Chapter 30. Eating Disorders

2. The nurse is preparing an education program regarding early identification of students at risk for developing anorexia nervosa. Which client does the nurse recognize as having the highest risk of developing an eating disorder? 1. Female ballet dancer 2. Female cheerleader 3. Male wrestler 4. Male swimmer

1. This is correct. A ballet dancer has a seven times greater risk of developing anorexia nervosa among females

18. The nurse assigns the nursing diagnosis "ineffective coping related to feelings of helplessness" to a client diagnosed with bulimia nervosa. Which is the most appropriate outcome related to this nursing diagnosis? 1. Exhibits ability to use adaptive strategies to cope with emotional issues 2. Achieves and maintains an expected BMI for weight and age 3. Demonstrates positive self-esteem by verbalizing positive aspects of self 4. Identifies consequences of fluid loss caused by self-induced vomiting

1. This is correct. Emotional issues must be resolved if these maladaptive responses are to be eliminated. Identifying alternative methods to deal with isolation will provide the client with healthier coping strategies.

9. The nurse is teaching parents of a 14-year-old client diagnosed with anorexia nervosa about prescribed medications. Which carries a black-box warning? 1. Fluoxetine 2. Phenelzine 3. Topiramate 4. Amitriptyline

1. This is correct. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), carries a black-box warning about the risk of increased suicidal ideation in adolescents.

10. A nursing instructor is teaching students about eating disorders. Which statement indicates that a student understands the differences between anorexia nervosa and bulimia nervosa? 1. "Clients diagnosed with anorexia nervosa exhibit malnutrition and dehydration." 2. "Hyperkalemia and hyponatremia are associated with anorexia nervosa." 3. "Signs of bulimia nervosa include hypotension, edema, and erosion of tooth enamel." 4. "Amenorrhea and parotid gland enlargement are symptoms of bulimia nervosa."

1. This is correct. Individuals diagnosed with anorexia nervosa exhibit nutritional deficits, malnutrition, and dehydration due to caloric restriction.

4. While assessing a client diagnosed with bulimia nervosa, the nurse observes multiple cavities, enamel erosion, and tooth sensitivity. Which best explains the nurse's findings? 1. Electrolyte imbalances 2. Self-induced vomiting 3. Nutritional deficits 4. Dehydration

2. This is correct. Erosion of tooth enamel and dental deterioration are results of selfinduced vomiting. The acidic emesis produced during purging damages the teeth and oral mucosa.

5. Which is used as first-line outpatient psychological treatment for adolescents diagnosed with anorexia nervosa? 1. Cognitive-based therapy 2. Family-based therapy 3. Dialectical behavior therapy 4. Individual psychotherapy

2. This is correct. Evidence supports the use of family-based treatment as the first-line outpatient psychological treatment for adolescents with anorexia nervosa. CBT is used with clients diagnosed with anorexia, bulimia, and binge eating disorder (BED).

7. The nurse tells the parents of an adolescent diagnosed with anorexia nervosa, "The social worker will be contacting you to schedule a family meeting." One of the client's parents states, "Why is that necessary? Our child is the one who needs treatment." Which response by the nurse is best? 1. "We expect every client and their family to attend two family sessions." 2. "Family intervention and support are important in managing eating disorders." 3. "The sessions are used to educate all family members about eating disorders. 4.B "During the meeting you will be able to resolve conflicts with your child."

2. This is correct. Family meetings focus on the needs of the client and their family. The nurse should educate the family on the importance of family involvement and support in the treatment of anorexia nervosa.

12. The nurse is developing nursing diagnoses for a newly admitted client diagnosed with anorexia nervosa. The client has a BMI of 15.8 kg/m2 . Which is the priority nursing diagnosis? 1. Ineffective coping 2. Imbalanced nutrition 3. Obesity 4. Disturbed body image

2. This is correct. The client weighs less than 85% of expected weight and has a BMI of 15.8 kg/m2 . The BMI range for normal weight is 20 to 24.9 kg/m2 . The client is at risk of potentially life-threatening symptoms of hypothermia, bradycardia, hypotension with orthostatic changes, peripheral edema, severe electrolyte imbalances, and cardiac muscle damage.

16. The nurse in the eating disorders clinic asks a client diagnosed with bulimia nervosa, "Can you recall a time when you were able to eat without purging?" Which is the most appropriate rationale for the nurse's question? 1. Determine the severity of symptoms. 2. Identify previous coping strategies. 3. Determine triggers for purging episodes. 4. Establish realistic treatment goals.

2. This is correct. The nurse is identifying the client's previous coping strategies to develop interventions that enable the client to utilize adaptive coping skills.

20. Which is the priority nursing intervention when caring for a client diagnosed with an eating disorder? 1. Accompany the client to the bathroom. 2. Remain with the client at least 1 hour after meals. 3. Encourage the client to keep a diary of food intake. 4. Discuss feelings and emotions associated with eating

2. This is correct. The nurse should remain with the client at least 1 hour after meals, as the client may use this time to discard food that has been stashed from the food tray or to engage in self-induced vomiting

3. The nurse is developing a care plan for a client diagnosed with anorexia nervosa and determines "disturbed body image" is the priority nursing diagnosis. Which is the most appropriate outcome criterion? 1. Achieve and maintain expected body mass index (BMI). 2. Verbalize understanding of maladaptive eating behaviors. 3. Exhibit decreased preoccupation with own appearance. 4. Discuss feelings and emotions associated with eating.

3. This is correct. "Disturbed body image" is defined as "confusion in mental picture of one's physical self." The most important outcome criterion for the client to demonstrate is an increase in self-esteem as manifested by verbalizing positive aspects of self and exhibiting decreased preoccupation with their own appearance.

1. The nurse is reviewing the plan of care for a 15-year-old client diagnosed with anorexia nervosa. The treatment team plans to implement cognitive behavior therapy (CBT). Which is the best rationale for the use of CBT for clients diagnosed with anorexia nervosa? 1. Recognize maladaptive eating patterns as defense mechanisms. 2. Promote autonomy and control over eating behaviors. 3. Eliminate emotional components of maladaptive eating patterns. 4. Allow client to establish goals of the treatment plan.

3. This is correct. CBT strives to eliminate the emotional components associated with unhealthy eating patterns by confronting irrational thinking patterns and associated feelings.

11. The clinic nurse is reviewing assessment findings of a client diagnosed with anorexia nervosa. Which of the following indicate that the client requires immediate hospitalization? 1. Body temperature of 98.6ºF 2. Potassium level above 3.5 mmol/L 3. BMI less than 75% of expected 4. Weight less than 90% of expected

3. This is correct. Hospitalization is indicated when the median BMI is less than 75% of that expected for the client's age and sex.

8. A client diagnosed with bulimia nervosa has been receiving CBT at the eating disorders clinics. Which of the following client actions indicates to the nurse that the client is making progress toward using adaptive eating behaviors? 1. Gains 2 lb in 1 week 2. Verbalizes importance of adequate nutrition 3. Identifies feelings associated with desire to binge 4. Takes antidepressant medications as prescribed

3. This is correct. Identifying feelings associated with the desire to binge indicates the client is making progress. Unresolved emotional issues contribute to binging and purging behaviors. Identifying these emotions enables client to replace unhealthy coping behaviors with adaptive behaviors.

19. The nurse on the eating disorder unit schedules group therapy sessions immediately after meals. Which is the best rationale for scheduling group therapy at this time? 1. Limit time allotted for meals. 2. Identify maladaptive eating behaviors. 3. Discuss feelings associated with eating behaviors. 4. Focus on regaining control.

3. This is correct. The best for scheduling group therapy immediately after meals is to address the emotional issues related to eating behavior, as it enables the nurse to observe clients following meals. Clients may use the time to after meals discard food that has been stashed from the food tray or to engage in self-induced vomiting.

13. The nurse in the outpatient clinic determines the priority nursing diagnosis for a client diagnosed with anorexia nervosa is "imbalanced nutrition: less than body requirements." Which is the most appropriate short-term goal for the client? 1. Demonstrate adaptive eating behaviors. 2. Discuss fears and anxieties. 3. Gain 2 lb per week. ' 4. Exhibit no signs of malnutrition and dehydration.

3. This is correct. Weight gain to restore homeostasis is the priority. Excessive weight loss leads to life-threatening malnutrition, dehydration, severe electrolyte imbalances, hypotension, bradycardia, and cardiac arrhythmias.

6. The nurse is assessing an adolescent who was brought to the emergency department after collapsing during Olympic figure skating training. The adolescent is diagnosed with severe malnutrition due to anorexia nervosa. Which client statement supports the use of a family-based approach? 1. "I just didn't drink enough water during practice." 2. "I eat just as much as everyone else on the team." 3. "I have to practice until my skating routine is perfect." 4. "I'm tired of fighting with my parents about eating."

4. This is correct. "I'm tired of fighting with my parents about eating" indicates there is conflict in the family around the client's eating behaviors. Conflicts arise in a family when a child is starving themself. The AED stands firmly against any model of eating disorders in which family influences are seen as the primary cause of eating disorders, condemns statements that blame families for their child's illness, and recommends that families be included in the treatment. Family-based approaches, such as the Maudsley approach, are supported by clinical evidence.

15. An experienced nurse on the eating disorders unit is explaining to a newly hired nurse the rationale for setting limits with clients. Which is the nurse's most appropriate explanation? 1. It encourages awareness of emotional issues. 2. It encourages understanding of behavior modification plan. 3. It promotes sense of control unhealthy eating behaviors. 4. It prevents power struggles with staff.

4. This is correct. Restrictions and limits must be established and carried out consistently to avoid power struggles, encourage patient compliance with therapy, and ensure patient safety.

The nurse is assessing a client newly admitted to the eating disorders unit. Which findings indicate the client may have a diagnosis of bulimia nervosa? Select all that apply

BMI of 24 kg/m^2 Erosion of tooth enamel Russell's sign

14. A 20-year-old client tells the nurse in the outpatient clinic, "I am so disgusted with myself. For the past month, there are times when I eat everything I can find. I want to vomit it all back up, but I have never been able to." Which is the nurse's best reply? 1. "It's normal to feel depressed after eating so much." 2. "Tell me about relationships with the people in your life." 3. "I am not surprised to hear you feel so disgusted with yourself." 4. "Have you ever been diagnosed with clinical depression?"

This is correct. The statement "Tell me about relationships with the people in your life" is the best reply. The nurse should gain more assessment data before teaching (a nursing intervention). The client demonstrates symptoms of BED, which are similar to those with bulimia nervosa; however, BED does not include compensatory purging. Interpersonal stressors, low self-esteem, and boredom are identified as possible triggers.

17. The nurse is reviewing assessment data of a client diagnosed with anorexia nervosa. The client's BMI dropped from 17 to 15.5 kg/m2 over the past 3 months. Which client statement best supports the assessment data? 1. "I'm glad I don't make myself throw up." 2. "My hair started falling out last week." 3. "You don't know what it's like to be fat." 4. "At least I am not gaining any weight."

This is correct. The subjective statement, "At least I am not gaining any weight" supports the BMI (objective data). According to DSM-5 criteria, the client's illness has progressed from mild (BMI of 17 kg/m2 or greater) to severe (BMI of 15 to 15.99 kg/m2 ). Anorexia nervosa is characterized by a morbid fear of obesity and gross distortion of body image even when an individual is obviously underweight or emaciated.