Chapter 30: Eating Disorders Practice Questions (answers and explanation at the end)
11. The nurse is assessing a client newly admitted to the eating disorders unit. Which findings indicate the client may have a diagnosis of bulimia nervosa? Select all that apply. 1. BMI of 24 kg/m2 2. Amenorrhea 3. Erosion of tooth enamel 4. Lanugo 5. Russell's sign
A. This is correct. Most individuals with bulimia nervosa have a BMI within a normal range for weight. The BMI range for normal weight is 18.5 to 24.9 kg/m2 C. This is correct. Gastric acid in the vomitus contributes to the erosion of tooth enamel among individuals with bulimia nervosa E. This is correct. Russell's sign is an indicator of purging and is characterized by calluses on the dorsal surface of the hands, typically the knuckles.
3. Which is used as first-line outpatient psychological treatment for adolescents diagnosed with anorexia nervosa? 1. Cognitive-based therapy 2. Family-based therapy 3. Dialectical behavior therapy 4. Individual psychotherapy
B. This is correct. Evidence supports the use of family-based treatment as the first-line outpatient psychological treatment for adolescents with anorexia nervosa. CBT is used with clients diagnosed with anorexia, bulimia, and binge eating disorder (BED)
7. The nurse is developing nursing diagnoses for a newly admitted client diagnosed with anorexia nervosa. The client has a BMI of 15.8 kg/m2 . Which is the priority nursing diagnosis? 1. Ineffective coping 2. Imbalanced nutrition 3. Obesity 4. Disturbed body image
B. This is correct. The client weighs less than 85% of expected weight and has a BMI of 15.8 kg/m2 . The BMI range for normal weight is 20 to 24.9 kg/m2 . The client is at risk of potentially life-threatening symptoms of hypothermia, bradycardia, hypotension with orthostatic changes, peripheral edema, severe electrolyte imbalances, and cardiac muscle damage
9. The nurse in the eating disorders clinic asks a client diagnosed with bulimia nervosa, "Can you recall a time when you were able to eat without purging?" Which is the most appropriate rationale for the nurse's question? 1. Determine the severity of symptoms. 2. Identify previous coping strategies. 3. Determine triggers for purging episodes. 4. Establish realistic treatment goals
B. This is correct. The nurse is identifying the client's previous coping strategies to develop interventions that enable the client to utilize adaptive coping skills
2. The nurse is developing a care plan for a client diagnosed with anorexia nervosa and determines "disturbed body image" is the priority nursing diagnosis. Which is the most appropriate outcome criterion? 1. Achieve and maintain expected body mass index (BMI). 2. Verbalize understanding of maladaptive eating behaviors. 3. Exhibit decreased preoccupation with own appearance. 4. Discuss feelings and emotions associated with eating
C. This is correct. "Disturbed body image" is defined as "confusion in mental picture of one's physical self." The most important outcome criterion for the client to demonstrate is an increase in self-esteem as manifested by verbalizing positive aspects of self and exhibiting decreased preoccupation with their own appearance.
1. The nurse is reviewing the plan of care for a 15-year-old client diagnosed with anorexia nervosa. The treatment team plans to implement cognitive behavior therapy (CBT). Which is the best rationale for the use of CBT for clients diagnosed with anorexia nervosa? 1. Recognize maladaptive eating patterns as defense mechanisms. 2. Promote autonomy and control over eating behaviors. 3. Eliminate emotional components of maladaptive eating patterns. 4. Allow client to establish goals of the treatment plan
C. This is correct. CBT strives to eliminate the emotional components associated with unhealthy eating patterns by confronting irrational thinking patterns and associated feelings
6. The clinic nurse is reviewing assessment findings of a client diagnosed with anorexia nervosa. Which of the following indicate that the client requires immediate hospitalization? 1. Body temperature of 98.6ºF 2. Potassium level above 3.5 mmol/L 3. BMI less than 75% of expected 4. Weight less than 90% of expected
C. This is correct. Hospitalization is indicated when the median BMI is less than 75% of that expected for the client's age and sex
5. A client diagnosed with bulimia nervosa has been receiving CBT at the eating disorders clinics. Which of the following client actions indicates to the nurse that the client is making progress toward using adaptive eating behaviors? 1. Gains 2 lb in 1 week 2. Verbalizes importance of adequate nutrition 3. Identifies feelings associated with desire to binge 4. Takes antidepressant medications as prescribed
C. This is correct. Identifying feelings associated with the desire to binge indicates the client is making progress. Unresolved emotional issues contribute to binging and purging behaviors. Identifying these emotions enables client to replace unhealthy coping behaviors with adaptive behaviors
10. The nurse on the eating disorder unit schedules group therapy sessions immediately after meals. Which is the best rationale for scheduling group therapy at this time? 1. Limit time allotted for meals. 2. Identify maladaptive eating behaviors. 3. Discuss feelings associated with eating behaviors. 4. Focus on regaining control
C. This is correct. The best for scheduling group therapy immediately after meals is to address the emotional issues related to eating behavior, as it enables the nurse to observe clients following meals. Clients may use the time to after meals discard food that has been stashed from the food tray or to engage in self-induced vomiting. Limiting time allotted for meals minimizes clients' attention on food and eating
4. The nurse is assessing an adolescent who was brought to the emergency department after collapsing during Olympic figure skating training. The adolescent is diagnosed with severe malnutrition due to anorexia nervosa. Which client statement supports the use of a family-based approach? 1. "I just didn't drink enough water during practice." 2. "I eat just as much as everyone else on the team." 3. "I have to practice until my skating routine is perfect." 4. "I'm tired of fighting with my parents about eating."
D. This is correct. "I'm tired of fighting with my parents about eating" indicates there is conflict in the family around the client's eating behaviors. Conflicts arise in a family when a child is starving themself. The AED stands firmly against any model of eating disorders in which family influences are seen as the primary cause of eating disorders, condemns statements that blame families for their child's illness, and recommends that families be included in the treatment. Family-based approaches, such as the Maudsley approach, are supported by clinical evidence
8. An experienced nurse on the eating disorders unit is explaining to a newly hired nurse the rationale for setting limits with clients. Which is the nurse's most appropriate explanation? 1. It encourages awareness of emotional issues. 2. It encourages understanding of behavior modification plan. 3. It promotes sense of control unhealthy eating behaviors. 4. It prevents power struggles with staff.
D. This is correct. Restrictions and limits must be established and carried out consistently to avoid power struggles, encourage patient compliance with therapy, and ensure patient safety.
