CH 20 Eating Disorders (PrepU)

The nurse provides care for a client who is diagnosed with anorexia nervosa. Which question should the nurse ask to assess the client for neuropsychiatric complications associated with the diagnosed eating disorder? "Do you experience abnormal taste sensations?" "Is your skin dry and your nails brittle?" "Do you experience constipation or diarrhea?" "How often do you menstruate?"

"Do you experience abnormal taste sensations?" There are many complications associated with eating disorders, including anorexia nervosa. The neuropsychiatric complications include abnormal taste sensations, often due to zinc deficiency. Other neuropsychiatric complications include apathetic depression, fatigue, mild organic mental symptoms, and sleep disturbances.

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? --"I don't think you are fat." --"Has something occurred that caused you to measure your thighs?" --"You are exactly the right weight for your height." --"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?" The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.

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." --"I know that if I could lose this last 10 pounds I'd feel completely different about things." --"What you don't understand is that it's way healthier to be skinny than fat, and it looks better." --"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." There are known to be both familial and genetic contributors to eating disorders.

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 realize this must be very difficult for you but try to remember I'm not your enemy." --"I'm not the root of your problem." --"I'm not going to take your insults personally but you need to be more respectful."

"I realize this must be very difficult for you but try to remember I'm not your enemy." The client initially may view the nurse, who is responsible for making the client eat, as the enemy. The client may hide or throw away food or become overtly hostile as anxiety about eating increases. The nurse must remember that the client's behavior is a symptom of anxiety and fear about gaining weight and not personally directed toward the nurse.

Which client being treated for anorexia displays assessment values that warrant hospitalization? --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 --A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt

A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL should be hospitalized because both values are troublesome.

Individuals with anorexia nervosa concentrate on which body cue? Anxiety Controlling food intake Weakness Hunger

Controlling food intake: Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.

A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which item would the nurse include? --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 --Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns --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

Which area of the brain has been associated with the symptoms of eating disorders? Medulla Hypothalamus Pons Cerebellum

Hypothalamus

For clients who purge, what is the most important goal? Understand that purging is an ineffective means of weight control Recognize that purging promotes binge eating Stop the behavior Develop the technique of distraction

Stop the behavior

A client with bulimia is being discharged from care. The nurse considers which indicator most important when evaluating the effectiveness of the care plan? The client has lost weight over the past year. The client has not learned to accept the client's body type The client eats six small meals per day. The client has moved into the client's own apartment.

The client eats six small meals per day. The nurse evaluates the client's physical and psychosocial responses to interventions. Desired physical outcomes include maintaining a healthy weight, normal laboratory values and vital signs, and return of secondary sexual characteristics and menstruation. Desired psychosocial outcomes include a realistic perception of body image, direct expression of feelings, improved self-esteem, a sense of control over self and environment, and constructive family process.

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 be on bedrest To assess for violence potential To reduce fluid intake To stop losing weight

To stop losing weight

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? Weight gain Mood elevation Increased activity Positive self-esteem

Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.

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 ... anorexia nervosa. binge-eating disorder. bulimia nervosa. eating disorder not otherwise specified.

anorexia nervosa. Anorexia is characterized by a voluntary refusal to eat and typically a weight less than 85% of what is considered normal for height and age. Clients with anorexia have a distorted body image and, to the bewilderment of others, view their emaciated bodies as fat.

Which is the most common disorder found in clients diagnosed with bulimia nervosa? Depression Anxiety Psychosis Substance abuse

depression: Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.

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? --"Five miles per day is too much. How about 3 miles per day?" --"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." --"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." Rigorous aerobic exercise generally is contraindicated when weight gain is a goal. Allowing the client to engage in moderate anaerobic exercise (e.g., weight lifting), however, would increase lean body mass as the client gains weight and minimize the gain in "fat weight," which is a great fear of the client.

A nurse is performing an admission assessment for an adolescent client diagnosed 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? "My father was always very thin." "I've never really liked myself." "I have a lot of confidence in myself." "I feel really close to my parents and my brother."

"I've never really liked myself." Body dissatisfaction is strongly related to low self-esteem and is a key characteristic of anorexia nervosa. Results of numerous studies have shown that low self-esteem, body dissatisfaction, and feelings of ineffectiveness and inadequacy put individuals at risk for an eating disorder.

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? "My strict dieting led to my problem with anorexia." "There are many factors involved with how I developed anorexia ." "Society told me I needed to be thin and I believed that." "There is a history of obsessive-compulsive disorder in my family."

"There are many factors involved with how I developed anorexia ." The etiology of anorexia nervosa is multidimensional. Some of the risk factors (discussed later) and the etiologic factors overlap. Initially, dieting may be the stimulus that leads to their development. Biologic vulnerability, developmental problems, and both family and social influences can be associated. However, the statement about many factors reflects the multidimensional nature of the disorder.

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? "Why do you prefer not to eat food?" "What do you think about how much you weigh right now?" "What do you believe has caused your anorexia?" "Is there anything that I can get you to eat right now?"

"What do you think about how much you weigh right now?" Open-ended questions that are not "loaded" or accusatory are most likely to elicit data from a client who has an eating disorder.

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? Bulimia nervosa, nonpurging type. Eating disorder not otherwise specified Anorexia nervosa, binge eating, and purging type Anorexia nervosa, restricting type

Anorexia nervosa, restricting type Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories."

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: Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms.

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 Bulimia nervosa Binge eating disorder Eating disorder not otherwise specified

Binge eating disorder is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese.

Which is a cardiac complication of an eating disorder? Bradycardia Hypertension Enlarged heart Thrombocytopenia

Bradycardia Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle.

The dentist of a client noticed that the client's teeth were losing enamel. The client is of average weight. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with enamel loss? Bulimia nervosa, purging type Anorexia nervosa, restricting type Binge eating disorder Anorexia nervosa, purging type

Bulimia nervosa, purging type: The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests bulimia nervosa, purging type.

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? Anorexia nervosa Binge-eating disorder Bulimia nervosa Eating disorder not otherwise specified

Bulimia nervosa: Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental cavities from the frequent contact of tooth enamel with food and acidic gastric fluids.

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 Chronic low self-esteem related to unrealistic self-expectations Anxiety related to job stressors Risk for impulse control related to unidentified triggers

Chronic low self-esteem related to unrealistic self-expectations Clients with eating disorders generally have low self-esteem even though they achieve well at school, sports, and work. Most nursing diagnoses for clients with eating disorders center on psychosocial problems, such as chronic low self-esteem related to unrealistic expectations from self or others, lack of positive feedback, and striving to please others to gain acceptance.

A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge eating disorder (BED). The students demonstrate understanding when they identify which characteristics as specific to BED? Select all that apply. Clients typically are obese. Clients refrain from purging behaviors. Binge eating periods are shorter. Clients engage in overexercising. Feelings of guilt do not occur after binging.

Clients typically are obese. Clients refrain from purging behaviors. BED is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors (such as overexercising). Individuals with BED also differ from those with other eating disorders in that most of them are obese. In addition, investigators have shown that individuals with BED have less dietary restraint and have a higher weight than those with bulimia nervosa. Binge-eating episodes are not shorter. Feelings of guilt occur with both bulimia nervosa and BED.

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? --One-on-one time with psychiatric staff and antidepressant medication therapy --Cognitive-behavioral therapy (CBT) including self-monitoring --Clearly stated unit rules and a supportive milieu --Daily reinforcement of sound dietary principles and meditation sessions

Cognitive-behavioral therapy (CBT) including self-monitoring For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. The primary interventions include CBT, including self-monitoring.

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 Anxiety Control Dependency

Control Often, nurses feel the need to offer control for a client who is helpless in controlling food, anxiety, and life.

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? Anxiety related to inadequate coping mechanisms Deficient fluid volume related to refusal to drink Impaired social interaction related to aggressive behavior Hyperactivity related to restlessness

Deficient fluid volume related to refusal to drink: The risk of dehydration posed by the client's refusal to drink likely supersedes the risk of imbalanced nutrition in the short term.

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? Drive for thinness Body image distortion Interoceptive awareness Perfectionism

Drive for thinness Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues.It is the result of body image distortion. Body image distortion occurs when an individual perceives his or her body disparately from how society views it. Interoceptive awareness is a term used to describe the sensory response to emotional and visceral cues, such as hunger.

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: Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Adminstration approval for the treatment of bulimia nervosa.

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 Condition of mouth and gums Heart rate and rhythm Throat and esophagus

Heart rate and rhythm: Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.

A nurse is reviewing the plan of care for a client diagnosed with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis? Disturbed body image Anxiety Imbalanced nutrition: less than body requirements Ineffective coping

Imbalanced nutrition: less than body requirements: A behavioral plan for increasing weight is part of a refeeding program that is instituted for a nursing diagnosis of imbalanced nutrition: less than body requirements.

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? Increasing client's coping skills for anxiety Communicating aggressively with the client Encouraging client take time away from peers for a time Nurturing the client's need for dependency

Increasing client's coping skills for anxiety Since clients with bulimia experience high anxiety levels and may use the binge-purge cycle as a coping mechanism, increasing coping skills for anxiety is a high priority nursing intervention.

The nurse provides care to a client who is diagnosed with an eating disorder. Which strategy should the nurse include in the client's plan of care to increase the client's self-concept? Practice meditation. Increase social contact. Keep a list of accomplishments. Limit physical activity to a reasonable schedule.

Keep a list of accomplishments: Wellness challenges must be addressed by the nurse when providing care to a client who is diagnosed with an eating disorder. Interventions that support increasing the client's self-concept include keeping a list of accomplishments, helping others, keeping busy, and counseling or therapy.

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? Overprotective of their children A history of substance abuse Maintenance of emotional distance from their children Alternation between loving and rejecting their children

Overprotective of their children Some families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. Family therapy may be beneficial for families of clients younger than 18 years old. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.

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 absence of a parent and/or the presence of a stepparent Passive parenting and lack of encouragement An overemphasis of peer relationships over family relationships

Poor communication and enmeshed family dynamics Family systems theories emphasize the role of the family in the development of eating disorders. Among the characteristics that are thought to contribute are enmeshed patterns of relationship and impaired communication.

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 Learning strategies to control impulses Describing physiologic consequences of anorexia nervosa Setting realistic goals

Setting realistic goals Because these clients tend to be perfectionist and set unrealistic goals for themselves, the nurse should educate the client about setting realistic and attainable goals.

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? Encouraging the client to suppress feelings regarding obesity Reinforcing the client's concerns over physical appearance Using an abrupt, forceful manner to communicate with the client Teaching the client alternative ways to lose weight

Teaching the client alternative ways to lose weight

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 experience diminished episodes of delusional thinking. --The client will verbalize acceptance of appearance. --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. Central to body image disturbance is a lack of acceptance of physical appearance. Consequently, acceptance of appearance is a priority in the care of a client with this problem. The thinking that characterizes the disorder is not classified as delusional. Promoting health maintenance is a relevant goal but is not specific to body image disturbance. Reducing body mass index does not address the etiology of this condition.

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? Complete blood count and differential Evidence of injury to skin by cutting Cardiac assessment and measurement of electrolyte levels Psychosocial assessment and determination of coping skills

While this client would certainly receive a complete blood count and respiratory assessment, the priority assessment in this client with the client's short-term and long-term histories would be focused on electrolyte levels and cardiac abnormalities, both of which are common manifestations of the repeated vomiting that characterizes bulimia nervosa.

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? engaging in severe dieting becoming sexually promiscuous compulsively washing his or her hands socially withdrawing

engaging in severe dieting: Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: By continuing to lose, these clients exert control over one aspect of their lives.

The nurse provides care to an adolescent client who presents to the emergency department (ED) after losing consciousness during a marching band performance. A differential diagnosis of anorexia nervosa is documented by the practitioner. Which finding noted when reviewing the client's laboratory data indicates a need for hospitalization? hypokalemia hypoglycemia hypermagnesemia hyperphosphatemia

hypokalemia: The criteria for hospitalization for the client who is diagnosed with an eating disorder include acute weight loss, < 85% below ideal; heart rate near 40 beats/min; temperature less than 97.0°F (36.1°C); blood pressure less than 80/50 mm Hg; poor motivation to recover; and electrolyte abnormalities, including hypokalemia, hypophosphatemia, and hypomagnesemia.