Halter ch 18: feeding, eating and elimination disorders QUESTIONS

Which patient statement acknowledges the characteristic behavior associated with a diagnosis of pica? a. "Nothing could make me drink milk." b. "I'm ashamed of it, but I eat my hair." c. "I haven't eaten a green vegetable since I was 3 years old." d. "I regurgitate and re-chew my food after almost every meal."

b. "I'm ashamed of it, but I eat my hair."

A patient reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal a. Tachycardia b. Hypokalemia c. Hypercalcemia d. Hypolipidemia

B Hypokalemia Vomiting causes loss of potassium leading to hypokalemia

Which assessment questions should be asked of a patient suspected of demonstrating characteristics of anorexia nervosa? a. "Do you find yourself feeling hungry?" b. "How would you describe your body?" c. "How often do you force yourself to vomit?" d. "Why do you choose to take laxatives?"

B. "How would you describe your body?" This question will reveal the cognitive distortion consistent with anorexia nervosa. Invariably the patient will describe self as fat despite being excessively underweight

Which statement is least likely to be made by a patient diagnosed with bulimia nervosa during the assessment interview? a. "I eat three meals each day and purge every evening." b. "I'm concerned about what others think about my binging and purging." c. "I feel as though my eating and purging are out of my control." d. "When i eat i feel calm, but then i realize i have to make myself vomit or gain weight."

B. "I'm concerned about what others think about my binging and purging." Most patients with bulimia purge after each meal

A coping mechanism used excessively by patients with anorexia nervosa is a. Denial b. Humor c. Altruism d. Projection

A Denial Denial is excessive thinness is the mainstay of the patient with anorexia nervosa

The patient with bulimia differs from the patient with anorexia nervosa by a. Maintaining a normal weight b. Holding a distorted body image c. Doing more rigorous exercising d. Purging to keep weight down

A Maintaining a normal weight Many bulimics are at or near normal weight, whereas patients with anorexia nervosa are underweight

While on an inpatient unit, you are caring for newly admitted Alyssa, a 16-year-old diagnosed with anorexia nervosa. Number the following nursing interventions in order of priority: a. ___ Initiate a therapeutic relationship. b. ___ Promote caloric consumption. c. ___ Assess for suicidal ideation d. ___ Review accomplishments made during treatment. e. ___ Explore feelings of underlying anxiety and low self-esteem.

A. 1 Initiate a therapeutic relationship. C. 2 Assess for suicidal ideation B. 3 Promote caloric consumption. E. 4 Explore feelings of underlying anxiety and low self-esteem. D. 5 Review accomplishments made during treatment.

A patient has been hospitalized with anorexia nervosa. The patient's weight is 65% of normal. For this patient, a realistic short-term goal for the first week of hospitalization would be: by the end of week 1, the patient will a. Gain a maximum of 3 lbs b. Develop a pattern of normal eating behavior c. Discuss fears and feelings about gaining weight d. Verbalize awareness of the sensation of hunger

A. Gain a maximum of 3 lbs The criteria outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema

Brittany is caring for a patient with bulimia. She recognizes which of the following nursing interventions as being most appropriate? a. Monitor the patient on bathroom trips after eating. b. Allow the patient extensive private time with family members. c. Provide meals whenever the patient requests them. d. Encourage the patient to select foods that she likes.

A. Monitor the patient on bathroom trips after eating.

Which of the following statements is true of bulimia? a. Patients with bulimia often appear at a normal weight b. Patient with bulimia binge eat but don't engage in compensatory measures c. Patients with bulimia severely restrict their food intake d. One sign of bulimia is lanugo

A. Patients with bulimia often appear at a normal weight Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

The nurse working with patient diagnosed with eating disorders can help families develop effective coping mechanisms by a. Teaching the family about the disorder and the patient's behaviors b. Stressing the need to suppress overt conflict within the family c. Urging the family to demonstrate greater caring for the patient d. Encouraging the family to use their usual social behaviors at meals

A. Teaching the family about the disorder and the patient's behaviors Families need information about specific eating disorders and the behaviors often seen in patients with these disorders. This information can serve as a basis for additional learning about how to support the family member

After stabilization of symptoms, what is the primary focus of treatment for a client diagnosed with anorexia nervosa? a. Weight restoration b. Improving interpersonal skills c. Learning effective coping methods d. Changing family interaction patterns

A. Weight restoration Weight restoration is the priority goal of treatment for the patient with anorexia nervosa because health is seriously threatened by the underweight status

Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of a. Historically poor patient compliance b. An increased risk of seizures c. The long-term effects on liver function d. The potential to cause gastric ulcers

B. An increased risk of seizures Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of an increased risk of seizures

A patient with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is a(n) a. Increase in the red blood cell count b. Disruption of the fluid and electrolyte balance c. Elevated serum potassium level d. Elevated serum sodium level

B. Disruption of the fluid and electrolyte balance Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives

When you're educating Erin and her mother about the medication dosage and side effects, Erin becomes upset and tearful, stating, "NO! I will not take that medication!" Which of the following is the most likely reason for Erin's feelings? a. Erin feels embarrassed to be taking psychiatric medication b. Erin is upset about the possible side effects of weight gain c. Erin is worried about the common adverse effect of sexual problems d. Erin's resistance is typical of her characteristics of rigidity and needing control

B. Erin is upset about the possible side effects of weight gain Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain but are not well accepted by patients who are frightened by the side effect of weight gain. There is nothing in the scenario to suggest Erin is embarrassed. Sexual side effects are more common with SRRI medication than atypical antipsychotics. Erin may have the characteristics described in option d, which are typical of patients with anorexia; however, during medication education it is more likely for her to be upset over the possibility of a side effect.

Which intervention would be least useful for accurate assessment of the weight of a patient diagnosed with anorexia nervosa? a. Weight two times daily, then three times weekly b. Weight fully clothed before breakfast c. Do not reweigh patient when patient requests d. Permit no oral intake before weighing

B. Weight fully clothed before breakfast Patients should be weighed wearing only bra and panties before ingesting any food or fluids in the morning

During the assessment of a patient with anorexia nervosa, it's not likely that the nurse would note indications of a. Introversion b. Social isolation c. High self-esteem d. Obsessive-compulsive tendencies

C High self-esteem Most patients with eating disorders have low self-esteem

The nurse is admitting a patient who weighs 100 pounds, is 66 inches tall, and is below ideal body weight. The patient's blood pressure is 130/80 mm Hg, pulse is 72 beats per minute, potassium is 2.5 mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands are shaking, and her parotid gland is enlarged. The patient states, "I am really nervous about coming to this unit." What is the priority nursing diagnosis? a. Powerlessness b. Risk for injury c. Imbalanced nutrition: Less than body requirements d. Anxiety

C Imbalanced nutrition: Less than body requirements

Ali is a 17 year old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? a. "I purge only once a day now instead of twice." b. "I feel a lot calmer lately, just like when i used to eat four or five cheese burgers." c. "I am a hard worker and I am very compassionate toward others." d. "I always purge when I'm alone so that I'm not a bad role model for my younger sister."

C. "I am a hard worker and I am very compassionate toward others." An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is incorrect because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging.

According to current theory, eating disorders: a. Are psychotic disorders in which patients experience body dysmorphic disorder b. Are frequently misdiagnosed c. Are possibly influenced by sociocultural factors d. Are rarely comorbid with other mental health disorders

C. Are possibly influenced by sociocultural factors 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.

In contrast to the patine diagnosed with anorexia nervosa, the patient diagnosed with bulimia usually a. Uses greater denial b. Is aware of the eating problem c. Fits more easily into the family d. Appraises his or her body more realistically

C. Fits more easily into the family There is less family concern about the patient with bulimia because these patients appear physically normal, the weight is at or near normal, they eat with the family and the purging is done in secret. The anorexic patient is noticed by the family for painful thinness and poor food intake

Biological theorists suggest that the cause of eating disorders may be a. Normal weight phobia b. Body image disturbance c. Serotonin imbalance d. Dopamine excess

C. Serotonin imbalance The SSRIs have been shown to improve the rate of weight gain and reduce the occurrence of relapse

Which intervention would be removed from the plan of care for a patient diagnosed with bulimia nervosa? a. Teach that fasting sets one up to binge eat b. Assist patient to identify trigger foods c. Support importance of avoiding forbidden foods d. Teach patient to plan and eat regularly scheduled meals

C. Support importance of avoiding forbidden foods No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy

A subjective symptom the nurse would expect to note during assessment of a patient with anorexia nervosa is a. Lanugo b. Hypotension c. 25lbs weight loss d. Fear of gaining weight

D Fear of gaining weight D is the only subjective data listed and it's universally true

Patient who is 16 years old, 5 foot, 3 inches tall and weights 80 pounds easts one tiny meal daily and engages in a rigorous exercise program. The nursing diagnosis for this patient would be a. Death anxiety b. Ineffective denial c. Disturbed sensory perception d. Imbalanced nutrition: less than body requirements

D Imbalanced nutrition: less than body requirements A body weight of 80 pounds for a 16 year old who is 5 foot 3 inches tall is ample evidence of this diagnosis

Your patient, Erin, is a 16-year-old patient newly diagnosed with anorexia. Her provider is starting her on medication to reduce compulsive behaviors regarding food and resistance to weight gain. You prepare teaching on which class of medication that may help these specific symptoms in eating disorders? a. Mood stabilizer b. Antidepressants c. Anxiolytics d. Atypical antipsychotics

D. Atypical antipsychotics Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders. The antidepressant fluoxetine (Prozac, an SSRI) has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety.

The nurse can determine that inpatient treatment for a patient diagnosed with an eating disorder would be warranted when the patient a. Weighs 10% below ideal body weight b. Has a serum potassium level of 3 mEq/L or greater c. Has a heart rate less than 60 beats/min d. Has systolic blood pressure less than 70 mmHg

D. Has systolic blood pressure less than 70 mmHg Systolic blood pressure of less than 70 mmHg is one of the established criteria signaling the need for hospitalization of a patient with anorexia nervosa. It suggests severe cardiovascular compromise

Taylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina: a. "I need to go through the belongings you have brought with you." b. "You can use the scale in the back room when you need to." c. "You will be eating five times a day here." d. "The daily structure is based around your desire to eat."

a. "I need to go through the belongings you have brought with you."

Which patient statement supports the diagnosis of anorexia nervosa? a. "I'm terrified of gaining weight." b. "I wish I had a good friend to talk to." c. "I've been told I drink way too much alcohol." d. "I don't get much pleasure out of life anymore."

a. "I'm terrified of gaining weight."

When considering an eating disorder, what is a physical criterion for hospital admission? a. A daytime heart rate of less than 50 beats per minute b. An oral temperature of 100°F or more c. 90% of ideal body weight d. Systolic blood pressure greater than 130 mm Hg

a. A daytime heart rate of less than 50 beats per minute

Malika has been overweight all of her life. Now an adult, she has health problems related to her excessive weight. Seeking weight loss assistance at a primary care facility Malika is surprised when the nurse practitioner suggests: a. A trial of SSRI antidepressant therapy b. Mild exercise to start, increasing in intensity over time c. Removing snack foods from the home d. Medication treatment for hypertension

a. A trial of SSRI antidepressant therapy

Which coping mechanism is used excessively by clients diagnosed with bulimia nervosa to cope with their obsession with their body image? a. Denial b. Humor c. Altruism d. Projection

a. Denial Denial of incongruence between body reality, body ideal, and body presentation is the mainstay of the client diagnosed with bulimia nervosa. None of the other mechanisms are as vital to their coping technique

Safety measures are of concern in eating-disorder treatments. Patients with anorexia nervosa are supervised closely to monitor: Select all that apply. a. Foods that are eaten b. Attempts at self-induced vomiting c. Relationships with other patients d. Weight

a. Foods that are eaten b. Attempts at self-induced vomiting d. Weight

When considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa? Select all that apply. a. Provide scheduled portion-controlled meals and snacks. b. Congratulate patients for weight gain and behaviors that promote weight gain. c. Limit time spent in bathroom during periods when not under direct supervision. d. Promote exercise as a method to increase appetite. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

a. Provide scheduled portion-controlled meals and snacks. c. Limit time spent in bathroom during periods when not under direct supervision. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

The nurse is planning care for a patient with a binge eating disorder. What outcomes are appropriate? Select all that apply. a. The patient will identify stressors that lead to binge eating. b. The patient will identify four alternate coping skills. c. The patient will increase dietary intake. d. The patient will experience satisfaction in eating alone.

a. The patient will identify stressors that lead to binge eating. b. The patient will identify four alternate coping skills

A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? a. Mood stabilizer b. Antidepressants c. Anxiolytics d. Atypical antipsychotics

b. Antidepressants The antidepressant fluoxetine (Prozac, an SSRI) has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders

Obesity can be the end result of a binge-eating disorder. The nurse understands that the best treatment option in persons with a binge-eating disorder promotes: a. Bariatric surgery b. Coping strategies c. Avoidance of public eating d. Appetite suppression medications

b. Coping strategies

Which of the following are true regarding feeding disorders in children? Select all that apply. a. Feeding disorders usually reflect poor parenting. b. Feeding disorders are often manifested in children with developmental delays. c. Feeding disorders are most often treated with a punishment system. d. In many cases, toddler mealtime difficulties spontaneously resolve with no intervention. e. Behavior modification has been found to be effective in treating feeding disorders.

b. Feeding disorders are often manifested in children with developmental delays. d. In many cases, toddler mealtime difficulties spontaneously resolve with no intervention. e. Behavior modification has been found to be effective in treating feeding disorders.

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? a. It will reduce the need for cognitive therapy. b. It will be prescribed at a higher than typical dose. c. There are a variety of medications to prescribe if fluoxetine proves to be ineffective. d. Long-term management of symptoms is best achieved with tricyclic antidepressants.

b. It will be prescribed at a higher than typical dose.

Malika agrees to try losing weight according to the nurse practitioner's outlined plan. Additional teaching is warranted when Malika states: a. "I am willing to admit I am depressed." b. "Psychotherapy will be a part of my treatment." c. "I prefer to have a gastric bypass rather than use this plan." d. "My comorbid conditions may improve with weight loss."

c. "I prefer to have a gastric bypass rather than use this plan."

Assessment of a patient suspected of experiencing bulimia nervosa calls for the nurse to perform a. A range of motion assessment b. Inspection of body cavities c. Inspection of the oral cavity d. Body fat analysis

c. Inspection of the oral cavity Repeated vomiting often causes dental erosions and caries

Which diagnosis from the list below would be given priority for a patient diagnosed with bulimia nervosa? a. Disturbed body image b. Chronic low self-esteem c. Risk for injury: electrolyte imbalance d. Ineffective coping: impulsive responses to problems

c. Risk for injury: electrolyte imbalance The patient who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss

Which intervention will promote independence in a patient being treated for bulimia nervosa? a. Have the patient monitor daily caloric intake and intake and output of fluids. b. Encourage the patient to use behavior modification techniques to promote weight gain behaviors. c. Ask the patient to use a daily log to record feelings and circumstances related to urges to purge. d. Allow the patient to make limited choices about eating and exercise as weight gain progresses

d. Allow the patient to make limited choices about eating and exercise as weight gain progresses