Chapter 22: Eating Disorders

9. A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

ANS: 1 Page: 569 Feedback 1 The nurse should understand that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia do not. 2 Clients with anorexia can experience amenorrhea. 3 Clients with bulimia nervosa typically do not experience these symptoms. 4 Clients with bulimia often have tooth enamel erosion.

3. A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide? 1. The emesis produced during purging is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries.

ANS: 1 Page: 570 Feedback 1 The nurse should explain to the client diagnosed with bulimia nervosa that his or her teeth will eventually deteriorate, because the emesis produced during purging is acidic and corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance. 2 This does not correlate with tooth enamel deterioration. 3 This does not lead to tooth enamel deterioration. 4 This statement does not educate the client about tooth enamel deterioration caused by vomiting.

8. The nurse is working with a client diagnosed with binge eating disorder. Which medication should the nurse expect to teach the client about? 1. Lisdexamfetamine (Vyvanse) 2. Dexfenfluramine (Redux) 3. Sibutramine (Meridia) 4. Pemoline (Cylert)

ANS: 1 Page: 584-585 Feedback 1 The nurse should teach the client about Lisdexamfetamine (Vyvanse). This medication has shown to be successful in the treatment of binge eating disorder. 2 Dexfenfluramine has been removed from the market because of its association with serious heart and lung disease. 3 Several deaths have been associated with the use of sibutramine by high-risk clients. Based on pressure from the U.S. Food and Drug Administration, the manufacturer issued a recall of the drug in October 2010. 4 Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

11. A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) 1. Binge eating with a diagnosis of obesity 2. Bingeing and purging with a diagnosis of bulimia nervosa 3. Weight loss with a diagnosis of anorexia nervosa 4. Amenorrhea with a diagnosis of anorexia nervosa 5. Emaciation with a diagnosis of bulimia nervosa

ANS: 1, 2 Page: 585 Feedback 1. The nurse should identify that topiramate is the drug of choice when treating binge eating with a diagnosis of obesity. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight. 2. The nurse should identify that topiramate is the drug of choice when treating bingeing and purging with a diagnosis of bulimia nervosa. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight. 3. Topiramate (Topamax) is not the drug of choice for weight loss with a diagnosis of anorexia nervosa. 4. Topiramate (Topamax) is not the drug of choice for amenorrhea with a diagnosis of anorexia nervosa. 5. Topiramate (Topamax) is not the drug of choice for emaciation with a diagnosis of bulimia nervosa.

12. A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.) 1. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." 2. "In this disorder, binge eating occurs, on average, at least once a week for three months." 3. "In this disorder, binge eating occurs, on average, at least two days a week for six months." 4. "In this disorder, distress regarding binge eating is present." 5. "In this disorder, distress regarding binge eating is absent."

ANS: 1, 3, 5 Page: 571 Feedback 1. According to the DSM-5 criteria for the diagnosis of binge-eating disorder, binge eating should not occur exclusively during the course of anorexia nervosa or bulimia nervosa. 2. This statement regarding binge eating is accurate, indicating that teaching has been effective. 3. The new time frame criteria in the DSM-5 states that binge eating must occur, on average, at least once a week for three months not two days a week for six months. 4. This statement indicates that teaching has been effective. 5. The DSM-5 criteria states that distress regarding binge eating would be present.

6. 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 response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." 3. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

ANS: 2 Page: 572 Feedback 1 This statement is not therapeutic to the family. 2 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 anorexia nervosa. 3 This statement is untrue, as family dynamics are linked to eating disorders. 4 This statement may cause family members to become defensive.

1. Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa? 1. The home environment maintains loose personal boundaries. 2. The home environment places an overemphasis on food. 3. The home environment is overprotective and demands perfection. 4. The home environment condones corporal punishment.

ANS: 3 Page: 572 Feedback 1 Home environments that maintain loose personal boundaries do not typically lead to anorexia nervosa. 2 Home environments that place an overemphasis on food do not typically lead to anorexia nervosa. 3 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 the parents viewed by the child as a means of gaining and remaining in control. 4 Home environments that condone corporal punishment do not typically lead to anorexia nervosa.

7. 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? 1. The client gained two pounds in one week. 2. The client focused conversations on nutritious food. 3. The client demonstrated healthy coping mechanisms that decreased anxiety. 4. The client verbalized an understanding of the etiology of the disorder.

ANS: 3 Page: 574 Feedback 1 Gaining two pounds in one week is not an appropriate indicator of a positive client behavioral change. 2 Focusing on conversations on nutritious foods is not an appropriate indicator of a positive client behavioral change. 3 The nurse should identify that a client who demonstrates healthy coping mechanisms to decrease anxiety indicates a positive behavioral change. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behavior. 4 Verbalizing an understanding of eating disorders in important, but is not appropriate indicator of a positive client behavioral change.

2. 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? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will perceive personal ideal body weight and shape as normal. 4. The client will not express a preoccupation with food.

ANS: 3 Page: 575-577 Feedback 1 Consuming adequate calories to sustain a normal weight may be unrealistic for this client. 2 Ceasing strenuous exercise programs may be unrealistic for this client. 3 The nurse should identify that the appropriate outcome for this client is to perceive personal ideal body weight and shape as normal. 4 Not expressing a preoccupation with food may be unrealistic for this client.

5. A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder? 1. "Skaters need to be thin to improve their daily performance." 2. "All the skaters on the team are following an approved 1,200-calorie diet." 3. "The exercise of skating reduces my appetite but improves my energy level." 4. "I am angry at my mother. I can only get her approval when I win competitions."

ANS: 4 Page: 572 Feedback 1 Stating that skaters need to be thin is not likely to contribute to the development of anorexia nervosa. 2 Stating that all skaters are following an approved diet is not likely to contribute to the development of anorexia nervosa. 3 This statement is not likely to contribute to the development of anorexia nervosa. 4 The client reflects insight when referring to feelings toward family dynamics that may have influenced the development of the disease. Families who are overprotective and perfectionistic can contribute to the development of anorexia nervosa.

10. A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time? 1. Altered nutrition less than body requirements 2. Altered social interaction 3. Impaired verbal communication 4. Altered family processes

ANS: 4 Page: 575-577 Feedback 1 Altered nutrition less than body requirements is not the priority at this time. 2 Altered social interaction is not the priority at this time. 3 Impaired verbal communication is not the priority at this time. 4 The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating.

4. A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's uncontrollable behaviors. 4. It allows clients to maintain control.

ANS: 4 Page: 584 Feedback 1 Behavior modification does not help the client correct distorted body image. 2 Behavior modification does not help the client address underlying client anger. 3 Behavior modification does not help the client manage uncontrollable behaviors. 4 Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders, because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques function to restore healthy weight.

13. The diagnosis of ___________________includes the symptoms of gross distortion of body image, preoccupation with food, and refusal to eat.

ANS: anorexia nervosa Page: 569 Feedback: Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat.

14. The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed ________________________.

ANS: bingeing Page: 569 Feedback: The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed bingeing. Bingeing is a classic symptom of the eating disorder defined as bulimia nervosa.

15. To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in ______________________ behaviors, which include self-induced vomiting, or the misuse of laxatives, diuretics, or enemas.

ANS: purging Page: 569-570 Feedback: To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in purging behaviors, which include self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In addition to these behaviors, other inappropriate compensatory behaviors, such as fasting or excessive exercise, may be noted.