PSYCH CH 20

Following a series of visits to her primary care provider and the hospital, a 22-year-old retail clerk has been diagnosed with anorexia nervosa. Which of the client's following statements demonstrates an accurate understanding of her diagnosis?

"I guess it's probably safe to say that anorexia runs in my family."

The nurse is interviewing Jessica, 18 years old, about her eating behaviors. Jessica's parents have brought her to treatment because her mother suspects that Jessica has been binge eating and vomiting. The nurse asks Jessica if she ever feels that she cannot control her eating. Jessica is silent for a moment, and her mother states, "I know she can't control it; she ate an entire cake last night!" Which of the following comments by the nurse is best?

"I see. Jessica, do you ever feel as though you cannot control your eating?"

While caring for a client with anorexia nervosa, the nurse anticipates that the client would have difficulty making which of the following comments?

"I'm mad at you because you won't let me go on a pass unless I gain weight!"

A nurse is performing an admission assessment for an adolescent girl with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the client's diagnosis?

"I've never really liked myself."

A nurse is interviewing a client diagnosed with bulimia nervosa about her family and her relationship with her mother. Which statement by the client would the nurse least likely associate with bulimia nervosa?

"My mother and I are close but not joined at the hip."

A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young woman who has been diagnosed with anorexia nervosa. Which of the following assessment questions is most therapeutic?

"What do you think about how much you weigh right now?"

Jamie is 16 years old and her identical twin sister was just diagnosed with anorexia nervosa. Jamie tells the nurse she is concerned that she may also develop the disorder. Which of the following responses by the nurse is the most appropriate?

"While eating disorders have shown a genetic link, environmental factors also play a role in the development of easting disorders."

Which of the following percentages accurately reflects the incidence of anorexia and bulimia in the United States?

1% to 4%

The psychiatric nurse caring for an anorectic teenager with a body mass index (BMI) of 15.2 assesses for the most serious complication facing this client when

Asking,"Do you ever think about hurting yourself?"

When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what?

Control

Individuals with anorexia nervosa concentrate on which of the following body cues?

Controlling food intake

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. She weighs 80 pounds and is 5'2" tall. She states that she usually eats salads so that she does not gain weight. The nurse suspects that the client most likely has

Anorexia nervosa

Based on a biochemical theory, the decreased levels of cholecystokinin found in the cases of obsessive-compulsive disorder (OCD), the psychiatric nurse assesses for symptoms and risk factors of

Anorexia nervosa

Which of the following is a cardiac complication of an eating disorder?

Bradycardia

While a nurse talks to the mother of a 15-year-old girl, the mother expresses concern over her daughter's eating and exercise habits. The mother says that as soon as her daughter comes home from school, she exercises for two to three hours every day. She says her daughter eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. Her daughter was complaining of tooth pain, and when the mother took her to the dentist, her daughter had over 10 cavities. Which of the following disorders is her daughter most likely suffering from?

Bulimia nervosa

A 17-year-old girl with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which of the following assessments?

Cardiac assessment and measurement of electrolyte levels

A client was admitted to the eating disorder unit with bulimia nervosa. When the nurse assesses for a history of complications of this disorder, which of the following are expected?

Dental erosion and chronic edema

The nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which of the following if noted in the clients' histories?

Depression

Which of the following is the most common disorder found in clients with bulimia nervosa?

Depression

A psychiatric-mental health nurse working in the community is planning an educational program for fifth and sixth grade teachers. Which of the following would the nurse include?

Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders

Patients diagnosed with anorexia nervosa undergo an intense physical and emotional process that overrides all physiologic body cues. This would be documented as which of the following?

Drive for thinness

Which of the following is a dental complication associated with purging?

Erosion of dental enamel

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 woman, is 5'2" and weighs 88 lbs. The nurse assesses her history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. She observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which of the following factors is a priority for the nurse to assess next?

Heart rate and rhythm

Which of the following would not be a finding on physical examination of the client with anorexia nervosa?

Hypokalemia

A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis?

Imbalanced Nutrition: Less Than Body Requirements

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which of the following would the nurse expect to find?

Impulsivity

Implementation of the nursing treatment plan for the client with bulimia may include which of the following?

Increasing coping skills for anxiety

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. She is 5' 5" tall and weighs 75 pounds. Which of the following is the highest priority nursing intervention?

Initiating total parenteral nutrition as ordered

Which of the following is a typical characteristic of parents of clients diagnosed with anorexia nervosa?

Overprotect their children

At the prompting of her friends, a 16-year-old girl has agreed to meet with her school nurse who suspects that the student may have an eating disorder. During the nurse's assessment, the nurse has asked the student to describe her family. Which of the following family processes and characteristics is thought to contribute to eating disorders?

Poor communication and enmeshed family dynamics

Which of the following medications has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits?

Prozac (fluoxetine)

A client with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following would the nurse include when teaching the client about the prescribed medication?

Report any weight changes that occur during the first few weeks this medication is taken.

The client with bulimia complains of feeling helpless and having a black future and says, "What's the use?" As the nurse plans the client's care, the most important priority diagnosis based on these data is what?

Risk for self-directed violence

Which technique is a type of cognitive behavioral therapy?

Self-monitoring

People diagnosed with bulimia nervosa have lower levels of which neurotransmitter?

Serotonin

An adolescent female has been diagnosed with anorexia nervosa. Which of the following interventions should be included in the client's plan of care?

Set up a strict eating plan for the client

A client with bulimia is being discharged from care. The nurse considers which of the following indicators most important when evaluating the effectiveness of the care plan?

The client eats six small meals per day

Which of the following behaviors differentiates an individual who is believed to have bulimia nervosa from a person who has anorexia nervosa?

The person engages in episodic binge eating.

After complaining of weakness and confusion while at school, a 16-year-old girl was admitted to the hospital where admission assessments revealed hypokalemia. The girl's friends and family strongly suspect that she has bulimia nervosa. In planning her nursing care and treatment, which of the following outcomes should be prioritized?

The client will be free of self-induced vomiting.

When admitted to the inpatient unit, Joyce is 5 feet 10 inches tall and weighs 100 lbs. What is the initial goal in her care?

To stop losing weight

Which of the following is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa?

Weight gain

Eating disorders primarily affect which of the following populations?

Young white females from upper socioeconomic groups

A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which of the following would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply.

• Body dissatisfaction • Obsessiveness • Cognitive distortions

The parents of a teenage girl who has just been diagnosed with anorexia nervosa are distraught at this development, stating, "We have no idea where this all came from." The preanorectic person is typically what?

A high achiever who is well behaved

Brandon is an overweight 32-year-old man who regularly binges on large amounts of food. After he binges, Brandon feels guilty and ashamed about eating the food. Despite the bad feelings, Brandon binges almost daily. Which of the following conditions is Brandon most likely suffering from?

Binge-eating disorder

A college student has been referred to the college clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what?

Body weight significantly below ideal for her height and age

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which of the following would the nurse expect to implement in conjunction with pharmacologic therapy?

Cognitive behavioral therapy

Which of the following is a nursing priority when caring for the patient with anorexia nervosa?

Establishing a trusting relationship

Which of the following areas of the brain has been associated with the symptoms of eating disorders?

Hypothalamus

Which of the following is a metabolic complication related to weight loss?

Hypothyroidism

The nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which of the following would the nurse include in the teaching plan?

Setting realistic goals

A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. She doesn't want to feel fat in her bathing suit on vacation. Her sodium level is 150 mEq/L; her potassium level is 3.2 mEq/L. She is 5' tall, weighs 100 lbs, and has lost 15 lbs in 3 weeks. Which of the following goals is a priority at this time?

Stabilize her electrolyte levels.

The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks her to step on the scale. The student asks if she can go to the bathroom first to empty her bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has:

Anorexia nervosa

Fluoxetine (Prozac) has been approved for the treatment of anorexia nervosa. Prozac is from which of the following drug classifications?

Antidepressant

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which of the following classes of medications can be used to treat eating disorders?

Antidepressants

Susan's dentist noticed that her teeth were losing enamel. When asked about this, Susan states that this "runs in her family." Which of the eating disorders is most often associated with dental caries and enamel loss?

Bulimia nervosa, purging type

A 30-year-old woman is in therapy for bulimia, depression, and anxiety. She relates that she feels unable to cope with the demands of her job and that her boyfriend recently ended their long-term relationship. She states that she frequently binges when her stress levels are high. She denies feeling suicidal but states, "I'm a mess. I'm just not smart enough to figure out how to run my life!" Which of the following nursing diagnoses would best identify the client's problems?

Chronic Low Self-Esteem related to unrealistic self-expectations

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. The primary interventions include

Cognitive-behavioral therapy (CBT) and guided self-change (GSC)

All of the following are behaviors associated with purging except

Consuming large amounts of food

Which of the following statements best describes the biologic theories of the etiology of eating disorders?

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.

For a client with anorexia nervosa, which goal takes the highest priority?

Establishing adequate daily nutritional intake

During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which of the following medications?

Fluoxetine (Prozac)

Exacerbation of anorexia nervosa results from the client's effort to

Gain control of one part of her life

For clients who purge, the most important goal is to

Stop the behavior

Debbie is 5 feet 6 inches tall, weighs 105 lb, exercises 4 hours per day, and does not engage in any binging or purging behaviors. She believes that she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." Debbie's most likely diagnosis is

anorexia nervosa, restricting type.

A client's diagnosis of anorexia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.)

• Client reports of "being depressed" • Claims that she "hasn't had a menstrual period in over 2 years." • Overheard telling other clients "I weigh myself three times a day when I'm home" • Consistently denies that she "has a problem with the way she looks"

A client's diagnosis of bulimia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.)

• Client reports of "being depressed" • History of purging "3 times a week for 2 years." • Often heard discussing "how hard it is to stay thin" with other clients

Which the following are criterion for hospitalization of patients with eating disorders? Select all that apply.

• Heart rate near 40 beats/min • Hypokalemia • Blood pressure less than 80/50 mm Hg • Poor motivation to recover • Hypomagnesemia