Eating disorders prepU, Chapter 20 Mental, Chapter 20: Eating Disorders
Which area of the brain has been associated with the symptoms of eating disorders? Hypothalamus Cerebellum Pons Medulla
Correct response: Hypothalamus Explanation: The hypothalamus has been associated with the symptoms of eating disorders.
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? Behavioral therapy Cognitive behavioral therapy Interpersonal therapy Family therapy
Cognitive behavioral therapy
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? "That's fine as long as you adhere to your eating program and do not use laxatives or purging." "No, exercise is not allowed until your weight is closer to normal." "Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass." "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."
When working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason? To raise self awareness and a sense of control To show the family evidence of the client's progress To document physical problems the client wants to share with the physician For the nurse to be able to document in the client record accurately
To raise self awareness and a sense of control
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Lithium Haloperidol Fluoxetine Bupropion
Fluoxetine
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
Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? Antidepressant Antianxiety Antiparkinsonian Antimanic
Antidepressant
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
The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first? Ask the client directly about thoughts of suicide or self-harm Identify the cues related to binging Control the eating responses Provide small regular meals and snacks
Ask the client directly about thoughts of suicide or self-harm
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
A nurse is interviewing a client and suspects an eating disorder. Which client statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply. "Everything about my school work needs to be perfect." "I want things to be the way I want them to be." "I'll stand up for what I want, regardless of what you say." "Things being out of order really bothers me." "I consider myself a really laid-back individual."
"Everything about my school work needs to be perfect." "I want things to be the way I want them to be." "Things being out of order really bothers me."
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?"
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."
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 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. What are your thoughts on what your mother has said?" "Do you often have to answer for your child?" " Is what your mother said true?" "I see. Do you ever feel as though you cannot control your eating?"
"I see. Do you ever feel as though you cannot control your eating?"
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!"
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? "Using laxatives is bad for you because your electrolytes can become unbalanced." "Using a laxative to purge is not an acceptable way to manage your weight." "Why do you want to take a laxative?" "Laxatives are not a part of your treatment plan."
"Laxatives are not a part of your treatment plan."
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 ."
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?"
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? "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." "Identical twins have about a 5% chance of both twins developing an eating disorder." "It is not genetics but the environment that increases your risk. Since you live together, you have an equal chance."
"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? "If you feel that way, then you can just leave." "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."
"You sound irritated; tell me about what is bothering you."
What percentage of clients who have fully recovered from bulimia nervosa later experience a relapse? 10% 23% 30% 50%
30%
Which individual most clearly exhibits the characteristics of body image disturbance? A 44-year-old who is committed to going to the gym every day both before work and after work A 71-year-old who talks frequently about multiple health problems A 20-year-old who weighs 98 pounds but who considers onself obese A 13-year-old who is in the fifth percentile of height and weight for age and sex
A 20-year-old who weighs 98 pounds but who considers onself obese
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 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg 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 client is being seen in the health clinic. During the nursing assessment, the client states that she has had amenorrhea for the last 6 months. The client weighs 80 pounds and is 5 feet 2 inches tall. The client states that she usually eats salads to not gain weight. These data supports which diagnosis? Anorexia nervosa Bulimia nervosa Depression Anxiety disorder
Anorexia nervosa
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? Anorexia nervosa, binge eating, and purging type Anorexia nervosa, restricting type Bulimia nervosa, nonpurging type. Eating disorder not otherwise specified
Anorexia nervosa, restricting type
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. The nurse identifies this as reflecting what? Body image disturbance Drive for thinness Interoceptive awareness Perfectionism
Body image disturbance
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 Being free of self-inflicted harm Using distraction to stop the urge to purge
Being free of self-inflicted harm
A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment? Heat intolerance Complaints of heartburn Hypertension Bradycardia
Bradycardia
A group of nurses is reviewing information about the complications associated with eating disorders. The group demonstrates understanding of the information when they identify which as a possible cardiac complication? Select all that apply. Hypertension Bradycardia Enlarged heart Ventricular tachycardia Loss of cardiac muscle
Bradycardia Ventricular tachycardia Loss of cardiac muscle
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
The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss? Bulimia nervosa, purging type Anorexia nervosa, restricting type Anorexia nervosa, purging type Binge eating disorder
Bulimia nervosa, purging type
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
Cardiac assessment and measurement of electrolyte levels
Which is a family risk factor for bulimia nervosa? Chaotic family Lack of emotional support Self-perception of being overweight 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 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
Which behavior is not associated with purging? Consuming large amounts of food Self-induced vomiting Use of laxative Misuse of diuretics
Consuming large amounts of food
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
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 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt
Correct response: A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL Explanation: 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. The values of the other clients do not meet the criteria for hospitalization.
The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss? Bulimia nervosa, purging type Anorexia nervosa, restricting type Anorexia nervosa, purging type Binge eating disorder
Correct response: Anorexia nervosa, purging type Explanation: The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests anorexia nervosa, purging type. Individuals with bulimia typically maintain normal weight. Binge eating disorder does not involve purging.
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? Anorexia nervosa, binge eating, and purging type Anorexia nervosa, restricting type Bulimia nervosa, nonpurging type. Eating disorder not otherwise specified
Correct response: Anorexia nervosa, restricting type Explanation: 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."
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
Correct response: Cardiac assessment and measurement of electrolyte levels Explanation: 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. Physical assessments would supersede psychosocial assessments and any injury to skin by intentional self-harm in the emergency setting.
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 One-on-one time with psychiatric staff and antidepressant medication therapy Daily reinforcement of sound dietary principles and meditation sessions Clearly stated unit rules and a supportive milieu
Correct response: Cognitive-behavioral therapy (CBT) including self-monitoring Explanation: For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. The primary interventions include CBT, including self-monitoring.
Which is the most common disorder found in clients diagnosed with bulimia nervosa? Depression Anxiety Psychosis Substance abuse
Correct response: Depression Explanation: 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.
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? Deficient fluid volume related to refusal to drink Impaired social interaction related to aggressive behavior 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? Respiratory distress and dyspnea Bacterial gastrointestinal infections and overhydration Metabolic acidosis and constricted colon 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 Primary insomnia Depression Aggression
Depression
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 Primary insomnia Depression Aggression
Depression
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? Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders Emphasis on the need for teachers to focus their prevention efforts on female students 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
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
Exacerbation of anorexia nervosa results from the client's effort to do what? Gain control of one part of life Manipulate family members Diminish conflict Live up to family expectations
Explanation: A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client's life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.
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? Throat and esophagus Condition of mouth and gums Heart rate and rhythm Patterns of activity and rest
Heart rate and rhythm
Which is a metabolic complication related to weight loss? Hypothyroidism Bradycardia Amenorrhea Leukopenia
Hypothyroidism
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? Disturbed body image Anxiety Imbalanced nutrition: less than body requirements Ineffective coping
Imbalanced nutrition: less than body requirements
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? Initiating total parenteral nutrition as ordered Initiating cognitive behavioral therapy as ordered Addressing the client's low self-esteem Monitoring vital signs and weight
Initiating total parenteral nutrition as ordered
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
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 Anxiety Nutrition that is less than body requirements Risk for self-directed violence
Risk for self-directed violence
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? Self-monitoring Guided imagery Distraction Music therapy
Self-monitoring
what is self monitoring
Self-monitoring is a cognitive-behavioral technique designed to help clients with bulimia. It may help clients identify behavior patterns and then implement techniques to avoid or replace them (Richards, Shingleton, Goldman, Siegel, & Thompson-Brenner, 2016). Self-monitoring techniques raise client awareness about behavior and help them regain a sense of control. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions, thoughts, circumstances, and interactions surrounding eating and binging or purging episodes.
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? Serotonin Norepinephrine Dopamine Acetylcholine
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 Restrict visits with the family until the client begins to eat Provide privacy during meals Encourage the client to exercise, which will reduce the client's anxiety
Set up a strict eating plan for the client
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
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? Stabilize electrolyte levels. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. Help build self-esteem. Develop a contract with the client to stop using laxatives and diuretics.
Stabilize electrolyte levels.
For clients who purge, what is the most important goal? Stop the behavior Understand that purging is an ineffective means of weight control Recognize that purging promotes binge eating 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 maintained a target weight for the last year. The client reports that the client has learned to accept the client's body. 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.
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 verbalize fears relating to the client's health needs. The client will acknowledge self-harm thoughts. The client will be free of self-induced vomiting. The client will identify alternatives to current coping patterns
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 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.
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? The person is preoccupied with body image. The person judges worth based on a lack of fat. The person has feeling of powerlessness The person engages in episodic binge eating.
The person engages in episodic binge eating.
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.
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? engaging in severe dieting socially withdrawing compulsively washing his or her hands becoming sexually promiscuous
engaging in severe dieting
When reviewing the documented history of an adult client with anorexia nervosa, what is the nurse most likely to find? (Select all that apply.) food restriction began at age 15 depression at age 16 lasting one month reported believing that friends were "jealous" of her body reports strong relationship with parents had successful outpatient treatment one year after onset of disorder
food restriction began at age 15 depression at age 16 lasting one month reported believing that friends were "jealous" of her body
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? "Let's talk about your ideas about your body and why you perceive yourself to be fat." "You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." "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 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."
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? "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."
Which percentage accurately reflects the prevalence of anorexia and bulimia in the United States? 1% to 4% 4% to 6% 6% to 9% 10% to 12%
1% to 4%
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
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
A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply. Body dissatisfaction Feelings of control Obsessiveness Boundary problems Sexuality fears Cognitive distortions
Body dissatisfaction Obsessiveness Cognitive distortions
A college student has been referred to the clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what? Onset of symptoms in early adolescence Body weight significantly below ideal for height and age Temper tantrums and sleep disturbance Oily skin and acne
Body weight significantly below ideal for height and age
A client's diagnosis of anorexia nervosa is supported when the psychiatric nurse documents assessment data that includes which finding? Select all that apply. Client reports "being depressed." Client claims that she "hasn't had a menstrual period in over 2 years." Client is overheard telling other clients "I weigh myself three times a day when I'm home." Client consistently denies that she "has a problem with the way she looks." Client has a history of "sleeping 9 hours a night and taking frequent naps."
Client reports "being depressed." Client claims that she "hasn't had a menstrual period in over 2 years." Client is overheard telling other clients "I weigh myself three times a day when I'm home." Client consistently denies that she "has a problem with the way she looks."
A client's diagnosis of bulimia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.) Client reports of "being depressed" History of purging "3 times a week for 2 years." Often heard discussing "how hard it is to stay thin" with other clients Lanugo observed on forearms and face Serum potassium of 3.8 mEq/L
Client reports of "being depressed" History of purging "3 times a week for 2 years." Often heard discussing "how hard it is to stay thin" with other clients
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.
Which intervention has been found to be most effective reducing the initial symptoms of bulimia? Cognitive behavior therapy and pharmacologic interventions Behavioral therapy and psychoeducation Daily monitoring of sound dietary principles and meditation sessions Clearly stated unit rules and a supportive milieu
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 One-on-one time with psychiatric staff and antidepressant medication therapy Daily reinforcement of sound dietary principles and meditation sessions Clearly stated unit rules and a supportive milieu
Cognitive-behavioral therapy (CBT) including self-monitoring
Which intervention has been found to be most effective reducing the initial symptoms of bulimia? Cognitive behavior therapy and pharmacologic interventions Behavioral therapy and psychoeducation Daily monitoring of sound dietary principles and meditation sessions Clearly stated unit rules and a supportive milieu
Correct response: Cognitive behavior therapy and pharmacologic interventions Explanation: The combination of cognitive behavior therapy and pharmacologic interventions is best for producing an initial decrease in symptoms.
A client diagnosed with anorexia nervosa is being treated in an outpatient setting in the community. Which activity would be the priority? Improving nutritional status Acknowledging the severity of the illness Confirming beliefs about body size Establishing a therapeutic relationship
Correct response: Establishing a therapeutic relationship Explanation: While improving nutritional status and acknowledging the severity of the illness are important, the client would be in relatively stable physical health if being treated in the community in an outpatient setting. The first priority, in this case, would be to establish a therapeutic relationship with the client. Establishing a therapeutic relationship with individuals with anorexia nervosa may be difficult initially because they tend to be suspicious and mistrustful especially of authority figures and health personnel whom they believe will intervene to disrupt their restricting and starvation behaviors placing them in a position of extreme fear of becoming fat.
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Lithium Haloperidol Fluoxetine Bupropion
Correct response: Fluoxetine Explanation: 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? Throat and esophagus Condition of mouth and gums Heart rate and rhythm Patterns of activity and rest
Correct response: Heart rate and rhythm Explanation: 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 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
Correct response: Imbalanced nutrition: less than body requirements Explanation: 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. Interventions for disturbed body image and anxiety involve addressing interoceptive awareness, helping clients understand their feelings, and initiating interpersonal therapy. Interventions for ineffective coping would address integrating the clients back into school, renewing friendships and relationships, and promoting participation in family therapy.
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
Correct response: Setting realistic goals Explanation: 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. Other topics such as weight monitoring, resources, and effects of restrictive eating should be included in the nurse's educational plan.
For clients who purge, what is the most important goal? Stop the behavior Understand that purging is an ineffective means of weight control Recognize that purging promotes binge eating Develop the technique of distraction
Correct response: Stop the behavior Explanation: The most important goal for a client who purges is to stop the behavior. All other options would not be the most important goal.
Which statement best describes the biologic theories of the etiology of eating disorders? Eating disorders involve dysregulation of multiple neurotransmitter systems and may be influenced by behavioral, cultural, and familial factors. Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component. Eating disorders result from family dysfunction involving a controlling mother; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.
Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.
When a 27-year-old is admitted for treatment of anorexia nervosa, the nurse prepares the client for diagnostic testing that includes what? Select all that apply. Electrocardiogram (ECG) Serum glucose Serum amylase Serum cortisol Serum uric acid
Electrocardiogram (ECG) Serum glucose Serum amylase Serum cortisol
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? Feelings of hunger Efforts at distraction Environmental cues Rigid rules about eating
Environmental cues
A client diagnosed with anorexia nervosa is being treated in an outpatient setting in the community. Which activity would be the priority? Improving nutritional status Acknowledging the severity of the illness Confirming beliefs about body size Establishing a therapeutic relationship
Establishing a therapeutic relationship
For a client diagnosed with anorexia nervosa, which goal takes priority? Establishing adequate daily nutritional intake 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
Exacerbation of anorexia nervosa results from the client's effort to do what? Gain control of one part of life Manipulate family members Diminish conflict Live up to family expectations
Gain control of one part of life
A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find? Impulsivity Panic Hyperactivity Delusions
Impulsivity
A nurse is assessing a client with anorexia nervosa. Which would the nurse be least likely to find? Hypokalemia Overly oily skin Salivary gland hypertrophy Dental enamel erosion
Overly oily skin
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 Provide the therapist with a strategy for client compliance 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
A college student has been referred to the college clinic for evaluation for anorexia nervosa. Which would help support the diagnosis? Onset of symptoms during preadolescence Significantly low body weight Temper tantrums Oily skin
Significantly low body weight
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
