The Point Chapter 20
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? "How often do you menstruate?" "Is your skin dry and your nails brittle?" "Do you experience constipation or diarrhea?" "Do you experience abnormal taste sensations?"
"Do you experience abnormal taste sensations?"
During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic? "You are exactly the right weight for your height." "You have always been very focused on your thighs. Is that the part of your body you like least?" "I don't think you are fat." "Has something occurred that caused you to measure your thighs?"
"Has something occurred that caused you to measure your thighs?"
Following a series of visits to the primary care provider and the hospital, a 22-year-old retail clerk has been diagnosed with anorexia nervosa. Which of the client's statements demonstrate an accurate understanding of the diagnosis? "I guess it's probably safe to say that anorexia runs in my family." "What you don't understand is that it's way healthier to be skinny than fat, and it looks better." "I know that if I could lose this last 10 pounds I'd feel completely different about things." "What no one seems to understand is that I'm concerned about my health, not ignoring it."
"I guess it's probably safe to say that anorexia runs in my family."
The nurse is interviewing an 18-year-old client about eating behaviors. The client's parents have brought the client to treatment because the client's mother suspects that the client has been binge eating and vomiting. The nurse asks the client if the client ever feels that the client cannot control the client's eating. The client's mother states, "I know the client can't control it; the client ate an entire cake last night!" Which comment by the nurse is best? "I see. What are your thoughts on what your mother has said?" " Is what your mother said true?" "Do you often have to answer for your child?" "I see. Do you ever feel as though you cannot control your eating?"
"I see. Do you ever feel as though you cannot control your eating?"
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? "I know if I eat pasta, I'll binge." "I'll take my medication when I feel the urge to binge." "How I feel about my body has little to do with my binging." "I'll eat small meals and snacks regularly."
"I'll eat small meals and snacks regularly."
A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder? "My strict dieting led to my problem with anorexia." "There are many factors involved with how I developed anorexia ." "Society told me I needed to be thin and I believed that." "There is a history of obsessive-compulsive disorder in my family."
"There are many factors involved with how I developed anorexia .
A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication? "What do you believe has caused your anorexia?" "Why do you prefer not to eat food?" "What do you think about how much you weigh right now?" "Is there anything that I can get you to eat right now?"
"What do you think about how much you weigh right now?"
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? "While eating disorders have been shown to have a genetic basis, other factors also play a role in its development." "Eating disorders have not been found to be genetic, so you do not have a particular risk." "It is not genetics but the environment that increases your risk. Since you live together, you have the same risk as your twin." "For identical twins, there is about a 5% chance that both twins develop an eating disorder."
"While eating disorders have been shown to have a genetic basis, other factors also play a role in its development."
Which client being treated for anorexia displays assessment values that warrant hospitalization? A 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt SUBMIT ANSWER
A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL
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, binge eating, and purging type Eating disorder not otherwise specified Anorexia nervosa, restricting type
Anorexia nervosa, restricting type
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? Mood stabilizers Antipsychotics Stimulants Antidepressants
Antidepressants
The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first? Identify the cues related to binging Control the eating responses Ask the client directly about thoughts of suicide or self-harm Provide small regular meals and snacks
Ask the client directly about thoughts of suicide or self-harm
A 25-year-old client is brought in for treatment by the client's parents. The client has been restricting activities and avoiding social contacts because the client has become preoccupied with the client's thighs, calling them "hideous" and "disfiguring." The client believes that people can't stop staring at them because they are so "deformed." Which is the term used to describe these symptoms? Hypochondriasis Body image disturbance Hypervigilance Conversion disorder
Body image disturbance
Which is a cardiac complication of an eating disorder? Hypertension Bradycardia Thrombocytopenia Enlarged heart
Bradycardia
A group of nurses is reviewing information about the complications associated with eating disorders. The group demonstrates understanding of the information when they identify which as a possible cardiac complication? Select all that apply. Bradycardia Hypertension Loss of cardiac muscle Enlarged heart Ventricular tachycardia
Bradycardia Ventricular tachycardia Loss of cardiac muscle
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? Bulimia nervosa, purging type Anorexia nervosa, purging type Anorexia nervosa, restricting type Binge eating disorder
Bulimia nervosa, purging type
A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment? Psychosocial assessment and determination of coping skills Complete blood count and differential Evidence of injury to skin by cutting Cardiac assessment and measurement of electrolyte levels
Cardiac assessment and measurement of electrolyte levels
A 30-year-old client is in therapy for bulimia, depression, and anxiety. The client relates that the client feels unable to cope with the demands of the client's job and that the client's partner recently ended their long-term relationship. The client states that the client frequently binges when stress levels are high. The client denies feeling suicidal but states, "I'm a mess. I'm just not smart enough to figure out how to run my life!" Which nursing diagnosis would bestidentify the client's problems? Anxiety related to job stressors Social isolation related to recent loss of significant relationship Chronic low self-esteem related to unrealistic self-expectations Risk for impulse control related to unidentified triggers
Chronic low self-esteem related to unrealistic self-expectations
A client's diagnosis of anorexia nervosa is supported when the psychiatric nurse documents assessment data that includes which finding? Select all that apply. Client claims that she "hasn't had a menstrual period in over 2 years." Client has a history of "sleeping 9 hours a night and taking frequent naps." Client reports "being depressed." Client consistently denies that she "has a problem with the way she looks." Client is overheard telling other clients "I weigh myself three times a day when I'm home."
Client reports "being depressed." Client claims that she "hasn't had a menstrual period in over 2 years." Client is overheard telling other clients "I weigh myself three times a day when I'm home." Client consistently denies that she "has a problem with the way she looks."
A client's diagnosis of bulimia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.) Often heard discussing "how hard it is to stay thin" with other clients History of purging "3 times a week for 2 years." Lanugo observed on forearms and face Serum potassium of 3.8 mEq/L Client reports of "being depressed"
Client reports of "being depressed" History of purging "3 times a week for 2 years." Often heard discussing "how hard it is to stay thin" with other clients
Which intervention has been found to be most effective reducing the initial symptoms of bulimia? Behavioral therapy and psychoeducation Clearly stated unit rules and a supportive milieu Daily monitoring of sound dietary principles and meditation sessions Cognitive behavior therapy and pharmacologic interventions
Cognitive behavior therapy and pharmacologic interventions
For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? One-on-one time with psychiatric staff and antidepressant medication therapy Clearly stated unit rules and a supportive milieu Cognitive-behavioral therapy (CBT) including self-monitoring Daily reinforcement of sound dietary principles and meditation sessions
Cognitive-behavioral therapy (CBT) including self-monitoring
When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what? Depression Anxiety Control Dependency
Control
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 Hyperactivity related to restlessness Impaired social interaction related to aggressive behavior Anxiety related to inadequate coping mechanisms
Deficient fluid volume related to refusal to drink
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? Bacterial gastrointestinal infections and overhydration Respiratory distress and dyspnea Metabolic acidosis and constricted colon Dental erosion and chronic edema
Dental erosion and chronic edema
Which is the most common disorder found in clients diagnosed with bulimia nervosa? Substance abuse Anxiety Psychosis Depression
Depression
especially alert for which if noted in the clients' histories? Paranoia Depression Primary insomnia Aggression
Depression
A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which item would the nurse include? Emphasis on the need for teachers to focus their prevention efforts on female students Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders
Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders
A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find? Tachycardia Oversensitivity to heat Dry skin Hyperkalemia
Dry skin
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 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 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.
A client diagnosed with anorexia nervosa is being treated in an outpatient setting in the community. Which activity would be the priority? Improving nutritional status Confirming beliefs about body size Acknowledging the severity of the illness Establishing a therapeutic relationship
Establishing a therapeutic relationship
For a client diagnosed with anorexia nervosa, which goal takes priority? Developing a contract with the nurse that sets a target weight Verbalizing the possible physiologic consequences of self-starvation Establishing adequate daily nutritional intake Identifying self-perceptions about body size as unrealistic
Establishing adequate daily nutritional intake
During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication? Fluoxetine Risperidone Olanzapine Ziprasidone
Fluoxetine
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Lithium Haloperidol Bupropion Fluoxetine
Fluoxetine
Exacerbation of anorexia nervosa results from the client's effort to do what? Diminish conflict Manipulate family members Live up to family expectations Gain control of one part of life
Gain control of one part of life
The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next? Condition of mouth and gums Heart rate and rhythm Patterns of activity and rest Throat and esophagus
Heart rate and rhythm
Which area of the brain has been associated with the symptoms of eating disorders? Pons Cerebellum Medulla Hypothalamus
Hypothalamus
A nurse is reviewing the plan of care for a client diagnosed with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis? Anxiety Imbalanced nutrition: less than body requirements Disturbed body image Ineffective coping
Imbalanced nutrition: less than body requirements
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 Increasing client's coping skills for anxiety Encouraging client take time away from peers for a time Nurturing the client's need for dependency
Increasing client's coping skills for anxiety
A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. The client is 5 feet 5 inches tall and weighs 75 pounds. Which is the priority nursing intervention? Initiating total parenteral nutrition as ordered Initiating cognitive behavioral therapy as ordered Addressing the client's low self-esteem Monitoring vital signs and weight
Initiating total parenteral nutrition as ordered
The nurse provides care to a client who is diagnosed with an eating disorder. Which strategy should the nurse include in the client's plan of care to increase the client's self-concept? Keep a list of accomplishments. Practice meditation. Limit physical activity to a reasonable schedule. Increase social contact.
Keep a list of accomplishments.
Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? Alternation between loving and rejecting their children A history of substance abuse Maintenance of emotional distance from their children Overprotective of their children
Overprotective of their children
At the prompting of friends, a 16-year-old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. During the nurse's assessment, the nurse has asked the client to describe the client's family. Which family process and characteristic is thought to contribute to eating disorders? The absence of a parent and/or the presence of a stepparent Passive parenting and lack of encouragement An overemphasis of peer relationships over family relationships Poor communication and enmeshed family dynamics
Poor communication and enmeshed family dynamics
The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what? Provide the client with a feeling of responsibility and control over the client's behavior Provide the therapist with a strategy for client compliance Allow the client a tool by which to negotiate behavior Provide the nurse with a tool for evaluating the plan of care
Provide the client with a feeling of responsibility and control over the client's behavior
The client with bulimia reports feeling helpless and says, "What's the use?" As the nurse plans the client's care, the priority diagnosis is which? Risk for self-directed violence Nutrition that is less than body requirements Anxiety Ineffective individual coping
Risk for self-directed violence
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? Self-monitoring Music therapy Guided imagery Distraction
Self-monitoring
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? Serotonin Dopamine Acetylcholine Norepinephrine
Serotonin
An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? Set up a strict eating plan for the client Encourage the client to exercise, which will reduce the client's anxiety Restrict visits with the family until the client begins to eat Provide privacy during meals
Set up a strict eating plan for the client
A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which would the nurse include in the education plan? Setting realistic goals Learning strategies to control impulses Describing physiologic consequences of anorexia nervosa Knowing the calorie content of numerous foods
Setting realistic goals
A college student has been referred to the college clinic for evaluation for anorexia nervosa. Which would help support the diagnosis? Onset of symptoms during preadolescence Oily skin Significantly low body weight Temper tantrums
Significantly low body weight
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. Stabilize electrolyte levels. Develop a contract with the client to stop using laxatives and diuretics.
Stabilize electrolyte levels.
For clients who purge, what is the most important goal? Stop the behavior Understand that purging is an ineffective means of weight control Recognize that purging promotes binge eating Develop the technique of distraction
Stop the behavior
A client with bulimia is being discharged from care. The nurse considers which indicator mostimportant when evaluating the effectiveness of the care plan? The client has moved into the client's own apartment. The client has not learned to accept the client's body type The client eats six small meals per day. The client has lost weight over the past year.
The client eats six small meals per day
A nurse is reviewing the medical records of several clients being treated for eating disorders at the community mental health center. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa? The client is of normal body weight. The client is preoccupied with food consumption. The client is preoccupied with body image. The client has feelings of powerlessness.
The client is of normal body weight.
After complaining of weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client's nursing care and treatment, which outcome should be prioritized? The client will identify alternatives to current coping patterns. The client will acknowledge self-harm thoughts. The client will be free of self-induced vomiting. The client will verbalize fears relating to the client's health needs.
The client will be free of self-induced vomiting.
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? engaging in severe dieting socially withdrawing compulsively washing his or her hands becoming sexually promiscuous
engaging in severe dieting
When reviewing the documented history of an adult client with anorexia nervosa, what is the nurse most likely to find? (Select all that apply.) reported believing that friends were "jealous" of her body had successful outpatient treatment one year after onset of disorder depression at age 16 lasting one month food restriction began at age 15 reports strong relationship with parents
food restriction began at age 15 depression at age 16 lasting one month reported believing that friends were "jealous" of her body
The nurse provides care to an adolescent client who presents to the emergency department (ED) after losing consciousness during a marching band performance. A differential diagnosis of anorexia nervosa is documented by the practitioner. Which finding noted when reviewing the client's laboratory data indicates a need for hospitalization? hypokalemia hypermagnesemia hypoglycemia
hypokalemia The criteria for hospitalization for the client who is diagnosed with an eating disorder include acute weight loss, < 85% below ideal; heart rate near 40 beats/min; temperature less than 97.0°F (36.1°C); blood pressure less than 80/50 mm Hg; poor motivation to recover; and electrolyte abnormalities, including hypokalemia, hypophosphatemia, and hypomagnesemia. Hypoglycemia would be expected with lack of intake and is not a criterion for hospitalization.
