Sem 3 - Unit 6 - Nutrition - NCO
What nursing intervention is the priority in the period immediately after an emaciated 13-year-old child's admission to the hospital for starvation resulting from anorexia nervosa? 1 Ensuring that rest and nutrition needs are met 2 Correcting the child's fluid and electrolyte imbalances 3 Obtaining more data about the child's diet and exercise program 4 Completing an assessment of the child's physical and mental status
2 Correcting the child's fluid and electrolyte imbalances Anorexic children are usually severely malnourished and have severe fluid and electrolyte imbalances. Unless these imbalances are corrected, cardiac irregularities and death may occur. Rest and nutrition, information on diet and exercise, and assessment of physical and mental status are important, but none is the priority at this time.
A nurse is planning health teaching for a 14-year-old girl hospitalized with the diagnosis of anorexia nervosa. What does the nurse assume is likely true of the client? 1 Is somewhat concerned that the eating behavior may threaten life 2 Has some understanding of anorexia nervosa because of media publicity 3 Has minimal awareness that reduced caloric intake has lethal implications 4 Is demonstrating an unconscious desire for death by selecting refusal of food as the method
3 Has minimal awareness that reduced caloric intake has lethal implications Even though anorexia nervosa is a popular media topic and people with the disorder may intellectually understand the lethal implications of not eating, they do not recognize it as their problem even when they are dying of starvation. People with anorexia nervosa are unconcerned with the physiologic danger of the consequences of their behavior and focus only on being fat. Adolescents typically feel indestructible and immortal; also, individuals with anorexia nervosa believe being fat is unhealthy and must be avoided at any cost.
The multidisciplinary team decides to use a behavior modification approach for a young client with anorexia nervosa. Which planned nursing intervention is an appropriate approach to use with this client? 1 Having the client role-play interactions with the parents 2 Providing the client with a high-calorie, high-protein diet 3 Restricting the client to the room until a 2-lb (0.9-kg) weight gain is achieved 4 Forcing the client to talk about favorite foods for 1 hour a day
3 Restricting the client to the room until a 2-lb (0.9-kg) weight gain is achieved Restricting the client to the room until a 2-lb (0.9-kg) weight gain is achieved reinforces behaviors that will assist in the achievement of specific goals. Having the client role-play interactions with the parents is not part of a behavior modification program. Providing the client with a high-calorie, high-protein diet is not part of a behavior modification program. Anorexic clients talk freely about food; the problem is ingestion, not discussion.
While admitting a young client with anorexia nervosa to the unit, the nurse finds a bottle of assorted pills in the client's luggage. The client tells the nurse that they are antacids for stomach pains. What is the best initial response by the nurse? 1 "Let's talk about your drug use." 2 "These pills don't look like antacids." 3 "Some people take pills to lose weight." 4 "Tell me more about these stomach pains."
4 "Tell me more about these stomach pains." "Tell me more about these stomach pains" is a nonthreatening, open-ended response that focuses discussion and leaves the channel of communication open. Although "Some people take pills to lose weight" is a true statement, this response does not encourage discussion. Although "Let's talk about your drug use" and "These pills don't look like antacids" do not quite accuse the client of lying, both are threatening responses that question the client's truthfulness.
The nurse notes that a young client with anorexia nervosa telephones home just before each mealtime. The client ignores reminders to eat and continues talking until the other clients are finished eating. The client then refuses to eat food that has gotten cold. What should the nurse do initially? 1 Insist that the client eat the food. 2 Revoke the client's telephone privileges. 3 Hang up the telephone when meals are served. 4 Schedule a family meeting to discuss the problem.
4 Schedule a family meeting to discuss the problem. By talking to the client on the telephone at mealtimes, the family is enabling the client to continue the self-destructive behavior; the client and family must be included in discussion of and possible solutions to the problem. Insisting that the client eat the food is a punitive approach that does not address the underlying problem. Revoking the client's telephone privileges is a behavior modification approach that may be used if talking to the family does not produce needed change. Hanging up the telephone when meals are served is a punitive approach that does not address the underlying problem.
A nurse, the family, and an adolescent client with anorexia nervosa are planning appropriate outcomes for the client. What is an appropriate short-term goal for the client? 1 Eat planned nutritious meals. 2 Gain 10 lb (4.5 kg) within 1 month. 3 Continue the same diet eaten at home. 4 Add 100 calories of carbohydrates to each meal.
1 Eat planned nutritious meals. Ingesting planned nutritious meals is a realistic goal that is likely to evoke the least anxiety in the short term. A person with anorexia nervosa has great anxiety about weight gain and responds best to nutritious foods when he or she has input into planning. The thought of gaining 10 lb (4.5 kg) within 1 month will overwhelm the client and increase anxiety. The diet eaten at home was probably a very low-calorie diet that promoted weight loss. Adding 300 calories a day will increase the client's anxiety and probably result in nonadherence to the planned regimen.
A nurse is caring for several clients with the diagnosis of bulimia nervosa. What primary feeling does the nurse anticipate that these clients experience after an episode of bingeing? 1 Guilt 2 Paranoia 3 Euphoria 4 Satisfaction
1 Guilt A sense of being out of control accompanies the consumption of large amounts of food, resulting in guilt, depression, and disgust with one's self. Paranoia is associated with paranoid schizophrenia, not with bulimia nervosa. After bingeing, a person with bulimia nervosa usually feels depressed rather than euphoric or satisfied.
A 17-year-old client is found to have anorexia nervosa. The psychiatrist, in conjunction with the client and the parents, decides to institute a behavior modification program. What does the nurse recall is a major component of behavior modification? 1 Rewarding positive behavior 2 Reducing necessary restrictions 3 Deconditioning fear of weight gain 4 Reducing anxiety-producing situations
1 Rewarding positive behavior In behavior modification [1] [2] [3] , positive behavior is reinforced, and negative behavior is not reinforced or punished. Reducing the number or complexity of necessary restrictions, deconditioning the fear of weight gain, and reducing the number of anxiety-producing situations may all be part of the program, but none is a major component.
A teenager with anorexia nervosa is admitted to the adolescent unit of a mental health facility and signs a contract calling for the client to gain weight or lose privileges. There is no weight gain after a week. What should the nurse explain to the client? 1 The prearranged consequences will go into effect. 2 Death from starvation could occur if the client does not eat. 3 Stricter goals will be instituted if the initial goals are not met. 4 It may be necessary to become involved with meal preparation.
1 The prearranged consequences will go into effect. The imposition of the prearranged consequences reinforces the agreed-upon contract; a behavior modification program must follow through consistently on issues of cause and effect. The threat of death from starvation is not therapeutic. Goals are not changed; prearranged consequences are instituted when goals are not met. Working with food will not stimulate the client's eating; this is not therapeutic or productive.
An adolescent with the diagnosis of anorexia nervosa is admitted to the psychiatric unit of a local hospital. What should the nurse include in the plan of care? 1 Limited opportunities for decision-making 2 Provision of supervision during and after mealtimes 3 Arrangements for a physical exercise program and time to complete it 4 A request that parents keep their visits to a minimum early in treatment
2 Provision of supervision during and after mealtimes Clients with anorexia nervosa often throw out or hide food and purge after eating. The client should be supervised to ensure that the client eats and does not vomit after meals. Limiting opportunities for decision-making fosters dependence, which is not desirable. The client's physical expenditure should be reduced because of malnutrition; exercise is usually limited. The parents are an important part of treatment and should be encouraged to visit unless visiting privileges are revoked because of insufficient weight gain.
What should the nurse do when an adolescent with the diagnosis of anorexia nervosa starts to discuss food and eating? 1 Listen to the client's list of favorite foods and secure these foods for the client. 2 Tell the client gently but firmly to direct the discussion of food to the nutritionist. 3 Use the client's current interest in food to encourage an increase in food intake. 4 Let the client talk about food as long as the client wants and limit discussion about eating.
2 Tell the client gently but firmly to direct the discussion of food to the nutritionist. All food issues should be discussed with the nutritionist, thereby removing a potential source of conflict between the nurse and client. Listening to the client's list of favorite foods and securing these foods will accomplish little, because the client's failure to eat is not based on food likes or dislikes. Using the client's current interest in food to encourage an increased food intake will increase the conflict between the nurse and client. Letting the client talk about food as long as the client wants and limiting discussion about eating may be self-defeating, because a discussion of food will be the major focus of all nurse-client interactions.
The parents of an adolescent child are worried about their daughter's use of laxatives. Which other behavior in the child does the nurse associate with bulimia nervosa? 1 The child is underweight for her age. 2 The child indulges in binge eating. 3 The child is obsessed with being thin. 4 The child prefers to starve to lose weight
2 The child indulges in binge eating. Bulimia nervosa is an eating disorder characterized by binge eating and the use of laxatives and self-induced vomiting to prevent weight gain. Anorexia nervosa is a clinical syndrome with both physical and psychosocial components. Clients with anorexia nervosa refuse to maintain body weight at the minimal normal weight for their age and height. An individual with anorexia nervosa has an intense fear of gaining weight. This individual often starves to lose weight.
Evaluation of clients with anorexia nervosa requires reassessment of behaviors after admission. Which finding indicates that the therapy is beginning to be effective? 1 Food is hidden in the client's pockets. 2 The client states that the hospitalization has been helpful. 3 The client has gained 6 lb (2.7 kg) since admission 3 weeks ago. 4 The client remains in the dining room eating for 1 hour after others have left.
3 The client has gained 6 lb (2.7 kg) since admission 3 weeks ago. Weight gain of 6 lb (2.7 kg) since admission 3 weeks ago is objective proof that the client's eating behaviors have improved. "Stashing" of food is a characteristic of an eating disorder, not a sign of improvement. The statement that the hospitalization has been helpful is subjective information and may be manipulative. "Marathon meals" with little actual food ingestion are common in people with anorexia.
What is a major recognizable difference between anorexia nervosa clients and bulimia nervosa clients? 1 Anorexia nervosa clients tend to be more extroverted than clients with bulimia. 2 Anorexia nervosa clients seek intimate relationships, whereas clients with bulimia avoid them. 3 Anorexia nervosa clients are at greater risk for fluid and electrolyte imbalances than are clients with bulimia. 4 Anorexia nervosa clients deny the problem, whereas clients with bulimia generally recognize that their eating pattern is abnormal.
4 Anorexia nervosa clients deny the problem, whereas clients with bulimia generally recognize that their eating pattern is abnormal. The client with anorexia nervosa denies the illness; the client with bulimia nervosa hides the behavior because she recognizes that the behavior is a problem. Clients with anorexia nervosa are more introverted and tend to avoid relationships. Clients with bulimia are at a greater risk for fluid and electrolyte problems because of the purging; clients with anorexia nervosa are at greater risk for severe nutritional deficiencies.
An adolescent is admitted to the psychiatric service in stable physical condition with the diagnosis of anorexia nervosa. The adolescent has lost 20 lb (9.1 kg) in 6 weeks and is very thin but is excessively concerned about being overweight. What is the most important initial nursing intervention? 1 Complimenting the physical appearance of the adolescent 2 Explaining the value of adequate nutrition to the adolescent 3 Exploring the reasons that the adolescent does not want to eat 4 Attempting to establish a trusting relationship with the adolescent
4 Attempting to establish a trusting relationship with the adolescent The problem is psychological. Therefore the nurse's initial approach should be directed toward establishing trust. The client is convinced about being overweight; complimenting the client will not change self-perception. The client is not ready for nutrition information. Exploring the reasons that the adolescent does not want to eat may be appropriate after trust has been established.
A nurse is caring for a newly admitted client with anorexia nervosa. What is the priority treatment for the client at this time? 1 Medications to reduce anxiety 2 Family psychotherapy sessions 3 Separation from family members 4 Correction of electrolyte imbalances
4 Correction of electrolyte imbalances Starvation or inadequate/inappropriate nutrition can lead to electrolyte imbalances, which are life threatening. Medication and therapy will be prescribed later and are not the priority at this time. Client independence, not separation from family members, is supported.
A nurse is assigned to care for an adolescent who has been admitted to the psychiatric hospital with a diagnosis of anorexia nervosa. What should the nurse's initial intervention be? 1 Scheduling an endocrinology consult because of amenorrhea 2 Confronting those behaviors that reflect an inflated self-importance 3 Arranging for psychotherapy sessions to help develop a desire to accommodate others 4 Developing a contract to achieve a weekly weight gain, with consequences for nonachievement
4 Developing a contract to achieve a weekly weight gain, with consequences for nonachievement Treatment usually includes a contract for weight gain, signed by the client, whereby privileges are revoked if the weight is not gained; the diet and the amount of food eaten are not the focus of care. Menstruation usually ceases because of severe malnutrition, not because of endocrine pathology. These clients have a low self-esteem and usually do not feel important.
A 16-year-old high school student who has anorexia nervosa tells the school nurse that she thinks she is pregnant even though she has had intercourse only once, more than a year ago. What is the most appropriate inference for the nurse to make about the student? 1 Using magical thinking 2 Submitting to peer pressure 3 Lying about the last time she had intercourse 4 Lacking knowledge that anorexia can cause amenorrhea
4 Lacking knowledge that anorexia can cause amenorrhea The loss of body fat from anorexia can cause amenorrhea; the client needs information. No data are available to support the fact that the client is using magical thinking, which is characterized by the belief that thinking or wishing something can cause it to occur; in light of the client's diagnosis of anorexia, this is not the first conclusion. Submitting to peer pressure is not related to this type of concern. Although the nurse should question the timeline again, the client's nutritional status should be explored first.
A nurse is caring for an adolescent with the diagnosis of anorexia nervosa. The plan of care should include helping the client do what? 1 Plan nutritious meals. 2 Change attitudes about nutrition. 3 Understand that more food must be eaten. 4 Recognize how the need to control influences behavior.
4 Recognize how the need to control influences behavior. The client's focus on controlling eating redirects attention away from those areas that are felt to be out of the client's control. This is how life's more difficult problems and challenges are avoided. Planning nutritious meals may not be productive, because these clients believe that they are eating nutritious meals. It is not the client's attitudes or beliefs about food but instead the distorted self-image that is the problem. Understanding that more food must be eaten may not be productive, because these clients believe that they are eating enough food.
A client with bulimia nervosa eats two sandwiches, two salads, and four desserts for lunch. What client behavior should the nurse anticipate after the meal is consumed? 1 Excessive exercise 2 Hoarding of more food for a later binge 3 Active socializing with small groups of clients 4 Withdrawing from the group to go to the bathroom
4 Withdrawing from the group to go to the bathroom Bulimia is characterized by the binge-purge cycle; most clients withdraw from others and vomit after an eating binge. Although some individuals with bulimia may exercise to excess, this is a more common finding with the diagnosis of anorexia nervosa. Although individuals with bulimia may hoard food, this behavior commonly occurs later, when limits are put on their intake. Most individuals with bulimia do not seek support or socialization after a binge, although they may socialize at other times.