Psych Nursing Quiz 9

A nurse assesses a client diagnosed with bulimia nervosa. Why should the nurse assess the client for the presence of dental caries? 1. The client vomits excessively. 2. The client participates in binge eating. 3. The client has experienced ipecac intoxication. 4. The client's daily caloric intake is excessive

.1. The client vomits excessively. Rationale In bulimia nervosa, induced vomiting causes reflux of hydrochloric acid over the tooth enamel, which leads to dental caries. Binge eating can cause gastric dilation or rupture, not dental caries. Ipecac intoxication can cause cardiac failure, not dental caries. Excessive caloric intake paired with purging can lead to the client having slightly low to normal body weight.

Which client statements and behaviors support the diagnosis of anorexia nervosa in a client who is 5 ft, 7 in tall? Select all that apply. 1. "I know I weigh 90 lb; I still look fat!" 2. "Nobody will like me if I look so grossly obese." 3. Engages in both a pre- and post-meal exercising ritual. 4. "I understand this isn't a healthy way to live, but I can't be fat." 5. Places one potato onto a plate and cuts it into many small pieces.

1. "I know I weigh 90 lb; I still look fat!" 2. "Nobody will like me if I look so grossly obese." 3. Engages in both a pre- and post-meal exercising ritual. 5. Places one potato onto a plate and cuts it into many small pieces. Rationale Thoughts and behaviors that are associated with anorexia nervosa include a view of the self as fat even when emaciated, a judgment of self-worth based on weight, possible development of a rigorous exercise regimen, and peculiar handling of food, for example cutting food into small bits. Saying "I understand this isn't a healthy way to live, but I can't be fat" demonstrates self-reflection that usually is lacking in the client diagnosed with anorexia nervosa.

Which are possible medical complications of anorexia nervosa? Select all that apply. 1. Acrocyanosis 2. Leukopenia 3. Dysmenorrhea 4. Hematuria 5. Hypokalemic acidosis

1. Acrocyanosis 2. Leukopenia 4. Hematuria Rationale Possible medical complications caused by anorexia include acrocyanosis, leukopenia, and hematuria. Clients with anorexia nervosa will more typically experience amenorrhea rather than dysmenorrhea, and hypokalemic alkalosis rather than hypokalemic acidosis.

The nurse should monitor a client diagnosed with anorexia nervosa for which medical complications? Select all that apply. 1. Acrocyanosis 2. Severe abdominal pain 3. Decreased bone density 4. Reduced chewing ability 5. Elevated blood carotene

1. Acrocyanosis 3. Decreased bone density 5. Elevated blood carotene Rationale Acrocyanosis, or blue coloration of extremities, can be seen in a client diagnosed with anorexia nervosa due to the presence of cool extremities caused by starvation. Decreased bone density also occurs due to low calcium intake caused by malnourishment and starvation. Carotenemia, or elevated levels of blood carotene, is seen as the client restricts the diet to prevent weight gain. Clients diagnosed with bulimia nervosa may have severe abdominal pain due to gastric dilation caused by binge eating. Clients diagnosed with bulimia nervosa have reduced chewing ability due to dental cavities, which are caused by induced vomiting.

A nurse assesses personality traits of a client diagnosed with an eating disorder. Which comment by the client most indicates bulimia nervosa rather than anorexia nervosa? 1. "I feel good. I feel just fine. I don't have any problems." 2. "I try to do what my parents want, but I usually don't get things right." 3. "If I want to do something, I just do it. I don't like to analyze things too much." 4. "I don't look as good as most of my friends. That's why I don't have many dates."

3. "If I want to do something, I just do it. I don't like to analyze things too much." Rationale Impulsivity is characteristic of bulimia nervosa. Denying having any problems, feelings of ineffectiveness, and low self-esteem and body image are findings more commonly associated with anorexia nervosa.

An adolescent client diagnosed with anorexia nervosa currently weighs 97 lb. The client's ideal body weight is 127 lb. What is the priority goal for this client? 1. Attain a weight of 114.3 lb. 2. Verbalize a realistic body image. 3. Demonstrate elevated self-concept. 4. Seek input from others when making decisions.

1. Attain a weight of 114.3 lb. After intervention for any acute symptoms, the client diagnosed with anorexia begins a weight restoration program that allows for incremental weight gain. The priority treatment goal is to reach 90% of ideal body weight, the weight at which most women are able to menstruate. Verbalizing a realistic body image and improved self-concept are important goals, but nutritional integrity with weight gain is a higher priority. The goal of treatment is to achieve independence with decision-making processes, not to seek input from others.

Which assessment findings support the diagnosis of anorexia nervosa in a female? Select all that apply. 1. Bradycardia 2. Amenorrhea 3. Hypertension 4. Prolonged QT interval 5. Lethargy related to hypothyroidism

1. Bradycardia 2. Amenorrhea 4. Prolonged QT interval 5. Lethargy related to hypothyroidism Rationale Medical complications associated with anorexia nervosa include bradycardia, amenorrhea, prolonged QT interval, and abnormal thyroid functioning resulting in hypothyroidism. Hypertension is not associated with anorexia nervosa.

A client says to the nurse, "If I get back to a BMI of 20, I will never be able to have the life I want." What cognitive distortion is this client displaying? 1. Catastrophizing 2. Personalization 3. Overgeneralization 4. Emotional reasoning

1. Catastrophizing Rationale Catastrophizing involves magnifying the consequences of an event to unrealistic proportions. Personalization involves overinterpreting events as having personal significance. Overgeneralization involves believing that a single event affects unrelated situations. Emotional reasoning involves the belief that subjective emotions determine reality.

A client is suspected of having anorexia nervosa. Which clinical manifestations does the nurse identify as symptoms of anorexia nervosa? Select all that apply. 1. Emaciation 2. Russell's sign 3. Dehydration 4. Yellow skin 5. Hyperkalemia

1. Emaciation 3. Dehydration 4. Yellow skin Rationale Anorexia nervosa is an eating disorder in which the client has intense Year of weight gain and refuses to maintain optimal weight. Due to malnourishment and starvation, the client is emaciated and dehydrated. The skin is yellow due to elevated carotene levels in the blood. Clients with bulimia nervosa have Russell's sign, or calluses and scars on the hand due to self-induced vomiting; this is not typically associated with anorexia nervosa. Hypokalemia, as opposed to hyperkalemia, is present in clients with anorexia nervosa due to dehydration.

Which signs and symptoms are most commonly associated with the diagnosis of anorexia nervosa? Select all that apply. 1. Fear of gaining weight 2. Chemical dependency 3. Rigorous exercise program 4. Self-induced vomiting 5. Peculiar handling of food

1. Fear of gaining weight 3. Rigorous exercise program 5. Peculiar handling of food Rationale A Year of gaining weight, a rigorous exercise program, and peculiar handling of Food are all commonly associated with anorexia nervosa. Chemical dependencies and self-induced vomiting are more typical of bulimia nervosa.

What is considered the "gold standard" for the pharmaceutical treatment of bulimia nervosa? 1. Fluoxetine 2. Olanzapine 3. Benzodiazepine 4. Anticonvulsant

1. Fluoxetine Rationale Fluoxetine has been approved by the Food and Drug Administration (FDA) for the treatment of bulimia nervosa and has been regarded as the "gold standard" in the treatment of this disorder. Olanzapine, a second-generation antipsychotic, is increasingly being reported in the literature to positively affect weight gain and improve cognition and body image for anorexia nervosa. Benzodiazepine and anticonvulsant therapies are not specifically indicated for eating disorders.

Regarding clients diagnosed with anorexia nervosa, monitoring which physiological signs should be the nurse's priority? Select all that apply. 1. Heart rate 2. Protein levels in urine 3. Dental health 4. Potassium levels in blood 5. Chewing ability 6. Esophageal structure

1. Heart rate 2. Protein levels in urine 4. Potassium levels in blood Rationale In clients with anorexia nervosa, heart rate, protein levels in urine, and potassium levels in blood should be monitored. These clients are at risk of bradycardia, proteinuria, and hypokalemic alkalosis. Dental health, chewing ability, and esophageal structure can become compromised in clients with bulimia nervosa related to self-induced vomiting.

A nurse assesses an adolescent client diagnosed with anorexia nervosa. Which physical findings support the diagnosis? Select all that apply. 1. Lanugo 2. Oily skin 3. Irregular heart rate 4. Extremities hot to touch 5. Pulse rate of 48 bpm

1. Lanugo 3. Irregular heart rate 5. Pulse rate of 48 bpm Rationale Lanugo, abnormal growth of fine hair, is a result of starvation. Cardiovascular changes, including an irregular heart rate and bradycardia, are consequences of dehydration and electrolyte abnormalities. Dehydration contributes to dry, rather than oily, skin. The client's skin on the extremities would be cool to the touch.

How do the assessment findings differ for a client diagnosed with bulimia compared to a client diagnosed with anorexia nervosa? 1. Maintains a normal weight 2. Purges to keep weight down 3. Holds a distorted body image 4. Performs more rigorous exercising

1. Maintains a normal weight Rationale Many bulimic clients are at or near normal weight, whereas clients diagnosed with anorexia nervosa are underweight. Clients with either disorder may engage in purging, distorted body image, or excessive exercise.

A nurse cares for a client diagnosed with bulimia nervosa. Which factors should the nurse discuss when educating the client about the eating disorder? 1. Meal planning 2. Effects of purging 3. Effects of starvation 4. Relaxation techniques 5. Avoiding forbidden foods

1. Meal planning Rationale Bulimia nervosa is characterized by repeated episodes of binge eating followed by inappropriate behaviors like induced vomiting or purgation to compensate. Meal planning will help the client follow a healthy diet and avoid binging and purging. Understanding the effects of purging is important to be able to avoid it and maintain a healthy routine. Following relaxation techniques can help in relieving stress by ways other than using food and help in recovery. Understanding the effects of starvation are more important in cases of patients with anorexia nervosa, because this disorder involves avoidance of Food due to Year of weight gain. Clients with bulimia nervosa should be encouraged to eat rather than to avoid forbidden foods.

What are the priority goals for all clients diagnosed with an eating disorder? Select all that apply. 1. Restore the client's nutritional state. 2. Achieve a body mass index (BMI) of at least 17 kg/m2. 3. Establish a minimum daily caloric intake. 4. Modify the client's disordered eating behaviors. 5. Help change distorted beliefs about body image.

1. Restore the client's nutritional state. 4. Modify the client's disordered eating behaviors. 5. Help change distorted beliefs about body image. Rationale The three main goals for all eating disorders are to restore the client's nutritional state, modify the client's disordered eating behaviors, and help change distorted beliefs about body image. Achieving a specific BMI and daily caloric intake and engaging the client in long-term group therapy may not be appropriate for every client.

The nurse suspects bulimia nervosa in a client. Which assessment findings support the nurse's suspicion? Select all that apply. 1. Scars on hand 2. Amenorrhea 3. Dental erosion 4. Parotid swelling 5. Constipation

1. Scars on hand 3. Dental erosion 4. Parotid swelling Rationale Bulimia nervosa is an eating disorder in which the client has recurrent episodes of uncontrollable binging followed by inappropriate compensatory behaviors, such as excessive exercise and induced vomiting. Due to self-induced vomiting, the client presents with scars on hands and dental erosion. The reflux of hydrochloric acid over the tooth enamel causes dental cavities. The parotid glands swell due to an increase in serum amylase levels. Clients are usually normal in weight due to excessive caloric intake with purging. They do not typically have amenorrhea, which is more common in clients with anorexia nervosa. Clients diagnosed with bulimia nervosa also have constipation due to starvation.

Which diagnostic laboratory results are pertinent to assessment of a client suspected of having bulimia nervosa? Select all that apply. 1. Serum glucose level 2. Liver function studies 3. Thyroid function 4. Electrolyte levels 5. Complete blood count

1. Serum glucose level 3. Thyroid function 4. Electrolyte levels 5. Complete blood count Rationale Medical evaluation usually includes a thorough physical examination, as well as pertinent laboratory testing, including glucose levels, thyroid function tests, electrolyte levels, and complete blood count. Although it may be appropriate in some cases, liver function testing is not considered primarily pertinent to the assessment process for bulimia nervosa.

What statement presents accurate information about clients diagnosed with bulimia nervosa? Select all that apply. 1. They are often at or slightly below their ideal body weight. 2. They often have a history of impulsivity and instability. 3. They are at low risk for suicidal ideation. 4. They may or may not exhibit purging behaviors. 5. They commonly require surgery for gastric rupture.

1. They are often at or slightly below their ideal body weight. 2. They often have a history of impulsivity and instability. 4. They may or may not exhibit purging behaviors. Rationale Clients with bulimia nervosa are often at or slightly below their ideal body weight, often have a history of impulsivity and instability, and may or may not exhibit purging behaviors. They are at high risk for suicidal ideation. Gastric rupture is rare.

Which is a focus for the acute phase of treatment for a client diagnosed with anorexia nervosa? 1. Weight restoration 2. Improving interpersonal skills 3. Learning effective coping methods 4. Changing family interaction patterns

1. Weight restoration Rationale Weight restoration is the priority goal of treatment for the client with anorexia nervosa, because health is threatened seriously by an acutely underweight status. Interpersonal skills, coping, and family interactions are important areas to be explored after the client's physical health has been stabilized.

Which statement made by a client diagnosed with bulimia indicates that an appropriate outcome for treatment has been met? 1. "I purge only once a day now instead of twice." 2. "I'm both a hard worker and a compassionate person." 3. "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." 4. "I always purge when I'm alone so that I'm not a bad role model for my younger sister."

2. "I'm both a hard worker and a compassionate person." Rationale An appropriate overall goal for the client with bulimia would include that the client be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is not an appropriate outcome, because the goal is to refrain from purging altogether. A goal is for the client to express feelings without food references such as associating feelings with eating cheeseburgers. Purging when alone is not a desired outcome because the client is still purging.

Which nursing assessment question best determines the client's motivation for binge eating? 1. "Does binging help you get the attention you need?" 2. "Would you say that you are less depressed after binging?" 3. "Are you less likely to hear voices while you are binging?" 4. "Do you sleep better, at least temporarily after binging?"

2. "Would you say that you are less depressed after binging?" Rationale Overeating is frequently noted as a symptom of a depression (e.g., atypical depression). High rates of mood disorders and personality disorders are found among binge eaters. Binge eaters also report a history of major depression significantly more often than non—binge eaters. They further report that binge eating is soothing and helps to regulate their moods. Binge eaters rarely do so for attention, to stop auditory hallucinations, or to improve sleep.

The school nurse assesses Your adolescents, all of whom outwardly appear healthy. Which adolescent meets one criterion for anorexia nervosa with mild severity? 1. 5 ft 2 in, 104 lb 2. 5 ft 7 in, 110 lb 3. 5 ft 5 in, 114 lb 4. 5 ft 8 in, 127 lb

2. 5 ft 7 in, 110 lb Rationale An ideal body mass index (BMI) falls in the range between 19 and 25. One criterion for anorexia nervosa with mild severity is a BMI equal to or greater than 17 kg/m 2. The adolescent who is 5 ft 7 in tall with a weight of 110 lb has a BMI of 17.2. The adolescents who are 5 ft 2 in, 104 lb; 5 ft 5 in, 114 lb; and 5 ft 8 in, 127 lb have BMIs of 19 or higher.

Which statement is true of clients diagnosed with bulimia nervosa? 1. They exhibit lanugo. 2. They severely restrict their food intake. 3. They often appear to have a normal weight. 4. They binge eat but do not engage in compensatory measures.

3. They often appear to have a normal weight. Clients diagnosed with bulimia are often at or close to ideal body weight and do not appear physically ill. Lanugo and severely restricting food intake are associated with anorexia nervosa. Binge eating without engaging in compensatory measures is a behavior characteristic of binge eating disorder.

The nurse assesses that a client has low weight, lanugo, cool extremities, and a fear of gaining weight. What disorder does the nurse suspect is the cause for the presence of these symptoms? 1. Bulimia nervosa 2. Anorexia nervosa 3. Binge eating disorder 4. Rumination disorder

2. Anorexia nervosa Rationale Anorexia nervosa is an eating disorder in which the client has intense fear of weight gain and refuses to maintain optimal weight. The client is underweight and presents with lanugo (downy hair on face and back) and cool skin on the extremities due to starvation. In bulimia nervosa, the client has recurrent episodes of uncontrollable binging. This is followed by inappropriate compensatory behaviors, such as excessive exercise, induced vomiting, and misuse of laxatives. In binge eating disorder, the client has recurrent episodes of uncontrollable binging followed by a feeling of distress, but the client shows no compensatory behavior. In rumination disorder, the client regurgitates the food and then rechews and reswallows the food or spits it out.

Which signs and symptoms are most commonly associated with a diagnosis of bulimia nervosa? Select all that apply. 1. Helplessness 2. Binge eating 3. Disturbed self-concept 4. Impulsive stealing 5. Associates weight with self-worth

2. Binge eating 3. Disturbed self-concept 4. Impulsive stealing Rationale Binge eating, a disturbed self-concept, and impulsive stealing are all commonly associated with bulimia nervosa. Controlling feelings of helplessness by restricting food intake and associating self-worth with weight are more commonly associated with anorexia nervosa.

A client presents with decreased cardiac output. The nurse notes that the client engages in binge eating and then exercises excessively to make up for the calories gained. Which diagnosis should the nurse suspect? 1. Binge eating 2. Bulimia nervosa 3. Anorexia nervosa 4. Weight management

2. Bulimia nervosa Rationale Bulimia nervosa involves repeated episodes of binge eating followed by inappropriate behaviors to compensate, such as exercise, induced vomiting, or purgation. Binge eating involves repeated episodes of overindulgence in eating followed by a feeling of guilt and distress but no compensatory behavior. Anorexia nervosa is having intense Year of weight gain and refusing to maintain optimal weight. Weight management involves developing a specific plan of diet and exercise and does not include binging followed by excessive exercise.

A client reveals self-induced vomiting as often as a dozen times a day. What does the nurse expect assessment findings to reveal? Select all that apply 1. Tachycardia 2. Hypokalemia 3. Hypercalcemia 4. Hypolipidemia

2. Hypokalemia Rationale Vomiting causes loss of potassium, leading to hypokalemia. Tachycardia, hypercalcemia, and hypolipidemia are not associated with vomiting.

A nurse is caring for a client recently diagnosed with bulimia nervosa. Which nursing action is most appropriate? 1. Weigh the client twice daily. 2. Monitor the client's bathroom trips after meals. 3. Provide snacks whenever the client requests them. 4. Encourage the client to make menu selections independently.

2. Monitor the client's bathroom trips after meals. Rationale The nurse should monitor the client's bathroom trips after meals to prevent self-induced vomiting. Weighing the client twice daily is excessive. Providing snacks whenever the client requests them reinforces dysfunctional eating patterns. Encouraging the client to make menu selections independently may occur later but not initially.

Which pathology do biological theorists suggest is a cause of eating disorders? 1. Dopamine excess 2. Serotonin imbalance 3. Normal weight phobia 4. Body image disturbance

2. Serotonin imbalance Rationale Serotonin pathways are abnormal in both anorexia nervosa and bulimia nervosa. Brain scans of clients with these disorders reveal altered serotonin receptors and transporters. Dopamine excess is not associated with eating disorders. Normal weight phobia and body image disturbance may be involved, but they are not biological factors.

A nurse assesses a client diagnosed with an eating disorder. Which comment by this client is most likely? 1. "Rules don't apply to me. I just do what's best for me." 2. "I feel good. I feel just fine. I don't have any problems." 3. "I have certain ways I like to do things, and that takes extra time." 4. "If I want to do something, I just do it. I don't like to overanalyze things."

3. "I have certain ways I like to do things, and that takes extra time." Rationale Clients diagnosed with eating disorders consistently exhibit personality traits of perfectionism and obsessive thoughts. Personality disorders occur more often in the eating disordered population than the general population, particularly obsessive-compulsive personality disorder. Believing that the rules do not apply to oneself, that one does not have any problems, or that one does what one wants would be expected from people with antisocial or narcissistic traits.

A nurse assesses Your adolescents diagnosed with various eating disorders. Which comment would the nurse most expect from the adolescent diagnosed with anorexia nervosa but not from an adolescent diagnosed with a different eating disorder? 1. "I look good because whenever I overeat, I purge myself." 2. "I love sweets. I make myself throw up so I can eat more." 3. "I have lost 60 Ibs but I'm still a size 2. I want to be a size 0." 4. "I've hidden my eating disorder from everyone, even my parents."

3. "I have lost 60 Ibs but I'm still a size 2. I want to be a size 0." Rationale The adolescent who wants to lose more weight after already losing a significant amount to become a size 0 is expressing the continued desire to lose weight associated with anorexia nervosa. Purging is associated with both bulimia and anorexia. The adolescent who engages in vomiting to be able to eat more sweets likely has binge eating disorder. Hiding an eating disorder from others is not unique to anorexia nervosa.

The nurse interviews a client suspected of having an eating disorder. Which statement by the client suggests the presence of a binge eating disorder? 1. "I do not want to eat food." 2. "I overuse diuretics and laxatives." 3. "I want to lose weight, but I don't exercise." 4. "I have a tendency to induce vomiting."

3. "I want to lose weight, but I don't exercise." Rationale Clients diagnosed with binge eating disorder have episodes of uncontrolled eating followed by feeling significantly distressed. However, they show no compensatory behaviors, such as exercise, to reduce the weight. Clients diagnosed with anorexia nervosa do not want to eat food due to Year of weight gain, and they starve themselves. Clients diagnosed with bulimia nervosa may use diuretics or laxatives to compensate for overeating. They may also induce vomiting to compensate for overeating.

Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate? 1. "You need to gain weight to become healthier." 2. "Your world would not change if you gained a few pounds." 3. "Tell me how your world would be different if you were fat." 4. "Your attractiveness is not defined by a number on the scales."

3. "Tell me how your world would be different if you were fat." Rationale Encouraging the client to elaborate on the statement is appropriate because it keeps the treatment client- centered and allows the client to explore his or her own feelings surrounding the eating disorder. The nurse should be careful not to take an authoritarian role; saying that the client needs to gain weight or that the client's world would not change crosses this line. Telling the client that attractiveness is not defined by a number on the scale does not take into account the client's distorted body image.

Which assessment data confirm that the client diagnosed with anorexia nervosa has achieved a fundamental treatment outcome? 1. Acknowledges that symptoms of depression exist 2. Client has eaten 60% of three meals per day for 3 consecutive weeks 3. Client has maintained weight at 87% of ideal body weight for 2 months 4. Demonstrates an understanding of what constitutes healthy eating habits

3. Client has maintained weight at 87% of ideal body weight for 2 months Some common outcome criteria for patients with anorexia nervosa include normalization of eating patterns, as evidenced by eating 75% of three meals per day plus two snacks, and achieving 85% to 90% of ideal body weight; demonstrating two new, healthy eating habits, not merely understanding of such habits; participating in treatment of associated psychiatric symptoms (defects in mood, self-esteem), not just acknowledging the presence of symptoms.

When considering an anorexic client's poor sense of self-esteem, which outcomes should the nurse include in the client's plan of care? Select all that apply. 1. Client will ingest nutrients to meet physical needs. 2. Client reports a decrease in stress and anxiety levels. 3. Client verbalizes confidence in managing needed eating changes. 4. Client participates actively in decision-making related to treatment. 5. Client's diagnostic results will demonstrate electrolytes are in balance.

3. Client verbalizes confidence in managing needed eating changes. 4. Client participates actively in decision-making related to treatment. Rationale Outcomes appropriate for issues related to low self-esteem include verbalizing a positive level of confidence, making informed life decisions, and expressing independence with decision-making processes. Meeting physical needs with nutrition relates to physiological needs. Reporting less stress and anxiety relates to the client's coping abilities. Electrolyte balance relates to physiological needs.

Which assessment will the nurse perform on a client suspected of having bulimia nervosa? 1. Body fat analysis 2. Inspection of body cavities 3. Inspection of the oral cavity 4. A range-of-motion assessment

3. Inspection of the oral cavity Rationale Repeated vomiting often causes dental erosions and caries. The nurse should inspect the oral cavity for these signs. Body fat analysis will not provide evidence for bulimia, because these clients often have a normal body weight. Inspection of body cavities and a range-of-motion assessment do not provide information that may indicate bulimia.

A client presents in the emergency department with 96.0° F (35.5° C) body temperature, body mass index (BMI) of 16, kg/m 2 and heart rate of 37 beats per minute. What is the most appropriate next action by the nurse? 1. Order a psychiatric assessment of the client. 2. Order parenteral nutrition for the client. 3. Prepare the client for inpatient hospitalization. 4. Educate the client about the ill effects of low weight.

3. Prepare the client for inpatient hospitalization. Rationale This client's physiological assessment meets the physical criteria for hospital admission. The nurse should admit the client before ordering psychiatric assessment, ordering parenteral nutrition, or educating the client.

While weighing clients on an eating disorders unit, a psychiatric technician says to the client, "I wish I had an eating disorder; maybe I'd lose a little weight." A nurse overhears the comment. What is the nurse's most appropriate action? 1. Report the incident to the nursing supervisor. 2. Ask the psychiatric technician, "What did you mean by that comment?" 3. Privately discuss the importance of sensitivity with the psychiatric technician. 4. Immediately interrupt the interaction between the client and psychiatric technician.

3. Privately discuss the importance of sensitivity with the psychiatric technician. Rationale It may be difficult for those working with clients diagnosed with eating disorders to understand that the disorder is not a lifestyle choice in the client's control. All who care for the client should keep in mind the goals of motivating the client to be healthier and gain weight. Comments like this one reinforce the client's unhealthy behavior. Discussing the importance of sensitivity will help the technician avoid making such comments in the future. Reporting the observation is not necessary if the technician is receptive to the nurse's guidance. What the technician means is irrelevant and therefore asking the technician what he or she means is unnecessary; what matters is that it is an inappropriate comment to make to the client. Immediately interrupting the interaction is inappropriate because of the presence of the client.

What is the cause of enlarged parotid glands in clients with eating disorders who engage in purging behavior? 1. Muscle wasting 2. Low body fat percentage 3. Salivary gland hyperstimulation 4. Laxative side effects

3. Salivary gland hyperstimulation Rationale The parotid glands are the largest of the salivary glands, located in each cheek in front of the ears. They become enlarged due to hyperstimulation from repeated vomiting. Muscle wasting, low body fat percentage, and laxative side effects do not cause enlarged parotid glands.

Which criterion does the nurse know warrants inpatient treatment for a client diagnosed with an eating disorder? 1. Weighs 10% below ideal body weight 2. Heart rate less than 60 beats per minute 3. Systolic blood pressure less than 70 mm Hg 4. Has lost more than 15% body weight over six months

3. Systolic blood pressure less than 70 mm Hg Rationale A systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a client diagnosed with anorexia nervosa. This finding suggests severe cardiovascular compromise. Weight of less than 75% ideal body weight (i.e., 25% below ideal body weight), heart rate less than 40 bpm, and weight loss more than 30% over six months are other criteria for inpatient treatment.

The nurse assesses a teenager who is underweight compared to others in a similar age and height category. During the assessment interview, the nurse finds that the teen has a fear of gaining weight and is refusing to eat. What does the nurse suspect the health care provider will diagnose? 1. Binge eating 2. Rumination disorder 3. Bulimia nervosa 4. Anorexia nervosa

4. Anorexia nervosa Rationale Anorexia nervosa refers to intense fear of weight gain and refusal of food to maintain weight. Binge eating involves repeated episodes of overindulgence in eating followed by a feeling of guilt and distress but no compensatory behavior. Rumination disorder is characterized by regurgitation, followed by re-chewing, reswallowing, or spitting. Bulimia nervosa involves repeated episodes of binge eating followed by inappropriate compensation behaviors, including induced vomiting or purging.

A client diagnosed with anorexia nervosa presents with severe dehydration and rapid weight loss over the past week. Which is the most appropriate nursing action? 1. Wait and watch. 2. Administer sedatives. 3. Pass along orders for lab work. 4. Assess for hospital admission.

4. Assess for hospital admission. Rationale A client with anorexia nervosa showing severe dehydration and rapid weight loss should be admitted to begin appropriate treatment and observation. If untreated, this condition can become life-threatening. A wait-and- watch approach is not advisable in this case, because severe dehydration and weight loss can have life- threatening consequences and need attention. The appropriate treatment can be decided after the client is hospitalized for inpatient care. Sedatives may help the client sleep, but they may not be helpful in managing anorexia nervosa. Laboratory investigations can be performed once the client is hospitalized for inpatient care.

A client is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the client's laboratory results. Which action should the nurse take next? Sodium 143 mEq/L Patassium 3.1 mEq/L Chloride 102 mEq/L Magnesium 2.2 mEq/L Calcium 8.4 mg/dL Phosphate 3.0 mg/dL 1. Measure the client's body temperature. 2. Inspect the client's skin and sclera for jaundice. 3. Assess the client's mucous membranes for erosion. 4. Auscultate the client's heart rate, rhythm, and sounds.

4. Auscultate the client's heart rate, rhythm, and sounds. Rationale The client's potassium level is low. In the absence of signs of severe hypothermia, the client's heart rate, rhythm, and sounds should be assessed next, because this is the most immediate threat to the client's well- being. There is no information available about the client's body temperature. There is nothing to indicate the client has liver problems and should be assessed for jaundice. Assessment of a client with bulimia often reveals erosion of the mucous membranes.

A client diagnosed with bulimia nervosa frequently uses enemas and laxatives to purge. The nurse should monitor the client for which imbalance? 1. Elevated serum sodium level 2. Elevated serum potassium level 3. Increase in the red blood cell count 4. Disruption of fluid and electrolyte balance

4. Disruption of fluid and electrolyte balance Rationale Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives. Serum sodium levels, potassium levels, and red blood cell count may be affected by purging, but the nurse can gain information about any of these imbalances by monitoring fluid and electrolyte balance overall.

Which is a subjective symptom the nurse would expect to note during assessment of a client diagnosed with anorexia nervosa? 1. Lanugo 2. Hypotension 3. 25-lb weight loss 4. Fear of gaining weight

4. Fear of gaining weight Rationale Fear of gaining weight is the only subjective datum listed, and it is universally true. Lanugo, hypotension, and a 25-lb weight loss are objective data.

A client is 16 years old, 5 ft, 3 in tall, and weighs 80 lb. This client eats one tiny meal daily and engages in a rigorous exercise program. Which nursing diagnosis is the priority? 1. Death anxiety 2. Ineffective denial 3. Disturbed sensory perception 4. Imbalanced nutrition: less than body requirements

4. Imbalanced nutrition: less than body requirements Rationale A body weight of 80 lb for a 16-year-oId who is 5 ft, 3 in tall demonstrates imbalanced nutrition, which is usually the priority diagnosis for clients diagnosed with anorexia nervosa. None of the client's symptoms are related to death anxiety, denial, or the senses.

For what nursing diagnosis is the outcome criteria "to address maladaptive beliefs, thoughts, and activities related to the eating disorder" most appropriate? 1. Imbalanced nutrition: less than body requirements 2. Risk for injury 3. Anxiety 4. Ineffective coping

4. Ineffective coping Rationale A nursing diagnosis of ineffective coping would suggest that the client needs to address maladaptive beliefs, thoughts, and activities related to the eating disorder. Outcomes criteria would likely be different for imbalanced nutrition, risk for injury, and anxiety.

What term describes the growth of fine, downy hair on the face and back of a client diagnosed with anorexia nervosa? 1. Amenorrhea 2. Russell's sign 3. Carotenemia 4. Lanugo

4. Lanugo Rationale Lanugo is the growth of fine, downy hair on the face and back. Amenorrhea is the abnormal absence of menstruation. Russell's sign is a callus on the knuckles from self-induced vomiting. Carotenemia is elevated carotene levels in the blood resulting in skin with yellow pallor.

Which classic characteristic is common among clients diagnosed with bulimia nervosa? 1. Male 2. Obesity 3. Involved in sports 4. Onset in late adolescence

4. Onset in late adolescence Rationale Anorexia nervosa has an average age of onset in early to middle adolescence whereas bulimia nervosa more typically appears in late adolescence. Eating disorders of all kinds are more prevalent in females than males. The DSM-5 states that only approximately one third of binge eaters are obese. Being involved in sports is not considered a characteristic.