chapter 31 MH

Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa?q

Restoring nutritional status to normal

The client with bulimia reports feeling helpless and says, "What's the use?" As the nurse plans the client's care, the priority diagnosis is which?

Risk for self-directed violence

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?

17.3 kg/m2

A client with a history of anorexia nervosa comes to the clinic for evaluation. During the visit, the client's body mass index (BMI) is obtained. The nurse determines that treatment has been effective based on which BMI measurement?

19.2 kg/m2

During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?

"Has something occurred that caused you to measure your thighs?"

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

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

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

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse?

"I realize this must be very difficult for you but try to remember I'm not your enemy."

One approach to establish adequate eating patterns for a client with anorexia is to assume a positive expectation of the client. Which is the best statement by the nurse?

"I will sit here quietly with you while you eat."

The nurse is sitting with the client at mealtime. The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach?

"Is there any way you can look at that sandwich as fuel for your body?"

A nurse, sitting with a client diagnosed with anorexia nervosa, notices that the client has eaten 80 percent of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse?

"Let's focus on your continued improvement. You ate 80 percent of your lunch."

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."

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?"

A nurse is providing care to a client with anorexia who is beginning a refeeding protocol. Based on the nurse's understanding of these protocols, the nurse would expect the client to start with how many calories per day?

1500

Which of the following clients being treated for anorexia displays assessment values that warrant hospitalization?

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

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 most likely diagnosis for this client is what?

Anorexia nervosa, restricting type

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?

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

Which may help a person to overcome an eating disorder that causes weight gain?

Believing that gaining weight is an effect of unhealthy lifestyle behaviors and losing weight is an effect of healthy lifestyle behaviors

A 15-year-old is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa?

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?

Bulimia nervosa

While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from?

Bulimia nervosa

Which intervention has been found to be most effective reducing the initial symptoms of bulimia?

Cognitive behavior therapy and pharmacologic interventions

Which behavior is not associated with purging?

Consuming large amounts of food

A client meets some (but not all) of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the client's weight is within the normal range. The nurse understands that based on DSM-5 criteria, this client would most likely be diagnosed with which of following?

Eating disorder not otherwise specified

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?

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?

Dental erosion and chronic edema

A client is diagnosed with anorexia nervosa, restricting type. The nurse interprets this as indicating the use of which of the following? Select all that apply.

Dieting Exercising

Which 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, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next?

HEART RATE + RHYTHM

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

Poor communication and enmeshed family dynamics

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

The immediate goal of nursing interventions in the care of a client with anorexia nervosa is which of the following?

Restoring nutritional status to normal

Fluoxetine includes a black box warning concerning which of the following?

Suicidality in children and adolescents

A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5' 8" tall and weighs only 90 lb. When considering the client's unrealistic body image, which intervention should be included in the care plan?

Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy

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

fluoxetine

A nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa?

The person engages in episodic binge eating.

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

Weighing the client twice daily

Which of the following terms describes a lack of clear role boundaries?

Which of the following terms describes a lack of clear role boundaries?

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 anorexia nervosa client is typically what?

a high achiever

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?

binge eating D/O

Which is a cardiac complication of an eating disorder?

bradycardia

fter complaining of weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client's nursing care and treatment, which outcome should be prioritized?

client will be free of self-induced vomiting

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

When working with the family of a client with anorexia nervosa, which of the following issues must be addressed?

control issues

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

depression

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

eager to please

Which would be most supportive for family and friends of a client with an eating disorder?

emotional, support, love & attention

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting?

engaging in severe dieting

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

gain control of one part of life

A mental health nurse is completing an initial assessment on a client diagnosed with anorexia nervosa. Which of the following is a typical characteristic of parents of clients diagnosed with anorexia nervosa?

overprotective of their children

A nurse is reading a journal article about anorexia nervosa and comorbidities. The article describes a strong association between anorexia and obsessive-compulsive disorder. The nurse demonstrates understanding of this information by identifiying which aspect as common to both of these disorders?

perfectionist

A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client?

self-moinitoring

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

serotonin

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 loose weight

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 what you're feeling right now

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

weight gain