Lippincott NCLEX Review - Adolescent With Eating Disorders
A young adult female client and her roommate go the emergency department due to gastrointestinal problems. The client reveals that she attends college and works at a coffee shop each evening. A diet history indicates that the client has unhealthy eating habits, commonly eating large amounts of carbohydrates and junk food with few fruits and vegetables. "Her stomach is upset a lot," the roommate says. She further reports that the client is "in the bathroom all the time." The nurse should refer the client to: 1. A mental health clinic. 2. A weight loss program. 3. An overeating support group. 4. The client's family primary health care provider.
1. The large carbohydrate intake and significant time in the bathroom are characteristics of bulimia. To address the problem, the client must obtain an evaluation of her physical and psychological status. Suggesting going to a weight loss program or overeating support group frames the problem as strictly a weight issue and ignores the psychological etiology of the problem. Seeing the family's primary health care provider does not address the psychological aspect of the client's illness, and the client must make the appointment herself.
The nurse discovers that an adolescent client with anorexia nervosa is taking diet pills rather than complying with the diet. What should the nurse do first? 1. Explain to the client how diet pills can jeopardize health. 2. Listen to the client about fears of losing control of eating while being treated. 3. Talk with the client about how weight loss and emaciation worry the health care providers. 4. Inquire about worries of the client's family concerning the client's physical and emotional health.
2. A client with anorexia nervosa commonly has an extreme fear of not being able to control weight. The nurse should address this fear. Explaining the dangers of diet pills or discussing health care provider or family concerns focuses on the effect of the client's weight loss on other people rather than the client. Unless the client is motivated to stop, the client will likely not be successful.
A client diagnosed with bulimia tells the nurse she only eats excessively when upset with her best friend, and then she vomits to avoid gaining a lot of weight. The nurse should next: 1. Schedule daily family therapy sessions. 2. Enroll client in a coping skills group. 3. Work with the client to limit her purging. 4. Have client take lorazepam (Ativan) 1 mg as needed whenever she feels the urge to binge.
2. Because the client eats excessively when upset, the best treatment would be a group to help her learn alternative coping skills. Trying to limit purging without controlling binging would result in weight gain and likely increase the client's purging. Daily family therapy sessions are not realistic. Taking lorazepam whenever she feels she needs to binge may temporarily calm the client, but does not address the cause of the binging and purging and further, will lead to drug dependence with long-term use.
A nurse works with a client diagnosed with bulimia. What is an appropriate long-term client goal for this client? 1. Eating meals at home without binging or purging. 2. Being able to eat out without binging or purging. 3. Managing stresses in life without binging or purging. 4. Being able to attend college in another state without binging or purging.
3. A successful outcome for a bulimic client is to avoid using the eating disorder as a coping measure when dealing with stress. Being able to attend college in another state, eat at home, and eat out without binging and purging are important goals, but do not address the primary problem of stress management and its connection to eating.
A client newly diagnosed with bulimia is attending the nurse-led group at the mental health center. She tells the group that she came only because her husband said he would divorce her if she didn't get help. Which of the following responses by the nurse is appropriate? 1. "You sound angry with your husband. Is that correct?" 2. "You will find that you like coming to group. These people are a lot of fun." 3. "Tell me more about why you are here and how you feel about that." 4. "Tell me something about what has caused you to be bulimic."
3. Encouraging the client to talk about why she is here and her feelings may reveal more information about what led her to come to the group and what led to her diagnosis. It also provides the nurse with valuable information needed to develop an appropriate plan of care. The comment that the client sounds angry presumes what the client is feeling and focuses the talk on her husband. The focus should be on the client, not the husband. Telling the client that she will like coming to group imposes the nurse's view onto the client. The statement also focuses on having fun in the group instead of stressing the therapeutic value. Having the client tell the nurse something about the cause of her bulimia ignores the client's original statement. In addition, it requires the client to have insight into the cause of her disease, which may not be possible at this point. Also, it may be too early in the relationship to discuss this disorder.
A hospitalized adolescent diagnosed with anorexia nervosa refuses to comply with her daily before-breakfast weigh-in. She states that she just drank a glass of water, which she feels will unfairly increase her weight. What is the nurse's best response to the client? 1. "You are here to gain weight so that will work in your favor." 2. "Don't drink or eat for 2 hours and then I'll weigh you." 3. "You must weigh in every day at this time. Please step on the scale." 4. "If you don't get on the scale, I will be forced to call your doctor."
3. In responding to the client, the nurse must be nonjudgmental and matter of fact. Telling her that weight gain is in her favor ignores the client's extreme fear of gaining weight. Putting off the weigh-in for 2 hours allows the client to manipulate the nurse and interferes with the need to weigh the client at the same time each day. Threatening to call the doctor is not likely to build rapport or a working relationship with the client.
The parents of a newly diagnosed 15-year-old with anorexia nervosa are meeting with the nurse during the admission process. Which of the following remarks by the parents should the nurse interpret as typical for a client with anorexia nervosa? 1. "We've given her everything, and look how she repays us!" 2. "She's had behavior problems for the past year both at home and at school." 3. "She's been a model child. We've never had any problems with her." 4. "We have five children, all normal kids with some problems at times."
3. Parents commonly describe their child as a model child who is a high achiever and compliant. These adolescents are typically well liked by teachers and peers. It is not typical for behavior problems to be reported. The description about having given the child everything and being repaid is more likely to describe an adolescent who is exhibiting behavior problems.
A nurse is working with a client with bulimia. Which of the following goals should be included in the care plan? Select all that apply. 1. The client will maintain normal weight. 2. The client will comply with medication therapy. 3. The client will achieve a positive self-concept. 4. The client will acknowledge the disorder. 5. The client will never have the desire to purge again.
1, 2, 3, 4. Because of the large number of calories ingested in a binge and the fact that a purge does not eliminate all calories consumed, the client with bulimia is of more normal weight but still must have a goal of maintaining that weight. Research has shown that selective serotonin reuptake inhibitors are effective in treating bulimia, and the client is usually amenable to taking the medication. The client with an eating disorder (bulimia and anorexia) has negative self-concepts that fuel her disordered eating, and attaining a positive self-concept is an appropriate goal. The nurse should work with the client with bulimia to help her recognize her eating as disordered. That recognition can make the client more amenable to treatment. It is not realistic to establish a goal that the client with bulimia will never have the desire to purge again.
When developing a teaching plan for a high school health class about anorexia 30. When developing a teaching plan for a high school health class about anorexia nervosa, which of the following should the nurse include as the primary group affected by this disease? 1. Women, age at onset between 12 and 20 years. 2. Men, onset during the college years. 3. Women, onset typically after 30 years. 4. Men, onset after 20 years.
1. Anorexia nervosa occurs most commonly in girls and women, with the age at onset between 12 and 20 years. It begins less commonly after 30 years. Although anorexia occurs in men, the prevalence rate is less than 5% to 10% of all cases of anorexia.
When teaching a group of adolescents about anorexia nervosa, the nurse should describe this disorder as being characterized by which of the following? 1. Excessive fear of becoming obese, near-normal weight, and a self-critical body image. 2. Obsession with the weight of others, chronic dieting, and an altered body image. 3. Extreme concern about dieting, calorie counting, and an unrealistic body image. 4. Intense fear of becoming obese, emaciation, and a disturbed body image.
4. An intense fear of becoming obese, emaciation, and a disturbed body image all are considered to be characteristic of anorexia nervosa. Near-normal weight is not associated with anorexia. The weight of others is not a primary factor. Concern about dieting is not strong enough language to describe the control of food intake in the individual with anorexia nervosa.
During the initial interview, a client with a compulsive eating disorder remarks, "I can't stand myself and the way I look." Which of the following statements by the nurse is most therapeutic? 1. "Everyone who has the same problem feels like you do." 2. "I don't think you look bad at all." 3. "Don't worry, you'll soon be back in shape." 4. "Tell me more about your feelings."
4. The nurse needs to explore more about the client's feelings to assess what underlies the eating disorder. The nurse also needs to evaluate the client's suicide risk. The other statements are not therapeutic because they minimize the client's feelings.
A community health nurse working with a group of fifth-grade girls is planning a primary prevention to help the girls avoid developing eating disorders during their teen years. The nurse should focus on which of the following? 1. Working with the school nurse to closely monitor the girls' weight during middle school. 2. Limiting the girls' access to media images of very thin models and celebrities. 3. Telling the girls' parents to monitor their daughter's weight and media access. 4. Helping the girls accept and appreciate their bodies and feel good about themselves.
4. The goal of a primary prevention program for eating disorders is for the girls to have positive feelings about themselves and their bodies. Monitoring of weight by parents and/or school nurses might note eating disorders early, particularly anorexia, but will not address the cause of the disorder. Limiting the girls' access to media would be impossible and does not prevent distress with one's body image.
The nurse is planning an eating disorder protocol for hospitalized clients experiencing bulimia and anorexia. Which elements should be included in the protocol? Select all that apply. 1. Clients must eat within view of a staff member. 2. Clients are not told their weight and cannot see their weight while being weighed. 3. Clients are not allowed to discuss food or eating in groups or informal conversation with peers. 4. Clients must rest within view of a staff member and not go to the bathroom for one-half hour to an hour after eating. 5. Clients cannot participate in any groups after admission until they gain 1 lb (0.45 kg).
1, 2, 4. In hospital settings, clients are not allowed to know their weight at the time they are being weighed to decrease obsessing about weight gain. They must also eat and rest in staff view and cannot use the bathroom for a period to prevent discarding food or vomiting ingested food (purging). The rest prevents the client from exercising off the calories they just consumed. Barring clients from ever talking about food or attending groups until they have gained weight diminishes the therapeutic value of the inpatient hospital stay.
While coaching a youth soccer team, the nurse has observed one of the teammates binging and purging on multiple occasions. The nurse asks the girl's mother to stay after practice and talk privately. Which of the following ways is best for the nurse to begin the conversation? 1. "Thank you for letting your daughter play on the team. She's a very good player and is also pleasant and easy to coach." 2. "I have some very bad news for you. Your daughter has a serious problem that is diagnosed as an eating disorder." 3. "I am a nurse. I have seen your daughter doing things that are considered to be part of an eating disorder." 4. "Let me get right to the point. Your daughter is very sick and needs to see a mental health therapist right away."
3. By telling the mother that the coach is a nurse and relaying the behaviors observed, the nurse gives the mother a chance to recognize the expertise of the coach and introduces the possibility of an eating disorder. Thanking the mother and complimenting the player does not begin to approach the topic. Telling the mother that the nurse has some very bad news is negative and dramatic. Additionally, although the observed behaviors suggest an eating disorder, it would be inappropriate for the nurse to medically diagnose the daughter. Although the daughter may indeed be very sick and need to see a therapist, the nurse should relate the information in a matter-of-fact, unemotional way
