploration of feelings. 3. Discussing preplanned meals to decrease anxiety around eating. 4. Educating the family to recognize purging side effects

1. Locking the client's door would be an appropriate behavioral approach to prevent purging in an in-patient setting, but would not assist the client to avoid the urge to purge when discharged. 2. Holding a mandatory group after mealtime to assist in exploration of feelings is an appropriate intervention to assist the hospitalized client diagnosed with bulimia nervosa to avoid the urge to purge after discharge. If the client can become aware of feelings that may trigger purging, future purging may be avoided. 3. Discussing preplanned meals to decrease anxiety around eating is an intervention focused on binging, not purging. 4. Educating the family to recognize purging side effects would not directly assist the client to avoid purging after discharge. This intervention is focused on providing the family tools to use if purging behaviors continue, not on assisting the client to avoid these behaviors. TEST-TAKING HINT: To answer this question correctly, the test taker must note the timeframe presented in the question. The client must be present on the unit for "1" to be a possible intervention. Although "2" occurs on the unit, the information presented in group therapy would assist the client to avoid purging behaviors after discharge. Answer "4" can be eliminated because it focuses on the family instead of the client.

When using a behavioral modification approach to the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? 1. A matter-of-fact, directive approach with the input of the entire treatment team. 2. Clients should perceive that they are in control of clearly communicated treatment choices. 3. Appropriate treatment choices are presented to the client's family for consideration. 4. The treatment team develops a system of rewards and privileges that can be earned by the client

2 1. A behavior modification program should be instituted with client input and involvement. A directive approach would not give the client the needed and sought-after control over behaviors. Typically, control issues are the underlying problem precipitating eating disorders. 2. A behavior modification program for clients diagnosed with eating disorders should ensure that the client does not feel "controlled" by the program. Issues of control are central to the etiology of these disorders, and for a program to succeed the client must perceive that the client is in control of behavioral choices. This is accomplished by contracting with the client for privileges based on weight gain. 3. A behavior modification program should be instituted with client input and involvement. Focusing on the family and excluding the client from treatment choices has been shown to be ineffective. 4. It is important for staff members and client to work jointly to develop a system to contract for rewards and privileges that can be earned by the client. The client should have ultimate control over behavior choices, including whether to abide by the contract. TEST-TAKING HINT: To select the correct answer, the test taker must understand that issues of control are central to the etiology of eating disorders. Effective nursing interventions are client focused. Only "2" involves the client in developing the plan of care.

An 18-year-old female client weighs 95 pounds and is 70 inches tall. She has not had a period in 4 months and states, "I am so fat!" Which statement is reflective of this client's symptoms? 1. The client meets the criteria for an Axis I diagnosis of bulimia nervosa. 2. The client meets the criteria for an Axis I diagnosis of anorexia nervosa. 3. The client needs further assessment to be diagnosed using the DSM-IV-TR. 4. The client is exhibiting normal developmental tasks according to Erikson.

2 1. Included in the diagnostic criteria for bulimia nervosa are binge eating, self-induced vomiting, abuse of laxatives, and poor self-evaluation. This client is not experiencing any binge eating, purging, or inappropriate use of laxatives. Although weight may fluctuate, clients diagnosed with bulimia nervosa can maintain weight within a normal range. This client does not meet the criteria for an Axis I diagnosis of bulimia nervosa. 2. Weight loss leading to maintenance of less than 85% of normal body weight is a criterion for the diagnosis of anorexia nervosa. Disturbance in the way the client views her body and amenorrhea for at least three consecutive menstrual cycles also must be present to validate the diagnosis. This client meets the criteria for an Axis I diagnosis of anorexia nervosa. 3. Because the client meets the diagnostic criteria for an Axis I diagnosis of anorexia nervosa, additional assessments are unnecessary. 4. Extreme weight loss, disturbed body image, and amenorrhea are not normal developmental tasks according to Erikson for an 18-year-old client. Erikson identified the development of a secure sense of self as the task of the adolescent (12 to 20 years) stage of psychosocial development. TEST-TAKING HINT: To answer this question correctly, the test taker must remember the DSM-IV-TR criteria for the diagnosis of anorexia nervosa and differentiate these from the criteria for bulimia nervosa.

A client diagnosed with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that this outcome addresses? 1. Ineffective coping R/T lack of control. 2. Altered nutrition: less than body requirements R/T decreased intake. 3. Self-care deficit: feeding R/T fatigue. 4. Anxiety R/T feelings of helplessness.

2 1. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of ineffective coping. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, or inability to use available resources. An appropriate outcome for ineffective coping for clients diagnosed with eating disorders would be to use healthy coping strategies effectively to deal with anxiety or lack of control without resorting to self-starvation. 2. The outcome of gaining 2 pounds in 1 week is directly related to the nursing diagnosis of altered nutrition: less than body requirements. Altered nutrition: less than body requirements is defined as the state in which an individual experiences an intake of nutrients insufficient to meet metabolic needs. Weight loss is characteristic of the diagnosis of anorexia nervosa, with weight gain being a critical outcome. 3. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of self-care deficit: feeding R/T fatigue. Self-care deficit is related to the inability of the client to perform the acts of self-care; in this case feeding. Clients diagnosed with anorexia nervosa have the ability to feed themselves, but choose not to because of impaired body image. 4. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of anxiety R/T feelings of helplessness. Feelings of depression and anxiety often accompany the diagnosis of anorexia nervosa, but in the short-term, weight gain would increase, not decrease, the anxiety experienced by the client. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the nursing outcome presented in the question with the correct nursing diagnosis. There always must be a correlation between the stated outcome and the problem statement.

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 nursing response is most appropriate? 1. "Thanks for checking in." 2. "I will accompany you to the bathroom." 3. "Let me know when you get back to the day room." 4. "I'll stand outside your door to give you privacy."

2 1. The response, "Thanks for checking in," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. 2. 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. 3. The response, "Let me know when you get back to the day room," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. 4. The response, "I'll stand outside your door to give you privacy," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits. TEST-TAKING HINT: The test taker must understand that sometimes all client needs cannot be met. Although privacy is a client need, in this case the nurse must put aside the client's need for privacy to intervene to prevent further nutritional deficits resulting from self-induced vomiting

A client with cachexia states, "I don't care what you say, I am horribly fat and will continue to diet." The client is experiencing arrhythmias and bradycardia. Based on this client's symptoms, which nursing diagnosis takes priority? 1. Ineffective denial. 2. Imbalanced nutrition: less than body requirements. 3. Disturbed body image. 4. Ineffective coping.

2 Cachexia is a state of ill health, malnutrition, and wasting. 1. When clients diagnosed with eating disorders are unable to admit the effect of maladaptive eating behaviors on life patterns, they are experiencing ineffective denial. This is a valid nursing diagnosis for this client because there is an inability to admit emaciation. This diagnosis should be considered, however, only after resolution of life-threatening nutritional status. 2. The immediate and priority problem that this client faces is imbalanced nutrition: less than body requirements. Impaired nutrition causes complications of emaciation, dehydration, and electrolyte imbalance that can lead to death. When the physical condition is no longer lifethreatening, other problems may be addressed. 3. When emaciated clients diagnosed with eating disorders are negative about their appearance and see themselves as overweight, they are experiencing disturbed body image. This is a valid nursing diagnosis for this client because the client views the body as "horribly fat" when in reality the client is critically thin. This diagnosis should be considered, however, only after resolution of life-threatening nutritional status. 4. Clients diagnosed with eating disorders cope ineffectively with stress and anxiety by maladaptive eating patterns. This is a valid nursing diagnosis because this client is choosing not to eat to deal with unconscious stressors. This diagnosis should be considered, however, only after resolution of life threatening nutritional status. TEST-TAKING HINT: To answer this question correctly, the test taker first must understand the terms used in the question, such as "cachexia." Physiological needs must take priority over psychological needs. If physiological needs are not addressed, the client is at risk for life-threatening complications

A client is leaving the in-patient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? 1. Client will accept refeeding as part of a daily routine. 2. Client will perform nasogastric tube feeding independently. 3. Client will verbalize recognition of "fat" body misperception. 4. Client will discuss importance of monitoring weights daily.

3 1. Accepting refeeding as part of a daily routine is an outcome that would be appropriate early in treatment and should have been accomplished before consideration for discharge planning. 2. Performing nasogastric tube feeding independently is an outcome that would be appropriate early in treatment and should have been accomplished before consideration for discharge planning. 3. The outcome of verbalizing recognition of misperception involving "fat" body image is a long-term outcome, appropriate for discharge planning for a client diagnosed with anorexia nervosa. 4. Monitoring weight on a daily basis is an inappropriate outcome for a client diagnosed with anorexia nervosa. Obsession about food and weight gain is a characteristic symptom of the disease, and this outcome would reinforce this problem. TEST-TAKING HINT: An outcome that is appropriate for discharge planning must be a long-term outcome. Answer choices "1" and "2" are short-term in nature and should occur early in treatment. Answer "4" would be excessive and inappropriate. Answers "1," "2," and "4" can be eliminated immediately

A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? 1. "I'm Italian, so I really enjoy a large plate of spaghetti." 2. "I'll weigh you after your meal." 3. "Let's focus on your continued improvement. You ate 80% of your lunch." 4. "Why do you always talk about food? Let's talk about swimming."

3 1. Because clients diagnosed with anorexia nervosa are obsessed with food, the nurse should not discuss food or eating behaviors. Discussion of food or eating behaviors can provide unintended positive reinforcement for negative behaviors. This statement by the nurse also focuses on the nurse and not the client. 2. The nurse should weigh the client daily, immediately on arising, following first voiding, and not after a meal. 3. It is important to offer support and positive reinforcement for improvements in eating behaviors. Because clients diagnosed with anorexia nervosa are obsessed with food, discussion of food can provide unintended positive reinforcement for negative behaviors. In this answer choice, the nurse is redirecting the client. 4. When the nurse requests an explanation that the client cannot give, the client may feel defensive. "Why" questions are blocks to therapeutic communication. TEST-TAKING HINT: The test taker must understand the underlying obsession and preoccupation with food that clients diagnosed with eating disorders experience. When this is understood, it is easy to choose an answer

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? 1. Mood disorders, which often accompany the diagnosis of bulimia nervosa. 2. Nutritional deficits, which are characteristic of bulimia nervosa. 3. Vomiting, which may lead to dehydration and electrolyte imbalance. 4. Binging, which causes abdominal discomfort

3 1. Mood disorders often accompany the diagnosis of bulimia nervosa, but the client symptoms described in the question do not reflect a mood disorder. 2. Nutritional deficits are characteristic of bulimia nervosa, but the client symptoms described in the question do not reflect a nutritional deficit. 3. Purging behaviors, such as vomiting, may lead to dehydration and electrolyte imbalance. Hallucinations and restlessness are signs of electrolyte imbalance. Dry mucous membranes indicate dehydration. 4. Binging large quantities of food can cause abdominal discomfort, but the client symptoms described in the question do not reflect abdominal discomfort. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize common signs and symptoms of electrolyte imbalance and dehydration.

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? 1. 5 to 10 years old. 2. 10 to 14 years old. 3. 18 to 22 years old. 4. 40 to 45 years old.

3 The onset of bulimia nervosa commonly occurs in late adolescence or early adulthood. Bulimia nervosa is more prevalent than anorexia nervosa. Research suggests that bulimia occurs primarily in societies that place emphasis on thinness as the model of attractiveness for women and where an abundance of food is available. 1. These ages are not within the range of late adolescence to early adulthood. 2. These ages are not within the range of late adolescence to early adulthood. Age 14 would be considered early, not late, adolescence. 3. These ages are within the range of late adolescence to early adulthood, in which the onset of bulimia nervosa commonly occurs. 4. These ages are not within the range of late adolescence to early adulthood. Age 40 falls in the category of late, not early, adulthood. TEST-TAKING HINT: The test taker must recognize the age ranges for onset of bulimia nervosa to answer this question correctly.

The nurse is assessing a client with a body mass index of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. 1. Hypoglycemia. 2. Rheumatoid arthritis. 3. Angina. 4. Respiratory insufficiency. 5. Hyperlipidemia.

3,4,5 Clients with a body mass index (BMI) of 30 or greater are classified as obese. It is important to learn the complications of obesity because, based on the World Health Organization guidelines, half of all Americans are obese. 1. Obese clients commonly have hyperglycemia, not hypoglycemia, and are at risk for developing diabetes mellitus. 2. Osteoarthritis, not rheumatoid arthritis, results from trauma to weight-bearing joints and is commonly seen in obese clients. 3. Workload on the heart is increased in obese clients, and this often leads to symptoms of angina. 4. Workload on the lungs is increased in obese clients, and this often leads to symptoms of respiratory insufficiency. 5. Obese clients often present with hyperlipidemia, particularly elevated triglyceride and cholesterol levels. TEST-TAKING HINT: To answer this question correctly, the test taker first must recognize that this client is obese as reflected by the BMI mentioned in the question.

A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements R/T altered body perception AEB client's being 5 feet 4 inches tall and weighing 75 pounds. Which nursing intervention would address this client's problem? 1. Encourage the client to keep a diary of food intake. 2. Plan exercise tailored to individual choice. 3. Help the client to identify triggers to self-induced purging. 4. Monitor physician-ordered nasogastric tube feedings.

4 1. Clients diagnosed with anorexia nervosa have a preoccupation with food. Focusing on food by encouraging the client to keep a food diary only reinforces maladaptive behaviors. Encouraging a food diary is an appropriate nursing intervention for clients designated as obese. 2. Clients diagnosed with anorexia nervosa are critically ill. They are not meeting their nutritional needs because of poor caloric intake. Exercise would increase the client's metabolic requirements further and exacerbate the client's problem. 3. Self-induced purging is typical of bulimia nervosa, not anorexia nervosa. Also, identifying triggers does not directly address the nursing diagnosis of imbalanced nutrition: less than body requirements. 4. If clients are unable or unwilling to maintain adequate oral intake, the physician may order a liquid diet to be administered via nasogastric tube. This treatment is initiated because without adequate nutrition a life-threatening situation exists for these clients. Nursing care of a client receiving tube feedings should be administered according to established hospital procedures. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the nursing intervention that addresses this problem. Only "4" correlates with the client problem of imbalanced nutrition: less than body requirements.

A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which intervention takes priority? 1. Assessment of family issues and health concerns. 2. Assessment of early disturbances in mother-infant interactions. 3. Assessment of the client's knowledge of selective serotonin reuptake inhibitors used in treatment. 4. Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems

4 1. It is important to assess family issues and health concerns, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 2. It is important to assess early disturbances in mother-infant interactions, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 3. It is important to assess the client's previous knowledge of selective serotonin reuptake inhibitors before any teaching, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 4. The immediate priority of nursing interventions in eating disorders is to restore the client's nutritional status. Complications of emaciation, dehydration, and electrolyte imbalance can lead to death. When the physical condition is no longer lifethreatening, other treatment modalities may be initiated. The assessment and monitoring of vital signs and lab values to recognize and anticipate these medical problems must take priority. TEST-TAKING HINT: To answer this question correctly, the test taker must note that the question requires a "priority" intervention. Physical needs that threaten life always take priority over psychological needs

Which outcome indicates that the client's problem of impaired body image has improved? 1. The client has gained up to 80% of body weight for age and size. 2. The client is free of symptoms of malnutrition and dehydration. 3. The client has not attempted to self-induce vomiting. 4. The client has acknowledged that perception of being "fat" is incorrect.

4 1. The outcome of gaining 80% of body weight for age and size indicates that the nursing diagnosis of imbalanced nutrition: less than body requirements, not impaired body image, has been resolved. Normal body weight is an indication of improved nutritional status. 2. Being free of symptoms of malnutrition and dehydration is an outcome that indicates that the nursing diagnosis of imbalanced nutrition: less than body requirement, not impaired body image, has been resolved. Nutritional status has improved when there are no signs of malnutrition and dehydration. 3. Not attempting self-induced vomiting is an outcome that indicates that the nursing diagnosis of altered coping, not impaired body image, has been resolved. Not resorting to the maladaptive coping mechanism of self-induced vomiting indicates improvement in the client's ability to cope effectively with stressors. 4. When clients can acknowledge that their perception of being "fat" is incorrect, they perceive a body image that is realistic and not distorted. This is evidence that the client's impaired body image has improved. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the outcome that indicates improvement of this problem. All outcomes presented may be appropriate for the client, but only "4" correlates with the client problem of impaired body image.

Psychoanalytically, the theory of obesity relates to the individual's unconscious equation of food with a. nurturance and caring. b. power and control. c. autonomy and emotional growth. d. strength and endurance.

a

The binging episode is thought to involve a. a release of tension, followed by feelings of depression. b. feelings of fear, followed by feelings of relief. c. unmet dependency needs and a way to gain attention. d. feelings of euphoria, excitement, and self-gratification.

a

From a physiological point of view, the most common cause of obesity is probably a. lack of nutritional education. b. more calories consumed than expended. c. impaired endocrine functioning. d. low basal metabolic rate

b

Jane is hospitalized on the psychiatric unit. She has a history and current diagnosis of Bulimia Nervosa. Which of the following symptoms would be congruent with Jane's diagnosis? a. Binging, purging, obesity, hyperkalemia b. Binging, purging, normal weight, hypokalemia c. Binging, laxative abuse, amenorrhea, severe weight loss d. Binging, purging, severe weight loss, hyperkalemia

b

Nancy, age 14, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Nancy? a. Complicated grieving b. Imbalanced nutrition: Less than body requirements c. Interrupted family processes d. Anxiety (severe)

b

Nurse Jones is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? a. "You know that if you don't eat, you will die." b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." c. "You might as well leave if you are not going to follow your therapy regimen." d. "You don't have to eat if you don't want to. It is your choice."

b

A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. "Don't worry. The dietitian will ensure you don't get too many calories in your diet." b. "Don't worry about your weight. We are going to work on other problems while you are in the hospital." c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. "You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital, because we know that is important to you."

c

Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? a. Bradycardia b. Amenorrhea c. Tolerance d. Convulsions

c

Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belviq) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Carbamazepine (Tegretol)

c

Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. Tachycardia, hypertension, hyperthermia b. Bradycardia, hypertension, hyperthermia c. Bradycardia, hypotension, hypothermia d. Tachycardia, hypotension, hypothermia

c