29.A - Feeding and Eating Disorders
The nurse is providing care to a preadolescent client who was recently diagnosed with bulimia nervosa. The client's mother states, "I am very weight and exercise conscious, and I try to ensure my children stay in shape and eat well so that they can succeed in life. I have no idea how my daughter developed bulimia. She must have inherited a genetic tendency for bulimia from her birth mother." Based on this data, which conclusion by the nurse is the most appropriate? A) The mother's focus on diet, exercise, and achievement fostered the client's eating disorder. B) The client must have inherited a genetic predisposition for eating disorders. C) The client must have a neurotransmitter abnormality. D) The mother is setting a good example for the client with her eating and exercise habits.
A) Many families of clients with eating disorders are achievement and performance oriented, with high ambition for the success of all members. In these families, body shape is frequently related to success, and a strong emphasis is placed on physical appearance and fitness. A family's focus on professional achievement as well as on food, diet, exercise, and weight control may become obsessive and contribute to the development of eating disorders among one or more family members-as appears to be the case in this client's family. There is not enough information to determine whether the client does or does not have a genetic predisposition to an eating disorder or a neurotransmitter abnormality. The client's mother is not setting a good example by being overly focused on eating and exercise.
A nurse is caring for a pregnant client who has a history of bulimia nervosa. Which of the following statements should the nurse include when counseling this client about the potential effects of pregnancy on eating disorder? A) "In some women with a history of eating disorders, pregnancy can lead to new or renewed onset of binge eating." B) "Only a tiny fraction of women with bulimia continue to engage in disordered eating during pregnancy." C) "Women with a history of bulimia or anorexia are at increased risk for pica during pregnancy." D) "Engaging in disordered eating while pregnant can harm you, but it is unlikely to affect the health of your fetus."
A) The nurse would be correct in stating that women with a history of eating disorders are at risk for new or renewed onset of binge eating during pregnancy. Research has found that pregnancy poses a risk for the onset of binge eating disorder (BED) in vulnerable individuals, occurring in nearly 1 in every 20 women. The rest of these statements are not accurate. A substantial proportion of women who have prepregnancy eating disorders continue to engage in disordered eating while pregnant; a history of eating disorders does not appear to increase the likelihood of pica during pregnancy; and disordered eating during pregnancy can result in negative fetal outcomes, such as low birth weight.
An adolescent client who currently weighs 50% of expected body weight tells the nurse, "I get upset and can't eat because my mother is constantly forcing food on me." Which treatments are indicated for this client? Select all that apply. A) Family-based psychotherapy B) Hospitalization C) Behavior modification D) Medication to increase appetite E) Placement with a foster family
A, B, C) Indications for hospitalization are a loss of 25-30% of body weight. This client currently weighs 50% of expected body weight, so hospitalization is likely necessary. Behavior modification techniques are used extensively in combination with counseling in the care of hospitalized clients with anorexia nervosa. Family-based psychotherapy is also indicated because the client feels her mother is forcing her to eat. Moving the client to a foster family is an extreme measure and might not help the problem. Medication to increase appetite is not an approved method of treatment for clients with anorexia nervosa.
A nurse who works in the emergency department is assessing a client with bulimia nervosa. Which assessment findings indicate that the client is dehydrated? Select all that apply. A) Dry mouth B) Hypertension C) Concentrated urine D) General weakness E) Poor skin turgor
A, C, D, E) Hypertension would not be a sign that the client is dehydrated. A client who is dehydrated may exhibit hypotension, dry mouth, poor skin turgor, lightheadedness or dizziness, general weakness, decreased urine production, and concentrated urine.
During a routine physical examination, a preadolescent client tells the nurse, "I am too fat, and I'm going to do whatever I can to look like the girls on the cover of fashion magazines." The nurse should plan care for this client based on which risk factor for eating disorders? A) A desire for a long-term profession B) Societal influences on body weight C) Unrealistic expectations D) Family influences on body weight
B) Risk factors for the development of eating disorders include female gender, age, and societal influences, including media stereotypes. This client is a preadolescent female who wants to look like the girls on the covers of fashion magazines; therefore, societal influences are clearly contributing to her risk for eating disorders. The client may be demonstrating unrealistic expectations; however, her main risk factors are her age, gender, and desire to look like the models in fashion magazines. No information is given about family influences on the client's body weight. The client may or may not be expressing a desire for a long-term profession.
The nurse is providing care to a client diagnosed with bulimia. The healthcare provider has prescribed medication to help decrease the client's binging and purging behavior. Which medication classification should the nurse include in the teaching plan for this client? A) Mood stabilizers B) Antidepressants C) Antipsychotics D) Anxiolytics
B) The antidepressant fluoxetine (Prozac) is the only medication approved by the U.S. Food and Drug Administration for treating bulimia. This and other antidepressants may help individuals for whom depression and anxiety are at the root of bulimic behavior. Fluoxetine appears to lessen binging and purging behaviors, reduce the likelihood of relapse, and improve attitudes toward eating.
A client who has been admitted with an eating disorder tells the nurse, "No matter what I do, I continue to be fat." Which of the following is the priority nursing diagnosis when planning care for this client? A) Ineffective Coping B) Disturbed Body Image C) Impaired Tissue Integrity D) Deficient Knowledge
B) The nursing diagnosis that best supports this client's needs is Disturbed Body Image. There is not enough information to determine whether the client does or does not have ineffective coping or deficient knowledge. Also, the nurse cannot determine whether the client has impaired tissue integrity based on the information in the client's statement.
The nurse is providing care to a client who has been diagnosed with anorexia nervosa. Which assessment findings indicate that the client has met some of the treatment goals related to the disease process? Select all that apply. A) The client is observed wearing wrinkled clothes, listening to a portable music device, and staring out the window. B) The client states that her menstrual cycle is regular and she is learning to prepare meals. C) The client's vital signs are within normal limits. D) The client's current weight is 75% of normal after 2 years of treatment. E) The client is overheard telling her mother that she will eat dinner if her mother buys her new jeans.
B, C) Evidence that the care provided to a client with anorexia nervosa has been successful includes a regular menstrual cycle, learning to prepare meals, and vital signs within normal limits. The client whose weight is 75% of normal would need additional treatment. The client who tells her mother that she will eat if she gets new jeans is demonstrating manipulative behavior, and this is evidence that treatment has not been successful. The client who is wearing wrinkled clothes and staring out the window is not demonstrating positive self-care behaviors and would benefit from additional intervention.
The nurse is providing care to a client who is diagnosed with bulimia. Which clinical manifestations does the nurse anticipate when conducting the client's physical assessment? Select all that apply. A) Increased urine output B) Hoarseness when speaking C) Poor skin turgor D) Low body temperature E) Elevated blood pressure
B, C) Physical signs of bulimia nervosa include hoarseness and esophagitis, dental enamel erosion, enlarged parotid glands, abrasions or calluses on the knuckles from inducing vomiting, menstrual irregularities, concentrated urine, decreased urine output, hypotension, elevated temperature, poor skin turgor, and weakness. Elevated blood pressure, low body temperature, and increased urine output are not typically observed in a client with bulimia.
Why is the presence of dental caries and enamel erosion more suggestive of bulimia nervosa than of anorexia nervosa? A) Unlike clients with anorexia nervosa, clients with bulimia nervosa are unlikely to consume sufficient amounts of calcium and other bone-building nutrients due to their restricted food intake. B) Unlike clients with anorexia nervosa, clients with bulimia nervosa tend to eat large amounts of sugar, which promotes tooth decay. C) Unlike clients with anorexia nervosa, clients with bulimia nervosa often purge by vomiting, which means their teeth are frequently exposed to the highly acidic contents of the stomach. D) Unlike clients with anorexia nervosa, clients with bulimia nervosa tend to consume large amounts of laxatives, which can damage the oral cavity.
C) Bulimia nervosa involves purging behaviors, whereas anorexia nervosa does not. Many clients with bulimia purge by inducing vomiting. Because the stomach contents are highly acidic, frequent vomiting can lead to enamel erosion and tooth decay. Both clients with bulimia and clients with anorexia experience nutritional deficiencies. Although clients with bulimia are more likely to consume sugar, this is not the primary cause of the tooth damage frequently associated with this disorder. Laxative use does not cause tooth decay
A college student tells the nurse about being "out of control" with eating. The client states, "I am trying to keep my weight down so my mom doesn't call me fat. Usually, I make myself throw up after eating." Based on this data, the nurse should plan on providing care for which of the following disorders? A) Binge-eating disorder B) Anorexia nervosa C) Bulimia nervosa D) Purging disorder
C) In bulimia nervosa, binge eating is followed by purging. Anorexia nervosa is characterized by extreme perfectionism, weight fear, significant weight loss, body image disturbances, strenuous exercising, and peculiar food-handling patterns. Binge-eating disorder is often associated with obesity and is characterized by binging twice a week for at least 6 months. Purging is not associated with binge-eating disorder. In purging disorder, purging is done without the ingestion of food beforehand.
A client tells the nurse that the thought of eating makes her anxious and nervous, so she just avoids eating altogether. Which of the following actions would be highest priority when planning care for this client? A) Providing instruction on the role of nutrition in normal menstruation B) Providing instruction on the importance of nutrition for vital signs and muscle tone C) Undertaking interventions to address anxiety and feelings of being in control D) Providing instruction on appropriate nutritional intake
C) The client is articulating feelings of anxiety and nervousness regarding eating. The nurse needs to include interventions to address the client's anxiety and feelings of being in control so that the root cause of the eating disorder can be addressed. Instruction on nutrition, normal menstruation, and bodily functions such as vital signs and muscle tone may be appropriate, but it is not the priority for the client at this time.
An experienced nurse practitioner is teaching a student nurse about feeding and eating disorders in the pediatric population. Which of the following statements from the student nurse indicates that more education is necessary? A) "Avoidant/restrictive food intake disorder, or ARFID, is the most common eating disorder among children." B) "In recent years, eating disorders have become more common in the pediatric population." C) "Many children are picky eaters, but few of them satisfy the diagnostic criteria for ARFID." D) "Eating disorders are overdiagnosed in children because providers often fail to distinguish picky eating from true ARFID."
D) ARFID is the most significant eating disorder diagnosis among children. The ARFID diagnosis eliminates picky eaters by identifying only those children with clinically significant restrictive eating problems that result in persistent failure to meet the child's nutritional and/or energy needs. In recent years, higher rates of eating disorders have been observed in younger children, boys, and minority groups than in years past. Still, eating disorders remain underdiagnosed in the pediatric population. Thus, the nurse's statement that eating disorders are overdiagnosed in children indicates the need for further education.
In an adult client, the presence of lanugo and dry, brittle nails is suggestive of which of the following conditions? A) Bulimia nervosa B) Binge-eating disorder C) Pica D) Anorexia nervosa
D) On physical assessment, patients with anorexia nervosa will appear emaciated. Their skin may be dry and covered by a fine layer of hair called lanugo, and their nails will appear to be dry and brittle. Although lanugo is a normal finding in newborn clients, it is nearly always associated with anorexia nervosa in adults.