Ch 22 Eating Disorders

C. tolerance

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

A, B, C, D

10. Joanne presents in the emergency department with complaints of suicidal ideation. The following date is collected by the nurse. Which of these assessment findings suggest that bulimia nervosa might be a health problem? Select all that apply. a. Joanne's parotid glands appear enlarged. b. Joanne's teeth have a "moth eaten" pattern of tooth decay. c. Joanne reports that she takes laxatives daily. d. Joanne's weight is within the expected range.

a. family should be actively involved in each phase of treatment

2. The Maudsley approach to treatment of adolescents with anorexia nervosa advances which of the following fundamental concepts? a. family should be actively involved in each phase of treatment. b. parents should be prohibited from involvement in helping their child eat more because there are often control issue. c. adolescents need to work on developing healthy self-identities before they can begin to gain weight. d. individual psychotherapy is the most effective treatment for adolescents with anorexia nervosa.

b. "There are some medications and psychological treatments that have demonstrated effectiveness in reducing binge eating behaviors."

3. John has sought help for his concern that he is binge eating, and he feels it has "gotten out of control." He asks the nurse what can be done to help him. Which of the following is the most accurate response? a. "There is nothing that can be done." b. "There are some medications and psychological treatments that have demonstrated effectiveness in reducing binge eating behaviors." c. "The primary problem is obesity. I can help you set up a calorie-restricted diet." d. "There are medications that can help with weight loss, but there are no medications effective for reducing binge eating."

3. Client will verbalize recognition of "fat" body misperception

A client is leaving the in-patient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? 1. Client will accept refeeding as part of a daily routine. 2. Client will perform nasogastric tube feeding independently. 3. Client will verbalize recognition of "fat" body misperception. 4Client will discuss importance of monitoring weight daily.

3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine.

A client diagnosed with bulimia nervosa has responded well to citalopram (Celexa). Which is the possible cause for this response? 1. There is an association between bulimia nervosa and dilated blood vessels and inactive alpha-adrenergic and serotoninergic receptors. 2. There is an association between bulimia nervosa and the neurotransmitter dopamine. 3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. 4. There is an association between bulimia nervosa and a malfunction of the thalamus.

b. imbalanced nutrition: less than body requirements.

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

c. bradycardia, hypotension, hypothermia

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

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

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

c. Fluoxetine (Prozac)

7. Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belviq) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Carbamazepine (Tegretol)

b. binging, purging, normal weight, hypokalemia

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

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

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

1. The client's BMI will be 20 by the 6-month follow-up appointment.

A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which long-term, correctly written outcome addresses client problem improvement? 1. The client's BMI will be 20 by the 6-month follow-up appointment. 2. The client will be free of signs and symptoms of malnutrition and dehydration. 3. The client will use one healthy coping mechanism during a time of stress by discharge. 4. The client will understand a previous dependency role by 3-month follow-up visit.

2. Altered nutrition: less than body requirements R/T decreased intake.

A client diagnosed with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that this outcome addresses? 1. Ineffective coping R/T lack of control. 2. Altered nutrition: less than body requirements R/T decreased intake. 3. Self-care deficit: feeding R/T fatigue. 4. Anxiety R/T feelings of helplessness.

4. Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems.

A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which intervention takes priority? 1. Assessment of family issues and health concerns. 2. Assessment of early disturbances in mother-infant interactions. 3. Assessment of the client's knowledge of selective serotonin reuptake inhibitors (SSRIs) used in treatment. 4. Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems.

1. Offer independent decision-making opportunities.

A client diagnosed with binge-eating disorder has a nursing diagnosis of low self-esteem. Which nursing intervention would address this client's problem? 1. Offer independent decision-making opportunities. 2. Review previously successful coping strategies. 3. Provide a quiet environment with decreased stimulation. 4. Allow the client to remain in a dependent role throughout treatment.

3. 18 to 22 years old.

A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? 1. 5 to 10 years old. 2. 10 to 14 years old. 3. 18 to 22 years old. 4. 40 to 45 years old.

2. "I will accompany you to the bathroom."

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate? 1. "Thanks for checking in." 2. "I will accompany you to the bathroom." 3. "Let me know when you get back to the dayroom." 4. "I'll stand outside your door to give you privacy."

3. Vomiting, which may lead to dehydration and electrolyte imbalance.

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? 1. Mood disorders, which often accompany the diagnosis of bulimia nervosa. 2. Nutritional deficits, which are characteristic of bulimia nervosa. 3. Vomiting, which may lead to dehydration and electrolyte imbalance. 4. Binging, which causes abdominal discomfort.

2. Imbalanced nutrition: less than body requirements.

A client with cachexia states, "I don't care what you say; I am horribly fat and will continue to diet." The client is experiencing arrhythmias and bradycardia. Based on this client's symptoms, which nursing diagnosis takes priority? 1. Ineffective denial. 2. Imbalanced nutrition: less than body requirements. 3. Disturbed body image. 4. Ineffective coping.

3. "Let's focus on your continued improvement. You ate 80% of your lunch."

A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? 1. "I'm Italian, so I really enjoy a large plate of spaghetti." 2. "I'll weigh you after your meal." 3. "Let's focus on your continued improvement. You ate 80% of your lunch." 4. "Why do you always talk about food? Let's talk about swimming."

3. Discoloration of dental enamel. 4. Bruises of the palate and posterior pharynx. 5. Dental enamel dysplasia.

After a routine dental examination on an adolescent, the dentist reports to the parents that bulimia nervosa is suspected. On which of the following assessment data would the dentist base this determination? Select all that apply. 1. Extreme weight loss. 2. Amenorrhea. 3. Discoloration of dental enamel. 4. Bruises of the palate and posterior pharynx. 5. Dental enamel dysplasia.

2. The client meets the criteria for a diagnosis of anorexia nervosa.

An 18 year-old female client weighs 95 pounds and is 70 inches tall. She has not had a period in 4 months and states, "I am so fat!" Which statement is reflective of this client's symptoms? 1. The client meets the criteria for a diagnosis of bulimia nervosa. 2. The client meets the criteria for a diagnosis of anorexia nervosa. 3. The client needs further assessment to be diagnosed. 4. The client is exhibiting normal developmental tasks according to Erikson.

4. Monitor physician-ordered nasogastric tube feedings.

Imbalanced nutrition: less than body requirements R/T altered body perception AEB client's being 5 feet 4 inches tall, weighing 75 pounds, is assigned to a client diagnosed with anorexia nervosa. Which nursing intervention would address this client's problem? 1. Encourage the client to keep a diary of food intake. 2. Plan exercise tailored to individual choice. 3. Help the client to identify triggers to self-induced purging. 4. Monitor physician-ordered nasogastric tube feedings.

1. The family is fearful of the social stigma of having a family member with emotional problems. 2. The family is dealing with feelings of guilt because of the perception that they have contributed to the disorder. 3. There may be a pattern of conflict avoidance, and the family fears conflict would surface in the sessions. 4. The family may be attempting to maintain family equilibrium by keeping the client in the sick role.

The family of a client diagnosed with anorexia nervosa has cancelled the past two family counseling sessions. Which of the following could be reasons for this nonadherence? Select all that apply. 1. The family is fearful of the social stigma of having a family member with emotional problems. 2. The family is dealing with feelings of guilt because of the perception that they have contributed to the disorder. 3. There may be a pattern of conflict avoidance, and the family fears conflict would surface in the sessions. 4. The family may be attempting to maintain family equilibrium by keeping the client in the sick role. 5. The client is now maintaining adequate nutrition, and the sessions are no longer necessary.

1. "Eating disorders result from very early and profound disturbances in father-infant interactions."

The instructor is teaching nursing students about the psychodynamic influences of eating disorders. Which statement indicates that more teaching is necessary? 1. "Eating disorders result from very early and profound disturbances in father-infant interactions." 2. "Disturbances in mother-infant interactions may result in retarded ego development." 3. "When a mother meets the physical and emotional needs of a child by providing food, this behavior contributes to the child's ego development." 4. "Poor self-image leads to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating."

3. Angina. 4. Respiratory insufficiency. 5. Hyperlipidemia.

The nurse is assessing a client with a body mass index (BMI) of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. 1. Hypoglycemia. 2. Rheumatoid arthritis. 3. Angina. 4. Respiratory insufficiency. 5. Hyperlipidemia.

1. "Factors such as taste and texture can affect appetite." 2. "The function of my digestive organs affects my eating behaviors." 5. "Society and culture influence eating patterns."

The nurse is teaching about factors that influence eating patterns. Which of the following statements indicate that learning has occurred? Select all that apply. 1. "Factors such as taste and texture can affect appetite." 2. "The function of my digestive organs affects my eating behaviors." 3. "High socioeconomic status determines nutritious eating patterns." 4. "Social interaction contributes little to eating patterns." 5. "Society and culture influence eating patterns."

2. Clients should perceive that they are in control of clearly communicated treatment choices.

When using a behavioral modification approach for the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? 1. Take a matter-of-fact, directive approach with the input of the entire treatment team. 2. Clients should perceive that they are in control of clearly communicated treatment choices. 3. Appropriate treatment choices are presented to the client's family for consideration. 4. The treatment team develops a system of rewards and privileges that can be earned by the client.

4. Clients diagnosed with anorexia nervosa have elevated cerebrospinal fluid cortisol levels and possible alterations in the regulation of dopamine.

Which anorexia nervosa etiology is from a neuroendocrine perspective? 1. Anorexia nervosa is more common among sisters and mothers of clients with the disorder than among the general population. 2. Altered structure and function of the thalamus is implicated in the diagnosis of anorexia nervosa. 3. There is a higher-than-expected frequency of mood disorders among first-degree relatives of clients diagnosed with anorexia nervosa. 4. Clients diagnosed with anorexia nervosa have elevated cerebrospinal fluid cortisol levels and possible alterations in the regulation of dopamine.

1. Dry, yellow skin.

Which anorexia nervosa symptom is physical in nature? 1. Dry, yellow skin. 2. Perfectionism. 3. Frequent weighing. 4. Preoccupation with food.

d. they are within their normal weight range

Which assessment finding would the nurse expect in clients diagnosed with bulimia? a. they are below normal weight b. they binge when they experience hunger c. they will be highly motivated to seek help d. they are within their normal weight range

4. Lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity.

Which etiological implication for obesity is from a physiological perspective? 1. Eighty percent of offspring of two obese parents become obese. 2. Individuals who are obese have unresolved dependency needs and are fixed in the oral stage of development. 3. Hyperthyroidism interferes with metabolism and may lead to obesity. 4. Lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity.

1. A poor black woman.

Which individual would be at highest risk for obesity? 1. A poor black woman. 2. A rich white woman. 3. A rich white man. 4. A well-educated black man.

b. body image disturbance

Which is characteristic of the diagnosis of anorexia nervosa? a. obsession with weight gain b. body image disturbance c. disregard for the feelings of others d. healthy family relationships

3. Fluoxetine (Prozac).

Which medication is used most often in the treatment of clients diagnosed with anorexia nervosa? 1. Fluphenazine (Prolixin). 2. Clozapine (Clozaril). 3. Fluoxetine (Prozac). 4. Methylphenidate (Ritalin).

2. Holding a mandatory group after mealtime to assist in exploration of feelings.

Which nursing intervention would directly assist a hospitalized client diagnosed with bulimia nervosa in avoiding the urge to purge after discharge? 1. Locking the door to the client's bathroom. 2. Holding a mandatory group after mealtime to assist in exploration of feelings. 3. Discussing preplanned meals to decrease anxiety around eating. 4. Educating the family to recognize purging side effects.

1. The client participates in individual therapy. 3. The client consumes adequate calories as determined by the dietitian. 5. The client states, "I realize that I can't be perfect."

Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? Select all that apply. 1. The client participates in individual therapy. 2. The client has a BMI of 16. 3. The client consumes adequate calories as determined by the dietitian. 4. The client is dependent on his or her mother for most basic needs. 5. The client states, "I realize that I can't be perfect."

2. Binge-eating disorder is described as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and this disorder can lead to obesity. 4. Obesity is not classified as an eating disorder but can be considered as a psychological factor affecting other medical conditions. 5. The World Health Organization defines obesity as a BMI of 30.0 or greater.

Which of the following statements are true as they relate to obesity? Select all that apply. 1. Obesity is a psychiatric disorder, and diagnostic criteria are similar to other eating disorders. 2. Binge-eating disorder is described as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and this disorder can lead to obesity. 3. Obesity is currently evaluated for all clients as a psychological factor affecting medical conditions. 4. Obesity is not classified as an eating disorder but can be considered as a psychological factor affecting other medical conditions. 5. The World Health Organization defines obesity as a BMI of 30.0 or greater.

3. Hypothalamus.

Which structure in the brain contains the appetite regulation center? 1. Thalamus. 2. Amygdala. 3. Hypothalamus. 4. Medulla.