Chapter 32: Eating Disorders

Which question is most important for the nurse to ask when assessing a bulmic patient who admits to using laxitives? A. "When did you last have a bowel movement?" B. "Are your feet and legs swollen?" C. "Do you ever have chest pain when you are exercising?" D. "Have you ever been told you have poor dental enamel?"

A. "When did you last have a bowel movement?" B. "Are your feet and legs swollen?" Laxatives can lead to reflex constipation, and both laxatives and diuretics are associated with rebound edema.

Which question is most important for the nurse to ask when assessing a bulmic patient who admits to using syrup of ipecac to cause post-binge vomiting? A. "When did you last have a bowel movement?" Incorrect B. "Are your feet and legs swollen?" C. "Do you ever have chest pain when you are exercising?" D. "Have you ever been told you have poor dental enamel?"

C. "Do you ever have chest pain when you are exercising?" Use of ipecac syrup to induce vomiting is dangerous and can cause fatal cardiomyopathy that can cause chest pain when the heart is stressed.

A 16-year-old patient has anorexia nervosa. Which term used to describe the menstrual history is characteristic of this disorder? a. Amenorrhea b. Dysmenorrhea c. Premenstrual syndrome d. Heavy menstrual flow

ANS: A Amenorrhea is common in patients with eating disorders, possibly due to altered hypothalamic function. The remaining options are not usually related to changes resulting from an eating disorder.

A patient is being assessed for a binge-eating associated eating disorder. Which assessment question is directed towards collecting data on the most commonly abused substance among this patient population? a. How much alcohol do you drink on a weekly basis? b. Do you use amphetamines to help control your weight? c. Do you rely on laxatives to control your bowel movements? d. How many packs of cigarettes do you smoke on a daily basis?

ANS: A Eating disorder symptoms predict the type of drug use, with bingeing associated more with alcohol and tranquilizer abuse, purging associated more with the abuse of multiple drugs, and restricting associated more with amphetamine.

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed? a. The nurse interacts with the patient in a protective fashion. b. The nurse's comments to the patient are compassionate and nonjudgmental. c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d. The nurse refers the patient to a self-help group for individuals with eating disorders.

ANS: A In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assumption of a parental role. Protective behaviors are part of the parent's role. The helpful nurse uses a problem-solving approach and focuses on the patient's feelings of shame and low self-esteem. Referring a patient to a self-help group is an appropriate intervention.

The nurse is caring for a patient who is being treated for comorbid eating and affective disorders. For which medication would the nurse expect to prepare a patient teaching plan? a. Fluoxetine (Prozac) b. Diazepam (Valium) c. Lorazepam (Ativan) d. Lithium

ANS: A SSRIs are effective in treatment of depression and have been found to be useful in treatment of eating disorders. Benzodiazepines like Valium and Ativan are used for anxiety reduction. Lithium is used for bipolar disorder.

Which reports describe behaviors that meets the criteria for a diagnosis of binge eating? Select all that apply. a. Sister reports, "She is so sad after she finishes." b. Claims, "I cant control myself when I get that way." c. The patient reports, "I'm making myself vomit at least twice a week." d. Mother reports seeing the patient eat entire loaf of bread for lunch. e. Maintains that, "I look okay now but I do this so I don't gain any weight."

ANS: A, B, C, D All described behaviors are characteristic of binge eating except for the belief that body image is currently acceptable.

A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis? A. The client will identify two alternative methods of dealing with isolation by day 3. B. The client will appropriately express angry feelings about lack of control by week 2. C. The client will verbalize two positive self attributes by day 3. D. The client will list five ways that the body reacts to bingeing and purging.

ANS: A The ability to identify alternative methods of dealing with isolation will provide the client with effective coping strategies to use instead of bingeing and purging.

A patient is being assessed for possible anorexia nervosa. Which behaviors are supportive of such a diagnosis? Select all that apply. a. Eats only red apples and green grapes b. Exercises 3 times a day every day c. Has lost 25 pounds but wears only pre-loss clothing d. Becomes extremely agitated whenever expected to eat e. Reports fantasies about being able to eat without gaining weight

ANS: A, B, C, D The characteristic of anorexia nervosa do not include fantasies about eating.

A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred? A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not." B. "Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not." C. "Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not." D. "Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not."

ANS: A The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food followed by purging.

The death rate from anorexia is higher than any other mental illness. Death usually results from: (Select all that apply.) a. Dehydration b. Loss of critical muscle mass c. Diabetes d. Electrolyte imbalances e. Suicide

ANS: A, B, D, E The mortality rate for anorexia due to complications of starvation, cardiac arrest, or suicide is approximately 5% per decade of follow-up. Death usually results from dehydration, loss of critical muscle mass, electrolyte imbalances, or suicide, because often clients are not seen by health professionals until the disorder has resulted in some physical problems.

Which assessment findings support a diagnosis of bulimia nervosa? Select all that apply. a. Loose watery stool b. Red rash on extremities c. Blood pressure of 88/58 d. A potassium level of 2.8 mEq/L e. Reports of mild muscle cramping

ANS: A, C, D, E A red rash on the extremities is not a characteristic of bulimia. All other options can be related to the disorder.

The mother of a teenager is concerned that the child may be anorexic. Which report of the teenagers behavior is support of such a diagnosis? (SATA) a. Insists she likes really baggy clothes b. Will eat only lean protein, fruits, and vegetables c. Has had one menstrual period in the last 2 years d. Although she has grown 3 inches, she has gained no weight e. Regularly claims that she will eat later but seldom does

ANS: A, C, D, E A willingness to eat lean meats, fruits, and vegetables would not be characteristic of a patient exhibiting anorexia. The remaining options could be seen in such a patient.

What is the main issue for adolescents with anorexia? a. Anxiety b. Control c. Body image d. Appropriate behavior

ANS: B The main issue for teenage anorectics is control.

How does the mortality rate among patients diagnosed with eating disorders compare to those with other psychiatric diagnoses? a. More deaths are attributed to substance abuse than to eating disorders. b. This disorder is associated with the highest death rate among all other disorders. c. This disorder has fewer associated deaths that any other impulse control disorder. d. More related deaths are recorded compared to those associated with schizophrenia.

ANS: B The mortality rate with eating disorders is higher than that seen with any other psychiatric diagnoses, and it has been reported at 4% to 20% of death among this population.

A 14-year-old patient newly admitted to the eating disorders unit refuses to eat meals and angrily shouts at the nurse, You cant make me eat! Ill do whatever I want to do. Which nursing intervention demonstrates an understanding of the priority safety issue for this anorexic patient? a. Placing the patients favorite low calorie beverages in open view b. Assigning a staff member to one-on-one observation of the patient c. Unlocking the patients bathroom only at specific times during the day d. Explaining to the patient that they will be required to keep an eating journal

ANS: B The patient, especially when stressed, is capable of self-mutilation and needs to be protected from doing so. The issues of hydration, purging, and therapy work do not have the priority that physical safety has.

A patient with severe weight loss as a result of anorexia nervosa has refused meal trays and supplemental feedings for 3 days since being admitted to the hospital and so re-feeding has been ordered. Which intervention will initiate this treatment? a. Scheduling a nutrition consult with the hospital dietitian b. Tube feedings until the patient eats 90% of all meals for 1 day c. IV infusions beginning immediately and continuing for 48 hours d. Placing the patient on suicide precautions and one-to-one observation

ANS: B The priority is to begin re-feeding, a procedure that involves tube feedings that are continued until the patient is voluntarily eating sufficient quantities. Re-feeding takes place using foods and fluids via the GI tract, rather than by the parenteral route. Although re-feeding is very threatening to the patient, since they have no control over the weight gain that will occur, suicide precautions are not indicated at this point, but careful assessments will continue. A nutritional consult is not useful at this point in the treatment since the patient is not making choices regarding eating.

What should the nurse consider as the initial step in the nurse-patient relationship for a patient diagnosed with anorexia nervosa? a. Formulate the nurse-patient contract. b. Place limits on the family involvement in treatment. c. Identify a therapeutic group of similar aged patients. d. Use confrontation to establish boundaries and limits.

a. Formulate the nurse-patient contract.

A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time? A. Ineffective coping R/T food obsession B. Altered nutrition: less than body requirements R/T inadequate food intake C. Risk for injury R/T suicidal tendencies D. Altered body image R/T perceived obesity

ANS: B Based on Maslow's hierarchy, the priority nursing diagnosis for this client must address physical needs prior to emotional considerations. This client must be immediately physically stabilized due to the life-threatening nature of his or her nutritional status.

A patient being treated for an eating disorder is prescribed re-feeding. Which outcome is the primary reason a patient receiving this treatment is closely monitored by the nursing staff? a. Complies with treatment commendation made by treatment team b. Regularly consumes and tolerates between 3000 to 4000 kcal/day c. No physical signs or symptoms of an electrolyte imbalance are observable d. Discharge depends on patients ability to demonstrate a gain of 3 pounds per week

ANS: C Although all options are outcomes requiring nursing assessment and monitoring, the acute and serious nature of electrolyte imbalances has priority over the remaining options.

A nursing intervention that will be planned to occur early in the nurse-patient relationship with a patient with an eating disorder is: a. Using confrontation to attack denial b. Placing the patient in a therapeutic group c. Formulating a therapeutic nurse-patient alliance d. Attacking enmeshment by separating patient and family

ANS: C An alliance is formulated early to give the patient an opportunity to participate in treatment and increase the patients sense of control, thus eliminating power struggles. Confrontation is rarely used early in the relationship. Placement in a group and anti-enmeshment techniques would normally take place after the contract has been agreed on.

A 5-year-old child was diagnosed with encopresis. Which assessment finding would the nurse expect associated with this diagnosis? The child: a. frequently smears feces on clothing and toys. b. experiences frequent nocturnal episodes of bedwetting. c. has accidents of defecation at kindergarten three times a week. d. has occasional episodes of voiding accidents at the day care center.

ANS: C Encopresis refers to unsuccessful bowel control. Bowel control is expected by age 5, so frequent involuntary defecation is associated with this diagnosis. Smearing feces is behavioral. Enuresis refers to the voiding of urine during the day (diurnal) or at night (nocturnal).

Which statement is the basis for the cross-cultural assessment practices of eating disorders? a. Mediterranean cultures are more likely to exhibit symptoms. b. Male-dominated cultures are more likely to accept this disorder. c. Westernized cultures tend to have similar numbers of diagnosed cases. d. Access to food is the primary factor in determining incidence of the disorder

ANS: C The incidence and prevalence of eating disorders around the world are similar among European countries, the United States, Canada, Mexico, Japan, Australia, and other Westernized countries. Access to food is not necessarily a cultural factor.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a clients home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.

ANS: C The nurse should assess that a home environment that is overprotective and demands perfection may be an influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents.

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the clients motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence.

ANS: C The nurse should identify that behavior modification therapy will be used because it provides the client with control over behavioral choices. Clients diagnosed with anorexia nervosa are often allowed to contract privileges based on weight gain. The client maintains control over eating and exercise.

When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this client's symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels B. Abnormal electroencephalogram (EEG) C. Metabolic acidosis D. Metabolic alkalosis

ANS: C Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. The nurse should attribute this client's fainting to the loss of alkaline stool due to laxative abuse which would lead to a relative metabolic acidotic condition.

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

ANS: C The nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self based on self-attributes instead of appearance and to realize that perfection is unrealistic.

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the rationale for scheduling group therapy at this time? A. To shift the clients' focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation

ANS: C When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.

A patients plan of care is being managed by an interdisciplinary team familiar with the etiology of eating disorders. Which team principle is most important to the successful treatment of this patient population? a. The team must preserve the patients sense of autonomy. b. The patient must be an active member of the care planning team. c. The patients family must be included in the decision-making process. d. The plan of care must demonstrate collaboration and consistency by the team.

ANS: D In order to best assure a good prognosis, the plan of care has to include consistent and collaborative efforts by all members of the interdisciplinary team. Although the remaining options are goals to be strived for, they do not have the importance that collaborative and consistent care planning has for successful treatment.

Which intervention best monitors the health status of a patient newly admitted for a diagnosis of bulimia nervosa? a. Scheduling a bone mineral density screening b. Performing a portable electrocardiogram (ECG) c. Obtaining a urine sample for a urine analysis d. Arranging for a serum potassium level to be drawn

ANS: D Patients with bulimia nervosa require initial assessment for acute fluid and electrolyte imbalances (particularly serum potassium) for the presence of life-threatening imbalances. Bone mineral density screening for osteopenia and osteoporosis and assessment is appropriate but it does not have priority over of the blood work to identify an acute life-threatening condition. The remaining options are not diagnostic tests that are generally required of this diagnosis.

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization? a. Urine output 40 mL/hr c. Serum potassium 3.4 mEq/L b. Pulse rate 58 beats/min d. Systolic blood pressure 62 mm Hg

ANS: D Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 mL/hr. A potassium level of 3.4 mEq/L is within the normal range.

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges? a. Powerlessness b. Ineffective coping c. Disturbed body image d. Imbalanced nutrition: less than body requirements

ANS: D The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, "I won't eat until I look thin." Select the priority initial nursing diagnosis. a. Anxiety related to fear of weight gain b. Disturbed body image related to weight loss c. Ineffective coping related to lack of conflict resolution skills d. Imbalanced nutrition: less than body requirements related to self-starvation

ANS: D The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient's self-starvation is the priority.

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects a theory about the underlying etiology of this disorder? A. I was just trying to be like everyone else. B. All the skaters on the team are following an approved 1,200-calorie diet. C. When I lose skating competitions, I also lose my appetite. D. I am angry at my mother. I can get her approval only when I win competitions.

ANS: D This client statement reflects a possible underlying etiology of anorexia nervosa. The client is expressing feelings about family dynamics that may have influenced the development of this disorder. Families who are overprotective and perfectionistic can contribute to a family members development of anorexia nervosa.

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects the underlying etiology of this disorder? A. "Skaters need to be thin to improve their daily performance." B. "All the skaters on the team are following an approved 1,200-calorie diet." C. "When I lose skating competitions, I also lose my appetite." D. "I am angry at my mother. I can only get her approval when I win competitions."

ANS: D This client statement reflects the underlying etiology of anorexia nervosa. The client is expressing feelings about family dynamics that may have influenced the development of this disorder. Families who are overprotective and perfectionistic can contribute to a family member's development of anorexia nervosa.

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

ANS: D When the client states, "I don't know why people are worried. I need to lose this weight," the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

The nurse expects to closely monitor which laboratory data when working with the binging-purging type of bulimic patient? A. Hypocalcemia B. Hypernatremia C. Hypokalemia D. Hypervolemia

C. Hypokalemia Hypokalemia is often evident in patients with chronic emesis and subsequent loss of gastrointestinal fluids. Hypocalcemia should be monitored for but is not the highest priority, since its resulting symptoms are less problematic than those of hypokalemia.

When considering those individuals diagnosed with anorexia nervosa, which client has the lowest probability of recovery? A. The client between the ages of 20 to 25 years. B. The client who is only 10 lb overweight. C. The client who self-induces vomiting. D. The client who exercises regularly.

C. The client who self-induces vomiting. Among patients diagnosed with anorexia nervosa, it was indicated that self-induced vomiting and greater trait anxiety predicted a lower likelihood of recovery. The remaining characteristics are generally not considered predictors of recovery.

What does refeeding syndrome involve?

Severe shifts in fluid and electrolyte levels from extracellular to intracellular spaces in severely emaciated patients can occur, causing cardiovascular, neurologic, and hematologic complications, and even death.

A nurse assesses a 25-year-old man with a suspected eating disorder. Which comment is most likely from this patient when the nurse asks about the patient's sexuality? a. "I just don't have much of a sex drive anymore." b. "I'm here because my girlfriend is worried about how much I exercise." c. "I am sexually active, but I sometimes have trouble maintaining an erection." d. "I've been involved in a satisfying relationship with my girlfriend for 3 years."

a. "I just don't have much of a sex drive anymore."

A patient diagnosed with anorexia nervosa has the nursing diagnosis imbalanced nutrition, less than body requirements, related to inadequate food intake. What is an appropriate long-term goal of the treatment plan for this patient? a. Gain 1 to 3 lb weekly. b. Exhibit fewer signs of malnutrition. c. Restore healthy eating patterns and normalize weight. d. Identify cognitive distortions about weight and shape.

c. Restore healthy eating patterns and normalize weight.

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention Monitor for complications of re-feeding. Which body system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Central nervous d. Cardiovascular

ANS: D Re-feeding resulting in a too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment becomes a necessity to ensure patient physiologic integrity. The other body systems are not initially involved in the re-feeding syndrome.

What priority nursing assessments should be made early in the refeeding process for a patient with anorexia nervosa? (Select all that apply.) a. Vital signs b. Skin integrity c. Peripheral edema d. Lung and heart sounds e. Level of consciousness

a. Vital signs c. Peripheral edema d. Lung and heart sounds e. Level of consciousness

A patient diagnosed with an eating disorder refuses to be weighed and says, "I just drank a big glass of water." What is the nurse's best response to the patient's comment? a. "Call me after you have emptied your bladder." b. "Being weighed today is not negotiable." c. "I will weigh you tomorrow." d. "You know the rules."

b. "Being weighed today is not negotiable."

Ana is admitted to the medical surgical floor for severe weight loss. Her diagnosis is anorexia nervosa. She is 16 and looks about 8. Her daily intake is about eight cans of diet soda. Your initial nursing goal is: A. Establish trust. B. Request nutritional supplements from Dietary. C. Explore with her the rationale for refusing to eat. D. B and C

ANS: A Though your first impulse might be one of the other responses, establishing trust is the initial goal.

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the client's motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence.

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the client's motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence.

Which statement is characteristically consistent with those individuals who engage in the restrictive form of anorexia nervosa? A. "I avoid situations where I would be expected to eat." B. "I exercise at the gym at least 6 days a week." C. "I was overweight before the eating disorder began." D. "Everyone who knows me knows I'm very competitive."

A. "I avoid situations where I would be expected to eat." B. "I exercise at the gym at least 6 days a week." D. "Everyone who knows me knows I'm very competitive." The restricters are more often young people in the normal or slightly above normal weight range for height and build before the eating disorder begins. This group views losing weight as more probable if they simply eat less and avoid social situations in which they are expected to eat. Restricters often withdraw to their rooms and avoid family and friends. It is not uncommon for them to be competitive, compulsive, and obsessive about their activities. They might participate in rigid exercise programs to help reduce their weight.

When a person diagnosed with anorexia nervosa genuinely loses the normal sensations of hunger, the nurse recognizes that the cause is associated with which physiologic process? A. Delayed gastric emptying B. Diminished abdominal peristalsis C. Dehydration D. Refeeding syndrome

A. Delayed gastric emptying Many patients have delayed gastric emptying, causing them to feel full much longer than most people. Thus, these patients do not have the normal desire to eat as often as others. Slower abdominal peristalsis combined with decreased intake leads to constipation, which fuels the use of laxatives, thus leading to dehydration and giving the anorectic a false sense of decreased weight. Dehydration can lead to irreversible renal damage.

Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach? The patient: a. now weighs 196 pounds. b. says, "I am using contraceptives." c. says, "I feel full after eating a small meal." d. reports problems with dry mouth and constipation.

ANS: A Lorcaserin is designed to make people feel full after eating smaller meals by activating a serotonin 2c receptor in the brain and blocking appetite signals. According to the FDA, this drug should be stopped if a patient does not have 5% weight loss after 12 weeks of use. If the patient now weighs 196 pounds, the medication has not been effective. The distracters indicate patient learning was effective and expected side effects of this medication.

Which of the following is NOT a characteristic of a patient with anorexia nervosa? A. Male B. Slightly overweight C. Anxious D. Perfectionistic

ANS: B Anorexic patients are generally severely underweight, can be male or female, anxious, and perfectionistic. They would not be overweight.

What approach would be most effective in helping a patient diagnosed with an eating disorder and hospitalized for extremely low weight who has been found sneaking diet pills? A. Education about the health risks and dangers of diet pills B. Discussion concerning the patient's fears of losing control when complying with the weight gain recommended Correct C. Discussion concerning the fears or worries generated in the family about current health status D. Confrontation of the patient regarding sneaking the diet pills and extreme thinness

B. Discussion concerning the patient's fears of losing control when complying with the weight gain recommended The correct option focuses on the significant issue in treatment for the patient; it avoids the diet pill use, which is a symptom and not representative of the key concern. This strategy represents the use of cognitive-behavior therapy with the patient.

During binge eating, the bulimic patient is most likely to consume what type of food? A. A leafy green salad with a creamy dressing B. Snack cakes with cream filling and icing C. A steak and fried potatoes D. A pizza with "everything" on it.

B. Snack cakes with cream filling and icing A variety of foods might be eaten during a binge, but the most common is high-calorie, high-carbohydrate "snack" food easily ingested in a short period. The other foods may be consumed, but they are not necessarily the food of choice.

Which statement is characteristically consistent with those individuals who engage in the vomiting-purging form of anorexia nervosa? A. "I avoid situations where I would be expected to eat." B. "I exercise at the gym at least 6 days a week." C. "I was overweight before the eating disorder began." D. "Everyone who knows me knows I'm very competitive."

C. "I was overweight before the eating disorder began." Compared with restricters, vomiters-purgers are more often overweight before the eating disorder begins, and their weight tends to fluctuate.

A patient experiencing an eating disorder is reluctant to step on the scale for weighing this morning. He says, "I just drank juice for breakfast, so I don't want to weigh today." How should the nurse respond to the patient's request? A. "It is okay to postpone your weighing if you will also eat some solid food to go with the juice for breakfast." B. "We can weigh you tomorrow instead. Don't forget to wait before you eat breakfast, though." C. "I will have to ask the team what to do in this case and get back to you with the decision." D. "It is weigh day today. Please step on the scale."

D. "It is weigh day today. Please step on the scale." Appropriate therapy for such a patient includes setting limits and stating in objective terms the expectation of weighing. This helps to manage the attempted manipulation common among such patients.

Which of the following interventions applies to all eating disorders? A. Encourage patients to identify the thoughts and feelings associated with eating. B. Do a strict intake, output, and calorie count for each shift. C. Keep patients in view for 1 to 2 hours after meals. D. Have a staff person monitoring each table during meals.

ANS: A As a general rule, eating disorders are associated with anxiety around meal time, so understanding thoughts and feelings associated with food is important for treatment. The other interventions may be needed for some patients at times, but not for all.

When preparing a therapeutic milieu for a patient who has bulimia nervosa, the nurse should provide: A. Realistic limits and guidelines on behavior after eating. B. A strict regimen of activities to ease the patients anxiety. C. Constant focus on the correct type and amount of food to instill adequate nutrition. D. Sympathy for the patients condition.

ANS: A Establishing realistic limits will give the patient a sense of control over his or her urge to binge and purge.

Your patient with anorexia nervosa is in the bathroom running in place at a rapid rate. What is the most likely reason for this behavior? A. She recently ate and wants to work off the calories to avoid gaining weight. B. She wants her heart rate increased so you will think she is having heart problems. C. She is a regular exerciser for good health. D. She is depressed and hopes this will make her feel more alert.

ANS: A Excessive exercise is a common behavior used by anorexics to purge calories after eating.

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? a. Assist the patient to identify triggers to binge eating. b. Provide corrective consequences for weight loss. c. Explore patient needs for health teaching. d. Assess for signs of impulsive eating.

ANS: A For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. The triggers are often anxiety-producing situations. Identifying these triggers makes it possible to break the binge-purge cycle. Because binge eating and purging directly affect physical status, the need to promote physical safety assumes the highest priority. The question calls for an intervention rather than an assessment.

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and has lost 25% of body weight. A nurse asks, Describe what you think about your present weight and how you look. Which response by the patient is most consistent with the diagnosis? a. I am fat and ugly. b. What I think about myself is my business. c. I am grossly underweight, but thats what I want. d. I am a few pounds overweight, but I can live with it.

ANS: A Patients diagnosed with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually disclose perceptions about self to others. The patient with anorexia will persist in trying to lose more weight.

One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from: a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9 C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36 C; pulse, 50 beats/min; blood pressure, 70/50 mm Hg c. 110 to 70 pounds over a 4-month period. Vital signs: temperature, 36.5 C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7 C; pulse, 62 beats/min; blood pressure, 74/48 mm Hg

ANS: A Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months, temperature below 36 C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.

The persistent eating of nonfood items such as clay, laundry starch, insects, leaves, or pebbles that lasts for longer than 1 month is called: a. Pica b. Bulimia c. Rumination d. Regurgitation

ANS: A Pica is the persistent eating of nonfood items that persists longer than 1 month and often is associated with a severe vitamin or mineral deficiency. Bulimia refers to an eating disorder that is commonly characterized by bingeing and purging; rumination is a rare disorder that refers to regurgitation and rechewing of food; regurgitation refers to partially digested food brought up into the mouth.

Physical assessment of a patient diagnosed with bulimia nervosa often reveals: a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. amenorrhea.

ANS: A Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and are not usually observed in bulimia.

An appropriate goal for a patient who is on behavior modification for anorexia nervosa is: A. Gain 2 pounds per week. B. Eat all food at each meal. C. Discuss the meaning of food to the patient for 1 hour every day. D. Gain as much weight as possible in the first month of treatment to prevent serious complications of starvation.

ANS: A Slow, steady weight gain is associated with good outcomes physically and emotionally. Eating all food at each meal is unrealistic. The meaning of food would be difficult to discuss for the patient. This disorder has nothing to do with cooking techniques.

Which of the following are generally NOT associated with bulimia nervosa? A. Starvation B. Depression C. Erosion of teeth D. Sore throat

ANS: A Starvation is associated with anorexia nervosa. In bulimia nervosa, the patient is eating large amounts and then purging.

A patient diagnosed with anorexia nervosa has a body mass index (BMI) of 14.8 kg/m2. Which assessment finding is most likely to accompany this value? a. Cachexia b. Leukocytosis c. Hyperthermia d. Hypertension

ANS: A The BMI value indicates extreme malnutrition. Cachexia is a hallmark of this problem. The patient would be expected to have leukopenia rather than leukocytosis. Hypothermia and hypotension are likely assessment findings.

A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding? A. The emesis produced during purging is acidic and corrodes the tooth enamel. B. Purging causes the depletion of dietary calcium. C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene leads to dental caries.

ANS: A The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.

A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred? A. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. B. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. C. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. D. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

ANS: A The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food, followed by purging.

An outpatient diagnosed with anorexia nervosa has begun re-feeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: a. assess lung sounds and extremities. b. suggest the use of an aerobic exercise program. c. positively reinforce the patient for the weight gain. d. establish a higher goal for weight gain the next week.

ANS: A Weight gain of more than 2 to 5 pounds weekly may overwhelm the hearts capacity to pump, leading to cardiac failure. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are undesirable because they increase the risk for cardiac complications.

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) A. Binge eating with obesity B. Bingeing and purging with a diagnosis of bulimia nervosa C. Weight loss with a diagnosis of anorexia nervosa D. Amenorrhea with a diagnosis of anorexia nervosa E. Emaciation with a diagnosis of bulimia nervosa

ANS: A, B The nurse should identify that topiramate (Topamax) is the drug of choice when treating binge eating with obesity and bingeing and purging with a diagnosis of bulimia nervosa. Topiramate (Topamax) is a novel anticonvulsant used in the long-term treatment of binge-eating disorder with obesity. The use of Topamax results in a significant decline in mean weekly binge frequency and significant reduction in body weight. With the use of this medication, episodes of bingeing and purging were decreased in clients diagnosed with bulimia nervosa.

A patient referred to the eating disorders clinic has lost 35 pounds in 3 months and has developed amenorrhea. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply. a. Peripheral edema b. Parotid swelling c. Constipation d. Hypotension e. Dental caries f. Lanugo

ANS: A, C, D, F Peripheral edema is often present because of hypoalbuminemia. Constipation related to starvation is often present. Hypotension is often present because of dehydration. Lanugo is often present and is related to starvation. Parotid swelling is associated with bulimia. Dental caries are associated with bulimia.

A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? a. Because severe anxiety concerning eating is expected, objective and subjective data must be routinely collected. b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment. c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met. d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.

ANS: B A sense of control for the patient is vital to the success of therapy. A diet that controls weight gain can allay patient fears of a too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that the patients needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an additional aspect of treatment.

Nurses know that the main difference between anorexia nervosa and bulimia nervosa is that the patient with bulimia nervosa: A. Is morbidly obese. B. Eats and purges in secret to keep the problem hidden. C. Gets pleasure from being able to control the urge to eat. D. Meal time is more stressful.

ANS: B Bulimia nervosa is a secretive disorder where the individual is often normal weight or slightly overweight and binges and purges in secret. Pleasure from controlling the urge to eat is associated with anorexia nervosa. Meal time is stressful for other disorders.

What behavior by a nurse caring for a patient diagnosed with an eating disorder indicates the nurse needs supervision? a. The nurses comments are nonjudgmental. b. The nurse uses an authoritarian manner when interacting with the patient. c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d. The nurse refers the patient to a self-help group for individuals with eating disorders.

ANS: B In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assume the role of a parent. The helpful nurse uses a problem-solving approach and focuses on the patients feelings of shame and low self-esteem. Referral to a self-help group is an appropriate intervention.

The nurse is identifying outcomes for a teenager diagnosed with anorexia nervosa. Which outcome has the greatest impact on long-term prognosis? a. Verbalize underlying psychological issues. b. Demonstrate effective coping skills related to conflict management. c. Demonstrate improvement in body imagine reflecting a realistic viewpoint. d. Consume adequate calories appropriate for age, height, and metabolic needs.

ANS: B Long-term prognosis is dependent on the patients ability to cope with the stressors that are at the root of the emotional problems such as conflict with family. Verbalization of underlying stressors is not a guarantee that there will be progress towards managing them. Acceptance of ones body and adequate calorie intake is possible only after coping skills are learned and used.

Which disorder is associated with persons with a body weight that is normal or even slightly above average? a. Pica b. Bulimia c. Obesity d. Anorexia nervosa

ANS: B Often, a bulimic has a body weight that is normal or even slightly above average. Pica is a disorder in which the individual is eating abnormal substances. Obese individuals are above normal weight, and individuals with anorexia nervosa have less than normal weight.

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient to: a. eat a small meal after purging. b. avoid skipping meals or restricting food. c. concentrate oral intake after 4 PM daily. d. understand the value of reading journal entries aloud to others.

ANS: B One goal of health teaching is the normalization of eating habits. Food restriction and skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce vomiting. Teaching the patient to concentrate intake after 4 PM will lead to late-day bingeing. Journal entries are private.

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? a. Binge eating disorder b. Anorexia nervosa c. Bulimia nervosa d. Pica

ANS: B Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. Pica refers to eating nonfood items.

Of the following observations, which is the most objective measure of improvement in your patient with anorexia nervosa? A. She eats all of her food on the tray at lunch. B. She gains 2 pounds from last week. C. She weighs herself daily. D. She tells you her friends are bringing her special foods

ANS: B Response B is the most objective to indicate improvement with an anorexia nervosa patient. Response A is a one-time observation, response C could be anxiety behavior, and response D could have many meanings.

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? a. Carefree flexibility b. Rigidity, perfectionism c. Open displays of emotion d. High spirits and optimism

ANS: B Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients diagnosed with eating disorders. The incorrect options are rare in a patient with anorexia nervosa. Inflexibility, controlled emotions, and pessimism are more the norm.

The main focus of medical management for anorexia is to: a. Encourage rapid weight gain. b. Encourage the client to eat voluntarily. c. Teach more appropriate food choices. d. Keep the client from developing additional problems.

ANS: B The main focus is to encourage the client to consume food voluntarily because this will allow for continued normal food consumption. Too rapid weight gain will lead to a feeling of loss of control, which could induce inappropriate eating behaviors again. Teaching appropriate food choices and keeping the client from developing additional problems occur as a part of the psychological management of the disorder.

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply? A. Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions. B. Family intervention and support are important in your childs recovery. C. Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support. D. Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed.

ANS: B The nurse should educate the family on the importance of family dynamics, involvement, and support in the treatment of anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of this disorder or impede the progress of recovery.

Which nursing intervention has priority as a patient diagnosed with anorexia nervosa begins to gain weight? a. Assess for depression and anxiety. b. Observe for adverse effects of re-feeding. c. Communicate empathy for the patients feelings. d. Help the patient balance energy expenditure and caloric intake.

ANS: B The nursing intervention of observing for adverse effects of re-feeding most directly relates to weight gain and is a priority. Assessing for depression and anxiety and communicating empathy relate to coping. Helping the patient balance energy expenditure and caloric intake is an inappropriate intervention.

Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa? A. Provide privacy during meals. B. Remain with the client for at least 1 hour after the meal. C. Encourage the client to keep a journal to document types of food consumed. D. Restrict client privileges when provided food is not completely consumed.

ANS: B A nurse should remain with clients diagnosed with either anorexia nervosa or bulimia nervosa for at least 1 hour after meals. This allows the nurse to monitor for food discarding (anorexia nervosa) and/or self-induced vomiting (bulimia nervosa).

A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention? A. To gain additional information about the progression of the disease process B. To emphasize that the client is capable of consuming food without purging C. To incorporate specific foods into the meal plan to reflect pleasant memories D. To assist the client to become more compliant with the treatment plan

ANS: B By asking the client to recall a time in life when food could be consumed without purging, the nurse is assessing previously successful coping strategies. This information can be used by the client to modify maladaptive behaviors in the present and future.

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply? A. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." C. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." D. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

ANS: B The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of this disorder.

A client with a diagnosis of anorexia is admitted to an inpatient setting. Which therapeutic intervention is used with caution prior to stabilization and weight gain? a. Establish rapport and trust b. IV or tube feeding c. Administering antidepressants d. Daily weights

ANS: C Administering antidepressants to clients with anorexia before they regain weight may be hazardous if the individual has a history of cardiac problems or presently has a low serum potassium level. Be sure to check the laboratory results of clients with eating disorders.

A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patients oral intake, the nurse should ask: a. Do you often feel fat? b. Who plans the family meals? c. What do you eat in a typical day? d. What do you think about your present weight?

ANS: C Although all the questions might be appropriate to ask, only What do you eat in a typical day? focuses on the eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family meal planning are unrelated to eating patterns. Asking for the patients thoughts on present weight explores the patients feelings about weight.

Your first goal in the care of a patient with an eating disorder is: A. Reassure the patient that he or she is attractive. B. Teach the patient nutrition requirements for his or her age and height. C. Establish a trusting relationship with the patient. D. Ask the patient to explain why he or she will not eat.

ANS: C Establishing trust is key to the ongoing relationship. Response A is false reassurance. Response B is unrelated to the patients emotional issues. In response D the patient may not be aware of the etiology.

When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this clients symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels B. Abnormal electroencephalogram (EEG) C. Metabolic acidosis D. Metabolic alkalosis

ANS: C Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. The nurse should attribute this clients fainting to the loss of alkaline stool due to laxative abuse, which would lead to a relative metabolic acidotic condition.

While providing health teaching for a patient diagnosed with bulimia nervosa, a nurse should emphasize information about: a. self-monitoring of daily food and fluid intake. b. establishing the desired daily weight gain. c. recognizing symptoms of hypokalemia. d. self-esteem maintenance.

ANS: C Hypokalemia results from potassium loss associated with vomiting. Physiologic integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the risk for hypokalemia.

Long-term prognosis for eating disorders is improved dramatically when treatment includes long-term cognitive-behavioral therapy. What statement provides the best explanation to the patient for this component to the treatment plan? a. This will help you identify a healthy, weight restoration diet. b. Medication alone will not help you from relapsing back to your old habits. c. In order to manage your disorder, you have to understand the root problems. d. Prognosis has been proven to be much better with both medication and therapy.

ANS: C Individuals need to resolve the core problems related to their eating behavior as well as the underlying psychological issues. Outcome literature indicates that long-term cognitive-behavioral, family, or interpersonal therapy, often in combination with antidepressant medication, results in the most sustained improvement. Long-term outcome studies show a more promising prognosis for those patients who continue treatment. Weight restoration is necessary but not sufficient for recovery. The options that discuss the components of treatment do not sufficiently explain the reasoning behind cognitive and behavior therapy.

Which statement is most true about anorexia nervosa? A. It is only found in females. B. A major symptom is loss of appetite. C. Overuse of laxatives is a common symptom. D. All of the above

ANS: C Laxative abuse is often part of purging behaviors to promote weight loss. The disorder is found in men, and patients are often hungry while denying themselves food.

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patients body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet, 4 inches tall. Which condition should be documented? a. Amenorrhea b. Alopecia c. Lanugo d. Stupor

ANS: C The fine, downy hair noted by the nurse is called lanugo. It is frequently seen in patients with anorexia nervosa. None of the other conditions can be supported by the data the nurse has gathered.

A clients altered body image is evidenced by claims of feeling fat, even though the client is emaciated. Which is the appropriate outcome criterion for this clients problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

ANS: C The nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self on the basis of self-attributes instead of appearance and to realize that perfection is unrealistic.

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? A. The client gains 2 pounds in 1 week. B. The client focuses conversations on nutritious food. C. The client demonstrates healthy coping mechanisms that decrease anxiety. D. The client verbalizes an understanding of the etiology of the disorder.

ANS: C The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behaviors.

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the best rationale for scheduling group therapy at this time? A. To shift the clients focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation

ANS: C When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.

ANS: C The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents.

A morbidly obese client is prescribed an anorexiant medication. The nurse should prepare to teach the client about which medication? A. Diazepam (Valium) B. Dexfenfluramine (Redux) C. Sibutramine (Meridia) D. Pemoline (Cylert)

ANS: C The nurse should teach the client that sibutramine (Meridia) is an anorexiant medication prescribed for morbidly obese clients. The mechanism of action in the control of appetite appears to occur by inhibiting the neutotransmitters serotonin and norepinephrine. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients? A. The nurse who understands the importance of three balanced meals a day B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption D. The nurse who grew up poor and frequently did not have enough food to eat

ANS: C The nurse who refuses to engage in power struggles related to food consumption will probably be most effective when dealing with clients diagnosed with eating disorders. Because of this attitude the nurse recognizes that the real issues have little to do with food or eating patterns. The nurse will be able to focus on the control issues that precipitated these behaviors.

A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. C. The client will gain 2 pounds prior to the next weekly appointment. D. The client will remain free of signs and symptoms of malnutrition and dehydration.

ANS: C The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, measurable, and also include a time frame.

A client diagnosed with bulimia nervosa is to receive fluoxetine (Prozac) by oral solution. The medication is supplied in a 100 mL bottle. The label reads 20 mg/5 mL. The doctor orders 60 mg q day. Which dose of this medication should the nurse dispense? A. 25 mL B. 20 mL C. 15 mL D. 10 mL

ANS: C Twenty mg of Prozac multiplied by three results in the calculated 60 mg daily dose ordered by the physician. Each 5 mL contains 20 mg. Five mL multiplied by three equals the liquid dosage of 15 mL.

What are the criteria for the diagnosis of bulimia? (Select all that apply.) a. Occasional episodes of binge eating b. Refusal to maintain body weight that is more than 15% below normal c. Excessive emphasis placed on body shape and weight d. Eating binges at least twice per week for at least 3 months

ANS: C, D These are two of the four criteria for the diagnosis of bulimia. Bulimia criteria include recurring episodes of binge eating rather than only occasional episodes; refusal to maintain body weight that is more than 15% below normal is a criterion for the diagnosis of anorexia nervosa.

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply. a. Flexible mealtimes b. Unscheduled weight checks c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips f. Privileges correlated with emotional expression

ANS: C, D, E Priority milieu interventions support the restoration of weight and a normalization of eating patterns. These goals require close supervision of the patients eating habits and the prevention of exercise, purging, and other activities. Menus are strictly adhered to. Patients are observed during and after meals to prevent them from throwing away food or purging. All trips to the bathroom are monitored. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.

Which are key features of anorexia nervosa? (Select all that apply.) a. Excessive laxative use b. Purging c. Severe weight loss d. Introverted personality e. Hunger is denied

ANS: C, D, E These are some of the key features of anorexia nervosa. Excessive laxative use and purging are characteristic of bulimia.

When a nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight, the nurse should state: a. You and I will have to sit down and discuss this problem. b. It bothers me to see you exercising. Youll lose more weight. c. Lets discuss the relationship between exercise and weight loss and how that affects your body. d. According to our agreement, no exercising is permitted until you have gained a specific amount of weight.

ANS: D A matter-of-fact statement that the nurses perceptions are different helps avoid a power struggle. Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients must be held accountable for required behaviors.

Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders? A. These programs help clients correct distorted body image. B. These programs address underlying client anger. C. These programs help clients manage uncontrollable behaviors. D. These programs allow clients to maintain control.

ANS: D Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders because the programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques aid in restoring healthy body weight.

During an episode of binge eating, what type of food is usually taken in large amounts? a. Fruits b. Red meat c. Fried or high fat content foods d. Cakes, donuts, or sweets

ANS: D Binge eating is defined as consuming an amount of food that is definitely larger than most individuals would eat in similar circumstances. During a binge an individual consumes large quantities of certain foods, usually carbohydrates.

Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? a. Weight, muscle, and fat are congruent with height, frame, age, and sex. b. Calorie intake is within the required parameters of the treatment plan. c. Weight reaches the established normal range for the patient. d. Patient expresses satisfaction with body appearance.

ANS: D Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This consideration is subjective. The other indicators are more objective but less related to the nursing diagnosis.

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: a. maintaining patients concentration and attention. b. shifting the patients focus from food to psychotherapy. c. focusing on weight control mechanisms and food preparation. d. processing the heightened anxiety associated with eating.

ANS: D Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to be successful in attaining therapeutic goals. Shifting the patients focus from food to psychotherapy and focusing on weight control mechanisms and food preparation are not desirable. Maintaining patients concentration and attention is important, but not the primary purpose of the schedule.

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will: a. weigh self accurately using balanced scales. b. limit exercise to less than 2 hours daily. c. select clothing that fits properly. d. gain 1 to 2 pounds.

ANS: D Only the outcome of a gain of 1 to 2 pounds can be accomplished within 1 week when the patient is an outpatient. The focus of an outcome is not on the patient weighing self. Limiting exercise and selecting proper clothing are important, but weight gain takes priority.

A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? a. What are your feelings about not eating the food that you prepare? b. You seem to feel much better about yourself when you eat something. c. It must be difficult to talk about private matters to someone you just met. d. Being thin does not seem to solve your problems. You are thin now but still unhappy.

ANS: D The correct response is the only strategy that attempts to question the patients distorted thinking.

A nursing diagnosis for a patient diagnosed with bulimia nervosa is: Ineffective coping, related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is, Within 2 weeks the patient will: a. appropriately express angry feelings. b. verbalize two positive things about self. c. verbalize the importance of eating a balanced diet. d. identify two alternative methods of coping with loneliness

ANS: D The outcome of identifying alternative coping strategies is most directly related to the diagnosis of Ineffective coping. Verbalizing positive characteristics of self and verbalizing the importance of eating a balanced diet are outcomes that might be used for other nursing diagnoses. Appropriately expressing angry feelings is not measurable.

Nurses realize the importance of family relationships in the life of a patient with anorexia nervosa. As a nurse, you would expect which of the following attitudes or behaviors in the parents of an adolescent with anorexia nervosa? A. Indifferent and inattentive B. Permissive and providing loose boundaries C. Immature and concerned with themselves D. Perfectionistic and overly demanding

ANS: D The parents of an adolescent with anorexia nervosa have often set very high standards that the child fears cannot be met.

A 14-year-old patient is diagnosed with anorexia nervosa. Nurses know this disorder is most associated with: A. Poor parenting. B. Anger at parents. C. Low self-esteem. D. Distorted body image.

ANS: D Though responses A, B, and C may be present, distorted body image is the primary disturbance.

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. I do not use any laxatives or diuretics to lose weight. B. I am losing lots of hair. Its coming out in handfuls. C. I know that I am thin, but I refuse to be fat! D. I dont know why people are worried. I need to lose this weight.

ANS: D When the client states, I dont know why people are worried. I need to lose this weight, the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

The mother of a teen with an eating disorder expresses a concern that the family is responsible for the problem. Which question will best help the nurse identify another influence that is likely to have played a role in the teenagers eating disorder? a. Does she have an after-school job? b. Does she have access to nutritious foods? c. Is there a family history of underweight adults? d. Is your daughter interested in clothes and fashion?

ANS: D Women in this culture are bombarded by the fashion industry and media messages equating beauty with thinness. Although it is true that eating disorders are less common in countries where food is not abundant, in this culture persons with eating disorders tend not to choose nutritious foods. Workplace competition with men would be of greater significance than this broad statement. The biologic tendency to be overweight may influence some persons.

A patient diagnosed with an eating disorder asks to be excused from a meal to use the restroom. What is the nurse's best response to the patient's request? a. "No one is permitted to leave the table during meals." b. "You may go after you've finished your meal." c. "I will go with you to the restroom." d. "No. I know you want to vomit."

c. "I will go with you to the restroom."

Which assessment findings related to the same patient help confirm a diagnosis of anorexia nervosa? (Select all that apply.) a. Patient reports amenorrhea for 9 months b. Patient is 5 feet 4 inches tall and weighs 85 lb c. Blood pressure (BP) 70/42 mm Hg d. Skin turgor is poor e. Pulse 68 beats/min

a. Patient reports amenorrhea for 9 months b. Patient is 5 feet 4 inches tall and weighs 85 lb c. Blood pressure (BP) 70/42 mm Hg d. Skin turgor is poor

One bed is available on the inpatient eating disorders unit. Assessment findings for four patients are listed as follows. Which patient has priority for admission? a. Weight decreased from 150 to 102 lb in 4 months. Vital signs are T 96.9°F; P 46 beats/min; BP 68/48 mm Hg. Amenorrhea for 8 months. b. Weight decreased from 110 to 86 lb in 4 months. Vital signs are T 97.5°F; P 60 beats/min; BP 80/66 mm Hg. Amenorrhea for 2 months. c. Weight decreased from 120 to 90 lb in 3 months. Vital signs are T 98°F; P 50 beats/min; BP 70/50 mm Hg. Menstruation scant for 3 months. d. Weight decreased from 90 to 78 lb in 5 months. Vital signs are T 97.7°F; P 62 beats/min; BP 74/52 mm Hg. Menstruation irregular for 6 months.

a. Weight decreased from 150 to 102 lb in 4 months. Vital signs are T 96.9°F; P 46 beats/min; BP 68/48 mm Hg. Amenorrhea for 8 months.

A nurse is engaged in psychoeducational activities with a hospitalized teenage patient diagnosed with bulimia nervosa. What response should the nurse provide when a patient asks, "What should I do when I feel the need to vomit?" a. "Do vigorous aerobic exercise until the urge goes away." b. "Seek out a staff member to talk about your feelings." c. "Call your parents on the phone to show you care." d. "Allow yourself to vomit, but avoid purging."

b. "Seek out a staff member to talk about your feelings."

A nurse planning care for a patient diagnosed with bulimia nervosa should recommend the use of what for therapy? a. Psychodynamic group therapy. b. Cognitive-behavioral therapy. c. Pharmacotherapy. d. Psychodrama.

b. Cognitive-behavioral therapy.

To meet DSM-V criteria for bulimia nervosa, the patient's history must reveal episodes of binge eating and compensatory behaviors occurring at least how often? a. Once a week for 6 months b. Once weekly for 3 months c. Three times weekly for a year d. Four times weekly for 6 months

b. Once weekly for 3 months

A patient diagnosed with bulimia nervosa has not responded to psychotherapeutic management. The health care provider is likely to prescribe a drug from which classification? a. Mood stabilizer b. Selective serotonin reuptake inhibitor (SSRI) antidepressant c. Typical antipsychotic d. Monoamine oxidase inhibitor antidepressant

b. Selective serotonin reuptake inhibitor (SSRI) antidepressant

A patient diagnosed with anorexia nervosa spills milk over a plate of partially eaten food. What is the nurse's best response to facilitate effective patient care? a. "That won't work. You are manipulating." b. "You are deliberately making mealtime difficult." c. "I will get you a fresh plate of food so you can finish." d. "You must eat your meal. I'll wait until you finish."

c. "I will get you a fresh plate of food so you can finish."

Which personality characteristic would the nurse expect in a patient diagnosed with an eating disorder? a. Grandiosity b. Impulsivity c. Perfectionism d. Suspiciousness

c. Perfectionism

School nurses should be particularly vigilant for signs of eating disorders related to what timeline? a. Fourth-graders who have never attended another school. b. Rebellious, aggressive girls at any age. c. Pre and post holidays and prior to summer break. d. At transitions between elementary, middle, and high school.

d. At transitions between elementary, middle, and high school.

The nurse interviews a patient who restricts food and is 25% underweight. When the patient says, "I still need to lose weight. I'm not thin enough" which defense mechanism is being implemented? a. Rationalization b. Projection c. Splitting d. Denial

d. Denial

What assessment finding supports a diagnosis of anorexia rather than bulimia? a. Body weight near normal for height b. Fluid and electrolyte imbalances are present c. Engages in strenuous exercise daily d. Eating disorder begin at age 14

d. Eating disorder begin at age 14

Which information about a patient diagnosed with bulimia nervosa should the nurse document as subjective data? a. Scarred fingers b. Sores around mouth c. Loss of tooth enamel d. Feeling out of control

d. Feeling out of control

Which assessment finding would the nurse document as subjective evidence of anorexia nervosa? a. Presence of lanugo on body b. Bradycardia notes upon regular assessment c. 25-lb weight loss over 3-month period d. Patient states fear of gaining weight

d. Patient states fear of gaining weight

A nurse teaches a class about bulimia nervosa to high school biology students. The nurse should provide what neurotransmitter process as a possible cause of this eating disorder? a. Hypersensitivity of norepinephrine b. Excessive dopamine activity c. Overproduction of GABA d. Serotonin deficits

d. Serotonin deficits

Which finding indicates that a patient diagnosed with anorexia nervosa has met a major objective of psychotherapeutic management? a. The patient's residual volume is less than 30 mL before tube feedings. b. The patient says, "I am no longer fearful of gaining weight." c. The patient reads cookbooks and plans nutritious meals. d. The patient weighs 90% of average body weight.

d. The patient weighs 90% of average body weight.