Ch. 20 Eating Disorders M.C.
A nurse is discussing the plan of care with a client who has anorexia nervosa. The client's weight is 15% below ideal. The nurse and client are now discussing the client's activity level. The client would like to run 5 miles per day as the client normally does. Which response by the nurse is best? "Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass." "No, exercise is not allowed until your weight is closer to normal." "Five miles per day is too much. How about 3 miles per day?" "That's fine as long as you adhere to your eating program and do not use laxatives or purging."
"Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass."
Which nursing statement is most effective in communicating a positive expectation of the client? "I'll give you 90 minutes to eat." "I will allow you space to eat in peace." "I will sit here quietly with you while you eat." "There are people who would truly appreciate this food."
"I will sit here quietly with you while you eat."
While caring for a client with anorexia nervosa, a nurse anticipates that the client would have difficulty making which comment? "I'm mad at you because you won't let me go on a pass unless I gain weight!" "I need to have everything in its place and perfect." "If I gain a pound, I'll just keep gaining weight." "I am very involved in preparing my food and counting calories."
"I'm mad at you because you won't let me go on a pass unless I gain weight!"
A nurse is performing an admission assessment for an adolescent client with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the client's diagnosis? "I feel really close to my parents and my brother." "My father was always very thin." "I've never really liked myself." "I have a lot of confidence in myself."
"I've never really liked myself."
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?" "You have to eat in moderation for good nutrition." "You seem to have a really hard time controlling your eating patterns." "Is this your way of showing your family that you can make decisions?"
"Is there any way you can look at that sandwich as fuel for your body?"
An adolescent diagnosed with anorexia nervosa is insistent on being allowed to take a laxative. Which response by the nurse best demonstrates the management of this client request? "Laxatives are not a part of your treatment plan." "Using a laxative to purge is not an acceptable way to manage your weight." "Why do you want to take a laxative?" "Using laxatives is bad for you because your electrolytes can become unbalanced."
"Laxatives are not a part of your treatment plan."
When documenting the mental status exam findings in the chart of a client with anorexia, the nurse notes poor judgment and insight. Which client statement would support this impression? "I know I have a problem. I need help." "Others are just trying to keep me from looking good." "I know my weight is a little below normal." "Those weight charts are for normal people. I am not normal."
"Others are just trying to keep me from looking good."
A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder? "Society told me I needed to be thin and I believed that." "There are many factors involved with how I developed anorexia ." "There is a history of obsessive-compulsive disorder in my family." "My strict dieting led to my problem with anorexia."
"There are many factors involved with how I developed anorexia ."
The client is 16 years old with an identical twin just diagnosed with anorexia nervosa. The client tells the nurse the client is concerned that the client may also develop the disorder. Which response by the nurse is the most appropriate? "It is not genetics but the environment that increases your risk. Since you live together, you have an equal chance." "Identical twins have about a 5% chance of both twins developing an eating disorder." "Eating disorders have not been found to be genetic, so you do not have a risk." "While eating disorders have shown a genetic link, other factors also play a role in its development."
"While eating disorders have shown a genetic link, other factors also play a role in its development."
A nurse is initiating a group for adolescent girls diagnosed with anorexia nervosa. Many of the clients in the group are irritable and resent having to attend. One of them comments, "This is a stupid waste of time!" Which response by the nurse would be most appropriate? "You sound irritated; tell me about what is bothering you." "You were assigned to this group by your therapist, so you must participate." "Sit down and be quiet; your peers would appreciate some peace and quiet." "If you feel that way, then you can just leave."
"You sound irritated; tell me about what is bothering you."
Which individual most clearly exhibits the characteristics of body image disturbance? 44-year-old who is committed to going to the gym every day both before work and after work 71-year-old who talks frequently about multiple health problems 20-year-old who weighs 98 pounds but who considers oneself obese 13-year-old who is in the fifth percentile of height and weight for age and sex
20-year-old who weighs 98 pounds but who considers oneself obese
Approximately what percentage of clients who have fully recovered from bulimia nervosa later experience a relapse? 23% 30% 10% 50%
30%
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? Eating disorder not otherwise specified Anorexia nervosa, restricting type Anorexia nervosa, binge eating, and purging type Bulimia nervosa, non-purging type.
Anorexia nervosa, restricting type
A client has been purging to maintain weight loss. Which would be an important goal immediate for this client? Understanding that purging is an ineffective means of weight control Recognizing that purging promotes binge eating Using distraction to stop the urge to purge Being free of self-inflicted harm
Being free of self-inflicted harm
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? Anorexia nervosa Binge eating disorder Bulimia nervosa Eating disorder not otherwise specified
Binge eating disorder
Which intervention has been found to be most effective reducing the initial symptoms of bulimia? Behavioral therapy and psychoeducation Clearly stated unit rules and a supportive milieu Daily monitoring of sound dietary principles and meditation sessions Cognitive behavior therapy and pharmacologic interventions
Cognitive behavior therapy and pharmacologic interventions
For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? Cognitive-behavioral therapy (CBT) including self-monitoring Clearly stated unit rules and a supportive milieu Daily reinforcement of sound dietary principles and meditation sessions One-on-one time with psychiatric staff and antidepressant medication therapy
Cognitive-behavioral therapy (CBT) including self-monitoring
During a family meeting for a client with an eating disorder, it becomes apparent that the family lacks clear role boundaries. The nurse should recognize what phenomenon? Potential abuse Autonomy Enmeshment Satiety
Enmeshment
When preparing a client with bulimia for discharge, the nurse suggests that the client and family continue with family therapy on an outpatient basis. Which of the following is the rationale for this suggestion? Family members often need to learn role independence and autonomy. Family members need to learn to monitor for signs of client relapse. Family relationships need to be strengthened due to a lifetime of disengagement. Family members often feel jealous of the attention the client has been receiving in treatment.
Family members often need to learn role independence and autonomy.
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? Patterns of activity and rest Throat and esophagus Heart rate and rhythm Condition of mouth and gums
Heart rate and rhythm
A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis? Imbalanced nutrition: less than body requirements Disturbed body image Ineffective coping Anxiety
Imbalanced nutrition: less than body requirements
A client has been diagnosed with anorexia nervosa. To assist the client to cope with her disease process, the client will complete which of the following actions? Keeping a journal and discussing it with the nurse Temporarily withdrawing from social contact Drinking 4 L of fluid per day Avoiding mirrors and reflective surfaces
Keeping a journal and discussing it with the nurse
A client is diagnosed with anorexia nervosa. The client's body mass index is 16.75 kg/m2. The nurse interprets this as indicating which level of severity of the condition? Extreme Moderate Severe Mild
Moderate
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 An overemphasis of peer relationships over family relationships Passive parenting and lack of encouragement The absence of a parent and/or the presence of a stepparent
Poor communication and enmeshed family dynamics
The emergency department nurse is assessing a client who has a recent history of bulimia nervosa. What objective assessment should the nurse prioritize? Oxygen saturation Temperature White blood cell count Potassium level
Potassium level
A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which would the nurse include in the education plan? Knowing the calorie content of numerous foods Setting realistic goals Describing physiologic consequences of anorexia nervosa Learning strategies to control impulses
Setting realistic goals
For clients who purge, what is the most important goal? Stop the behavior Recognize that purging promotes binge eating Understand that purging is an ineffective means of weight control Develop the technique of distraction
Stop the behavior
A client with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. Considering the client's unrealistic body image, which intervention should be included in the care plan? Asking the client to compare the client's figure with magazine photographs of women the client's age Confronting the client about the client's actual appearance during one-on-one sessions, scheduled during each shift Telling the client of the nurse's concern for the client's health and desire to help the client make decisions to keep the client healthy Assigning the client to group therapy in which participants provide realistic feedback about the client's weight
Telling the client of the nurse's concern for the client's health and desire to help the client make decisions to keep the client healthy
The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress? The client can identify calorie content for each meal The client identifies healthy ways of coping with anxiety The client spends time resting in her room after meals The client verbalizes knowledge of former eating patterns as unhealthy.
The client identifies healthy ways of coping with anxiety.
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? becoming sexually promiscuous socially withdrawing compulsively washing his or her hands engaging in severe dieting
engaging in severe dieting
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? socially withdrawing becoming sexually promiscuous compulsively washing his or her hands engaging in severe dieting
engaging in severe dieting
Which is a metabolic complication related to weight loss? Hypothyroidism Amenorrhea Leukopenia Bradycardia
Hypothyroidism
Exacerbation of anorexia nervosa results from the client's effort to do what? Diminish conflict Gain control of one part of life Live up to family expectations Manipulate family members
Gain control of one part of life
The nurse is planning the care for a client with anorexia nervosa. The nurse should recognize that the client's behavior most likely has what motivation? Manipulating her family members or friends Diminishing the likelihood of conflict Gaining control of one part of her life Living up to her family's expectations
Gaining control of one part of her life
Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa? Changing her irrational thinking about her body Establishing a target weight to be achieved by discharge Restoring nutritional status to normal Gaining insight into the effects of anorexia on her physical health
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? Ineffective individual coping Nutrition that is less than body requirements Risk for self-directed violence Anxiety
Risk for self-directed violence
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? Guided imagery Music therapy Self-monitoring Distraction
Self-monitoring
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? Serotonin Norepinephrine Acetylcholine Dopamine
Serotonin
An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? Set up a strict eating plan for the client Encourage the client to exercise, which will reduce the client's anxiety Restrict visits with the family until the client begins to eat Provide privacy during meals
Set up a strict eating plan for the client
A college student has been referred to the college clinic for evaluation for anorexia nervosa. Which would help support the diagnosis? Oily skin Significantly low body weight Onset of symptoms during preadolescence Temper tantrums
Significantly low body weight
Which percentage accurately reflects the prevalence of anorexia and bulimia in the United States? 2% to 4% 6% to 9% 10% to 12% 4% to 6%
2% to 4%
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?" "You are exactly the right weight for your height." "I don't think you are fat." "You have always been very focused on your thighs. Is that the part of your body you like least?"
"Has something occurred that caused you to measure your thighs?"
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? "What you don't understand is that it's way healthier to be skinny than fat, and it looks better." "I guess it's probably safe to say that anorexia runs in my family." "I know that if I could lose this last 10 pounds I'd feel completely different about things." "What no one seems to understand is that I'm concerned about my health, not ignoring it."
"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'm sorry that you are angry but you cannot throw food at me." "I'm not going to take your insults personally but you need to be more respectful." "I'm not the root of your problem." "I realize this must be very difficult for you but try to remember I'm not your enemy."
"I realize this must be very difficult for you but try to remember I'm not your enemy."
The nurse is interviewing an 18-year-old client about eating behaviors. The client's parents have brought the client to treatment because the client's mother suspects that the client has been binge eating and vomiting. The nurse asks the client if the client ever feels that the client cannot control the client's eating. The client's mother states, "I know the client can't control it; the client ate an entire cake last night!" Which comment by the nurse is best? "I see. Do you ever feel as though you cannot control your eating?" "Do you often have to answer for your child?" "I see. What are your thoughts on what your mother has said?" " Is what your mother said true?"
"I see. Do you ever feel as though you cannot control your eating?"
A client with anorexia weighs less than 85% of the client's normal body weight. The client says, "I'm so fat, I can't even get through this doorway, much less fit into any of my clothes." Which is the nurse's most therapeutic response? "You only weigh 100 pounds. It is just not true that you are fat." "I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about." "You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." "Let's talk about your ideas about your body and why you perceive yourself to be fat."
"I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about."
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? "I'll eat small meals and snacks regularly." "I'll take my medication when I feel the urge to binge." "How I feel about my body has little to do with my binging." "I know if I eat pasta, I'll binge."
"I'll eat small meals and snacks regularly."
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 believe has caused your anorexia?" "What do you think about how much you weigh right now?" "Why do you prefer not to eat food?" "Is there anything that I can get you to eat right now?"
"What do you think about how much you weigh right now?"
Which client 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 glucose of 58mg/dL A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg A 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm
A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL
Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? Antiparkinsonian Antidepressant Antianxiety Antimanic
Antidepressant
The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first? Provide small regular meals and snacks Ask the client directly about thoughts of suicide or self-harm Control the eating responses Identify the cues related to binging
Ask the client directly about thoughts of suicide or self-harm
The nurse understands that before a client with an eating disorder can accept their body image, he or she must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? Coping skills are dependent on a supportive upbringing. When body image is positive, the client will develop better coping skills. Being able to cope in healthy ways improves the ability to accept a realistic body image. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills.
Being able to cope in healthy ways improves the ability to accept a realistic body image.
A 15-year-old female 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 Amenorrhea for at least two cycles Absence of hunger feelings Erosion of dental enamel
Body weight less than normal for age, height, and overall physical health
A college student has been referred to the clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what? Oily skin and acne Onset of symptoms in early adolescence Body weight significantly below ideal for height and age Temper tantrums and sleep disturbance
Body weight significantly below ideal for height and age
Which is a cardiac complication of an eating disorder? Hypertension Enlarged heart Bradycardia Thrombocytopenia
Bradycardia
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? Eating disorder not otherwise specified Anorexia nervosa Binge-eating disorder Bulimia nervosa
Bulimia nervosa
A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment? Evidence of injury to skin by cutting Psychosocial assessment and determination of coping skills Complete blood count and differential Cardiac assessment and measurement of electrolyte levels
Cardiac assessment and measurement of electrolyte levels
Which is a family risk factor for bulimia nervosa? Lack of emotional support Self-perception of being overweight Chaotic family Inability to deal with conflict
Chaotic family
A 30-year-old client is in therapy for bulimia, depression, and anxiety. The client relates that the client feels unable to cope with the demands of the client's job and that the client's partner recently ended their long-term relationship. The client states that the client frequently binges when stress levels are high. The client denies feeling suicidal but states, "I'm a mess. I'm just not smart enough to figure out how to run my life!" Which nursing diagnosis would best identify the client's problems? Social isolation related to recent loss of significant relationship Risk for impulse control related to unidentified triggers Chronic low self-esteem related to unrealistic self-expectations Anxiety related to job stressors
Chronic low self-esteem related to unrealistic self-expectations
A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which would the nurse expect to implement in conjunction with pharmacologic therapy? Family therapy Cognitive behavioral therapy Behavioral therapy Interpersonal therapy
Cognitive behavioral therapy
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? Depression Dependency Anxiety Control
Control
Individuals with anorexia nervosa concentrate on which body cue? Hunger Weakness Controlling food intake Anxiety
Controlling food intake
Which is not a goal for treating the severely malnourished client with anorexia nervosa? Correction of body image disturbance Correction of electrolyte imbalances Nutritional rehabilitation Weight restoration
Correction of body image disturbance
Which of the following statements is true? Anorexia nervosa was not recognized as an illness until the 1960s Cultures in which beauty is linked to thinness have an increased risk for eating disorders Eating disorders are a major health problem only in the United States and Europe Individuals with anorexia nervosa are popular with their peers as a result of their thinness.
Cultures in which beauty is linked to thinness have an increased risk for eating disorders
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? Impaired social interaction related to aggressive behavior Deficient fluid volume related to refusal to drink Anxiety related to inadequate coping mechanisms Hyperactivity related to restlessness
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? Metabolic acidosis and constricted colon Respiratory distress and dyspnea Bacterial gastrointestinal infections and overhydration Dental erosion and chronic edema
Dental erosion and chronic edema
A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories? Paranoia Depression Aggression Primary insomnia
Depression
Which is the most common disorder found in clients diagnosed with bulimia nervosa? Psychosis Substance abuse Anxiety Depression
Depression
A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? Dieting helps build a positive self-image in children. Dieting during childhood restricts essential nutrients needed for normal growth. Dieting at an early age teaches healthy eating habits. Dieting at an early age may lead to the development of eating disorders.
Dieting at an early age may lead to the development of eating disorders.
The nurse is providing care to a client diagnosed with anorexia and notes that the client demonstrates behaviors that reflect an intense physical and emotional process that overrides all physiologic body cues. Which term would the nurse use to document this finding? Body image distortion Drive for thinness Interoceptive awareness Perfectionism
Drive for thinness
Which of the following would be most supportive for family and friends of a client with an eating disorder? Emotional support, love, and attention. Focus on food intake, calories, and weight. Unlimited access to unhealthy foods that the client enjoys. Positive reinforcement for weight gain.
Emotional support, love, and attention.
A nurse is planning to explain the purpose of the behavioral therapy technique of self-monitoring to a client with bulimia nervosa. The nurse would emphasize keeping a diary to record what? Rigid rules about eating Feelings of hunger Efforts at distraction Environmental cues
Environmental cues
Which is a dental complication associated with purging? Erosion of dental enamel Seizures Elevated blood urea nitrogen (BUN) Enlarged pancreas
Erosion of dental enamel
For a client diagnosed with anorexia nervosa, which goal takes priority? Developing a contract with the nurse that sets a target weight Identifying self-perceptions about body size as unrealistic Verbalizing the possible physiologic consequences of self-starvation Establishing adequate daily nutritional intake
Establishing adequate daily nutritional intake
During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication? Ziprasidone Olanzapine Risperidone Fluoxetine
Fluoxetine
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Bupropion Lithium Haloperidol Fluoxetine
Fluoxetine
Which of the following interventions would be appropriate for a client with anorexia nervosa? Allowing the client to eat whenever she feels hungry Insisting that the client sit in the dining room until all food is eaten Having the client in view of staff for 90 minutes after each meal Permitting the client to eat any food she chooses, as long as she is eating
Having the client in view of staff for 90 minutes after each meal
A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find? Panic Impulsivity Delusions Hyperactivity
Impulsivity
A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? Encouraging client take time away from peers for a time Increasing client's coping skills for anxiety Communicating aggressively with the client Nurturing the client's need for dependency
Increasing client's coping skills for anxiety
A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. The client is 5 feet 5 inches tall and weighs 75 pounds. Which is the priority nursing intervention? Addressing the client's low self-esteem Initiating cognitive behavioral therapy as ordered Initiating total parenteral nutrition as ordered Monitoring vital signs and weight
Initiating total parenteral nutrition as ordered
An adolescent female has been diagnosed with anorexia nervosa. Which of the following interventions should be included in the client's plan of care? Encourage the client to exercise in order to reduce anxiety Provide frequent feedback to the client on her behaviors Restrict visits with the family until the client begins to eat Provide privacy during meals.
Provide frequent feedback to the client on her behaviors.
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? Allow the client a tool by which to negotiate behavior Provide the nurse with a tool for evaluating the plan of care Provide the client with a feeling of responsibility and control over the client's behavior Provide the therapist with a strategy for client compliance
Provide the client with a feeling of responsibility and control over the client's behavior
A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. The client doesn't want to feel fat in a bathing suit on vacation. The client's sodium level is 150 mEq/L; potassium level is 3.2 mEq/L. The client is 5 feet tall, weighs 100 pounds, and has lost 15 pounds in 3 weeks. Which goal is a priority at this time? Develop a contract with the client to stop using laxatives and diuretics. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. Help build self-esteem. Stabilize electrolyte levels.
Stabilize electrolyte levels.
The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which intervention is indicated? Supervise the client closely for 2 hours after meals and snacks Increase the daily caloric intake from 1,500 to 2,000 calories Increase the client's fluid intake Request an order from the physician for fluoxetine
Supervise the client closely for 2 hours after meals and snacks
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? Using an abrupt, forceful manner to communicate with the client Encouraging the client to suppress feelings regarding obesity Reinforcing the client's concerns over physical appearance Teaching the client alternative ways to lose weight
Teaching the client alternative ways to lose weight
After 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? The client will be free of self-induced vomiting. The client will verbalize fears relating to the client's health needs. The client will identify alternatives to current coping patterns. The client will acknowledge self-harm thoughts.
The client will be free of self-induced vomiting.
The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care? The client will demonstrate measures to reduce body mass index. The client will demonstrate actions that promote health maintenance. The client will verbalize acceptance of appearance. The client will experience diminished episodes of delusional thinking.
The client will verbalize acceptance of appearance.
When working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason? To show the family evidence of the client's progress To raise self awareness and a sense of control For the nurse to be able to document in the client record accurately To document physical problems the client wants to share with the physician
To raise self awareness and a sense of control
Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? Positive self-esteem Mood elevation Weight gain Increased activity
Weight gain
The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks the student to step on the scale. The student asks if the student can go to the bathroom first to empty the student's bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has ... binge-eating disorder. anorexia nervosa. eating disorder not otherwise specified. bulimia nervosa.
anorexia nervosa.
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? Antipsychotics Stimulants Mood stabilizers Antidepressants
Antidepressants
Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? A history of substance abuse Maintenance of emotional distance from their children Overprotective of their children Alternation between loving and rejecting their children
Overprotective of their children
Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? Leave the client alone to relax during meals. Offer liquid protein supplements if the client is unable to complete meal. Observe the client for 30 minutes after all meals. Weigh the client weekly in the same clothing at the same time of day.
Offer liquid protein supplements if the client is unable to complete meal.
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 Allow the client a tool by which to negotiate behavior Provide the therapist with a strategy for client compliance Provide the nurse with a tool for evaluating the plan of care
Provide the client with a feeling of responsibility and control over the client's behavior
A client with bulimia is learning to use the technique of self-monitoring. Which intervention by the nurse would be most beneficial for this client? Ask the client to write about all feelings and experiences related to food Assist the client in making daily meal plans for 1 week Encourage the client to ignore feelings and impulses related to food Teach the client about nutrition content and calories of various foods.
Ask the client to write about all feelings and experiences related to food.
A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include? Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns Emphasis on the need for teachers to focus their prevention efforts on female students Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades
Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders
A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find? Tachycardia Hyperkalemia Dry skin Oversensitivity to heat
Dry skin
The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? Careless Outspoken Defiance Eager to please
Eager to please
A client diagnosed with anorexia nervosa is being treated in an outpatient setting in the community. Which activity would be the priority? Acknowledging the severity of the illness Improving nutritional status Establishing a therapeutic relationship Confirming beliefs about body size
Establishing a therapeutic relationship
Which area of the brain has been associated with the symptoms of eating disorders? Hypothalamus Cerebellum Medulla Pons
Hypothalamus
When admitted to the inpatient unit, a client is 5 feet 10 inches tall and weighs 100 pounds. What is the initial goal in the client's care? To stop losing weight To be on bedrest To reduce fluid intake To assess for violence potential
To stop losing weight
A teenager is being evaluated for an eating disorder. Which finding would suggest anorexia nervosa? Guilt and shame about eating patterns Lack of knowledge about food and nutrition Refusal to talk about food-related topics Unrealistic perception of body size
Unrealistic perception of body size
The nurse is planning the care for a client with an eating disorder. Which of the following should not be included in the client's care plan? Sitting with the client during meals and snacks Weighing the client after each meal Being alert for attempts to hide or discard food or to inflate weight Observing the client following meals and snack for 1 to 2 hours
Weighing the client after each meal
