Ch 18 Questions

A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to support which electrolyte imbalance? a. Hypercalcemia b. Hypernatremia c. Hypokalemia d. Hypolipidemia

Hypokalemia Vomiting causes loss of potassium, leading to hypokalemia. Vomiting is not the trigger for any of the other options presented.

Effective care of a client suspected of experiencing bulimia nervosa calls for the nurse to perform which assessment? a. body fat analysis. b. a range of motion assessment. c. inspection of the oral cavity. d. inspection of body cavities.

inspection of the oral cavity. Repeated vomiting often causes dental erosions and caries. None of the other options represent frequently engaged dysfunctional behaviors.

After stabilization of symptoms, what is the primary focus of treatment for a client diagnosed with anorexia nervosa? a. Improving interpersonal skills b. Weight restoration c. Learning effective coping methods d. Changing family interaction patterns

Weight restoration Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status. The other options are addressed are secondary to the physiological goal of weight restoration.

Ali is a 17-year-old patient diagnosed with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? a. "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." b. "I always purge when I'm alone so that I'm not a bad role model for my younger sister." c. "I purge only once a day now instead of twice." d. "I am a hard worker and I am very compassionate toward others."

"I am a hard worker and I am very compassionate toward others." An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is incorrect because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging.

A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? a. Mood stabilizers b. Antidepressants c. Atypical antipsychotics d. Anxiolytics

Antidepressants The antidepressant fluoxetine has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders.

Which coping mechanism is used excessively by clients diagnosed with bulimia nervosa to cope with their obsession with their body image? a. Projection b. Humor c. Altruism d. Denial

Denial Denial of incongruence between body reality, body ideal, and body presentation is the mainstay of the client diagnosed with bulimia nervosa. None of the other mechanisms are as vital to their coping technique.

A client diagnosed with bulimia nervosa uses enemas and laxatives to purge to maintain weight. What is the likely physiological outcome of this practice? a. Disruption of the fluid and electrolyte balance b. Elevated serum potassium level c. Elevated serum sodium level d. Increase in the red blood cell count

Disruption of the fluid and electrolyte balance Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives. There would be a decrease in potassium and sodium levels while the concentration of, but not actual red cell count would be affected.

According to current theory, which statement regarding eating disorders is accurate? a. Eating disorders are rarely comorbid with other mental health disorders. b. Eating disorders are possibly influenced by sociocultural factors. c. Eating disorders are frequently misdiagnosed. d. Eating disorders are psychotic disorders in which patients experience body dysmorphic disorder.

Eating disorders are possibly influenced by sociocultural factors. The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders.

Which subjective symptom should the nurse expect to note during assessment of a client diagnosed with anorexia nervosa? a. Hypotension b. Lanugo c. 25-lb weight loss d. Fear of gaining weight

Fear of gaining weight Fear of weight gain is the only subjective data listed, and it is universally true of clients diagnosed with anorexia nervosa. The remaining options are objective signs.

A client hospitalized with anorexia nervosa has a weight that is 65% of normal. For this client, what is a realistic short-term goal for the first week of hospitalization regarding the physical impact of his/her weight? a. Verbalize awareness of the sensation of hunger. b. Develop a pattern of normal eating behavior. c. Discuss fears and feelings about gaining weight. d. Gain a maximum of 3 lb.

Gain a maximum of 3 lb. The critical outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema. While all the remaining goals are appropriate, none have the physical focus that is the initial priority.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when which assessment data is observed? a. Has serum potassium level of 3 mEq/L or greater. b. Has systolic blood pressure less than 90 mm Hg. c. Weighs 10% below ideal body weight. d. Has a heart rate less than 60 beats/min.

Has systolic blood pressure less than 90 mm Hg. Systolic blood pressure of less than 90 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise. None of the remaining options represent data aligned with the criteria for hospitalization.

A client, who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds, eats one tiny meal daily and engages in a rigorous exercise program. Which nursing diagnosis addresses this assessment data? a. Death anxiety b. Imbalanced nutrition: less than body requirements c. Ineffective denial d. Disturbed sensory perception

Imbalanced nutrition: less than body requirements A body weight of 80 pounds for a 16-year-old who is 5 foot, 3 inches tall is ample evidence of this diagnosis. There is no support in the data as presented to justify any of the other nursing diagnoses.

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? a. It will be prescribed at a higher than typical dose. b. Long-term management of symptoms is best achieved with tricyclic antidepressants. c. There are a variety of medications to prescribe if fluoxetine proves to be ineffective. d. It will reduce the need for cognitive therapy.

It will be prescribed at a higher than typical dose. Research has shown that antidepressant medication together with cognitive-behavioral therapy brings about improvement in bulimic symptoms. Fluoxetine (Prozac), an Selective serotonin reuptake inhibitors (SSRI) antidepressant, has FDA approval for acute and maintenance treatment of bulimia nervosa in adult patients. When fluoxetine is used for bulimia, it is typically at a higher dose than is used for depression. Although no other drugs have FDA approval for this disorder, tricyclic antidepressants helped reduce binge eating and vomiting over short terms.

The client experiencing bulimia differs from the client diagnosed with anorexia nervosa by exhibiting which characteristic? a. Purging to keep weight down b. Holding a distorted body image c. Maintaining a normal weight d. Doing more rigorous exercising

Maintaining a normal weight Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight. The other characteristics are commonly shared among persons with either disorder.

Which statement is true of the eating disorder referred to as bulimia? a. Patients with bulimia severely restrict their food intake. b. One sign of bulimia is lanugo. c. Patients with bulimia binge eat but do not engage in compensatory measures. d. Patients with bulimia often appear at a normal weight.

Patients with bulimia often appear at a normal weight. Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa? a. Chronic low self-esteem b. Ineffective coping: impulsive responses to problems c. Disturbed body image d. Risk for injury: electrolyte imbalance

Risk for injury: electrolyte imbalance The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss. This electrolyte imbalance is potentially life threatening. While appropriate none of the other options are as likely to risk the client's life.

Biological theorists suggest that the cause of eating disorders may be related to which factor? a. Body image disturbance b. Serotonin imbalance c. Dopamine excess d. Normal weight phobia

Serotonin imbalance The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse. None of the remaining options are currently supported by any biological theories.

The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by implementing which intervention? a. Stressing the need to suppress overt conflict within the family b. Encouraging the family to use their usual social behaviors at meals c. Teaching the family about the disorder and the client's behaviors d. Urging the family to demonstrate greater caring for the client

Teaching the family about the disorder and the client's behaviors Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member. While the other options may be appropriate for specific client families, they are not as fundamental as the correct option.

Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa? a. Do not reweigh client when client requests. b. Weigh 2 times daily first week, then three times weekly. c. Permit no oral intake before weighing. d. Weigh fully clothed before breakfast.

Weigh fully clothed before breakfast. Clients should be weighed daily first week, then three times weekly wearing only bra and panties or underwear before ingesting any food or fluids in the morning. Reweighing is not a request that should be afforded to the client.