Psych CH 24: Eating Regulation Response and Eating D/O

24 The first step in the creation of a therapeutic alliance between a nurse and a patient with a maladaptive response to eating regulation is: a. formulation of a nurse-patient contract. b. resolution of conflicts with family members. c. nurse and patient will agree on perception of patient's body. d. the means of stabilizing the patient's nutritional status will be specified.

ANS: A A nurse-patient contract obtains commitment to the treatment process. By signing a contract, the patient will understand the treatment he or she will be receiving and will be able to make informed decisions about treatment and honoring the contract. DIF: Cognitive Level: Application REF: Text Page: 489 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

24 An individual is seeking treatment for bulimia nervosa. The therapist decides to use cognitive behavioral therapy and medication. For what medication can a nurse expect to develop a patient education program? a. A selective serotonin reuptake inhibitor (SSRI), such as escitalopram (Lexapro) b. A mood stabilizer, such as lithium c. A calcium channel blocker, such as nifedipine (Procardia) d. An antianxiety medication, such as buspirone (Buspar)

ANS: A Antidepressant medications have been shown to have a therapeutic benefit for many patients with bulimia and binge-eating disorder. Because the side-effect profile is least troublesome for SSRI antidepressants, this is the type of medication the nurse can expect to be used. DIF: Cognitive Level: Comprehension REF: Text Pages: 493-494 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

24 A patient who has a maladaptive response to eating regulation says, "I know my parents are already upset about me losing so much weight, but I need to lose a lot more to be at a weight that doesn't make me feel fat." This statement suggests that the best treatment setting for this patient would be: a. the hospital. b. an outpatient program. c. a day treatment program. d. at home with weekly nursing visits.

ANS: A Hospitalization would be appropriate because reinstatement of physiological stability is a high priority and may not be possible on an outpatient basis because of the patient's reluctance to accept treatment. DIF: Cognitive Level: Application REF: Text Page: 489 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

24 A patient with an eating disorder states, "Now that I've gained 4 pounds, I can't wear shorts until I lose it again." The patient is exhibiting which cognitive distortion related to maladaptive eating regulation responses? a. Magnification b. Personalization c. Superstitious thinking d. Dichotomous thinking

ANS: A In magnification, the patient overestimates the significance of undesirable events. Stimuli are embellished with meaning not supported by objective analogies. The remaining answers list other types of cognitive distortions that often accompany maladaptive eating responses. DIF: Cognitive Level: Comprehension REF: Text Page: 490 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 A nurse would assess for which behavior to substantiate a diagnosis of bulimia nervosa? a. Abuse of diuretics and laxatives b. Introverted personality traits c. Disinterest in sexual activity d. Denial of hunger at all times

ANS: A Individuals with bulimia nervosa without bingeing or purging tend to abuse laxatives and/or diuretics and tend to be extroverted and sexually active and experience hunger. DIF: Cognitive Level: Application REF: Text Page: 481 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 The coping mechanism patients with anorexia nervosa use maladaptively is: a. denial. b. projection. c. introjection. d. rationalization.

ANS: A Patients with anorexia nervosa use denial about the appropriateness of body weight, their nutritional intake, their insistence of normalcy, and their need for help. DIF: Cognitive Level: Comprehension REF: Text Page: 486 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 What is the central concept around which a family education plan for preventing childhood eating problems is constructed? a. Promoting self-demand feeding for the child b. Distinguishing between physical and psychological hunger c. Scheduling meals because children do not recognize physical hunger d. Parental expectations of ideal intake as determinants of healthy eating habits

ANS: A The education plan should be built around the concept that self-demand feeding in children promotes adaptive eating regulation responses. This is often difficult to accept for parents who have acquired maladaptive eating regulation responses or who believe various myths about feeding. DIF: Cognitive Level: Comprehension REF: Text Page: 484 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

24 Which information would be most important to a nurse assessing a patient's motivation to change behavior associated with maladaptive eating regulation responses? a. The number, on a scale of 1 to 10, that reflects the patient's desire for treatment b. The name of a support person the patient identifies for emotional support c. The disadvantages the patient identifies as resulting from the maladaptive behavior d. The reasons the patient identifies as the factors that originally caused the maladaptive behavior

ANS: A This information relates directly to a means of determining the patient's motivation for change. Identifying the disadvantages of the maladaptive behavior as well as the factors that were the basis of the disorder assists in evaluating patient insight. Naming a supportive person relates to environmental support for change. DIF: Cognitive Level: Analysis REF: Text Pages: 485-486 TOP: Nursing Process: Diagnosis|Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity

24 A nurse assesses that which individual is most likely to engage in binge-eating behaviors characteristic of bulimia? A person who: a. weighs 225 pounds and is 5 feet 4 inches tall. b. is 5 pounds overweight and cannot stick to a diet. c. lost 40 pounds but gained it back within 1 year. d. monitors caloric intake in order to fit into a small suit.

ANS: B A person with bulimia typically is of average weight or is slightly overweight and has a history of unsuccessful dieting. DIF: Cognitive Level: Analysis REF: Text Page: 480 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 A patient is diagnosed with anorexia nervosa. A nurse who is assessing for co-morbid psychiatric disorders should begin by looking for signs of which common, concurrent diagnosis? a. Phobias b. Depression c. Schizophrenia d. Personality disorder

ANS: B Co-morbid major depression or dysthymia has been reported in 50% to 75% of people with anorexia and bulimia, and obsessive-compulsive disorder may be found in as many as 25% of patients with anorexia nervosa. Anxiety disorders and substance abuse also occur, but their incidence is lower than depression. Individuals who have binge-eating disorder, not anorexia nervosa, are more likely to have a personality disorder. Schizophrenia is not reported to be associated with anorexia nervosa. DIF: Cognitive Level: Application REF: Text Pages: 482-483 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 Which statement would help the nurse conclude that a patient with an eating disorder is exhibiting cognitive distortion? a. "I see now that I need to establish my own preferences and routines." b. "Bingeing makes my feelings of both isolation and loneliness go away." c. "Controlling what I eat has been a way for me to exert control over my life." d. "I need to watch for hunger and fatigue as triggers for my eating disorder."

ANS: B Cognitive distortions are personal beliefs that lack logic and are not reflective of reality. Bingeing is a maladaptive eating response to feelings of isolation and loneliness and is not a cure for those feelings in spite of the patient's belief. The other statements do not represent cognitive distortions since they are logical and based in reality. DIF: Cognitive Level: Analysis REF: Text Pages: 490-491 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 Care planning requires that a nurse recognize that the dynamic focus directing care of a patient with anorexia nervosa is: a. managing weight gain. b. controlling personal stressors. c. minimizing dependency on food. d. expressing independence and autonomy.

ANS: B For a patient with anorexia nervosa, the major issue is about control of the person's life and fears. Whether the fear is of maturity, independence, failure, sexuality, or parental demands, patients with anorexia nervosa believe the solution to the problem lies in controlling their food intake and their bodies. With increasing family concern, patients with anorexia nervosa also control the focus of significant others. DIF: Cognitive Level: Application REF: Text Page: 486 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

24 A nurse would expect to assess which feature in a patient diagnosed with anorexia nervosa without bingeing or purging? a. Claims of sexual activity b. Denial of hunger at all times c. Extroverted personality traits d. Abuse of diuretics and laxatives

ANS: B Individuals with anorexia nervosa without bingeing or purging tend to deny the experience of hunger, are introverted, rarely use laxatives or diuretics, and tend to be sexually inactive. DIF: Cognitive Level: Application REF: Text Page: 488 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 A short-term goal for a patient with anorexia nervosa is "Patient will select and eat a balanced diet." The nurse includes which nursing intervention in the care plan that will foster attainment of this goal? a. Allow patient to weigh self every time a meal is completely eaten. b. Assist the patient to fill out the dietary menus to ensure a balanced diet. c. Encourage the patient to engage in only appropriate compensatory exercise. d. Implement contracted consequences 50% of the time if a meal is not completed.

ANS: B Nursing interventions that help to achieve this goal involve the use of protocols that specify the number of meals and their timing and that the diet is balanced. Exercise for the purpose of compensating for additional caloric intake is discouraged. Contracts should be enforced 100% of the time. The frequency of weighing is also determined as part of a treatment protocol and is not used as a reward for eating. DIF: Cognitive Level: Application REF: Text Pages: 489-490 TOP: Nursing Process: Outcome Identification|Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

24 A patient with an eating disorder states, "I heard people laughing behind me in the check-out line at the department store. I bet they thought it was funny that I gained a pound in the last few days." The patient is exhibiting which cognitive distortion related to maladaptive eating regulation responses? a. Magnification b. Personalization c. Overgeneralization d. Dichotomous thinking

ANS: B Personalization is an egocentric interpretation of impersonal events or overinterpretation of events related to the self. DIF: Cognitive Level: Comprehension REF: Text Page: 490 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 A nurse has completed the assessment for a patient who has a maladaptive response to eating regulation. Findings include: height, 5 feet 3 inches; current weight, 80 pounds with weight loss of 30% of body weight; poor skin turgor; lanugo; amenorrhea of 6 months' duration; and admits to restricting intake to 350 calories daily. These assessment findings are most consistent with the medical diagnosis of: a. bulimia nervosa. b. anorexia nervosa. c. binge-eating disorder. d. disturbed body image.

ANS: B The assessment data are most consistent with the medical diagnosis of anorexia nervosa, a disorder in which intense fear of gaining weight leads to a body weight 15% below normal for height and amenorrhea. Disturbed body image is not a medical diagnosis. DIF: Cognitive Level: Application REF: Text Page: 486 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 Which goal has priority for a patient with anorexia nervosa undergoing nutritional stabilization? a. Schedules meals appropriately b. Eats 100% of each meal served c. Selects food items from a menu d. Prepares food under supervision

ANS: B The first goal is that the patient is able to eat meals that are served. Only then may the patient assume some control over scheduling of meals and food selection. Finally, the patient can shop for food and prepare it under supervision. DIF: Cognitive Level: Analysis REF: Text Pages: 486-487 TOP: Nursing Process: Outcome Identification|Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

24 A nurse has recently been assigned to a unit that specializes in the care of patients diagnosed with eating disorders. The nurse should consider which action as having priority when preparing for this new assignment? a. Becoming familiar with the unit's policies and procedures b. Arranging to mentor with a nurse who has experience on the unit c. Self-reflecting on personal feelings regarding body weight and size d. Attending an educational seminar that focuses on maladaptive eating disorders

ANS: C Before working with patients with maladaptive eating regulation responses, nurses must closely examine their own feelings and prejudices about weight and body size. Nurses who suspect that they have an eating disorder or are in some way prejudiced may not be able to provide care for patients who cannot regulate their eating responses. DIF: Cognitive Level: Application REF: Text Page: 479 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 Which therapy is shown through evidence to be most effective for a patient with an eating disorder? a. Supportive therapy b. Behavioral therapy c. Cognitive behavioral therapy d. Psychoanalytical group therapy

ANS: C Eating disorders clearly involve cognitive distortions and faulty thinking about body shape, body weight, and food. Research has shown that cognitive behavioral therapy is superior to other types of psychotherapy. DIF: Cognitive Level: Comprehension REF: Text Pages: 490-491 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

24 What is the rationale for establishing a contract with a patient with an eating disorder at the beginning of treatment? a. The patient and nurse form a coalition that is difficult for the family to disrupt. b. A team approach to planning therapy ensures that physical and emotional needs will be met. c. Patient involvement in decision making increases the sense of control and promotes cooperation. d. Permission for refeeding is essential because this measure has the potential for negative effects.

ANS: C It is often difficult to secure patient cooperation with treatment. A contract helps engage the patient in the therapeutic alliance and obtains commitment to the treatment process. DIF: Cognitive Level: Application REF: Text Page: 489 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

24 A major difference in assessment findings between a patient with anorexia nervosa and a patient with bulimia nervosa is that the patient with bulimia: a. is well nourished while the patient with anorexia nervosa is malnourished. b. denies hunger while the patient with anorexia nervosa admits experiencing hunger. c. is often of near-normal weight while the patient with anorexia nervosa is underweight. d. has a distorted body image while the patient with anorexia nervosa has a realistic body image.

ANS: C Patients with anorexia nervosa are underweight; the patient with bulimia has experienced less weight loss. Both may be malnourished. Patients with anorexia nervosa deny hunger; patients with bulimia do not deny feeling hungry. Patients with anorexia nervosa have body-image distortion; patients with bulimia are more likely to experience body-image dissatisfaction. DIF: Cognitive Level: Comprehension REF: Text Page: 479 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 When undertaking care for patients with eating disorders, a nurse should first: a. perform a complete patient assessment. b. obtain a history from the patient's family. c. examine personal feelings about weight. d. question the patient as to when he or she last ate a meal.

ANS: C Self-examination before beginning therapeutic work is wise. If the nurse suspects that he or she has an eating disorder, it may be difficult to provide care for patients who cannot regulate their eating responses. DIF: Cognitive Level: Application REF: Text Page: 479 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24 A patient has a maladaptive response to eating regulation. Findings include the following: T, 96.6° F; BP, 68/40; P, 40; R, 20; poor skin turgor; admits to restricting intake to 350 calories daily; and diagnostic testing reveals serum potassium of 2.9 mEq/L and urine specific gravity of 1.028. What is the highest priority nursing diagnosis for this patient? a. Imbalanced nutrition, less than body requirements b. Disturbed body image c. Deficient fluid volume d. Powerlessness

ANS: C The patient is malnourished and is experiencing dehydration, as evidenced by the low BP, poor skin turgor, and high urine specific gravity. For this reason, highest priority should be placed on restoring circulating volume, followed by increasing caloric intake. When the primary physiological needs are being met (according to Maslow), secondary needs such as body image can be addressed, and powerlessness can be explored if it applies. DIF: Cognitive Level: Application REF: Text Page: 482 TOP: Nursing Process: Diagnosis|Nursing Process: Analysis MSC: NCLEX: Physiological Integrity

24 A nurse would evaluate that a family education plan for preventing childhood eating problems was effective if which outcome is evident? a. Parents serve three meals per day plus midmorning, midafternoon, and bedtime snacks. b. Parents indicate an interest in learning about healthier eating patterns for their children. c. Parents use food to reward their children for only especially good behavior or outstanding achievements. d. Parents keep a diary to record both physical and psychological signs of hunger for themselves and their children.

ANS: D Parents need to be aware of the difference between physical hunger and psychological hunger since doing so will assist the parents in modeling healthy eating behaviors and minimizing the potential for maladaptive eating behaviors in their children. DIF: Cognitive Level: Analysis REF: Text Page: 484 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

24 After assessing a patient with anorexia nervosa, a nurse writes the following nursing diagnosis: imbalanced nutrition, less than body requirements related to refusal to eat as evidenced by being 25% below body weight for height. The expected outcome should be listed as "Patient will: a. identify cognitive distortions about food, weight, and body shape." b. exhibit fewer signs of malnutrition within 2 weeks of hospitalization." c. be able to describe both the physical and emotional complications of the eating disorder." d. restore healthy eating patterns and normalize physiological parameters related to ideal weight."

ANS: D The outcome is a more comprehensive statement than short-term goals that contribute to eventual outcome attainment. The other options should be considered short-term goals. DIF: Cognitive Level: Application REF: Text Pages: 486-487 TOP: Nursing Process: Outcome Identification MSC: NCLEX: Psychosocial Integrity