230 Somatic symptom & Eating disorders
A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? "What are your feelings about not eating foods that you prepare?" "You seem to feel much better about yourself when you eat something." "It must be difficult to talk about private matters to someone you just met." "Being thin doesn't seem to solve your problems. You are thin now but still unhappy."
"Being thin doesn't seem to solve your problems. You are thin now but still unhappy." (The correct response is the only strategy that attempts to question the patient's distorted thinking.)
A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate? "You and I will have to sit down and discuss this problem." "It bothers me to see you exercising. I am afraid you will lose more weight." "Let's discuss the relationship between exercise, weight loss, and the effects on your body." "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."
"According to our agreement, no exercising is permitted until you have gained a specific amount of weight." (A matter-of-fact statement that the nurse's perceptions are different will help to 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.)
Physical assessment of a patient diagnosed with bulimia often reveals: prominent parotid glands. thin, brittle hair. peripheral edema. 25% underweight.
prominent parotid glands. (Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and not usually seen in bulimia.)
A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: maintaining patients' concentration and attention. shifting the patients' focus from food to psychotherapy. promoting processing of anxiety associated with eating. focusing on weight control mechanisms and food preparation.
promoting processing of anxiety associated with eating. (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.)
Ch. 17: Somatic Symptom DIsorders
Ch. 17: Somatic Symptom DIsorders
Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? "A combination of antianxiety and antidepressant therapy is the most effective therapy." "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."
"Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders." (CBT is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this disorder.)
Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? "I purge only once a day now instead of twice." "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." "I am a hard worker and I am very compassionate toward others." "I always purge when I'm alone so that I'm not a bad role model for my younger sister."
"I am a hard worker and I am very compassionate toward others." (An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is incorrect because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging.)
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and 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? "I am fat and ugly." "What I think about myself is my business." "I'm grossly underweight, but that's what I want." "I'm a few pounds overweight, but I can live with it."
"I am fat and ugly." (Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually tell people perceptions of self. The patient with anorexia does not recognize his or her thinness and will persist in trying to lose more weight.)
A patient says, "I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive reframing? "You do not have a brain tumor. The more you talk about it, the more it reinforces your belief." "Let's see if there are any other possible explanations for your vomiting." "You seem so worried. Let's talk about how you're feeling." "We need to talk about something else."
"Let's see if there are any other possible explanations for your vomiting." (Questioning the evidence is a cognitive reframing technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.)
A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient? "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion." "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I'm getting seriously dehydrated." "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage." "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."
"Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion." (Patients with conversion (functional neurological) disorder demonstrate a lack of concern regarding the seriousness of symptoms. This lack of concern is termed "la belle indifférence." There is also a specific, identifiable cause for the development of the symptoms; in this instance, the death of a parent would precipitate stress. The distracters relate to sexual dysfunction and illness anxiety disorder.)
Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder? "What are you unable to do now but were previously able to do?" "How many doctors have you seen in the last year?" "Who do you talk to when you're upset?" "Did you experience abuse as a child?"
"What are you unable to do now but were previously able to do?" (Secondary gains should be assessed. Secondary gains reinforce maladaptive behavior. The patient's dependency needs may be evident through losses of abilities. When secondary gains are prominent, the patient is more resistant to giving up the symptom. There may be a history of abuse or doctor shopping, but the question does not assess the associated gains.)
A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient: "Do you often feel fat?" "Who plans the family meals?" "What do you eat in a typical day?" "What do you think about your present weight?"
"What do you eat in a typical day?" (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 patient's thoughts on present weight explores the patient's feelings about weight.)
Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" "Your legs don't work because your brain is screwed up." "Your emotional distress is being expressed as a physical symptom." "You are making up your symptoms as a cry for help." "You are overly anxious about having a severe illness."
"Your emotional distress is being expressed as a physical symptom." (Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder.)
One bed is available on the inpatient eating disorders unit. Which patient should be admitted to this bed? The patient whose weight decreased from: 150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg 120 to 90 pounds over a 3-month period. Vital signs are temperature, 36° C; pulse, 50 beats/min; blood pressure 70/50 mm Hg 110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5° C; pulse, 60 beats/min; blood pressure 80/66 mm Hg 90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7° C; pulse, 62 beats/min; blood pressure 74/48 mm Hg
150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg (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.)
A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A court date this week for drunk driving Was adopted at the age of 5 years A history of physical abuse by his stepfather Raised primarily in a single parent household
A court date this week for drunk driving (Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. Being raised in a single parent home is not known to be a causative factor in malingering.)
A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply. Flexible mealtimes Unscheduled weight checks Adherence to a selected menu Observation during and after meals Monitoring during bathroom trips Privileges correlated with emotional expression
Adherence to a selected menu Observation during and after meals Monitoring during bathroom trips (Priority milieu interventions support restoration of weight and normalization of eating patterns. This requires close supervision of the patient's eating and prevention of exercise, purging, and other activities. There is strict adherence to menus. Observe patients during and after meals to prevent throwing away food or purging. Monitor all trips to the bathroom. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.)
Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? Binge eating Bulimia nervosa Anorexia nervosa Eating disorder not otherwise specified
Anorexia nervosa (Overly controlled eating behaviors, extreme weight loss, 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. The patient with eating disorder not otherwise specified may be obese.)
Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder? Narcotic analgesics for use as needed for acute pain Antidepressant medications to treat underlying depression Long-term use of benzodiazepines to support coping with anxiety Conventional antipsychotic medications to correct cognitive distortions
Antidepressant medications to treat underlying depression (Various types of antidepressants may be helpful in somatic disorders directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood, but fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of anti-anxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence. Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful. Narcotic analgesics are not indicated.)
A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? Mood stabilizers Antidepressants Anxiolytics Atypical antipsychotics
Antidepressants (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. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders.)
Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? Assist the patient to identify triggers to binge eating. Provide corrective consequences for weight loss. Assess for signs of impulsive eating. Explore needs for health teaching.
Assist the patient to identify triggers to binge eating. (For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. Often the triggers are anxiety-producing situations. Identification of 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 highest priority.)
The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction? Renal Integumentary Endocrine Cardiovascular
Cardiovascular (Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment is a necessity to ensure the patient's physiological integrity. The other body systems are not initially involved in the refeeding syndrome.)
Ch. 18: Eating and Feeding Disorders
Ch. 18: Eating and Feeding Disorders
A patient with blindness related to conversion (functional neurological) disorder says, "All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don't find me as interesting." Which nursing diagnosis is most relevant? Social isolation Interrupted family processes Chronic low self-esteem Ineffective health maintenance
Chronic low self-esteem (The patient mentions that the symptoms make people more interested. This indicates that the patient feels uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in the scenario.)
What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? Client will walk unassisted within 1 week. Client will return to a pre-illness level of functioning within 2 weeks. Client will be able to state two new effective coping skills within 2 weeks. Client will assume full self-care within 3 weeks.
Client will be able to state two new effective coping skills within 2 weeks. (An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic.)
It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? Utilizing many different therapeutic strategies or modalities for enhanced coping Involving every member of the family as well as the patient in treatment Incorporating spirituality and religion into treatment Considering all dimensions of the patient, including biological, psychological, and sociocultural
Considering all dimensions of the patient, including biological, psychological, and sociocultural (It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care.)
A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply. Peripheral edema Parotid swelling Constipation Hypotension Dental caries Lanugo
Peripheral edema Constipation Hypotension Lanugo (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 a somatic symptom disorder says, "Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear." Which nursing diagnoses apply to this patient? Select all that apply. Spiritual distress Decisional conflict Adult failure to thrive Impaired social interaction Ineffective role performance
Spiritual distress Ineffective role performance (The patient's verbalization is consistent with spiritual distress. The patient's description of being unable to provide for and burdening the family indicates ineffective role performance. No data support diagnoses of adult failure to thrive, impaired social interaction, or decisional conflict.)
According to current theory, which statement regarding eating disorders is accurate? Eating disorders are psychotic disorders in which patients experience body dysmorphic disorder. Eating disorders are frequently misdiagnosed. Eating disorders are possibly influenced by sociocultural factors. Eating disorders are rarely comorbid with other mental health disorders.
Eating disorders are possibly influenced by sociocultural factors. (The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders.)
What is an essential difference between somatic symptom disorders and factitious disorders? Somatic symptom disorders are under voluntary control, whereas factitious disorders are unconscious and automatic. Factitious disorders are precipitated by psychological factors, whereas somatic symptom disorders are related to stress. Factitious disorders are individually determined and related to childhood sexual abuse, whereas somatic symptom disorders are culture bound. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization.
Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization. (The key is the only fully accurate statement. Somatic symptom disorders involve expression of stress through bodily symptoms and are not under voluntary control or culture bound. Factitious disorders are under voluntary control.)
A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings regarding this patient support the suspected diagnosis? Select all that apply. Female Reports frequent syncope Rates pain as "1" on a scale of "10" First diagnosed with psoriasis at age 12 Reports insomnia often results from back pain
Female Reports frequent syncope Reports insomnia often results from back pain (There is no chronic disease to explain the symptoms for patients with somatic symptom disorder. Patients report multiple symptoms; gastrointestinal and pseudoneurological symptoms are common. This disorder is more common in women than in men. Patients with conversion disorder would have a tendency to underrate pain.)
Which presentations suggest the possibility of a factitious disorder, self-directed type? Select all that apply. History of multiple hospitalizations without findings of physical illness History of multiple medical procedures or exploratory surgeries Going from one doctor to another seeking the desired response Claims illness to obtain financial benefit or other incentive Difficulty describing symptoms
History of multiple hospitalizations without findings of physical illness History of multiple medical procedures or exploratory surgeries (Persons with factitious disorders, self-directed type, typically have a history of multiple hospitalizations and medical workups, with negative findings from workups. Sometimes they have even had multiple surgeries seeking the origin of the physical complaints. If they do not receive the desired response from a hospitalization, they may elope or accuse staff of incompetence. Such persons usually seek treatment through a consistent health care provider rather than doctor-shopping, are not motivated by financial gain or other external incentives, and present symptoms in a very detailed, plausible manner indicating considerable understanding of the disorder or presentation they are mimicking.)
A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely? Dysthymic disorder Somatic symptom disorder Antisocial personality disorder Illness anxiety disorder (hypochondriasis)
Illness anxiety disorder (hypochondriasis) (Illness anxiety disorder (hypochondriasis) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Somatic symptom disorder involves fewer symptoms. Dysthymic disorder is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others.)
A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results were normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect? Conversion (functional neurological) disorder Illness anxiety disorder (hypochondriasis) Somatic symptom disorder Factitious disorder
Illness anxiety disorder (hypochondriasis) (Patients with illness anxiety disorder have fears of serious medical problems, such as cancer or heart disease. These fears persist despite medical evaluations and interfere with daily functioning. There are no complaints of pain. There is no evidence of factitious or conversion disorder.)
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? Powerlessness Ineffective coping Disturbed body image Imbalanced nutrition: less than body requirements
Imbalanced nutrition: less than body requirements (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 was 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 currently 2.7 mg/dL. Which nursing diagnosis applies? Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia
Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia (The patient's history and lab result support the nursing diagnosis "Imbalanced nutrition: less than body requirements." Data are not present that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.)
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. Anxiety related to fear of weight gain Disturbed body image related to weight loss Ineffective coping related to lack of conflict resolution skills Imbalanced nutrition: less than body requirements related to self-starvation
Imbalanced nutrition: less than body requirements related to self-starvation (The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient's self-starvation is the priority.)
When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? It will reduce the need for cognitive therapy. It will be prescribed at a higher than typical dose. There are a variety of medications to prescribe if fluoxetine proves to be ineffective. Long-term management of symptoms is best achieved with tricyclic antidepressants.
It will be prescribed at a higher than typical dose. (Research has shown that antidepressant medication together with cognitive-behavioral therapy brings about improvement in bulimic symptoms. Fluoxetine (Prozac), an Selective serotonin reuptake inhibitors (SSRI) antidepressant, has FDA approval for acute and maintenance treatment of bulimia nervosa in adult patients. When fluoxetine is used for bulimia, it is typically at a higher dose than is used for depression. Although no other drugs have FDA approval for this disorder, tricyclic antidepressants helped reduce binge eating and vomiting over short terms.)
A child has a history of multiple hospitalizations for recurrent systemic infections. The child is not improving in the hospital, despite aggressive treatment. Factitious disorder by proxy is suspected. Which nursing interventions are appropriate? Select all that apply. Increase private visiting time for the parents to improve bonding. Keep careful, detailed records of visitation and untoward events. Place mittens on the child to reduce access to ports and incisions. Encourage family members to visit in groups of two or three. Interact with the patient frequently during visiting hours.
Keep careful, detailed records of visitation and untoward events. Encourage family members to visit in groups of two or three. Interact with the patient frequently during visiting hours. (Factitious disorder by proxy is a rare condition wherein a person intentionally causes or perpetuates the illness of a loved one (e.g., by periodically contaminating IV solutions with fecal material). When this disorder is suspected, the child's life could be at risk. Depending on the evidence supporting this suspicion, interventions could range from minimizing unsupervised visitation to blocking visitation altogether. Frequently checking on the child during visitation and minimizing unobserved access to the child (by encouraging small group visits) reduces the opportunity to take harmful action and increases the collection of data that can help determine whether this disorder is at the root of the child's illness. Detailed tracking of visitation and untoward events helps identify any patterns there might be between select visitors and the course of the child's illness. Increasing private visitation provides more opportunity for harm. Educating visitors about aseptic techniques would not be of help if the infections are intentional, and preventing inadvertent contamination by the child himself would not affect factitious disorder by proxy.)
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? Amenorrhea Lanugo Alopecia Stupor
Lanugo (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.)
Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight? Assess for depression and anxiety. Observe for adverse effects of refeeding. Communicate empathy for the patient's feelings. Help the patient balance energy expenditures with caloric intake.
Observe for adverse effects of refeeding. (The nursing intervention of observing for adverse effects of refeeding most directly relates to weight gain and is a priority. Assessing for depression and anxiety, as well as communicating empathy, relate to coping. Helping the patient achieve balance between energy expenditure and caloric intake is an inappropriate intervention.)
Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? Weight, muscle, and fat congruence with height, frame, age, and sex Calorie intake is within required parameters of treatment plan Weight reaches established normal range for the patient Patient expresses satisfaction with body appearance
Patient expresses satisfaction with body appearance (Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This is a subjective consideration. The other indicators are more objective but less related to the nursing diagnosis.)
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? Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable. Patient involvement in decision making increases sense of control and promotes compliance with treatment. Because of increased risk of physical problems with refeeding, the patient's permission is needed. A team approach to planning the diet ensures that physical and emotional needs will be met.
Patient involvement in decision making increases sense of control and promotes compliance with treatment. (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 too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an additional aspect of treatment.)
Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)? Voluntary control of symptoms Results of diagnostic testing Patient's style of presentation The role of secondary gains
Patient's style of presentation (Patients with illness anxiety disorder (hypochondriasis) tend to be more anxious about their concerns and display more obsessive attention to detail, whereas the patient with conversion (functional neurological) disorder often exhibits less concern with the symptom they are presenting than would be expected. Neither disorder involves voluntary control of the symptoms. Results of diagnostic testing for both would be negative (i.e., no physiological basis would be found for the symptoms). Secondary gains can occur in both disorders but are not necessary to either.)
Which statement is true of the eating disorder referred to as bulimia? Patients with bulimia often appear at a normal weight. Patients with bulimia binge eat but do not engage in compensatory measures. Patients with bulimia severely restrict their food intake. One sign of bulimia is lanugo.
Patients with bulimia often appear at a normal weight. (Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.)
Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively? Flooding Relaxation techniques Response prevention Systematic desensitization
Relaxation techniques (Somatic symptom disorders are commonly associated with complicated reactions to stress. These reactions are accompanied by muscle tension and pain. Relaxation can diminish the patient's perceptions of pain and reduce muscle tension. The distracters are modalities useful in treating selected anxiety disorders.)
Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? Carefree flexibility Open displays of emotion Rigidity, perfectionism High spirits and optimism
Rigidity, perfectionism (Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients with eating disorders. The incorrect options are rare in a patient with an eating disorder. Inflexibility, controlled emotions, and pessimism are more the rule.)
Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization? Urine output 40 mL/hr Serum potassium 3.4 mEq/L Pulse rate 58 beats/min Systolic blood pressure 62 mmHg
Systolic blood pressure 62 mmHg (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.)
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? The nurse interacts with the patient in a protective fashion. The nurse's comments to the patient are compassionate and nonjudgmental. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. The nurse refers the patient to a self-help group for individuals with eating disorders.
The nurse interacts with the patient in a protective fashion. (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.)
A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse's planning for this patient? The patient is suppressing accurate feelings regarding the problem. The patient's anxiety is relieved through the physical symptom. The patient's optic nerve transmission has been impaired. The patient will not disclose genuine fears.
The patient's anxiety is relieved through the physical symptom. (Psychoanalytical theory suggests conversion reduces anxiety through production of a physical symptom symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. While some MRI studies suggest that patients with conversion disorder have an abnormal pattern of cerebral activation, there is no actual alternation of nerve transmission. The other distracters oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).)
An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: assess lung sounds and extremities. suggest use of an aerobic exercise program. positively reinforce the patient for the weight gain. establish a higher goal for weight gain the next week.
assess lung sounds and extremities. (Weight gain of more than 2 to 5 pounds weekly may overwhelm the heart's 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 medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding that the patient will probably: readily seek psychiatric counseling. be resistant to accepting psychiatric help. attend psychotherapy sessions without encouragement. be eager to discover the true reasons for physical symptoms.
be resistant to accepting psychiatric help. (Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling offered, these patients reject both.)
A nurse's neighbor says, "I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?" The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including: (select all that apply) cancer. hip fractures. hypertension. immune disorders. cardiovascular disease.
cancer. hypertension. immune disorders. cardiovascular disease. (A number of diseases can be worsened or brought to awareness by intense emotional stress. Immune disorders can be complicated associated with detrimental effects of stress on the immune system. Others can be brought about indirectly, such as cardiovascular disease due to acute or chronic hypertension. Hip fractures are not in this group.)
A patient with a somatic symptom disorder has the nursing diagnosis "Interrupted family processes related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient." An appropriate outcome is that the patient will: assume roles and functions of other family members. demonstrate performance of former roles and tasks. focus energy on problems occurring in the family. rely on family members to meet personal needs.
demonstrate performance of former roles and tasks. (The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and resumption of former roles are necessary to change this pattern. The distracters are inappropriate outcomes.)
A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should: establish a "buddy" system with other patients who can feed the patient at each meal. expect the patient to feed self after explaining arrangement of the food on the tray. direct the patient to locate items on the tray independently and feed self. address needs of other patients in the dining room, then feed this patient.
expect the patient to feed self after explaining arrangement of the food on the tray. (The patient is expected to maintain some level of independence by feeding self, while the nurse is supportive in a matter-of-fact way. The distracters support dependency or offer little support.)
Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis "Imbalanced nutrition: less than body requirements." Within 1 week, the patient will: weigh self accurately using balanced scales. limit exercise to less than 2 hours daily. select clothing that fits properly. gain 1 to 2 pounds.
gain 1 to 2 pounds. (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 would not be on the patient weighing self. Limiting exercise and selecting proper clothing are important, but weight gain takes priority.)
A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient: sees a relationship between symptoms and interpersonal conflicts. has little difficulty communicating emotional needs to others. rarely derives personal benefit from the symptoms. has altered comfort and activity needs.
has altered comfort and activity needs. (The patient frequently has altered comfort and activity needs associated with the symptoms displayed (fatigue, insomnia, weakness, tension, pain, etc.). In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic symptom disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.)
A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to: self-monitoring of daily food and fluid intake. establishing the desired daily weight gain. how to recognize hypokalemia. self-esteem maintenance.
how to recognize hypokalemia. (Hypokalemia results from potassium loss associated with vomiting. Physiological 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 dangers associated with hypokalemia.)
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 that within 2 weeks the patient will: appropriately express angry feelings. verbalize two positive things about self. verbalize the importance of eating a balanced diet. identify two alternative methods of coping with loneliness.
identify two alternative methods of coping with loneliness. (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.)
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient: to eat a small meal after purging. not to skip meals or restrict food. to increase oral intake after 4 PM daily. the value of reading journal entries aloud to others.
not to skip meals or restrict food. (One goal of health teaching is 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 eat a large breakfast but no lunch and increase intake after 4 PM will lead to late-day bingeing. Journal entries are private.)
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: now weighs 196 pounds. says, "I am using contraceptives." says, "I feel full after eating a small meal." reports problems with dry mouth and constipation.
now weighs 196 pounds. (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.)
A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as: minimally successful. marginally successful. partially successful. totally achieved.
partially successful. (Decreased preoccupation with symptoms and increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.)
To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms: are generally chronic. can be voluntarily controlled. have a physiological basis. provide relief from health anxiety.
provide relief from health anxiety. (At the unconscious level, the patient's primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide secondary gain, patients frequently fiercely cling to the symptoms. The symptoms tend to be chronic, but that does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.)
A patient diagnosed with a somatic symptom disorder says, "My pain is from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to assess: mood. secondary gains. cognitive style. identity and memory.
secondary gains. (Secondary gains should be assessed. The patient's dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient's diagnosis has been established.)
To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority: explain the pathophysiology of symptoms. help these patients suppress feelings of anger. shift focus from somatic symptoms to feelings. investigate each physical symptom as it is reported.
shift focus from somatic symptoms to feelings. (Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that the patient would express feelings, including anger if it is present. Once physical symptoms are investigated, they do not need to be reinvestigated each time the patient reports them.)
