exam E 1.4
A nurse is caring for a patient who has bulimia nervosa and who has stopped purging behavior. The patient tells the nurse that she is afraid she is going to gain weight. Which of the following is an appropriate response by the nurse? "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments" "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you" "Instead of worrying about your weight, try to focus on other problems at this time" "Many patients are concerned about their weight. However, the dietician will ensure that you don't get too many calories in your diet"
"I understand you have concerns about your weight, but first, let's talk about your recent accomplishments" acknowledge concerns and then focus on accomplishment to promote self-esteem and self-image
Which statement by the patient's family indicates the need for more teaching about the treatment of anorexia nervosa? "Therapy could take between 1-6 years for this disorder" "If she will just eat more, we can take her home and she'll be ok" "Support groups and family therapy are important aspects of treatment" "She will have to be hospitalized if she has dehydration or electrolyte imbalance"
"If she will just eat more, we can take her home and she'll be ok"
A 45-year-old female two months after bariatric surgery, tells the nurse, "My skin is hanging in folds. I think I need cosmetic surgery." Which response by the nurse is most appropriate? "The skin folds will disappear once most of the weight is lost." "The important thing is that you are improving your health." "Perhaps you would like to talk to a counselor about your body image." "Cosmetic surgery is a possibility once your weight has stabilized."
"Cosmetic surgery is a possibility once your weight has stabilized."
The nurse is discussing bariatric surgery complications with a patient. Which statement by the patient indicates understanding of a common side effect of the procedure? "Unfortunately I may experience gastritis after having bariatric surgery" "I know an umbilical hernia might happen after I have bariatric surgery" "Gallstones are a common occurrence in patients who have bariatric surgery" "I understand that gastric ulcers frequently occur in patients who have bariatric surgery"
"Gallstones are a common occurrence in patients who have bariatric surgery"
A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea, sweating, and diarrhea shortly after eating meals. What response by the nurse is most appropriate? "Reduce the amount of redefined sugars that you are eating" "You may be experiencing a postoperative infection" "This is common after the type of surgery you had" "Try to eat your meals slower to promote absorption"
"Reduce the amount of redefined sugars that you are eating"
After bariatric surgery a patient who is being discharged tells the nurse, "I prefer to be independent. I am not interested in any support groups." Which response by the nurse is best? "Because there are many lifestyle changes after surgery, we recommend support groups." "I hope you change your mind so that I can suggest a group for you." "Tell me what types of resources you think you might use after this surgery." "Support groups have been found to lead to more successful weight loss after surgery."
"Tell me what types of resources you think you might use after this surgery."
A 15-year-old girl reports to the school nurse that she feels she does not fit in and feels near tears all the time. She states her grades are declining. The nurse's best approach to this situation would be: "Everyone has 'down times.' Let's get you signed up with a tutor." "Come back again next week and we can talk some more about this problem." "Don't be silly...of course you fit in. You have many friends." "That must feel awful, what has helped you in dealing with these feeling before?"
"That must feel awful, what has helped you in dealing with these feeling before?" validating feelings and exploring coping skills.
Your patient with anorexia is admitted to your medical surgical unit for malnutrition. She tells you she does not want to eat when her tray is delivered. Which statement is the best response? "The doctor said you will need a feeding tube if you don't eat" "I will ask the doctor to order an appetite stimulant" "You have to eat or you will starve" "What happens to you when you see the food tray?"
"What happens to you when you see the food tray?"
A patient who has Class II obesity as well as severe type 2 diabetes is considering gastric bypass surgery. The nurse is reviewing possible complications with the patient. Which of the following nutrition related complications should the nurse discuss with the patient. (SELECT ALL THAT APPLY) 1 dumping syndrome 2 iron deficiency 3 nausea and vomiting 4 hypothyroidism 5 Vit B12 deficiency
1 2 3 5
The nurse assesses the patient for the signs and symptoms that characterize a major depressive disorder, which are: (Select all that apply.) 1 indecisiveness 2 suicidal ideation 3 buying large quantities of candy 4 sleep disturbances 5 euphoria
1 2 4
The nurse outlines the treatment for a person with anxiety disorders, which include: (Select all that apply. 1 individual therapy 2 alprazolam medication 3 eat a variety of foods 4 education about disorder 5 adderall medication
1 2 4
The nurse explains that the medically supervised approach to weight reduction will include: (SELECT ALL THAT APPLY): 1 an exercise program 2 stress reduction 3 medications to suppress the appetite 4 participation in a support group 5 change in concepts about food
1 2 4 5
LPN is unable to give 5 categories of medications. Match the medication with the category that it belongs. (you have to get all right to get the point) 1. Antiarrhythmic 2. Oxytocics 3. Blood products 4. Antineoplastics 5. Hyperalimentation choices: Morphin Vancomycin Zofran Cytoxan Platelet Pitocin Amiodarone TPN
1. Amiodarone , 2.Pitocin , 3.Platelets , 4. Cytoxan, 5. Total parental nutrition
Which of the following would be a good strategy for parents to adopt to prevent unhealthy eating patterns in their children? Post a photo of a well-proportioned role model on the refrigerator to encourage health eating Encourage children to always eat all that is on their plates to emphasis healthy eating habits Have special food treats available and use them only as rewards for good behavior Eat a variety of foods
Eat a variety of foods
The nurse is reviewing the medical history of a patient who is being evaluated for anorexia nervosa. Which characteristic(s) would be consistent with the condition? (Select all that apply.) 1 Binge eating 2 Body weight less than 85% of what is expected for height and weight 3 Loss of 2 to 3 pounds in the past month 4 Frequent mood changes 5 Absence of three consecutive menstrual periods
2 4 5
A nurse is assisting a charge nurse with an admission assessment of a patient who has bulimia nervosa with purging behavior. Which of the following are expected findings? (SELECT ALL THAT APPLY). 1 Mottling of the skin 2 Hyponatremia 3 presence of lanugo on the face 4 slightly elevated body weight 5 Hypokalemia
2, 4, 5
During an interview, the nurse is discussing dietary habits with a patient. Which tool would be the best choice to use as a quick screening tool to assess dietary intake? Food diary Comprehensive diet history Calorie count 24 hour recall
24 hour recall screening to see if more needs to be done the 24 hour recall is usually the easiest and can help discuss patterns from there. Food diary requires time to do and bring to a check up.
In bulimia, the purging is done to achieve which of the following? Feelings of euphoria at getting rid of the food A need to gain attention A release of guilt A way to gain control
A release of guilt after the binge, the purge removes the guilt of the over eating.
The nurse is caring for a patient who has anorexia nervosa. Which of the following behaviors, often associated with this disorder, would be of most concern. being sexually provocative having friends sneak alcohol or drugs in to her Expressing suicidal ideations manipulating the nurse
A: Expressing suicidal ideations suicidal ideation requires immediate intervention for safety.
A nurse is caring for a female patient who was recently admitted to the hospital for anorexia nervosa. The nurse enters the patient's room and notes that the patient is doing vigorous push-ups. Which nursing action is appropriate? Allow the patient to complete her exercise program Tell the patient that she is not allowed to exercise vigorously Interrupt the patient and offer to take her for a walk Interrupt the patient and weigh her immediately
A: Interrupt the patient and offer to take her for a walk interrupting the behavior, changing the vigorous exercise to a slower one
A person with an eating disorder might present with which of the following signs and symptoms? Tachycardia and hypotension Hyperglycemia and hyperthyroidism Bradycardia, hypotension, and dry, cracking skin Fever and excessively oily skin
Bradycardia, hypotension, and dry, cracking skin
Which of the following is an example of a maladaptive coping mechanism? Going to the beach Imagery Denial Deep breathing
Denial
The client's laboratory report of sodium 118 mEq/L. What is the most important nursing intervention for this client? Institute fall precautions. Establish seizure precautions. Monitor for cardiac dysrhythmias. Assess for sores at boney prominces.
Establish seizure precautions.
Which of the following should be avoided by the patient with dumping syndrome? grilled cheese sandwhich chicken wrap eggs and bacon cinnamon roll with icing
cinnamon roll with icing breads expand in the stomach and need to have protein each meal.
Which other mental health diagnosis often accompanies an eating disorder? schizophrenia depression personality disorder bipolar disorder
depression
The nurse would expect which of the following psychological responses to continuous weight loss from an individual with anorexia nervosa? disappointment in the failure to maintain control of his/her body improvement in his/her feelings about themselves, because he/she is maintaining self-control fear of death concern for his/her overall health
improvement in his/her feelings about themselves, because he/she is maintaining self-control
The school nurse suspects a 14-year-old of having anorexia nervosa because the nurse has observed that the adolescent: has early onset of sexual development. is binging on rich foods. uses frequent enemas and laxatives. is doing excessive rigorous exercises.
is doing excessive rigorous exercises. over exercise is a common manifestation of anorexia
A student who is known for battling anorexia is brought into the school nurse's office. The student was found on the bathroom floor, they are thin, face sunken in, and minimally responsive to painful stimuli. The student is breathing 8 breaths a minute, shallow and irregularly.What is the nurse's priority intervention? Ask the student what they ate today Start an perpheral IV Intiate seizure precautions Place a cold wet cloth on the students forehead.
Intiate seizure precautions
A student who is known for battling anorexia is brought into the school nurse's office. The student was found on the bathroom floor, they are thin, face sunken in, and minimally responsive to painful stimuli. The student is breathing 8 breaths a minute, shallow and irregularly. What is the school nurse's priority? Intiate the emergency protocol Notify the student's parents of their child's current condition Elevate the student's head To place the AED on the student
Intiate the emergency protocol
The client's laboratory report of potassium at 2.8 mEq/L. What is the most important nursing intervention for this client? Establish seizure precautions. Examine boney areas for sores. Monitor for cardiac dysrhythmias. Institute fall precautions.
Monitor for cardiac dysrhythmias.
A student who is known for battling anorexia is brought into the school nurses office. The student was found on the bathroom floor, they are thin, face sunken in, and minimally responsive to painful stimuli. The student is breathing 8 breaths a minute, shallow and irregularly. What acid base balance would the nurse anticipate the patient is in? Respiratory Acidosis Metabolic Alkalosis Respiratory Alkalosis Metabolic Acidosis
Respiratory Acidosis
A mother approaches the nurse in the eating disorders inpatient clinic with concerns about the probability of the success of the treatment for her daughter. The nurse's best response would be: "Treatment of eating disorders is very successful. Your daughter will be out of here within the week" "The behavior seen in eating disorders is very difficult to change. Your daughter will require long-term therapy even after she leaves our facility" "We use only behavior modification therapy here and have found it to be very successful in treating eating disorders" "As long as your daughter follows our rules, she will progress quickly toward a cure"
"The behavior seen in eating disorders is very difficult to change. Your daughter will require long-term therapy even after she leaves our facility"
A mother approaches the nurse in the eating disorders inpatient clinic with concerns about the probability of the success of the treatment for her daughter. The nurse's best response would be: "Treatment of eating disorders is very successful. Your daughter will be out of here within the week" "The behavior seen in eating disorders is very difficult to change. Your daughter will require long-term therapy even after she leaves our facility" "We use only behavior modification therapy here and have found it to be very successful in treating eating disorders" "As long as your daughter follows our rules, she will progress quickly toward a cure" Eating disorders are complex, and are easy to fall back into. They require life long changes and challenges.
"The behavior seen in eating disorders is very difficult to change. Your daughter will require long-term therapy even after she leaves our facility"
The nurse is assisting a 79-year-old patient with information about diet and weight loss. The patient has a body mass index (BMI) of 31. How should the nurse instruct this patient? "You are a little overweight. Cut down on calories and increase your activity, and you should be fine." "You are considered obese and will need to consult with your doctor about a plan that includes exercises, not diet, to decrease weight." "You are morbidly obese, and we would like to schedule you an appointment to speak with a bariatric specialist about surgery." "Your weight is within normal limits. Continue maintaining with current lifestyle choices."
"You are considered obese and will need to consult with your doctor about a plan that includes exercises, not diet, to decrease weight."
A priority nursing intervention to help patients with eating disorders is: have the patient chart his or her own intake and output Let the patient know he or she will be watched closely at mealtimes Encourage the patient to express underlying feelings about food, body image, and self-worth Lock the patient's bathroom door for 2 hours after each meal
Encourage the patient to express underlying feelings about food, body image, and self-worth
A patient with anorexia nervosa: Typically seeks the company of others Is not likely to have a body image disturbance has an increased resting energy expenditure Frequently complains of constipation
Frequently complains of constipation
A nurse on an acute care unit is assisting with planning care for a patient who has anorexia. Which of the following nursing actions is appropriate to include in the patient's plan of care? Provide the patient with a high-fat diet at the start of treatment Allow the patient to select preferred meal times Implement one-to-one observation during meal times Establish consequences for purging behavior
Implement one-to-one observation during meal times
After gastric bypass, a 42 year old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a PCA for pain control. Which nursing action should be included in the postoperative plan of care? Remind the patient that PCA use may slow the return of bowel function. Irrigate the NG tube frequently. Offer sips of fruit juices at frequent intervals. Support the surgical incision during patient coughing and turning in bed.
Support the surgical incision during patient coughing and turning in bed. the incision needs support for all the tissue surrounding it. The patient has an NG to suction, and doesn't need oral intake, the NG doesn't need irrigation unless it is not draining, While narcotics slow bowel function they can use the PCA for pain management until they are switched over to orals.
The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best excerise plan for weight loss? Playing soccer for an hour on the weekend Walking for 30 mins most days of the week Running for 10 to 15 minutes 3 times/week Lifting weights with friends 3 times/week
Walking for 30 mins most days of the week
When the nurse assesses a potassium level of 2.9 mEq/L in a patient who has been chronically vomiting, the nurse will be alert for: hyperactive bowel sounds. increased reflexes. abdominal pain. excessive urinary output.
abdominal pain.
A patient comments to the nurse that obesity afflicts only those who are weak-willed and cannot control themselves. The nurse tell this patient there are several factors that contribute to obesity including: all of the options are correct physiologic metabolic genetic
all of the options are correct Obesity is a complex problem involving genetics, metabolism and physiologic responses with in the body.
An adolescent has an intense fear of becoming obese and severe disturbance in body image and refuses to eat. The adolescent may have: bulimia. dysphagia. thin syndrome. anorexia nervosa.
anorexia nervosa.
Patients undergoing bariatric surgery are most at risk for developing: nutritional deficiencies hypertension kidney stones coronary artery disease
nutritional deficiencies
A complication resulting from obesity is: colon cancer renal failure hypotension obstructive sleep apnea
obstructive sleep apnea
The nurse explains that the laparoscopic adjustable gastric banding surgery is best described as: obstructive restrictive/malabsorptive restrictive malabsorptive
restrictive
A patient with anorexia has a PIV to help replace fluids and electrolytes after being brought in to the hospital. The nurse is is concerned the PIV is infiltrated, which symptoms would match the nurses concern? red streak up the arm. burning sensation and no feeling at the site. sweling, pain, and skin cool to touch. pain, heat, and swelling.
sweling, pain, and skin cool to touch.
