Chapter 32- Eating Disorders

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 response by the nurse is most appropriate? a. "I will accompany you to the bathroom." b. "Thanks for checking in." c. "I'll stand outside your door to give you privacy." d. "Let me know when you get back to the dayroom."

a. "I will accompany you to the bathroom." After each meal or snack, clients may be required to remain in view of staff for a period of time to ensure they do not empty the stomach by vomiting. Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. The response, "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the behavior. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.

Which nursing statement is most effective in communicating a positive expectation of the client? a. "I will sit here quietly with you while you eat." b. "I will allow you space to eat in peace." c. "I'll give you 90 minutes to eat." d. "There are people who would truly appreciate this food."

a. "I will sit here quietly with you while you eat." This statement reflects the nurse's expectation that the client will eat, yet the nurse still will provide adequate supervision. Setting a deadline establishes a conflictual, rules-based dynamic between the nurse and client which is not likely to be therapeutic. The nurse should be present, both to supervise and promote therapeutic relationship; it would be inappropriate to leave the client alone during a meal. Instilling guilt about how others would like the food is inappropriate because guilt does not lead to a positive self-concept.

A client comes to the health clinic for a physical exam. He is complaining that he is not happy with himself about being overweight. He has been depressed for several weeks. When discussing his weight goal, he asks the nurse, "What is a normal or healthy BMI?" The nurse's correct response would include which of the following? a. 18 to 24.9 b. 30 to 34.9 c. 25 to 29 d. 35 to 39.9

a. 18 to 24.9 A "healthy" BMI ranges from 18 to 24.9. An individual with a BMI of 25 to 29 is considered to be moderately overweight or preobese. A BMI of 30 to 34.9 is considered moderately obese. A BMI of 35 to 39 is deemed to be severely obese.

The parents of a teenage girl who has just been diagnosed with anorexia nervosa are distraught at this development, stating, "We have no idea where this all came from." The anorexia nervosa client is typically what? a. A high achiever b. Listless and unmotivated c. The first-degree relative or close friend of a person who is obese d. Socially withdrawn with below average intelligence

a. a high achiever The pre-anorexic client is generally considered to be a "model child and student" who is meek, compliant, perfectionistic, and overachieving.

The nurse is helping a client with an eating disorder to accept the client's body image. The client must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? a. Being able to cope in healthy ways improves the ability to accept a realistic body image. b. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills. c. Coping skills are dependent on a supportive upbringing. d. When body image is positive, the client will develop better coping skills.

a. being able to cope in healthy ways improves the ability to accept a realistic body image When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image. Coping skills can be learned and honed even if the client's upbringing was less than supportive. Changes in body image result from enhanced coping; they do not cause enhanced coping. Eating disorders have biologic elements to their etiology, but this does not rule out the development of positive coping.

Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa? a. Disturbed body image b. Deficient knowledge (nutritious eating patterns) c. Social isolation d. Imbalanced nutrition—less than body requirements

a. disturbed body image The client's dissatisfaction with body image is an enduring belief pattern that is firmly ingrained and, therefore, very difficult to change. Imbalanced nutrition—less than body requirements, deficient knowledge (nutritious eating patterns), and social isolation are nursing diagnoses that can be worked through with education and support more easily than the diagnosis of disturbed body image.

Exacerbation of anorexia nervosa results from the client's effort to do what? a. Gain control of one part of life b. Diminish conflict c. Manipulate family members d. Live up to family expectations

a. gain control of one part of life A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client's life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.

An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? a. Set up a strict eating plan for the client b. Restrict visits with the family until the client begins to eat c. Encourage the client to exercise, which will reduce the client's anxiety d. Provide privacy during meals

a. set up a strict eating plan for the client Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals—not given privacy. Exercise must be limited and supervised.

The nurse provides care for a client who is diagnosed with anorexia nervosa. Which question should the nurse ask to assess the client for neuropsychiatric complications associated with the diagnosed eating disorder? a. "How often do you menstruate?" b. "Do you experience abnormal taste sensations?" c. "Do you experience constipation or diarrhea?" d. "Is your skin dry and your nails brittle?"

b. "Do you experience abnormal taste sensations?" There are many complications associated with eating disorders, including anorexia nervosa. The neuropsychiatric complications include abnormal taste sensations, often due to zinc deficiency. Other neuropsychiatric complications include apathetic depression, fatigue, mild organic mental symptoms, and sleep disturbances. Abnormal menstrual cycles and/or amenorrhea are reproductive complications associated with anorexia nervosa. Dermatologic complications include dry skin and brittle nails. Constipation and/or diarrhea are both gastrointestinal complications associated with anorexia nervosa.

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse? a. "I'm not going to take your insults personally but you need to be more respectful." b. "I realize this must be very difficult for you but try to remember I'm not your enemy." c. "I'm sorry that you are angry but you cannot throw food at me." d. "I'm not the root of your problem."

b. "I realize this must be very difficult for you but try to remember I'm not your enemy." The client initially may view the nurse, who is responsible for making the client eat, as the enemy. The client may hide or throw away food or become overtly hostile as anxiety about eating increases. The nurse must remember that the client's behavior is a symptom of anxiety and fear about gaining weight and not personally directed toward the nurse. The other options are nurse rather than client focused.

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? a. "I know if I eat pasta, I'll binge." b. "I'll eat small meals and snacks regularly." c. "I'll take my medication when I feel the urge to binge." d. "How I feel about my body has little to do with my binging."

b. "I'll eat small meals and snacks regularly." Clients with bulimia need to normalize their eating patterns. Therefore, the statement about eating small meals and snacks regularly indicates understanding of the need to normalize eating patterns. Emotional and environmental cues, not specific foods, influence the eating patterns in bulimia. Medication, if prescribed, is taken regularly, not just when the client experiences the urge to binge. Body image dissatisfaction is an underlying factor associated with bulimia.

The nurse has been teaching the client's family about the client's eating disorder, anorexia nervosa. Which statement by the family would indicate to the nurse that teaching was effective? a. "We will eat our evening meals together with no exceptions." b. "We will negotiate resolutions to family conflicts." c. "We will spend less time discussing troublesome family members." d. "We will give her frequent encouragement for eating well and maintaining her weight."

b. "We will negotiate resolutions to family conflicts." Families of clients with eating disorders typically put too much emphasis on food and are less skilled at discussing family conflicts and allowing the client to begin gaining independence. Answer A allows little or no compromise; the client needs to be able to make decisions for him or herself. Answer C indicates that the client is a problem to the family. Family members can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight.

The client is 16 years old and has an identical twin just diagnosed with anorexia nervosa. The client shares with the nurse a concern about also developing the disorder. Which response by the nurse is the most appropriate? a. "It is not genetics but the environment that increases your risk. Since you live together, you have the same risk as your twin." b. "While eating disorders have been shown to have a genetic basis, other factors also play a role in its development." c. "Eating disorders have not been found to be genetic, so you do not have a particular risk." d. "For identical twins, there is about a 5% chance that both twins develop an eating disorder."

b. "While eating disorders have been shown to have a genetic basis, other factors also play a role in its development." Most experts agree that anorexia nervosa (as well as bulimia nervosa) is multidimensional and multidetermined, so it is most accurate to tell the client that both genetics and other factors play a role. Genetic research shows that there is a genetic vulnerability to anorexia nervosa, especially in females. Genetic heritability accounts for an estimated 50%-80% of the risk of developing an eating disorder. However, separating genetic influences from environmental influences is difficult when twins share a similar family environment.

A client is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The client believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this client is what? a. Eating disorder not otherwise specified b. Anorexia nervosa, restricting type c. Bulimia nervosa, nonpurging type. d. Anorexia nervosa, binge eating, and purging type

b. Anorexia nervosa, restricting type Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories."

The nurse is helping a client with an eating disorder to accept the client's body image. The client must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? a. When body image is positive, the client will develop better coping skills. b. Being able to cope in healthy ways improves the ability to accept a realistic body image. c. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills. d. Coping skills are dependent on a supportive upbringing.

b. Being able to cope in healthy ways improves the ability to accept a realistic body image. When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image. Coping skills can be learned and honed even if the client's upbringing was less than supportive. Changes in body image result from enhanced coping; they do not cause enhanced coping. Eating disorders have biologic elements to their etiology, but this does not rule out the development of positive coping.

The difference between clients with anorexia nervosa and bulimia nervosa is which of the following? a. There is no real difference between these two types of clients. b. Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior. c. Anorexia has a psychological basis, whereas the cause of bulimia is biologic. d. Bulimia can be life threatening, whereas anorexia is seldom so.

b. Clients who are anorexic are proud of their control over eating, whereas bulimic clients are ashamed of their behavior. Clients with bulimia know their behavior is pathologic and are ashamed of it; clients with anorexia think they are fine and see no problem with their weight-control efforts. Anorexia nervosa is a life-threatening eating disorder. Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families.

A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? a. Dieting during childhood can promote self-discipline in children who are obese. b. Dieting at an early age may lead to the development of eating disorders. c. Dieting at an early age teaches healthy eating habits. d. Dieting helps build a positive self-image in children.

b. Dieting at an early age may lead to the development of eating disorders. A specific cause for eating disorders is unknown. Initially, dieting may be the stimulus that leads to their development. Dieting is also associated with the risk factor of dissatisfaction with body image. Children need well-balanced diets rather than calorie restriction diets. Healthy eating patterns do not require dieting because dieting may instill unhealthy attitudes toward food. Obesity is complex and self-discipline does not address each component of this health problem.

The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder? a. Moist skin b. Excessive exercise c. Wearing tight-fitting clothing d. Tachycardia

b. Excessive exercise Clients with eating disorders utilize excessive exercise to burn as many calories as possible. Medical complications of eating disorders include bradycardia, hypotension, and dry, cracking skin due to dehydration. The client will wear loose-fitting clothes to hide his or her body.

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect? a. Anorexia nervosa b. Binge eating disorder c. Bulimia nervosa d. Eating disorder not otherwise specified

b. binge eating disorder Binge eating disorder is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese. The client does not restrict eating so anorexia is not appropriate. Eating disorder not otherwise specified refers to partial syndromes but does not met the criteria for anorexia or bulimia.

A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment? a. Heat intolerance b. Bradycardia c. Hypertension d. Complaints of heartburn

b. bradycardia Associated physical exam findings include cold intolerance, complaints of constipation and abdominal pain, hypotension, and bradycardia.

A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected? a. Respiratory distress and dyspnea b. Dental erosion and chronic edema c. Bacterial gastrointestinal infections and overhydration d. Metabolic acidosis and constricted colon

b. dental erosion and chronic edema In bulimia, dental erosion (from frequent vomiting) and chronic edema (from fluid imbalances) are common. Dyspnea, bacterial gastrointestinal infections, and metabolic acidosis are not characteristics of bulimia.

Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? a. lithium b. fluoxetine c. haloperidol d. bupropion

b. fluoxetine Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Adminstration approval for the treatment of bulimia nervosa.

A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. The client doesn't want to feel fat in a bathing suit on vacation. The client's sodium level is 150 mEq/L; potassium level is 3.2 mEq/L. The client is 5 feet tall, weighs 100 pounds, and has lost 15 pounds in 3 weeks. Which goal is a priority at this time? a. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. b. Stabilize electrolyte levels. c. Develop a contract with the client to stop using laxatives and diuretics. d. Help build self-esteem.

b. stabilize electrolyte levels Restoring nutritional balance is a priority for clients with severe eating disorders. Clients who are clearly malnourished need to become physiologically stabilized until they are no longer at risk for severe medical complications related to starvation. Refeeding the very low-weight client with anorexia means that nurses must carefully monitor cardiac function; another important intervention is to carefully monitor electrolytes. These clients are at risk for developing a "refeeding syndrome" with accompanying hypokalemia.

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? a. mood disorders, which often accompany the diagnosis of bulimia nervosa b. vomiting, which may lead to dehydration and electrolyte imbalance c. nutritional deficits, which are characteristic of bulimia nervosa d. binging, which causes abdominal discomfort

b. vomiting, which may lead to dehydration and electrolyte imbalance People who frequently vomit have many dental problems, such as loss of tooth enamel, chipped and ragged teeth, and dental caries. Frequent vomiting may also result in mouth sores. Purging behaviors, such as vomiting, may lead to dehydration and electrolyte imbalance. Hallucinations and restlessness can be signs of electrolyte imbalance. Dry mucous membranes indicate dehydration.

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? a. Positive self-esteem b. Weight gain c. Increased activity d. Mood elevation

b. weight gain Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.

The nurse has just completed an admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression? a. "I know my weight is a little below normal." b. "I know I have a problem. I need help." c. "Others are just trying to keep me from looking good." d. "Those weight charts are for normal people. I am not normal."

c. "Others are just trying to keep me from looking good." Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. An admission of need shows a high level of insight. Acknowledging a low weight does not show insight because the client is more likely to be far below norms. Stating "I am not normal" shows distorted cognition, but this is not necessarily in the domains of judgment and insight.

An individual with which body mass index (BMI) would be classified as having mild anorexia nervosa? a. 16.2 kg/m2 b. 15.4 kg/m2 c. 17.4 kg/m2 d. 20 kg/m2

c. 17.4 kg/m2 The severity of anorexia nervosa is classified as follows: mild: BMI ≥ 17 kg/m2; moderate: BMI 16-16.99 kg/m2; and severe: BMI 15-15.99 kg/m2. A BMI of 20 kg/m2 is considered normal.

The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia? a. Insist that the client complete all meals provided. b. Encourage autonomy by allowing the client to have total control over food choices. c. Encourage the entire family to engage in a balanced and regular dietary pattern. d. Provide the client a diet of mainly vegetables and salads.

c. Encourage the entire family to engage in a balanced and regular dietary pattern. Clients with eating disorders can benefit when the entire family makes positive changes. This shows solidarity and makes it easier for the client to maintain healthy behaviors. Eating only salads and vegetables during the day may set up clients for later binges as a result of too little dietary fat and carbohydrates. The client with an eating disorder will not make healthy food choices independently. It is also not possible or beneficial for family and friends to force the client to eat.

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? a. Encouraging client take time away from peers for a time b. Communicating aggressively with the client c. Increasing client's coping skills for anxiety d. Nurturing the client's need for dependency

c. Increasing client's coping skills for anxiety Since clients with bulimia experience high anxiety levels and may use the binge-purge cycle as a coping mechanism, increasing coping skills for anxiety is a high priority nursing intervention. A perception of lack of control and helplessness is at the source of eating disorders. . A firm, accepting, and patient approach is important in working with these individual, not an aggressive approach, which could render the nurse-client relationship ineffective. Since the client already tends to isolate when bingeing and purging, increasing involvement with others would be a positive treatment modality. Meeting dependency needs is nontherapeutic; the nurse does not need to rescue the client but rather to teach the client to be less helpless.

What is the primary difference between anorexia nervosa and bulimia nervosa? a. There is no real difference between these two types of disorders. b. Bulimia can be life threatening, whereas anorexia is seldom so. c. Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. d. Anorexia has a psychological basis, whereas the cause of bulimia is biologic.

c. clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior Clients with bulimia know their behavior is pathologic and are ashamed of it; clients with anorexia think they are fine and see no problem with their weight-control efforts. Anorexia nervosa is a life-threatening eating disorder. Both disorders have psychological and biological components of their etiology.

Individuals with anorexia nervosa concentrate on which body cue? a. anxiety b. hunger c. controlling food intake d. weakness

c. controlling food intake Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.

All of the following would be included as interventions for eating disorders to establish nutritional eating patterns except ... a. observing the client following meals and snack for 1 to 2 hours b. being alert for attempts to hide or discard food or inflate weight c. weighing the client twice daily d. siting with the client during meals and snacks

c. weighing the client twice daily Weighing the client twice daily puts emphasis on weight and should not be included as an intervention for a client with an eating disorder. Interventions that should be implemented include sitting with the client during meals and snacks, observing the client following meals and snack for 1 to 2 hours, and being alert for attempts to hide or discard food or inflate weight.

The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective? a. "I am keeping a record of everything I eat and how I am feeling every day." b. "I am beginning to understand how my lack of self-control is hurting me." c. "I am getting more comfortable confronting people when I have conflict with them." d. "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."

d. "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." Self-monitoring is a cognitive-behavioral technique designed to help clients with bulimia. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions and triggers. In this way, clients begin to see connections between emotions and situations and eating behaviors. The nurse can then help clients to develop ways to manage emotions such as anxiety by using relaxation techniques or distraction with music or another activity. Keeping a record of feelings and food intake is helpful, but not if it is unaccompanied by healthy responses and changes in behavior. Managing conflict is important but this is not an example of self-monitoring. Stating a lack of self-control is not therapeutic because self-control is not the key to recovery from eating disorders. Efforts that focus solely on self-control are rarely successful or sustainable.

A nurse, sitting with a client diagnosed with anorexia nervosa, notices that the client has eaten 80 percent of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? a. "I like hamburgers a lot but why do you always talk about food? b. "I really enjoy a large plate of spaghetti." c. "I'll weigh you after your meal." d. "Let's focus on your continued improvement. You ate 80 percent of your lunch."

d. "Let's focus on your continued improvement. You ate 80 percent of your lunch." Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. It is important to offer support and positive reinforcement for improvements in eating behaviors. Because clients diagnosed with anorexia nervosa are obsessed with food, discussion of food can provide unintended positive reinforcement for negative behaviors. In this answer choice, the nurse is appropriately redirecting the client. When the nurse requests an explanation that the client cannot give, the client may feel defensive. "Why" questions are blocks to therapeutic communication.

The dentist of a client noticed that the client's teeth were losing enamel. The client is of average weight. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with enamel loss? a. Anorexia nervosa, restricting type b. Anorexia nervosa, purging type c. Binge eating disorder d. Bulimia nervosa, purging type

d. Bulimia nervosa, purging type The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests bulimia nervosa, purging type. Individuals with bulimia typically maintain normal weight. Binge eating disorder does not involve purging.

Which statement best describes the theories of the etiology of eating disorders? a. Eating disorders are caused by dysregulation of multiple neurotransmitter systems that predispose a dysfunctional response to certain environmental factors. b. Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component. c. Eating disorders result from family dysfunction; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. d. Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.

d. Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors. Eating disorders can be best understood in terms of a multifactorial etiology. Most experts agree that anorexia and bulimia develop from a complex interaction of individual, family, and sociocultural factors. Research strongly suggests that eating disorders may originate in part from hypothalamic, hormonal, neurotransmitter, or biochemical disturbances. Whether the biologic abnormalities seen in clients with eating disorders contribute to the disorders or are secondary to the dysregulation in the eating behavior remains unclear.

When working with the family of a client with anorexia nervosa, which issue must be addressed? a. Codependence b. Sexual identity c. Self-discipline d. Control

d. control Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity may be relevant to some clients, but the presence of control issues is relevant in all clients with anorexia nervosa.

When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? a. Sexual identity b. Self-discipline c. Codependence d. Control issues

d. control issues Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity are not pertinent issues to address with the family.

Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care? a. Impaired social interaction related to aggressive behavior b. Anxiety related to inadequate coping mechanisms c Hyperactivity related to restlessness d. Deficient fluid volume related to refusal to drink

d. deficient fluid volume related to refusal to drink The risk of dehydration posed by the client's refusal to drink likely supersedes the risk of imbalanced nutrition in the short term. Both diagnoses are more immediate concerns than the client's social interactions. There is no evidence of anxiety or hyperactivity related to restlessness.

Which is the most common disorder found in clients diagnosed with bulimia nervosa? a. Substance abuse b. Anxiety c. Psychosis d. Depression

d. depression Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.

Which would be most supportive for family and friends of a client with an eating disorder? a. Focus on food intake, calories, and weight b. Unlimited access to unhealthy foods that the client enjoys c. Positive reinforcement for weight gain d. Emotional support, love, and attention

d. emotional support, love, and attention The nurse explains to family and friends that they can be most helpful by providing emotional support, love, and attention. They can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight. Structure around eating is more therapeutic than providing constant, unlimited access to food. Positive reinforcement can be beneficial but this must be framed in a context of support, love and attention in order for the client to accept it.

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? a. compulsively washing his or her hands b. socially withdrawing c. becoming sexually promiscuous d. engaging in severe dieting

d. engaging in severe dieting Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: By continuing to lose, these clients exert control over one aspect of their lives. While the remaining options may demonstrative reactive behaviors, they are not generally associated with over-productive parenting.

During an initial interview at a clinic, a young client states that there is nothing wrong with the client. Which would indicate to the nurse that this client might have anorexia nervosa? a. episodes of overeating and excessive weight gain b. expressions of a positive self-concept c. flexible thought patterns and spontaneity d. severe weight loss due to self-imposed dieting

d. severe weight loss due to self-imposing dieting Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.