Ch. 31 Eating Disorders

The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective? "I am getting more comfortable confronting people when I have conflict with them." "I am beginning to understand how my lack of self-control is hurting me." "I am keeping a record of everything I eat and how I am feeling every day." "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."

"I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which comment indicates that the client may be suffering from anorexia nervosa? "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." "I like the way I look. I just need to keep my weight down because I'm a cheerleader." "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." "I do diet around my periods; otherwise, I just get so bloated."

"I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."

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 response by the nurse is most appropriate? "I'll stand outside your door to give you privacy." "I will accompany you to the bathroom." "Let me know when you get back to the dayroom." "Thanks for checking in."

"I will accompany you to the bathroom."

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? "I'll eat small meals and snacks regularly." "I'll take my medication when I feel the urge to binge." "I know if I eat pasta, I'll binge." "How I feel about my body has little to do with my binging."

"I'll eat small meals and snacks regularly."

An adolescent diagnosed with anorexia nervosa is insistent on being allowed to take a laxative. Which response by the nurse best demonstrates the management of this client request? "Laxatives are not a part of your treatment plan." "Using a laxative to purge is not an acceptable way to manage your weight." "Using laxatives is bad for you because your electrolytes can become unbalanced." "Why do you want to take a laxative?"

"Laxatives are not a part of your treatment plan."

The nurse has just completed an admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression? "Others are just trying to keep me from looking good." "Those weight charts are for normal people. I am not normal." "I know my weight is a little below normal." "I know I have a problem. I need help."

"Others are just trying to keep me from looking good."

The nurse is assisting the client with anorexia nervosa to express feelings more openly. Which response by the nurse would be most likely to encourage expression of feelings? "Tell me when you feel bad." "Are you sad?" "You look anxious." "Tell me what you are feeling right now."

"Tell me what you are feeling right now."

A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication? "What do you think about how much you weigh right now?" "Is there anything that I can get you to eat right now?" "Why do you prefer not to eat food?" "What do you believe has caused your anorexia?"

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

A client is diagnosed with mild anorexia nervosa based on body mass index (BMI). Which BMI would the nurse identify as reflecting mild anorexia nervosa? 16.75 kg/m2 16.1 kg/m2 17.3 kg/m2 15.5 kg/m2

17.3 kg/m2

An individual with which body mass index (BMI) would be classified as having mild anorexia nervosa? 16.2 kg/m2 20 kg/m2 15.4 kg/m2 17.4 kg/m2

17.4 kg/m2

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? 18 to 22 years old 10 to 14 years old 5 to 10 years old 25 to 35 years old

18 to 22 years old

A client comes to the health clinic for a physical exam. He is complaining that he is not happy with himself about being overweight. He has been depressed for several weeks. When discussing his weight goal, he asks the nurse, "What is a normal or healthy BMI?" The nurse's correct response would include which of the following? 35 to 39.9 30 to 34.9 25 to 29 18 to 24.9

18 to 24.9

Which of the following clients being treated for anorexia displays assessment values that warrant hospitalization? A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt A 16-year-old with serum potassium of 3.8 mEq/L and a BP of 98/66 mmHg A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL A 32-year-old with a temperature of 98°F and a pulse rate of 54

A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL

The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss? Binge eating disorder Anorexia nervosa, purging type Bulimia nervosa, purging type Anorexia nervosa, restricting type

Anorexia nervosa, purging type

A client is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The client believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The mostlikely diagnosis for this client is what? Anorexia nervosa, restricting type Bulimia nervosa, nonpurging type. Eating disorder not otherwise specified Anorexia nervosa, binge eating, and purging type

Anorexia nervosa, restricting type

Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? Antianxiety Antimanic Antidepressant Antiparkinsonian

Antidepressant

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? Stimulants Antidepressants Mood stabilizers Antipsychotics

Antipsychotics

The nurse is helping a client with an eating disorder to accept the client's body image. The client must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? Coping skills are dependent on a supportive upbringing. Being able to cope in healthy ways improves the ability to accept a realistic body image. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills. When body image is positive, the client will develop better coping skills.

Being able to cope in healthy ways improves the ability to accept a realistic body image.

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect? Bulimia nervosa Eating disorder not otherwise specified Binge eating disorder Anorexia nervosa

Binge eating disorder

A client with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. The nurse identifies this as reflecting what? Body image disturbance Drive for thinness Interoceptive awareness Perfectionism

Body image disturbance

A 15-year-old is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? Absence of hunger feelings Body weight less than normal for age, height, and overall physical health Irregular menstrual cycles Erosion of dental enamel

Body weight less than normal for age, height, and overall physical health

A client has an eating disorder characterized by consuming an amount of food much larger than a person would normally eat. Afterward, the client often purges the food or exercises excessively. Between binges, the client often eats low-calorie foods or fasts. What is the client's most likely diagnosis? Pica Bulimia nervosa Rumination Anorexia nervosa

Bulimia nervosa

What is the primary difference between anorexia nervosa and bulimia nervosa? Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. Anorexia has a psychological basis, whereas the cause of bulimia is biologic. There is no real difference between these two types of disorders. Bulimia can be life threatening, whereas anorexia is seldom so.

Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior.

The difference between clients with anorexia nervosa and bulimia nervosa is which of the following? Anorexia has a psychological basis, whereas the cause of bulimia is biologic. Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior. Bulimia can be life threatening, whereas anorexia is seldom so. There is no real difference between these two types of clients.

Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior.

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 Dependency Depression Anxiety

Control

When working with the family of a client with anorexia nervosa, which issue must be addressed? Sexual identity Self-discipline Codependence Control

Control

Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care? Anxiety related to inadequate coping mechanisms Hyperactivity related to restlessness Impaired social interaction related to aggressive behavior Deficient fluid volume related to refusal to drink

Deficient fluid volume related to refusal to drink

A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected? Bacterial gastrointestinal infections and overhydration Metabolic acidosis and constricted colon Respiratory distress and dyspnea Dental erosion and chronic edema

Dental erosion and chronic edema

A client with an eating disorder states, "I've gained 2 pounds, so soon I'll be up by 100 pounds." The nurse interprets this as which of the following? Catastrophizing Magnification Selective abstraction Dichotomous thinking

Dichotomous thinking

A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? Dieting helps build a positive self-image in children. Dieting at an early age may lead to the development of eating disorders. Dieting at an early age teaches healthy eating habits. Dieting during childhood can promote self-discipline in children who are obese.

Dieting at an early age may lead to the development of eating disorders.

When working with a client with anorexia nervosa, which of the following nursing diagnoses is most difficult to resolve successfully? Social isolation Deficient knowledge (nutritious eating patterns) Imbalanced nutrition: less than body requirements Disturbed body image

Disturbed body image

The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? Careless Eager to please Defiant Outspoken

Eager to please

The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia? Provide the client a diet of mainly vegetables and salads. Encourage the entire family to engage in a balanced and regular dietary pattern. Encourage autonomy by allowing the client to have total control over food choices. Insist that the client complete all meals provided.

Encourage the entire family to engage in a balanced and regular dietary pattern.

Which of the following terms describes a lack of clear role boundaries? Autonomy Satiety Enmeshment Empathy

Enmeshment

The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder? Moist skin Excessive exercise Tachycardia Wearing tight-fitting clothing

Excessive exercise

Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Haloperidol Lithium Bupropion Fluoxetine

Fluoxetine

Clients with anorexia nervosa become totally absorbed in their quest for weight loss and thinness. An exacerbation of anorexia nervosa results from the client's effort to ... Manipulate family members Gain control of one part of her life Live up to family expectations Diminish conflict

Gain control of one part of her life

Exacerbation of anorexia nervosa results from the client's effort to do what? Manipulate family members Gain control of one part of life Diminish conflict Live up to family expectations

Gain control of one part of life

All of the following nursing diagnoses are appropriate for the care of a client with anorexia nervosa. Which nursing diagnosis has the priority? Activity intolerance Ineffective coping Imbalanced nutrition: less than body requirements Chronic low self-esteem

Imbalanced nutrition: less than body requirements

While assessing the family dynamics of a client with an eating disorder, which does the nurse most likely discover? Supportive and encouraging relationships Overcontrolling parents Multiple siblings Lack of interest in the client by other family members

Overcontrolling parents

The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what? Provide the client with a feeling of responsibility and control over the client's behavior Provide the therapist with a strategy for client compliance Provide the nurse with a tool for evaluating the plan of care Allow the client a tool by which to negotiate behavior

Provide the client with a feeling of responsibility and control over the client's behavior

An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? Provide privacy during meals Encourage the client to exercise, which will reduce the client's anxiety Set up a strict eating plan for the client Restrict visits with the family until the client begins to eat

Set up a strict eating plan for the client

A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. The client doesn't want to feel fat in a bathing suit on vacation. The client's sodium level is 150 mEq/L; potassium level is 3.2 mEq/L. The client is 5 feet tall, weighs 100 pounds, and has lost 15 pounds in 3 weeks. Which goal is a priority at this time? Stabilize electrolyte levels. Develop a contract with the client to stop using laxatives and diuretics. Help build self-esteem. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds.

Stabilize electrolyte levels.

Fluoxetine includes a black box warning concerning which of the following? Suicidality in children and adolescents Renal failure Stroke Myocardial infarction

Suicidality in children and adolescents

An obese client is admitted to the facility for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client? Teaching the client alternative ways to lose weight Encouraging the client to suppress feelings regarding obesity Reinforcing the client's concerns over physical appearance Using an abrupt, forceful manner to communicate with the client

Teaching the client alternative ways to lose weight

When admitted to the inpatient unit, a client is 5 feet 10 inches tall and weighs 100 pounds. What is the initial goal in the client's care? To assess for violence potential To stop losing weight To reduce fluid intake To be on bedrest

To stop losing weight

All of the following would be included as interventions for eating disorders to establish nutritional eating patterns except ...

Weighing the client twice daily

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? Weight gain Positive self-esteem Increased activity Mood elevation

Weight gain

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

assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems

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 mostlikely the cause of this client's symptoms? vomiting, which may lead to dehydration and electrolyte imbalance binging, which causes abdominal discomfort nutritional deficits, which are characteristic of bulimia nervosa mood disorders, which often accompany the diagnosis of bulimia nervosa

vomiting, which may lead to dehydration and electrolyte imbalance