Eating Disorders :::: PSYCH Test 1
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? -"How I feel about my body has little to do with my binging." -"I'll take my medication when I feel the urge to binge." -"I know if I eat pasta, I'll binge." -"I'll eat small meals and snacks regularly."
"I'll eat small meals and snacks regularly." Explanation: 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.
A 15-year-old client with anorexia nervosa has been admitted to a mental health unit. The client refuses to eat. Which statement is appropriate for the nurse to make? -"If you don't eat, it may be necessary to feed you by tube or I.V." -"You don't have to eat." -"Why do you think you're fat? You're underweight. Here — look in the mirror." -"You really look terrible at this weight. I hope you'll eat."
"If you don't eat, it may be necessary to feed you by tube or I.V." Explanation: Clients with anorexia nervosa can refuse food to the point of cardiac damage. Tube feedings and I.V. infusions are ordered to prevent such damage. The nurse should inform the client in a matter-of-fact manner of the treatment options and possibilities. Saying the client doesn't have to eat doesn't tell the client about the consequences of choosing not to eat. Stating that a client is too thin won't change the client's self-image.
The nurse is discussing health concerns and issues with a group of caregivers of adolescents. Which statement made by a caregiver would indicate a need for follow-up by the nurse? -"My 16-year-old spends so much time with his girlfriend, it worries me." -"My daughter is already 15 and she hasn't ever had a menstrual period." -"Our daughter has never had any health problems, and now she has developed so many cavities." -"I don't know if I want my 15-year-old son to drive; I know that at that age teens sometimes don't use good judgement."
"Our daughter has never had any health problems, and now she has developed so many cavities." Explanation: The clues to bulimia nervosa may be few but include dental caries and erosion from frequent exposure to stomach acid, throat irritation, and endocrine and electrolyte imbalances.
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? Bulimia nervosa, nonpurging type. Anorexia nervosa, restricting type Anorexia nervosa, binge eating, and purging type Eating disorder not otherwise specified
Anorexia nervosa, restricting type Explanation: 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 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? Anorexia nervosa, restricting type Anorexia nervosa, purging type Bulimia nervosa, purging type Binge eating disorder
Bulimia nervosa, purging type Explanation: 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.
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? -Deficient fluid volume related to refusal to drink -Anxiety related to inadequate coping mechanisms -Hyperactivity related to restlessness -Impaired social interaction related to aggressive behavior
Deficient fluid volume related to refusal to drink Explanation: 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? Psychosis Substance abuse Depression Anxiety
Depression Explanation: 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 medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Lithium Fluoxetine Bupropion Haloperidol
Fluoxetine Explanation: 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 nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? Communicating aggressively with the client Encouraging client take time away from peers for a time Increasing client's coping skills for anxiety Nurturing the client's need for dependency
Increasing client's coping skills for anxiety Explanation: 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.
Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? A history of substance abuse Overprotective of their children Maintenance of emotional distance from their children Alternation between loving and rejecting their children
Overprotective of their children Explanation: Some families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. Family therapy may be beneficial for families of clients younger than 18 years old. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.
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? -Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. -Help build self-esteem. -Develop a contract with the client to stop using laxatives and diuretics. Stabilize electrolyte levels.
Stabilize electrolyte levels. Explanation: 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.
Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? Increased activity Weight gain Mood elevation Positive self-esteem
Weight gain Explanation: Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.
The nurse is assessing a client who has bulimia nervosa. The nurse would expect the assessment data to include that the client: engages in binge eating. reports constipation, cold intolerance, and bradycardia. engages in alcohol and substance abuse. weighs less than 85% of normal weight for height.
engages in binge eating. Explanation: A client with bulimia usually engages in food binges and is usually of normal weight or overweight. The other choices are signs and symptoms of anorexia nervosa.
A nurse is caring for a client diagnosed with bulimia nervosa. The most appropriate initial goal for this client is to: restrict eating to three meals per day. control eating impulses. avoid shopping for large amounts of food. identify a connection between anxiety and eating behaviors.
identify a connection between anxiety and eating behaviors. Explanation: Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping for large amounts of food isn't a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the care plan after initially addressing stress and underlying issues. Eating three meals per day isn't a realistic goal early in treatment.
A nurse is caring for a 17-year-old female client with bulimia. Which complication of this disease may the nurse see in this child? Severe acne Hernia Menstrual problems Partial paralysis
Menstrual problems Explanation: Paralysis, hernia, and acne are not distinguishing features of bulimia. Bulimia is an eating disorder that has assessment findings of menstrual problems, esophagitis, cardiac arrhythmias, and fluid and electrolyte imbalance.
Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? Weight gain Mood elevation Positive self-esteem Increased activity
Weight gain Explanation: Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.
As a representative of the treatment team, a nurse is reviewing results of diagnostic studies with the family of an adolescent with anorexia nervosa. What explanation should the nurse give the family about the client's abnormal blood urea nitrogen (BUN) value? -"The BUN is decreased because your daughter has developed hypothyroidism." -"The BUN is decreased because your daughter is hypertensive." -"The BUN is elevated because your daughter has hypoglycemia." -"The BUN is elevated because your daughter is dehydrated."
"The BUN is elevated because your daughter is dehydrated." Explanation: A client with anorexia nervosa will have an elevated BUN as a result of dehydration. A decreased BUN isn't associated with anorexia nervosa or with hypothyroidism. An elevated BUN isn't associated with hypoglycemia. A client with anorexia nervosa will have hyperglycemia related to a drastic decrease in nutritional intake. A decreased BUN value isn't associated with anorexia nervosa or with hypertension. A client with anorexia nervosa will have hypotension caused by impaired cardiac functioning.
Which statement best describes the theories of the etiology of eating disorders? -Eating disorders are caused by dysregulation of multiple neurotransmitter systems that predispose a dysfunctional response to certain environmental factors. -Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component. -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 result from family dysfunction; neurotransmitter dysfunction is a result, not a cause, of the eating disorder.
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. Explanation: 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.
Which statement best describes the theories of the etiology of eating disorders? -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 are caused by dysregulation of multiple neurotransmitter systems that predispose a dysfunctional response to certain environmental factors. -Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component. -Eating disorders result from family dysfunction; neurotransmitter dysfunction is a result, not a cause, of the eating disorder.
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. Explanation: 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.
