psychiatric chapter 14

What classic characteristic is noted in clients diagnosed with bulimia nervosa?

Onset in late adolescence

A patient with anorexia nervosa is particularly resistant to the idea of 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?

Patient involvement in decision making increases sense of control and promotes compliance with treatment.

Disturbed body image is the nursing diagnosis for a patient with an eating disorder. Which outcome indicator is most appropriate to monitor?

Patient satisfaction with body appearance'

Which statement made by the parent of a teen with anorexia nervosa signals to a nurse that teaching needs exist?

"Will treatment affect my child's number one standing on the gymnastics team?"

Which nursing assessment question is focused on determining the client's motivation for binge eating?

"Would you say that you are less depressed after binging?"

When a nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed upon weekly weight, the nurse should state:

"According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient with anorexia nervosa. Which statement by the nurse supports this type of therapy?

"Being thin doesn't seem to solve your problems. You're thin now but still unhappy."

A patient is diagnosed with anorexia nervosa. The history reveals the patient virtually stopped eating 5 months ago and lost 25% of body weight. A nurse tells the patient, "Describe what you think about your present weight and how you think you look." Which response would be most consistent with the diagnosis?

"I'm fat and ugly."

Which statement is a nurse is most likely to hear during an interview session from a patient with anorexia nervosa?

"I'm fat and ugly."

Which statement by a patient with an eating disorder reflects correct understanding of the condition rather than a cognitive distortion?

"I've been coping with disappointment by overeating."

Which statement by a nurse caring for a patient with an eating disorder signals a need for supervision?

"The patient's perfectionism and resistance often make me angry."

A patient referred to the eating disorders clinic has lost 35 pounds during one summer. To assess the patient's eating patterns, the nurse should ask:

"What do you eat in a typical day?"

One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from:

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

A nurse managing the care of a client diagnosed with an eating disorder has begun to experience frustration when the client consistently pushes back against the planned interventions. What action on the part of the nurse is indicated to help strengthen the nurse-client relationship?

Acknowledging to the client that working toward these treatment goals must be very frightening

A patient is referred to the mental health center by the family health care provider. Over the past year, the patient has cooked gourmet meals for family members, but eats only tiny portions of the food. The patient wears layers of loose clothing, saying, "It's just my style." The patient's weight has dropped from 130 to 95 pounds. The patient has amenorrhea. The history and symptoms are most consistent with which medical diagnosis?

Anorexia nervosa

Which nursing intervention has highest priority for a patient with bulimia nervosa?

Assist the patient to identify triggers to binge eating.

A nursing care plan contains the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction?

Cardiovascular

Which nursing intervention will best address the intense need to control demonstrated by a client receiving treatment of bulimia nervosa?

Clearly stating expectations and admitting that they differ from those of the client

Which assessment data confirms that the client diagnosed with anorexia nervosa has achieved a fundamental treatment outcome?

Client has maintained weight at 87% of ideal body weight for 2 months

Which nursing diagnosis is more relevant for a patient with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient with bulimia nervosa who purges?

Imbalanced nutrition: less than body requirements

A patient is diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is 2.7 mg/dL. Which nursing diagnosis applies?

Imbalanced nutrition: less than body requirements related to refusal to eat, as evidenced by loss of 25% of body weight and hypokalemia

A patient being admitted to the eating disorders unit has a yellow cast to the skin, has hair that is limp and dry, and has fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet and sullen during the physical assessment saying only, "I don't intend to eat until I lose enough weight to look thin." What is the best initial nursing diagnosis?

Imbalanced nutrition: less than body requirements related to self-starvation

Which theme might be expected during family therapy with two parents, two siblings, and a teen patient with anorexia nervosa who engages in provocative behavior?

Lack of trust in the patient by the family

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet 4 inches tall. Which term should be documented?

Lanugo

A student transferred from a hometown community college to a university 100 miles from home. She was slow to make new friends at the university. The history shows a close relationship with her mother and sister and that she broke up with her boyfriend of 2 years. She began to eat large quantities when she felt sad, and then induce vomiting. These cycles continued until they interfered with her schoolwork. She sought help from the university health clinic. During the initial interview, what other priority issue should a nurse address?

Losses

What nursing intervention best supports the outcome that a patient with anorexia nervosa will gain 1 to 2 pounds per week?

Observe for adverse side effects of refeeding.

Which characteristic is a nurse most likely to assess in a patient with anorexia nervosa?

Rigidity, perfectionism

A patient with an eating disorder has been under significant stress and works long hours. At home, the patient watches television and eats until going to bed. The patient is too tired to exercise and has gained 25 pounds in 1 month. The patient is 5 feet tall and weighs 175 pounds. A desired outcome for the patient is to recognize the anxiety that precedes binge eating and reduce it with a constructive strategy. Which intervention addresses the outcome?

Teach stress reduction techniques such as relaxation and imagery.

What behavior might signal that a nurse caring for a patient with bulimia nervosa is experiencing rescue feelings?

The nurse assesses the patient's problem as poor eating habits and provides a diet to follow.

Which finding for a patient with an eating disorder signals a nurse that the patient should be hospitalized for treatment?

Urine output less than 30 mL/hr

A patient referred to the eating disorders clinic has lost 35 pounds during the summer and developed amenorrhea. For which physical manifestations of anorexia nervosa should a nurse assess? (More than one answer is correct.)

a.Peripheral edema c.Constipation d.Hypotension f.Lanugo

A patient with anorexia nervosa being treated on an outpatient basis has begun refeeding. Between the first and second appointments the patient gains 8 pounds. The nurse should:

assess lung sounds and extremities.

When a patient with anorexia is admitted for treatment, what should the milieu provide? (More than one answer is correct.)

b.Adherence to a selected menu c. Observation during and after meals e.Monitoring during bathroom trips

A patient diagnosed with anorexia nervosa will be treated as an outpatient. A desired outcome related to the nursing diagnosis of Imbalanced nutrition: less than body requirements would be that within 1 week, the patient will:

gain 1 to 2 pounds.

A nursing diagnosis for a patient with bulimia nervosa is Ineffective coping related to feelings of loneliness and isolation as evidenced by use of overeating to comfort self followed by self-induced vomiting. The outcome related to this diagnosis is that within 2 weeks the patient will:

identify two alternative methods of coping with loneliness and isolation.

An appropriate intervention for a patient with bulimia nervosa who binges and purges is to teach the patient:

not to skip meals or restrict food.

Nursing physical assessment of a patient with bulimia often reveals:

prominent parotid glands.

A nurse responsible for conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of:

promoting processing of anxiety associated with eating.

While providing health teaching for a patient with binge-purge bulimia, a nurse should prioritize information about:

symptoms of hypokalemia.