EATING DISORDERS TEST #3

What clinical manifestations will you see upon a physical assessment with a female pt with anorexia nervosa?

*Bony/Skeletal appearance *Skin will have yellow/grey appearance (Sallow Appearance) *Skin will be dry, paper thin, poor skin turgor *Skin will have Lanugo (fine baby hair on parts of body that should be hairless): Lanugo is caused by nutritional deficiencies *Women will have Amenorrhea : Excessive exercising and not getting enough nutrition

Name so complication that you will have with Bulimia.

*Electrolyte Imbalance (can cause Cardiac Dysrhythmias) *Renal Impairment (This is why you see more of a higher mortality/morbidity rate with Bulimia patients than anorexia) (Will see more a sudden death with Bulimia cause with anorexia you are just starving yourself which is a slow death) Emergent: *Esophageal rupture *Stomach rupture (Which leads to Peritonitis=Sepsis=DEATH) *Mallory Weiss Tear (Tear where the esophagus meets the stomach) (Always indicative to excessive induced vomiting)

Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client? A. Providing one-on-one supervision during meals and for 1 hour afterward B. Letting the client eat with other clients to create a normal mealtime atmosphere C. Trying to persuade the client to eat and thus restore nutritional balance D. Giving the client as much time to eat as desired

A CORRECT *Because the client with anorexia nervosa may discard food or induce vomiting in the bathroom, the nurse should provide one-on-one supervision during meals and for 1 hour afterward. Option B wouldn't be therapeutic because other clients may urge the client to eat and give attention for not eating. Option C would reinforce control issues, which are central to this client's underlying psychological problem. Instead of giving the client unlimited time to eat, as in option D, the nurse should set limits and let the client know what is expected.

For a female client with anorexia nervosa, Nurse Jimmy is aware that which goal takes the highest priority? A. The client will establish adequate daily nutritional intake B. The client will make a contract with the nurse that sets a target weight C. The client will identify self-perceptions about body size as unrealistic D. The client will verbalize the possible physiological consequences of self-starvation

A. CORRECT *According to Maslow's hierarchy of needs, all humans need to meet basic physiological needs first. Because a client with anorexia nervosa eats little or nothing, the nurse must first plan to help the client meet this basic, immediate physiological need. The nurse may give lesser priority to goals that address long-term plans (as in option B), self-perception (as in option C), and potential complications (as in option D).

For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa? A. They tend to overprotect their children B. They usually have a history of substance abuse C. They maintain emotional distance from their children D. They alternate between loving and rejecting their children

A. CORRECT *Clients with anorexia nervosa typically come from a family with parents who are controlling and overprotective. These clients use eating to gain control of an aspect of their lives. The characteristics described in options B, C, and D isn't typical of parents of children with anorexia.

The nurse is preparing to perform an admission assessment on a pt with a diagnosis of bulimia nervosa. Which assessment findings should the nurse expect to note? (select all that apply) A. Dental Decay B. Moist, oily skin C. Loss of tooth enamel D. Electrolyte Imbalances E. Body weight well below ideal range

A. CORRECT *Pt will exhibit dental decay and loss of tooth enamel if pt has been inducing vomiting C. CORRECT *Pt will exhibit dental decay and loss of tooth enamel if pt has been inducing vomiting D. CORRECT *Electrolyte imbalances are present

A nurse is caring for an adolescent pt who has anorexia nervosa with recent rapid weight loss and a current weight loss and a current weight loss and a current weight of 90lbs. Which of the following statements indicates the pt is experiencing the cognitive distortion of catastrophizing?" A. "Life isn't worth living if I gain weight." B. "Don't pretend like you don't know how fat I am." C. "If I could be skinny, I know I'd be popular." D. "When I look in the mirror, I see myself as obese

A: CORRECT *This statement reflects the cognitive distortion of catastrophizing b/c the pt's perception of her appearance or situation is much worse than her current condition.

A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (SATA) A. "What is your relationship like with your family?" B. "Why do you want to lose weight?" "Would you describe your current eating habits?" C. "At what weight do you believe you will look better?" D. "Can you discuss your feelings about your appearance?"

A: CORRECT *A nursing history of a pt who has anorexia nervosa should include an assessment of family and interpersonal relationships C. CORRECT *Nursing history of a pt who has anorexia nervosa should include an assessment of the pt's current eating habits E. CORRECT *A nursing history of a pt who has anorexia nervosa should include include an assessment of the pt's perception of the issue

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate? A. "Let me know when you get back to the day room." B. "I will accompany you to the bathroom." C. "I'll stand outside your door to give you privacy." D. "Thanks for checking in."

B. CORRECT

A pt with anorexia nervosa is a member of a predischarge support group. The pt verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the pt to replace the pt;s old clothes. The pt believes that the new clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate behavior? A. Normal Behavior B. Evidence of the pt's disturbed body image C. Regression as the pt is moving toward the community D. Indicative of the pt's ambivalence about hospital discharge

B. CORRECT *Evidence of the pt's disturbed body image

The nurse is caring for a female pt who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the pt's room and notes that the pt is engaged in rigorous push-ups. Which nursing action is Most Appropriate? A. Interrupt the pt and weigh her immediately B. Interrupt the pt and offer to take her for a walk C. Allow the pt to complete her exercise program D. Tell the pt that she is not allowed to exercise rigorously

B. CORRECT *Pt's with anorexia frequently are preoccupied with rigorous exercise

A client whose husband just left her has a recurrence of anorexia nervosa. Nurse Vic caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to: A. manipulate her husband B. gain control of one part of her life C. commit suicide D. live up to her mother's expectations

B. CORRECT *By refusing to eat, a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. This eating disorder doesn't represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement). The client isn't attempting to commit suicide through starvation; rather, by refusing to eat, she is expressing feelings of despair, worthlessness, and hopelessness.

A pt with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a 2-bed room. A newly admitted pt will be assigned to this pt's room. Which pt would be the Best choice as a roommate for the pt with anorexia nervosa? A. pt with pneumonia B. pt undergoing diagnostic tests C. pt who thrives on managing others D. pt who could benefit from the pt's assistance at mealtime

B. pt undergoing diagnostic tests *The pt with anorexia nervosa is most likely experiencing hematological complications, such as leukopenia. This is why a pt undergoing diagnostic testing is acceptable

A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (SATA) A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of Lanugo on the face

B: CORRECT *Hypokalemia is an expected finding of purging-type bulimia nervosa D: CORRECT *Most pt's who have bulimia nervosa maintain a weight within a normal range or slightly higher

What is the "cylcle" for Bulimia pt's?

Binge~Purge *These pts eat everything in site and then they feel an extreme sense of guilt or shame, so they purge themselves by inducing vomiting or extreme laxative use

Who is more likely to use laxatives, Anorexia pt or Bulimia pt?

Bulimia pt with purging *last resort for anorexia pt to get to their goal wt, seen mainly in bulimia pt with purging

The nurse is assessing a client with a body mass index of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. A. Rheumatoid arthritis. B. Hypoglycemia. C. Respiratory insufficiency. D. Angina. E. Hyperlipidemia.

C, D, E. CORRECT *Clients with a body mass index (BMI) of 30 or greater are classified as obese. It is important to learn the complications of obesity because, based on the World Health Organization guidelines, half of all Americans are obese.Workload on the heart is increased in obese clients, and this often leads to symptoms of angina. Workload on the lungs is increased in obese clients, and this often leads to symptoms of respiratory insufficiency. Obese clients often present with hyperlipidemia, particularly elevated triglyceride and cholesterol levels. Obese clients commonly have hyperglycemia, not hypoglycemia, and are at risk for developing diabetes mellitus. Osteoarthritis, not rheumatoid arthritis, results from trauma to weight-bearing joints and is commonly seen in obese clients.

Who is the most common for you to see diagnosed with Bulimia? A. 35 yr old nursing student B. 10 yr old who likes to play video games C. 17 yr old who is a wrestler D. 54 yr old opera singer

C. 17 yr old who is a wrestler *Will see more in a high school athlete who is trying to make weight

Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? A. Fill out the client's menu and make sure she eats at least half of what is on her tray. B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.

C. CORRECT *Allowing the client to select her own food from the menu will help her feel some sense of control. She must then eat 100% of what she selected. Remaining with the client for at least 1 hour after eating will prevent purging. Bulimic clients should only be allowed to eat food provided by the dietary department.

A female client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, nurse Tair should plan to: A. severely restrict the client's physical activities B. weigh the client daily, after the evening meal C. monitor vital signs, serum electrolyte levels, and acid-base balance D. instruct the client to keep an accurate record of food and fluid intake

C. CORRECT *An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid base balance is crucial. Option A may worsen anxiety. Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.

Nurse Penny is aware that the following medical conditions is commonly found in clients with bulimia nervosa? A. Allergies B. Cancer C. Diabetes mellitus D. Hepatitis A

C. CORRECT *Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. The eating disorder isn't typically associated with allergies, cancer, or hepatitis A.

Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: A. avoid shopping for large amounts of food B. control eating impulses C. identify anxiety-causing situations D. eat only three meals a day

C. CORRECT *Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping for large amounts of food isn't a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues. Eating three meals per day isn't a realistic goal early in treatment.

During an admission interview, a client with anorexia nervosa complains of feeling cold all the time and asks the nurse why. Which of the following is the most appropriate response by the nurse? A. "You probably aren't dressing warmly enough." B. "Let me take your temperature." C. "There is a loss of subcutaneous fat." D. "You might be getting a cold."

C. CORRECT *Clients who have a history of anorexia frequently complain of feeling cold all the time that is unrelated to weather and clothing. Hypothermia is the result of dehydration or a loss of subcutaneous tissue.

Nurse Harry is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? A. Restrict visits with the family until the client begins to eat B. Provide privacy during meals C. Set up a strict eating plan for the client D. Encourage the client to exercise, which will reduce her anxiety

C. CORRECT *Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals — not given privacy. Exercise must be limited and supervised.

A 14-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. Nurse Kris conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader." B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." D. "I do diet around my periods; otherwise, I just get so bloated."

C. CORRECT *Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Most clients with anorexia nervosa don't like the way they look, and their self-perception may be distorted. A girl with cachexia may perceive herself to be overweight when she looks in the mirror. Preferring fast food over healthy food is common in this age-group. Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.

A nurse is caring for a pt who has bulimia nervosa and has stopped purging behavior. The pt tells the nurse that she is afraid she is going to gain weight. Which of the following response should the nurse make? A. "Many pts are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."

C: CORRECT *This statement acknowledges the pt's concern and then focuses the conversation on the pt's accomplishments which can promote pt self-esteem and self-image

A female client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5′ 8″ (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client's unrealistic body image, which intervention should the nurse Angel be included in the plan of care? A. Asking the client to compare her figure with magazine photographs of women her age B. Assigning the client to group therapy in which participants provide realistic feedback about her weight C. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift D. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy

D. CORRECT *A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about health. Instead of protecting the client's health, options A, B, and C may serve to make the client defensive and more entrenched in her unrealistic body image.

A 24-year old client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings? A. Avoid discussing the client's perceptions and feelings B. Focus discussions on food and weight C. Avoid discussing unrealistic cultural standards regarding weight D. Provide objective data and feedback regarding the client's weight and attractiveness

D. CORRECT *By focusing on reality, this strategy may help the client develop a more realistic body image and gain self-esteem. Option A is inappropriate because discussing the client's perceptions and feeling wouldn't help her to identify, accept, and work through them. Focusing discussions on food and weight would give the client attention for not eating, making option B incorrect. Option C is inappropriate because recognizing unrealistic cultural standards wouldn't help the client establish more realistic weight goals.

During postprandial monitoring, a female client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response? A. "I trust you not to purge." B. "How are you purging and when do you do it?" C. "Don't worry. I won't allow you to purge today." D. "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."

D. CORRECT *His response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives. Because their therapeutic relationships with caregivers are less important than their need to purge, they don't fear betraying the nurse's trust by engaging in the activity. They commonly plot purging and rarely share their secrets about it. An authoritarian or challenging response may trigger a power struggle between the nurse and client.

The nurse is assessing a 19 year-old female client with bulimia. Which of the following laboratory reports would the nurse anticipate? A. Increased sodium retention B. Decreased albumin C. Increased serum glucose D. Decreased potassium

D. CORRECT *In bulimia, loss of electrolytes can occur in addition to signs and symptoms of starvation and dehydration.

A nurse on an acute care unit is planning care for a pt who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions should the nurse include in the pts plan of care? A. Allow the client to select preferred meal times B. Establish consequences for purging behavior C. Provide the pt with a high fat diet at the start of treatment D. Implement one-to-one observation during meal times

D: CORRECT *The nurse should closely monitor the pt during and after meals to prevent purging

Who will usually identify a diagnosis of bulimia in a pt first? Why?

Dentist *Will have eroded enamel on teeth from the acid in the vomit Will usually be seen at the back teeth (molars) b/c thats where the acid hits first *Will have cavities (caries) from acid

Which hand will you see Russell's Sign on?

Dominant Hand

What gender are you more likely to see with the diagnosis of Anorexia Nervosa?

FEMALES

When a bulimia pt is eating dinner, what will the nurses responsibility be after the meal?

If they are going through treatment, pt may eat a normal family meal and then in 30 minutes purge. Someone needs to stay with them to watch actions until the food is considered absorbed

What is the common appearance for a Bulimia pt? (weight)

Normal look: Average weight OR Obese (may have a BMI thats ok and a increased BMI d/t obesity)

IF you believe that the pt is not telling you the truth about their actions, who else could you as the nurse ask?

Parents/Family *Also interview/talk with family members, when pt won't tell the truth sometimes family can tell you. Ex. Bulimics will hide food

Who is the best choice to work with these types of patients?

Psych Nurses (The Real Professionals)

What is it called when a pt has calluses knuckles or back of hand d/t repeated induced-vomiting?

Russell's Sign

Why are we seeing more cases of Anorexia Nervosa now than years before for males and females?

Social Stigmas

Explain the main difference between Bulimia and Binge Eating Disorder?

VERY similar to Bulimia BUT there is NO PURGING (Vomiting)