Ch 20 PrepUs: Eating Disorders

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? 1."Has something occurred that caused you to measure your thighs?" 2."You have always been very focused on your thighs. Is that the part of your body you like least?" 3."You are exactly the right weight for your height." 4."I don't think you are fat."

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

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? 1."Laxatives are not a part of your treatment plan." 2."Using laxatives is bad for you because your electrolytes can become unbalanced." 3."Using a laxative to purge is not an acceptable way to manage your weight." 4."Why do you want to take a laxative?"

1."Laxatives are not a part of your treatment plan."

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? 1."What do you think about how much you weigh right now?" 2."Why do you prefer not to eat food?" 3."Is there anything that I can get you to eat right now?" 4."What do you believe has caused your anorexia?"

1."What do you think about how much you weigh right now?"

Which client being treated for anorexia displays assessment values that warrant hospitalization? 1.A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL 2.A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt 3.A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg 4.A 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm

1.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? 1.Antidepressant 2.Antianxiety 3.Antiparkinsonian 4.Antimanic

1.Antidepressant

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? 1.Dental erosion and chronic edema 2.Bacterial gastrointestinal infections and overhydration 3.Metabolic acidosis and constricted colon 4.Respiratory distress and dyspnea

1.Dental erosion and chronic edema

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? 1.Heart rate and rhythm 2.Patterns of activity and rest 3.Condition of mouth and gums 4.Throat and esophagus

1.Heart rate and rhythm

People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? 1.Serotonin 2.Acetylcholine 3.Norepinephrine 4.Dopamine

1.Serotonin

A college student has been referred to the college clinic for evaluation for anorexia nervosa. Which would help support the diagnosis? 1.Significantly low body weight 2.Temper tantrums 3.Onset of symptoms during preadolescence 4.Oily skin

1.Significantly low body weight

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? 1.Stabilize electrolyte levels. 2.Develop a contract with the client to stop using laxatives and diuretics. 3.Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. 4.Help build self-esteem.

1.Stabilize electrolyte levels.

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? 1.Bulimia nervosa, nonpurging type. 2.Anorexia nervosa, restricting type 3.Anorexia nervosa, binge eating, and purging type 4.Eating disorder not otherwise specified

2.Anorexia nervosa, restricting type

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? 1.Stimulants 2.Antidepressants 3.Mood stabilizers 4.Antipsychotics

2.Antidepressants

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? 1.Eating disorder not otherwise specified 2.Binge eating disorder 3.Anorexia nervosa 4.Bulimia nervosa

2.Binge eating disorder

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? 1.Risk for impulse control related to unidentified triggers 2.Chronic low self-esteem related to unrealistic self-expectations 3.Social isolation related to recent loss of significant relationship 4.Anxiety related to job stressors

2.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? 1.Behavioral therapy 2.Cognitive behavioral therapy 3.Family therapy 4.Interpersonal therapy

2.Cognitive behavioral therapy

Individuals with anorexia nervosa concentrate on which body cue? 1.Hunger 2.Controlling food intake 3.Anxiety 4.Weakness

2.Controlling food intake

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? 1.Maintenance of emotional distance from their children 2.Overprotective of their children 3.A history of substance abuse 4.Alternation between loving and rejecting their children

2.Overprotective of their children

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? 1.The client will identify alternatives to current coping patterns. 2.The client will be free of self-induced vomiting. 3.The client will verbalize fears relating to the client's health needs. 4.The client will acknowledge self-harm thoughts.

2.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? 1.The client will experience diminished episodes of delusional thinking. 2.The client will verbalize acceptance of appearance. 3.The client will demonstrate actions that promote health maintenance. 4.The client will demonstrate measures to reduce body mass index.

2.The client will verbalize acceptance of appearance.

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? 1."I'll take my medication when I feel the urge to binge." 2."I know if I eat pasta, I'll binge." 3."I'll eat small meals and snacks regularly." 4."How I feel about my body has little to do with my binging."

3."I'll eat small meals and snacks regularly."

Which is the most common disorder found in clients diagnosed with bulimia nervosa? 1.Anxiety 2.Substance abuse 3.Depression 4.Psychosis

3.Depression

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? 1.Ziprasidone 2.Risperidone 3.Fluoxetine 4.Olanzapine

3.Fluoxetine

Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? 1.Haloperidol 2.Bupropion 3.Fluoxetine 4.Lithium

3.Fluoxetine

Exacerbation of anorexia nervosa results from the client's effort to do what? 1.Diminish conflict 2.Manipulate family members 3.Gain control of one part of life 4.Live up to family expectations

3.Gain control of one part of life

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? 1.Disturbed body image 2.Ineffective coping 3.Imbalanced nutrition: less than body requirements 4.Anxiety

3.Imbalanced nutrition: less than body requirements

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? 1.Provide the therapist with a strategy for client compliance 2.Allow the client a tool by which to negotiate behavior 3.Provide the client with a feeling of responsibility and control over the client's behavior 4.Provide the nurse with a tool for evaluating the plan of care

3.Provide the client with a feeling of responsibility and control over the client's behavior

For clients who purge, what is the most important goal? 1.Understand that purging is an ineffective means of weight control 2.Develop the technique of distraction 3.Stop the behavior 4.Recognize that purging promotes binge eating

3.Stop the behavior

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? 1.Reinforcing the client's concerns over physical appearance 2.Encouraging the client to suppress feelings regarding obesity 3.Teaching the client alternative ways to lose weight 4.Using an abrupt, forceful manner to communicate with the client

3.Teaching the client alternative ways to lose weight

A nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa? 1.The person judges worth based on a lack of fat. 2.The person has feeling of powerlessness 3.The person engages in episodic binge eating. 4.The person is preoccupied with body image.

3.The person engages in episodic binge eating.

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? 1.Mood elevation 2.Increased activity 3.Weight gain 4.Positive self-esteem

3.Weight gain

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? 1."Let's talk about your ideas about your body and why you perceive yourself to be fat." 2."You only weigh 100 pounds. It is just not true that you are fat." 3."You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." 4."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."

4."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."

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? 1.Psychosocial assessment and determination of coping skills 2.Complete blood count and differential 3.Evidence of injury to skin by cutting 4.Cardiac assessment and measurement of electrolyte levels

4.Cardiac assessment and measurement of electrolyte levels

Which intervention has been found to be most effective reducing the initial symptoms of bulimia? 1.Clearly stated unit rules and a supportive milieu 2.Behavioral therapy and psychoeducation 3.Daily monitoring of sound dietary principles and meditation sessions 4.Cognitive behavior therapy and pharmacologic interventions

4.Cognitive behavior therapy and pharmacologic interventions

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? 1.Hyperactivity related to restlessness 2.Anxiety related to inadequate coping mechanisms 3.Impaired social interaction related to aggressive behavior 4.Deficient fluid volume related to refusal to drink

4.Deficient fluid volume related to refusal to drink

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? 1.Emphasis on the need for teachers to focus their prevention efforts on female students 2.Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades 3.Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns 4.Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders

4.Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders

For a client diagnosed with anorexia nervosa, which goal takes priority? 1.Verbalizing the possible physiologic consequences of self-starvation 2.Identifying self-perceptions about body size as unrealistic 3.Developing a contract with the nurse that sets a target weight 4.Establishing adequate daily nutritional intake

4.Establishing adequate daily nutritional intake

Which area of the brain has been associated with the symptoms of eating disorders? 1.Pons 2.Medulla 3.Cerebellum 4.Hypothalamus

4.Hypothalamus

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? 1.Passive parenting and lack of encouragement 2.An overemphasis of peer relationships over family relationships 3.The absence of a parent and/or the presence of a stepparent 4.Poor communication and enmeshed family dynamics

4.Poor communication and enmeshed family dynamics