Chapter 18- Eating Disorders

What musculoskeletal change may occur in a patient diagnosed with bulimia nervosa? 1. Osteopenia 2. Ostemyopathy 3. Osteoporosis 4. Muscle wasting

ans 1 Rationale Osteopenia can occur in patients diagnosed with bulimia nervosa. Myopathy, muscle wasting, and osteoporosis are musculoskeletal conditions that occur as a result of anorexia nervosa, not bulimia nervosa. p. 337

Which neurobiological factor contributes to the dysregulation of appetite, mood, and impulse control in eating disorders? 1. Altered Serotonin 2. Decreased Dopamine 3. Altered glutamate 4. Increased tryptophan

Ans 1 Rationale Altered serotonin levels contribute to the dysregulation of appetite, mood, and impulse control in eating disorders. Tryptophan is an amino acid essential to serotonin synthesis and is only available through diet. A function of dopamine is "pleasure" or "reward" chemical in the brain. A decrease in dopamine is not associated with anorexia. Glutamate is a neurotransmitter that sends signals between nerve cells and plays a role in learning and memory, not eating disorders. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. p. 335

What is a coping mechanism used excessively by patients with anorexia nervosa? 1. Denial 2. Humor 3. Altruism 4. Projection

Ans 1 Rationale Denial of excessive thinness is the mainstay of the patient with anorexia nervosa. p. 338, Table 18.3

The nurse is assessing a patient with binge eating disorder. What diagnosis should the nurse consider when the patient shows feelings of inadequacy? 1. Anxiety 2. Ineffective coping 3. Imbalanced nutrition 4. Disturbed body image

Ans 1 Rationale The nursing diagnosis of anxiety is made when the patient shows feelings of discomfort or inadequacy. Ineffective coping is noted if the patient uses eating as a coping method. Imbalanced nutrition is diagnosed when the patient shows irregular eating patterns and is overweight. Disturbed body image is noted when the patient shows embarrassment due to weight gain. p. 348, Table 18.6

During assessment of a patient with anorexia nervosa, it is not likely that the nurse would note indications of which of the following? 1. Weight restoration 2. Improving interpersonal skills 3. Learning effective coping methods 4. Changing family interaction patterns

Ans 1 Rationale Weight restoration is the priority goal of treatment for the patient with anorexia nervosa because health is threatened seriously by the underweight status. p. 338

According to current theory, which statement is true regarding eating disorders? 1. They are frequently misdiagnosed. 2. They are possibly influenced by sociocultural factors. 3. They are rarely comorbid with other mental health disorders. 4. They are psychotic disorders in which patients experience body dysmorphic disorder.

Ans 2 Rationale The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders. pp. 335-336

A patient reveals that he or she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal which of the following? 1. Tackycardia 2. Hypokalemia 3. Hypercalcemia 4. Hypolipidemia

Ans 2 Rationale Vomiting causes loss of potassium, leading to hypokalemia. p. 344, Table 18.4

The nurse is caring for a patient with bulimia nervosa who overuses laxatives but does not purge. Which drug is known to be effective to treat the patient? 1. Qsymia 2. Bupropion 3. Olanzapine 4. Lorcaserin

Ans 2 Rationale Bupropion is known to be effective in patients with bulimia nervosa who do not purge. It is contraindicated in patients who purge as it increases the risk of seizures. Antipsychotic agents such as olanzapine are effective to treat anorexia nervosa. Olanzapine improves the mood, decreases obsessive behaviors, and reduces resistance to weight gain. Lorcaserin and Qsymia are known to be effective to treat patients with binge eating. They block appetite signals and produce feelings of fullness. p. 349, Table 18.7

A patient diagnosed with anorexia nervosa presents to the clinic with a body mass index (BMI) of 15 kg/m 2. Based on BMI, which level of severity does the nurse document? 1. Mild 2. Severe 3. Moderate 4. Extreme

Ans 2 Rationale A BMI of 15 to 15.99 kg/m 2 is considered severe. A BMI of 16 to 16.99 kg/m 2 is moderate. A BMI of less than 15 is extreme. A BMI of 17kg/m 2 or more is mild. p. 334

The nurse recognizes bariatric surgery as a treatment for which disorder? 1. Anorexia Nervosa 2. Binge Eating 3. Rumination 4. Bulimia Nervosa

Ans 2. Rationale Bariatric surgery is an option to treat binge eating disorder as the patients are obese due to overeating, with no compensatory activities such as exercise. Patients with anorexia nervosa are underweight as they starve themselves due to fear of weight gain. They do not need bariatric surgery. Patients with bulimia nervosa tend to overeat, which is followed by compensatory behaviors, such as excessive exercise or misuse of laxatives. They are usually normal in weight or close to ideal weight and they do not need bariatric surgery. In rumination disorder the patient regurgitates the food, which is followed by rechewing and reswallowing or spitting. It does not cause obesity and bariatric surgery is not necessary. pp. 348-349

Which of the following statements is true of bulimia? 1.Patients with bulimia have lanugo. 2.Patients with bulimia severely restrict their food intake. 3. Patients with bulimia often appear to have a normal weight. 4. Patients with bulimia binge eat but do not engage in compensatory measures.

Ans 3 Rationale Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. Not engaging in compensatory measures, severely restricting food, and lanugo do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa. p. 344, Table 18.4

Assessment of a patient suspected of experiencing bulimia nervosa calls for the nurse to perform which of the following? 1. Body fat analysis 2. Inspection of body cavities 3. Inspection of the oral cavity 4. A range of motion assessment

Ans 3 Rationale Repeated vomiting often causes dental erosions and caries. p. 343

A patient diagnosed with anorexia nervosa and which assessment finding meets the criteria for hospitalization? 1. Oral temperature 98.1°F 2. Heart rate 56 beats per minute 3. Serum potassium level 2.6 mEq/L 4. Systolic blood pressure 88 mm Hg

Ans 3 Rationale Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances warrant hospitalization because of risks regarding cardiac regulation. Other criteria for hospitalization include severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute and systolic blood pressure less than 70 mm Hg. p. 338

A patient with anorexia nervosa presents with severe dehydration and rapid weight loss in the last week. What appropriate action should the nurse take? 1. Wait and watch 2. Prescribe sedatives 3. Obtain orders for lab work 4. Suggest hospital admission

Ans 4 Rationale A patient with anorexia nervosa showing severe dehydration and rapid weight loss should be admitted beginning with appropriate treatment and observation. If untreated, this condition can become life-threatening. Wait and watch approach is not advisable in this case as it can have life-threatening consequences and needs attention. The appropriate treatment can be decided after the patient is hospitalized for inpatient care. Sedatives may help the patient to sleep but may not be helpful in managing anorexia nervosa. Laboratory investigations can be performed once the patient is hospitalized for inpatient care. p. 338

What term is used to document the symptom where the patient is underweight but monitors the weight excessively to prevent weight gain? 1. Powerlessness 2. Ineffective coping 3. Imbalanced nutrition 4. Disturbed body image

Ans 4 Rationale If the patient is underweight but self-monitors weight excessively, the nurse documents it as disturbed body image. If the patient has indecisive behavior or a feeling of shame, the nurse documents it as powerlessness. If the patient has self-destructive behavior, the nurse documents it as ineffective coping. If the patient has signs such as dehydration or decreased urine output or decreased blood pressure, the nurse documents it as imbalanced nutrition. p. 338, Table 18.3

The nurse learns that Qsymia contains two components, namely topiramate and phentermine. What is the function of phentermine? 1. It burns calories quickly. 2. It reduces the taste sensation. 3. It produces feelings of fullness. 4. It influences leptin blood levels.

Ans 4 Rationale Phentermine influences the blood concentration of the appetite-regulating hormone leptin by releasing the neural norepinephrine. Thereby it acts as an appetite suppressant. Topiramate is an antiseizure medication that produces feelings of fullness, reduces the taste sensation, and burns calories quickly. p. 337, Table 18.7

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

Ans 4 Rationale Fear of gaining weight is the only subjective datum listed and is universally true. p. 334

A nurse is teaching a patient with bulimia nervosa about scheduling healthy, balanced meals. Why does a nurse consider providing this patient education important? 1. To identify trigger foods 2. To realize health effects 3. To include forbidden foods 4. To avoid binge-purge cycles

Ans 4 Rationale Learning about scheduled balanced meals can help the patient to maintain a steady dietary regimen and avoid binge-purge cycles. Identifying trigger foods can be done by encouraging the patient to explore ideas about trigger foods. Including forbidden foods can be achieved by discussing the patient's irrational thoughts regarding those foods. Health effects of purging can be taught by educating the patient about the ill effects of induced vomiting. p. 345