Eating disorders (better set)
A coping mechanism used excessively by clients with anorexia nervosa is A. denial. B. humor. C. altruism. D. projection.
A Denial of excessive thinness is the mainstay of the client with anorexia nervosa.
The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by A. teaching the family about the disorder and the client's behaviors. B. stressing the need to suppress overt conflict within the family. C. urging the family to demonstrate greater caring for the client. D. encouraging the family to use their usual social behaviors at meals.
A Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member.
Which statement is least likely to be made by a client diagnosed with bulimia nervosa during the assessment interview? A. "I eat three meals each day and purge every evening." B. "I'm concerned about what others think about my binging and purging." C. "I feel as though my eating and purging are out of my control." D. "When I eat I feel calm, but then I realize I have to make myself vomit or gain weight."
A Most clients with bulimia purge after each meal.
Which of the following statements is true of bulimia? A. Patients with bulimia often appear at a normal weight. B. Patients with bulimia binge eat but do not engage in compensatory measures. C. Patients with bulimia severely restrict their food intake. D. One sign of bulimia is lanugo.
A 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.
A client has been hospitalized with anorexia nervosa. The client's weight is 65% of normal. For this client, a realistic short-term goal for the first week of hospitalization would be: By the end of week 1, the client will A. gain a maximum of 3 lb. B. develop a pattern of normal eating behavior. C. discuss fears and feelings about gaining weight. D. verbalize awareness of the sensation of hunger.
A The critical outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema.
A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding? A. The emesis produced during purging is acidic and corrodes the tooth enamel. B. Purging causes the depletion of dietary calcium. C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene leads to dental caries.
A The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.
A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred? A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not." B. "Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not." C. "Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not." D. "Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not."
A The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food followed by purging.
A focus for the acute phase of treatment for anorexia nervosa would be A. weight restoration. B. improving interpersonal skills. C. learning effective coping methods. D. changing family interaction patterns.
A Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status.
When you are educating Erin and her mother about the medication dosage and side effects, Erin becomes upset and tearful, stating, "No! I will not take that medication!" Which of the following is the most likely reason for Erin's feelings? A. Erin feels embarrassed to be taking psychiatric medication. B. Erin is upset about the possible side effect of weight gain. C. Erin is worried about the common adverse effect of sexual problems. D. Erin's resistance is typical of her characteristics of rigidity and needing control.
B Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain but are not well accepted by patients who are frightened by the side effect of weight gain. There is nothing in the scenario to suggest Erin is embarrassed. Sexual side effects are more common with SRRI medication than atypical antipsychotics. Erin may have the characteristics described in option d, which are typical of patients with anorexia; however, during medication education it is more likely for her to be upset over the possibility of a side effect.
A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time? A. Ineffective coping R/T food obsession B. Altered nutrition: less than body requirements R/T inadequate food intake C. Risk for injury R/T suicidal tendencies D. Altered body image R/T perceived obesity
B Based on Maslow's hierarchy, the priority nursing diagnosis for this client must address physical needs prior to emotional considerations. This client must be immediately physically stabilized due to the life-threatening nature of his or her nutritional status.
Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of A. historically poor patient compliance. B. an increased risk of seizures. C. the long-term effects on liver function. D. the potential to cause gastric ulcers.
B Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of an increased risk of seizures.
A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention? A. To gain additional information about the progression of the disease process B. To emphasize that the client is capable of consuming food without purging C. To incorporate specific foods into the meal plan to reflect pleasant memories D. To assist the client to become more compliant with the treatment plan
B By asking the client to recall a time in life when food could be consumed without purging, the nurse is assessing previously successful coping strategies. This information can be used by the client to modify maladaptive behaviors in the present and future
A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to: A. manipulate her husband. B. gain control of one part of her life. C. commit suicide. D. live up to her mother's expectations.
B By refusing to eat, a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. This eating disorder doesn't represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement). The client isn't attempting to commit suicide through starvation; rather, by refusing to eat, she is expressing feelings of despair, worthlessness, and hopelessness.
Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa? A. Weigh two times daily, then three times weekly. B. Weigh fully clothed before breakfast. C. Do not reweigh client when client requests. D. Permit no oral intake before weighing.
B Clients should be weighed wearing only bra and panties before ingesting any food or fluids in the morning.
A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is a(n) A. increase in the red blood cell count. B. disruption of the fluid and electrolyte balance. C. elevated serum potassium level. D. elevated serum sodium level.
B Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives.
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 reply? A. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." C. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." D. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."
B 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 this disorder.
Which assessment question should be asked of a client suspected of demonstrating characteristics of anorexia nervosa? A. "Do you find yourself feeling hungry?" B. "How would you describe your body?" C. "How often do you force yourself to vomit?" D. "Why do you choose to take laxatives?"
B This question will reveal the cognitive distortion consistent with anorexia nervosa. Invariably the client will describe self as fat despite being excessively underweight.
A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal A. tachycardia. B. hypokalemia. C. hypercalcemia. D. hypolipidemia.
B Vomiting causes loss of potassium, leading to hypokalemia.
A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the client's motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence
C
A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to: A. severely restrict the client's physical activities. B. weigh the client daily, after the evening meal. C. monitor vital signs, serum electrolyte levels, and acid-base balance. D. instruct the client to keep an accurate record of food and fluid intake.
C An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid base balance is crucial. Option A may worsen anxiety. Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.
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? A. "I purge only once a day now instead of twice." B. "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." C. "I am a hard worker and I am very compassionate toward others." D. "I always purge when I'm alone so that I'm not a bad role model for my younger sister."
C 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.
Which intervention would be removed from the plan of care for a client diagnosed with bulimia nervosa? A. Teach that fasting sets one up to binge eat. B. Assist client to identify trigger foods. C. Support importance of avoiding forbidden foods. D. Teach client to plan and eat regularly scheduled meals.
C No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy.
Assessment of a client suspected of experiencing bulimia nervosa calls for the nurse to perform A. a range of motion assessment. B. inspection of body cavities. C. inspection of the oral cavity. D. body fat analysis.
C Repeated vomiting often causes dental erosions and caries.
According to current theory, eating disorders: A. are psychotic disorders in which patients experience body dysmorphic disorder. B. are frequently misdiagnosed. C. are possibly influenced by sociocultural factors. D. are rarely comorbid with other mental health disorders.
C 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.
Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa ? A. Disturbed body image B. Chronic low self-esteem C. Risk for injury: electrolyte imbalance D. Ineffective coping: impulsive responses to problems
C The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss.
Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.
C 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 controlling and demanding parents.
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? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.
C The nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self based on self-attributes instead of appearance and to realize that perfection is unrealistic.
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? A. The client gains 2 pounds in 1 week. B. The client focuses conversations on nutritious food. C. The client demonstrates healthy coping mechanisms that decrease anxiety. D. The client verbalizes an understanding of the etiology of the disorder.
C The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing which is followed by inappropriate compensatory behaviors
A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. C. The client will gain 2 pounds prior to the next weekly appointment. D. The client will remain free of signs and symptoms of malnutrition and dehydration.
C The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, measurable, and also include a time frame.
In contrast to the client diagnosed with anorexia nervosa, the client diagnosed with bulimia usually A. uses greater denial. B. is aware of the eating problem. C. fits more easily into the family. D. appraises his or her body more realistically.
C There is less family concern about the client with bulimia because these clients appear physically normal, the weight is at or near normal, they eat with the family, and the purging is done in secret. The anorexic client is noticed by the family for painful thinness and poor food intake.
An important intervention in monitoring the dietary compliance of a client with bulimia is: A. Allowing the client privacy during mealtimes B.Praising her for eating all her meal C. Observing her for 1-2 hours after meals D.Encouraging her to choose foods she likes and to eat in moderation
C To prevent the client from inducing vomiting after eating, the client should be observed for 1-2 hours after meals. Allowing privacy as stated in answer A will only give the client time to vomit. Praising the client for eating all of a meal does not correct the psychological aspects of the disease; thus, answer B is incorrect. Encouraging the client to choose favorite foods might increase stress and the chance of choosing foods that are low in calories and fats so D is not correct.
A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the rationale for scheduling group therapy at this time? A. To shift the clients' focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation
C When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.
Your patient, Erin, is a 16-year-old patient newly diagnosed with anorexia. Her provider is starting her on medication to reduce compulsive behaviors regarding food and resistance to weight gain. You prepare teaching on which class of medication that may help these specific symptoms in eating disorders? A. Mood stabilizers B. Antidepressants C. Anxiolytics D. Atypical antipsychotics
D 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. 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.
Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders? A. These programs help clients correct distorted body image. B. These programs address underlying client anger. C. These programs help clients manage uncontrollable behaviors. D. These programs allow clients to maintain control.
D 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 aid in restoring healthy body weight
A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is A. lanugo. B. hypotension. C. 25-lb weight loss. D. fear of gaining weight.
D Option D is the only subjective data listed, and it is universally true.
The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when the client A. weighs 10% below ideal body weight. B. has a serum potassium level of 3 mEq/L or greater. C. has a heart rate less than 60 beats/min. D. has systolic blood pressure less than 70 mm Hg.
D Systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise.
A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects the underlying etiology of this disorder? A. "Skaters need to be thin to improve their daily performance." B. "All the skaters on the team are following an approved 1,200-calorie diet." C. "When I lose skating competitions, I also lose my appetite." D. "I am angry at my mother. I can only get her approval when I win competitions."
D This client statement reflects the underlying etiology of anorexia nervosa. The client is expressing feelings about family dynamics that may have influenced the development of this disorder. Families who are overprotective and perfectionistic can contribute to a family member's development of anorexia nervosa.