Chapter 31 Eating Disorders Study Questions

Anorexia is characterized by a BMI of:

17.5 or lower

What is considered a normal BMI range?

20-24.9

What is the overweight BMI range?

25-29.9

The average american woman has a BMI of ___ while fashion models have an average BMI of ___

26; 18

The client with bulimia differs from the client with anorexia nervosa by a. maintaining a normal weight. b. holding a distorted body image. c. doing more rigorous exercising. d. purging to keep weight down.

A. maintaining a normal weight. Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight.

What is the formula for BMI?

BMI= weight (kg)/height (m^2)

Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? a. bradycardia b. amenorrhea c. tolerance d. convulsions

C. Tolerance

Anorexia Nervosa Sample Question Which is characteristic of the diagnosis of anorexia nervosa? A. Obsession with weight gain B. Body image disturbance C. Disregard for the feelings of others D. Healthy family relationships

Correct answer: B ◦ The distortion in body image by a client diagnosed with anorexia nervosa is manifested by thoughts that they are fat when they are obviously underweight or even emaciated.

The nurse is teaching a class on obesity prevention. Which statement by a student indicates that learning about obesity has occurred? A. "Obesity is classified as a psychiatric disorder in the DSM-5." B. "Obesity is defined as a body mass index (BMI) of 25.0 to 29.9." C. "Eighty percent of offspring of two obese parents are obese." D. "Lesions in the appetite center in the thalamus may contribute to obesity.

Correct answer: C ◦ Genetics have been implicated in the development of obesity. Research indicates that 80 percent of offspring of two obese parents are obese.

A client is 5'8'' tall and weighs 105 pounds. The client has been taking laxatives daily, an self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? A. Ineffective denial B. Disturbed body image C. Low self-esteem D. Imbalanced nutrition: less than body requirements

Correct answer: D ◦ This client is malnourished and underweight due to self-induced vomiting and laxative abuse. Nutritional status is compromised and this problem must be prioritized to establish physiological integrity.

Which statement is least likely to be made by a client diagnosed with bulimia nervosa during the assessment interview? a. "I eat three meals each day and purge every evening." b. "I'm concerned about what others think about my binging and purging." c. "I feel as though my eating and purging are out of my control." d. "When I eat I feel calm, but then I realize I have to make myself vomit or gain weight."

a. "I eat three meals each day and purge every evening." Most clients with bulimia purge after each meal.

The binging episode is thought to involve: a. A release of tension, followed by feelings of depression b. Feelings of fear, followed by feelings of grief c. unmet dependency needs and a way to gain attention d. feelings of euphoria, excitement, and self-gratification

a. A release of tension, followed by feelings of depression

A coping mechanism used excessively by clients with anorexia nervosa is a. denial. b. humor. c. altruism. d. projection.

a. denial. Denial of excessive thinness is the mainstay of the client with anorexia nervosa.

A client has been hospitalized with anorexia nervosa. The client's weight is 65% of normal. For this client, a realistic short-term goal for the first week of hospitalization would be: By the end of week 1, the client will a. gain a maximum of 3 lb. b. develop a pattern of normal eating behavior. c. discuss fears and feelings about gaining weight. d. verbalize awareness of the sensation of hunger.

a. 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.

Psychoanalytically, the theory of obesity relates to the individual's unconscious equation of food with: a. nurturance and caring b. power and control c. autonomy & emotional growth d. strength and endurance

a. nurturance and caring

The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by a. teaching the family about the disorder and the client's behaviors. b. stressing the need to suppress overt conflict within the family. c. urging the family to demonstrate greater caring for the client. d. encouraging the family to use their usual social behaviors at meals.

a. 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.

A focus for the acute phase of treatment for anorexia nervosa would be a. weight restoration. b. improving interpersonal skills. c. learning effective coping methods. d. changing family interaction patterns.

a. 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.

Which assessment question should be asked of a client suspected of demonstrating characteristics of anorexia nervosa? a. "Do you find yourself feeling hungry?" b. "How would you describe your body?" c. "How often do you force yourself to vomit?" d. "Why do you choose to take laxatives?"

b. "How would you describe your body?" This question will reveal the cognitive distortion consistent with anorexia nervosa. Invariably the client will describe self as fat despite being excessively underweight.

Nurse Jones is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. the client continues to refuse to eat. What is the most appropriate response by the nurse? a. You know that if you don't eat you'll die. b. If you continue to refuse to take food orally, you will be fed through a nasogastric tube c. You might as well leave if you are not going to follow your therapy regimen d. You don't have to eat if you don't want to. It is your choice.

b. If you continue to refuse to take food orally, you will be fed through a nasogastric tube

Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of a. historically poor patient compliance. b. an increased risk of seizures. c. the long-term effects on liver function. d. the potential to cause gastric ulcers.

b. an increased risk of seizures. Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of an increased risk of seizures.

Jane is hospitalized on the psychiatric unit. she has a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with Jane's diagnosis? a. binging, purging, obesity, hyperkalemia b. binging, purging, normal weight, hypokalemia c. binging, laxative abuse, amenorrhea, severe weight loss d. binging, purging, severe weight loss, hyperkalemia

b. binging, purging, normal weight, hypokalemia

A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is a(n) a. increase in the red blood cell count. b. disruption of the fluid and electrolyte balance. c. elevated serum potassium level. d. elevated serum sodium level.

b. 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.

A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal a. tachycardia. b. hypokalemia. c. hypercalcemia. d. hypolipidemia.

b. hypokalemia. Vomiting causes loss of potassium, leading to hypokalemia.

Nancy, age 14, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Nancy? a. complicated grieving b. imbalanced nutrition, less than body requirements c. interrupted family processes d. anxiety (severe)

b. imbalanced nutritition: less than body requirements

From a physiological point of view, the most common cause of obesity is probably: a. lack of nutritional education b. more calories consumed than expended c. impaired endocrine functioning d. low basal metabolic rate

b. more calories consumed than expended

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

b.Weigh fully clothed before breakfast. Clients should be weighed wearing only bra and panties before ingesting any food or fluids in the morning.

Your patient, Erin, is a 16-year-old patient newly diagnosed with anorexia. Her provider is starting her on medication to reduce compulsive behaviors regarding food and resistance to weight gain. You prepare teaching on which class of medication that may help these specific symptoms in eating disorders? a. Mood stabilizers b. Antidepressants Incorrect c. Anxiolytics d. Atypical antipsychotics

d. Atypical antipsychotics 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. The antidepressant fluoxetine (Prozac, an SSRI) has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety.

A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is a. lanugo. b. hypotension. c. 25-lb weight loss. d. fear of gaining weight.

d. fear of gaining weight. Option D is the only subjective data listed, and it is universally true.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when the client a. weighs 10% below ideal body weight. b. has a serum potassium level of 3 mEq/L or greater. c. has a heart rate less than 60 beats/min. d. has systolic blood pressure less than 70 mm Hg.

d. has systolic blood pressure less than 70 mm Hg. Systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise.

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. The nursing diagnosis for this client would be a. death anxiety. b. ineffective denial. c. disturbed sensory perception. d. imbalanced nutrition: less than body requirements.

d. 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.

A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. Don't worry. The dietitian will ensure you don't get too many calories in your diet. b. Don't worry about your weight. We are going to work on other problems while you are in the hospital. c. I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now I want you to tell me more about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital because we know that is important to you."

c. I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now I want you to tell me more about your recent invitation to join the National Honor Society. That's quite an accomplishment."

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

c. 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.

Which intervention would be removed from the plan of care for a client diagnosed with bulimia nervosa? a. Teach that fasting sets one up to binge eat. b. Assist client to identify trigger foods. c. Support importance of avoiding forbidden foods. d. Teach client to plan and eat regularly scheduled meals.

c. Support importance of avoiding forbidden foods. No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy.

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

c. 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 of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. tachycardia, hypertension, hyperthermia b. bradycardia, hypertension, hypethermia c. bradycardia, hypotension, hypothermia d. tachycardia, hypotension, hypothermia

c. bradycardia, hypotension, hypothermia

In contrast to the client diagnosed with anorexia nervosa, the client diagnosed with bulimia usually a. uses greater denial. b. is aware of the eating problem. c. fits more easily into the family. d. appraises his or her body more realistically.

c. fits more easily into the family. There is less family concern about the client with bulimia because these clients appear physically normal, the weight is at or near normal, they eat with the family, and the purging is done in secret. The anorexic client is noticed by the family for painful thinness and poor food intake.

During assessment of a client with anorexia nervosa, it is not likely that the nurse would note indications of a. introversion. b. social isolation. c. high self-esteem. d. obsessive-compulsive tendencies.

c. high self-esteem. Most clients with eating disorders have low self-esteem.

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

c. inspection of the oral cavity. Repeated vomiting often causes dental erosions and caries.

Which medication has been used with some success in clients with anorexia nervosa? a. lorcaserin (Belviq) b. diazepam (valium) c. fluoxetine (prozac) d. carbamazepine (Tegretol)

c. prozac

Biological theorists suggest that the cause of eating disorders may be a. normal weight phobia. b. body image disturbance. c. serotonin imbalance. d. dopamine excess.

c. serotonin imbalance. The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse.