Townsend Mental Health: Chapter 31 Eating Disorders, 2204 Eating Disorders, Chapter 22: Eating Disorders, Chapter 14 - Eating Disorders, Chapter 22: Eating Disorders

What do individuals with bulimia do?

"purge" themselves of the excessive intake with self-induced vomiting or the misuse of laxatives, diuretics, or enemas

In binge-eating disorder, 3 more more of the what behaviors are present?

1. eating much more rapidly than normal 2. eating until feeling uncomfortably full 3. eating large amounts of food when not feeling physically hungry 4. eating alone because of feeling embarrassed by how much one is eating 5. feeling disgusted with oneself, depressed, or very guilty after overeating

The age group predominantly affected by eating disorders is:

12-30 years

Anorexia is characterized by a BMI of:

17.5 or lower

What is considered a normal BMI range?

20-24.9

What is the overweight BMI range?

25-29.9

The average american woman has a BMI of ___ while fashion models have an average BMI of ___

26; 18

Obesity is defined as a BMI of ___ or greater

30

Extremely obese is a BMI of ___ or greater

40

___% of offspring of two obese parents are obese

80

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.

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.

The client with bulimia differs from the client with anorexia nervosa by a. maintaining a normal weight. b. holding a distorted body image. c. doing more rigorous exercising. d. purging to keep weight down.

A. maintaining a normal weight. Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight.

A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa, should the nurse provide? 1. The emesis produced during purging is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries

ANS: 1 Rationale: The nurse should explain to the client diagnosed with bulimia nervosa that his or her teeth will eventually deteriorate, because the emesis produced during purging is acidic and corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.

A morbidly obese client is prescribed an anorexiant medication. The nurse should expect to teach the client about which medication? 1. Phentermine (Mirapront) 2. Dexfenfluramine (Redux) 3. Sibutramine (Meridia) 4. Pemoline (Cylert)

ANS: 1 Rationale: The nurse should teach the client that phentermine is an anorexiant medication prescribed for morbidly obese clients. Phentermine works on the hypothalamus to stimulate the adrenal glands to release norepinephrine, a neurotransmitter that signals a fight-or-flight response, reducing hunger. Dexfenfluramine has been removed from the market because of its association with serious heart and lung disease. Several deaths have been associated with the use of sibutramine by high-risk clients. Based on pressure from the FDA, the manufacturer issued a recall of the drug in October 2010. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression

A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not

ANS: 1 Rationale: The nurse should understand that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia do not. Anorexia is characterized by a morbid fear of obesity and often results in low caloric and nutritional intake. Bulimia is characterized by episodic, rapid consumption of large quantities of food followed by purging

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) 1. Binge eating with a diagnosis of obesity 2. Bingeing and purging with a diagnosis of bulimia nervosa 3. Weight loss with a diagnosis of anorexia nervosa 4. Amenorrhea with a diagnosis of anorexia nervosa 5. Emaciation with a diagnosis of bulimia nervosa

ANS: 1, 2 Rationale: The nurse should identify that topiramate is the drug of choice when treating binge eating with a diagnosis of obesity or bingeing and purging with a diagnosis of bulimia nervosa. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight.

Which of the following would contribute to a client's excessive weight gain? (Select all that apply.) 1. A hypothalamus lesion 2. Hyperthyroidism 3. Diabetes mellitus 4. Cushing's disease 5. Low levels of serotonin

ANS: 1, 3, 4 Rationale: Lesions in the appetite and satiety centers in the hypothalamus may contribute to overeating and lead to obesity. Hypothyroidism, not hyperthyroidism, is a problem that interferes with basal metabolism and may lead to weight gain. Weight gain can also occur in response to the decreased insulin production of diabetes mellitus and the increased cortisone production of Cushing's disease. New evidence also exists to indicate that low levels of the neurotransmitter serotonin may play a role in compulsive eating

A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.) 1. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." 2. "In this disorder, binge eating occurs, on average, at least once a week for three months." 3. "In this disorder, binge eating occurs, on average, at least two days a week for six months." 4. "In this disorder, distress regarding binge eating is present." 5. "In this disorder, distress regarding binge eating is absent."

ANS: 1, 3, 5 Rationale: According to the DSM-5 criteria for the diagnosis of binge-eating disorder, binge eating should not occur exclusively during the course of anorexia nervosa or bulimia nervosa. The new time frame criteria in the DSM-5 states that binge eating must occur, on average, at least once a week for three months not two days a week for six months. The DSM-5 criteria states that distress regarding binge eating would be present

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 response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." 3. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

ANS: 2 Rationale: 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 anorexia nervosa

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa? 1. The home environment maintains loose personal boundaries. 2. The home environment places an overemphasis on food. 3. The home environment is overprotective and demands perfection. 4. The home environment condones corporal punishment.

ANS: 3 Rationale: 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 the parents viewed by the child as a means of gaining and remaining in control.

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? 1. The client gained two pounds in one week. 2. The client focused conversations on nutritious food. 3. The client demonstrated healthy coping mechanisms that decreased anxiety. 4. The client verbalized an understanding of the etiology of the disorder

ANS: 3 Rationale: The nurse should identify that a client who demonstrates healthy coping mechanisms to decrease anxiety indicates a positive behavioral change. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behavior

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? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will perceive personal ideal body weight and shape as normal. 4. The client will not express a preoccupation with food.

ANS: 3 Rationale: The nurse should identify that the appropriate outcome for this client is to perceive personal 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 nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's uncontrollable behaviors. 4. It allows clients to maintain control

ANS: 4 Rationale: 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 function to restore healthy weight.

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder? 1. "Skaters need to be thin to improve their daily performance." 2. "All the skaters on the team are following an approved 1200-calorie diet." 3. "The exercise of skating reduces my appetite but improves my energy level." 4. "I am angry at my mother. I can only get her approval when I win competitions."

ANS: 4 Rationale: The client reflects insight when referring to feelings toward family dynamics that may have influenced the development of the disease. Families who are overprotective and perfectionistic can contribute to the development of anorexia nervosa.

A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time? 1. Altered nutrition less than body requirements 2. Altered social interaction 3. Impaired verbal communication 4. Altered family processes

ANS: 4 Rationale: The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating

14. Which nursing intervention has the highest priority for a patient with bulimia nervosa? a. Assist the patient to identify triggers to binge eating. b. Provide corrective consequences for weight loss. c. Assess for signs of impulsive eating. d. Explore patient needs for health teaching.

ANS: A For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. The triggers are often anxiety-producing situations. Identifying these triggers makes it possible to break the binge-purge cycle. Because binge eating and purging directly affect physical status, the need to promote physical safety assumes the highest priority.

23. Which statement is a nurse most likely to hear from a patient with anorexia nervosa? a. "I'm fat and ugly." b. "I have nice eyes." c. "I'm thin for my height." d. "My parents don't pay much attention to me."

ANS: A Patients with eating disorders have distorted body images; they see themselves as overweight even when their weight is subnormal. "I'm thin for my height" is therefore unlikely to be heard from a patient with anorexia nervosa. Poor self-image precludes making positive statements about self, such as "I have nice eyes." Many patients with eating disorders see supportive others as intrusive and out of tune with their needs.

15. One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from: a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9° C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36° C; pulse, 50 beats/min; blood pressure, 70/50 mm Hg c. 110 to 70 pounds over a 4-month period. Vital signs: temperature 36.5° C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7° C; pulse, 62 beats/min; blood pressure, 74/48 mm Hg

ANS: A Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months, temperature below 36° C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.

20. Physical assessment of a patient with bulimia often reveals: a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. amenorrhea.

ANS: A Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and are not usually observed in bulimia.

A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis? A. The client will identify two alternative methods of dealing with isolation by day 3. B. The client will appropriately express angry feelings about lack of control by week 2. C. The client will verbalize two positive self attributes by day 3. D. The client will list five ways that the body reacts to bingeing and purging.

ANS: A The ability to identify alternative methods of dealing with isolation will provide the client with effective coping strategies to use instead of bingeing and purging.

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.

ANS: 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."

ANS: 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.

4. A patient with anorexia nervosa virtually stopped eating 5 months ago and has lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis? a. "I'm fat and ugly." b. "What I think about myself is my business." c. "I'm grossly underweight, but that's what I want." d. "I'm a few pounds overweight, but I can live with it."

ANS: A Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually tell others perceptions of self. The patient with anorexia will persist in trying to lose more weight.

25. An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: a. assess lung sounds and extremities. b. suggest the use of an aerobic exercise program. c. positively reinforce the patient for the weight gain. d. establish a higher goal for weight gain the next week.

ANS: A Weight gain of more than 2 to 5 pounds weekly may overwhelm the heart's capacity to pump, leading to cardiac failure. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are undesirable because they increase the risk for cardiac complications.

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) A. Binge eating with obesity B. Bingeing and purging with a diagnosis of bulimia nervosa C. Weight loss with a diagnosis of anorexia nervosa D. Amenorrhea with a diagnosis of anorexia nervosa E. Emaciation with a diagnosis of bulimia nervosa

ANS: A, B The nurse should identify that topiramate (Topamax) is the drug of choice when treating binge eating with obesity and bingeing and purging with a diagnosis of bulimia nervosa. Topiramate (Topamax) is a novel anticonvulsant used in the long-term treatment of binge-eating disorder with obesity. The use of Topamax results in a significant decline in mean weekly binge frequency and significant reduction in body weight. With the use of this medication, episodes of bingeing and purging were decreased in clients diagnosed with bulimia nervosa.

1. A patient referred to the eating disorders clinic has lost 35 pounds in 3 months and has developed amenorrhea. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply. a. Peripheral edema b. Parotid swelling c. Constipation d. Hypotension e. Dental caries f. Lanugo

ANS: A, C, D, F Peripheral edema is often present because of hypoalbuminemia. Constipation related to starvation is often present. Hypotension is often present because of dehydration. Lanugo is often present and is related to starvation. Parotid swelling is associated with bulimia. Dental caries are associated with bulimia.

Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa? A. Provide privacy during meals. B. Remain with the client for at least 1 hour after the meal. C. Encourage the client to keep a journal to document types of food consumed. D. Restrict client privileges when provided food is not completely consumed.

ANS: B A nurse should remain with clients diagnosed with either anorexia nervosa or bulimia nervosa for at least 1 hour after meals. This allows the nurse to monitor for food discarding (anorexia nervosa) and/or self-induced vomiting (bulimia nervosa).

8. A patient with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? a. Because severe anxiety concerning eating is expected, objective and subjective data must be routinely collected. b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment. c. A team approach to planning the diet ensures that physical and emotional needs are met. d. Because of increased risk of physical problems with refeeding, obtaining patient permission is essential.

ANS: B A sense of control for the patient is vital to the success of therapy. A diet that controls weight gain can allay patient fears of a too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an additional aspect of treatment.

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

ANS: 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.

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

ANS: 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.

12. What behavior by a nurse caring for a patient with an eating disorder indicates the nurse needs supervision? a. The nurse's comments are nonjudgmental. b. The nurse uses an authoritarian manner when interacting with the patient. c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d. The nurse refers the patient to a self-help group for individuals with eating disorders.

ANS: B In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assume the role of a parent. The helpful nurse uses a problem-solving approach and focuses on the patient's feelings of shame and low self-esteem. Referral to a self-help group is an appropriate intervention.

11. An appropriate intervention for a patient with bulimia nervosa who binges and purges is to teach the patient to: a. eat a small meal after purging. b. avoid skipping meals or restricting food. c. concentrate intake after 4 PM daily. d. understand the value of reading journal entries aloud to others.

ANS: B One goal of health teaching is the normalization of eating habits. Food restriction and skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce vomiting. Teaching the patient to concentrate intake after 4 PM will lead to late-day bingeing. Journal entries are private.

21. Which personality characteristic is a nurse most likely to assess in a patient with anorexia nervosa? a. Carefree flexibility b. Rigidity, perfectionism c. Open displays of emotion d. High spirits and optimism

ANS: B Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients with eating disorders. The incorrect options are rare in a patient with an eating disorder. Inflexibility, controlled emotions, and pessimism are more the norm.

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."

ANS: 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.

7. Which nursing intervention has priority as a patient with anorexia nervosa begins to gain weight? a. Assess for depression and anxiety. b. Observe for adverse effects of refeeding. c. Communicate empathy for the patient's feelings. d. Help the patient balance energy expenditure and caloric intake.

ANS: B The nursing intervention of observing for adverse effects of refeeding most directly relates to weight gain and is a priority. Assessing for depression and anxiety and communicating empathy relate to coping. Helping the patient balance energy expenditure and caloric intake is an inappropriate intervention.

3. A patient who is referred to the eating disorders clinic has lost 35 pounds during 3 months. To assess eating patterns, the nurse should ask the patient: a. "Do you often feel fat?" b. "Who plans the family meals?" c. "What do you eat in a typical day?" d. "What do you think about your present weight?"

ANS: C Although all the questions might be appropriate to ask, only "What do you eat in a typical day?" focuses on the eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family meal planning are unrelated to eating patterns. Asking for the patient's thoughts on present weight explores the patient's feelings about weight.

When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this client's symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels B. Abnormal electroencephalogram (EEG) C. Metabolic acidosis D. Metabolic alkalosis

ANS: C Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. The nurse should attribute this client's fainting to the loss of alkaline stool due to laxative abuse which would lead to a relative metabolic acidotic condition.

16. While providing health teaching for a patient with binge-purge bulimia, a nurse should emphasize information about: a. self-monitoring of daily food and fluid intake. b. establishing the desired daily weight gain. c. recognizing the symptoms of hypokalemia. d. self-esteem maintenance.

ANS: C Hypokalemia results from potassium loss associated with vomiting. Physiologic integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the risk for hypokalemia.

1. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? a. Binge eating b. Bulimia nervosa c. Anorexia nervosa d. Eating disorder not otherwise specified

ANS: C Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. The patient with an eating disorder not otherwise specified may be obese.

17. As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet, 4 inches tall. Which term should be documented? a. Amenorrhea b. Alopecia c. Lanugo d. Stupor

ANS: C The fine, downy hair noted by the nurse is called lanugo. It is frequently seen in patients with anorexia nervosa. None of the other conditions can be supported by the data the nurse has gathered.

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.

ANS: 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.

ANS: 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.

ANS: 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 morbidly obese client is prescribed an anorexiant medication. The nurse should prepare to teach the client about which medication? A. Diazepam (Valium) B. Dexfenfluramine (Redux) C. Sibutramine (Meridia) D. Pemoline (Cylert)

ANS: C The nurse should teach the client that sibutramine (Meridia) is an anorexiant medication prescribed for morbidly obese clients. The mechanism of action in the control of appetite appears to occur by inhibiting the neutotransmitters serotonin and norepinephrine. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients? A. The nurse who understands the importance of three balanced meals a day B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption D. The nurse who grew up poor and frequently did not have enough food to eat

ANS: C The nurse who refuses to engage in power struggles related to food consumption will probably be most effective when dealing with clients diagnosed with eating disorders. Because of this attitude the nurse recognizes that the real issues have little to do with food or eating patterns. The nurse will be able to focus on the control issues that precipitated these 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.

ANS: 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.

A client diagnosed with bulimia nervosa is to receive fluoxetine (Prozac) by oral solution. The medication is supplied in a 100 mL bottle. The label reads 20 mg/5 mL. The doctor orders 60 mg q day. Which dose of this medication should the nurse dispense? A. 25 mL B. 20 mL C. 15 mL D. 10 mL

ANS: C Twenty mg of Prozac multiplied by three results in the calculated 60 mg daily dose ordered by the physician. Each 5 mL contains 20 mg. Five mL multiplied by three equals the liquid dosage of 15 mL.

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

ANS: 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.

2. A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply. a. Flexible mealtimes b. Unscheduled weight checks c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips f. Privileges correlated with emotional expression

ANS: C, D, E Priority milieu interventions support the restoration of weight and a normalization of eating patterns. These goals require close supervision of the patient's eating habits and the prevention of exercise, purging, and other activities. Menus are strictly adhered to. Patients are observed during and after meals to prevent them from throwing away food or purging. All trips to the bathroom are monitored. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.

26. When a nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight, the nurse should state: a. "You and I will have to sit down and discuss this problem." b. "It bothers me to see you exercising. You'll lose more weight." c. "Let's discuss the relationship between exercise and weight loss and how that affects your body." d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

ANS: D A matter-of-fact statement that the nurse's perceptions are different helps avoid a power struggle. Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients must be held accountable for required behaviors.

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.

ANS: 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.

2. Disturbed body image is the nursing diagnosis for a patient with an eating disorder. Which outcome indicator is most appropriate to monitor? a. Weight, muscle, and fat are congruent with height, frame, age, and sex. b. Calorie intake is within the required parameters of the treatment plan. c. Weight reaches the established normal range for the patient. d. Patient expresses satisfaction with body appearance.

ANS: D Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This consideration is subjective. The other indicators are more objective but less related to the nursing diagnosis.

19. A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: a. Maintaining patients' concentration and attention. b. Shifting the patients' focus from food to psychotherapy. c. Focusing on weight control mechanisms and food preparation. d. Processing the heightened anxiety levels associated with eating.

ANS: D Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to be successful in attaining therapeutic goals. Shifting the patients' focus from food to psychotherapy and focusing on weight control mechanisms and food preparation are not desirable. Maintaining patients' concentration and attention is important, but not the primary purpose of the schedule.

6. Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will: a. Weigh self accurately using balanced scales. b. Limit exercise to less than 2 hours daily. c. Select clothing that fits properly. d. Gain 1 to 2 pounds.

ANS: D Only the outcome of a gain of 1 to 2 pounds can be accomplished within 1 week when the patient is an outpatient. The focus of an outcome is not on the patient weighing self. Limiting exercise and selecting proper clothing are important, but weight gain takes priority.

9. A nursing care plan for a patient with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Central nervous d. Cardiovascular

ANS: D Refeeding resulting in a too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment becomes a necessity to ensure patient physiologic integrity. The other body systems are not initially involved in the refeeding syndrome.

22. Which assessment finding for a patient with an eating disorder meets a criterion for hospitalization? a. Urine output: 40 ml/hr b. Pulse rate: 58 beats/min c. Serum potassium: 3.4 mEq/L d. Systolic blood pressure: 62 mm Hg

ANS: D Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 ml/hr. A potassium level of 3.4 mEq/L is within the normal range.

10. A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? a. "What are your feelings about not eating the food that you prepare?" b. "You seem to feel much better about yourself when you eat something." c. "It must be difficult to talk about private matters to someone you just met." d. "Being thin doesn't seem to solve your problems. You're thin now but still unhappy."

ANS: D The correct response is the only strategy that attempts to question the patient's distorted thinking.

13. A nursing diagnosis for a patient with bulimia nervosa is: Ineffective coping, related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will: a. appropriately express angry feelings. b. verbalize two positive things about self. c. verbalize the importance of eating a balanced diet. d. identify two alternative methods of coping with loneliness.

ANS: D The outcome of identifying alternative coping strategies is most directly related to the diagnosis of Ineffective coping. Verbalizing positive characteristics of self and verbalizing the importance of eating a balanced diet are outcomes that might be used for other nursing diagnoses. Appropriately expressing angry feelings is not measurable.

24. Which nursing diagnosis is more applicable to a patient with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient with bulimia nervosa who purges? a. Powerlessness b. Ineffective coping c. Disturbed body image d. Imbalanced nutrition: less than body requirements

ANS: D The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.

5. A patient has anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The serum potassium is 2.7 mg/dl. Which nursing diagnosis applies? a. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b. Disturbed energy field, related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c. Ineffective health maintenance, related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d. Imbalanced nutrition: less than body requirements, related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

ANS: D The patient's history and laboratory results support the fourth nursing diagnosis. Available data do not confirm that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.

18. A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet, 4 inches. The patient is quiet and says only, "I won't eat until I look thin." What is the priority initial nursing diagnosis? a. Anxiety, related to fear of weight gain b. Disturbed body image, related to weight loss c. Ineffective coping, related to lack of conflict resolution skills d. Imbalanced nutrition: less than body requirements, related to self-starvation

ANS: D The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient's self-starvation is the priority.

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."

ANS: 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.

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

ANS: D When the client states, "I don't know why people are worried. I need to lose this weight," the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

The diagnosis of __________________ ___________________includes the symptoms of gross distortion of body image, preoccupation with food, and refusal to eat

ANS: anorexia nervosa Rationale: Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat

The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed ________________________.

ANS: bingeing Rationale: The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed bingeing. Bingeing is a classic symptom of the eating disorder defined as bulimia nervosa

To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in ______________________ behaviors, which include self-induced vomiting, or the misuse of laxatives, diuretics, or enemas

ANS: purging Rationale: To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in purging behaviors, which include self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In addition to these behaviors, other inappropriate compensatory behaviors, such as fasting or excessive exercise may be noted

What is the formula for BMI?

BMI= weight (kg)/height (m^2)

What is considered obesity?

Body mass index (BMI) of 30

Onset of bulimia versus onset of anorexia:

Bulimia onset is late adolescence & adulthood Anorexia onset is early to late adolescence

Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? a. bradycardia b. amenorrhea c. tolerance d. convulsions

C. Tolerance

Neurochemical influecnes in bulimia nervosa:

Decreased serotonin and norepinephrine. Evidence for this is the fact that there is often a positive response to SSRI treatment

Psychodynamic theories suggest that eating disorders are the result of:

Early and profound disturbances in mother-infant interactions. This causes delayed ego development, disturbance in body identity and distortion in body image

Physiological symptoms of anorexia:

Excessive weight loss, hypothermia, bradycardia, hypotension, edema, lanugo, amenorrhea, cardiac irregularities

True or False: the incidence of eating disorders has decreased since the middle of the twentieth century

FALSE - increased

DSM-5 crtieria for severity of bulimia nervosa: mild: moderate: severe: extreme:

Mild: 1-3 episodes of inappropriate compensatory behaviors/week Moderate: average of 4-7 " " " severe: average of 8-13 " " extreme: average of 14 or more episodes/week

DSM-5 diagnostic criteria for anorexia nervosa severity: Mild: Moderate: Severe: Extreme:

Mild: BMI greater than or equal to 17 Moderate: BMI between 16-16.99 Severe: BMI 15-15.99 Extreme: BMI < 15

What medications are effective in treating anorexia nervosa?

None specifically. Other symptoms like anxiety and depression may be treated with prozac or clomipramine. One study found the antipsychotic olanzapine/Zyprexa to be helpful

The psychoanalytic view of obesity proposes:

Obese individuals have unresolved dependency needs and are fixed in the oral stage of psychosexual development.

What medication is most likely to be prescribed for someone with bulimia nervosa?

Prozac/fluoxetine, 60 mg/day (which is triple the usual dose). It is possible that this decreases carbohydrate cravings and thus binge episodes

The theory of family as a system suggests that anorexia nervosa is:

Reinforced in an effort to avoid spousal conflict; parents are avoiding marital conflict by defining the sick child as the problem; there's unhealthy enmeshment; desire to maintain appearances at all costs

What are the types of anorexia nervosa?

Restricting type: during last 3 months the ct has not engaged in recurrent episodes of binge eating or purging behaviore Binge-eating/purgin type: during the last 3 months the ct HAS purged/binged

What medication has shown to be effective in individuals with BED & obesity?

The anticonvulsant topiramate

Where is the appetite center of the brain located?

The hypothalamus

Pyschoanalytically, the theory of obesity relates to the individual's unconscious equation of food with a. nurturance and caring b. power and control c. autonomy and emotional growth d. strength and endurance

a.

The binging episode is thought to involve: a. a release of tension, followed by feelings of depression b. feelings of fear, followed by feelings of relief c. unmet dependency needs and a way to gain attention d. feelings of euphoria, excitement, and self-gratification

a.

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. "I eat three meals each day and purge every evening." Most clients with bulimia purge after each meal.

The binging episode is thought to involve: a. A release of tension, followed by feelings of depression b. Feelings of fear, followed by feelings of grief c. unmet dependency needs and a way to gain attention d. feelings of euphoria, excitement, and self-gratification

a. A release of tension, followed by feelings of depression

A coping mechanism used excessively by clients with anorexia nervosa is a. denial. b. humor. c. altruism. d. projection.

a. denial. Denial of excessive thinness is the mainstay of the client with 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. gain a maximum of 3 lb. 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.

Psychoanalytically, the theory of obesity relates to the individual's unconscious equation of food with: a. nurturance and caring b. power and control c. autonomy & emotional growth d. strength and endurance

a. nurturance and caring

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. teaching the family about the disorder and the client's behaviors. 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.

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. Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status.

What is a disorder that is characterized by a morbid fear of obesity and a gross distortion of body image?

anorexia nervosa

What disorders often accompany anorexia?

anxiety and depression

From a physiological point of view, the most common cause of obesity is probably a. lack of nutritional education b. more calories consumed than expended c. impaired endocrine functioning d. low basal metabolic rate

b.

Jane is hospitalized on the psychiatric unit. She has a history and current diagnosis of Bulimia Nervosa. Which of the following symptoms would be congruent with Jane's diagnosis? a. Binging, purging, obesity, hyperkalemia b. binging, purging, normal weight, hypokalemia c. binging, laxative abuse, amenorrhea, severe weight loss c. binging, purging, severe weight loss, hyperkalemia

b.

Nancy, age 14, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Nancy? a. complicated grieving b. imbalanced nutrition: less than body requirements c. interrupted family processes d. anxiety (Severe)

b.

Nurse Jones is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? a. "You know that if you don't eat, you will die." b. "if you continue to refuse to take food orally, you will be fed through a nasogastric tube." c. "You might as well leave if you are not going to follow your therapy regimen" d. "you don't have to eat if you don't want to. It is your choice."

b.

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. "How would you describe your body?" This question will reveal the cognitive distortion consistent with anorexia nervosa. Invariably the client will describe self as fat despite being excessively underweight.

Nurse Jones is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. the client continues to refuse to eat. What is the most appropriate response by the nurse? a. You know that if you don't eat you'll die. b. If you continue to refuse to take food orally, you will be fed through a nasogastric tube c. You might as well leave if you are not going to follow your therapy regimen d. You don't have to eat if you don't want to. It is your choice.

b. If you continue to refuse to take food orally, you will be fed through a nasogastric tube

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. an increased risk of seizures. Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of an increased risk of seizures.

Jane is hospitalized on the psychiatric unit. she has a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with Jane's diagnosis? a. binging, purging, obesity, hyperkalemia b. binging, purging, normal weight, hypokalemia c. binging, laxative abuse, amenorrhea, severe weight loss d. binging, purging, severe weight loss, hyperkalemia

b. binging, purging, normal weight, hypokalemia

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. Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives.

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. hypokalemia. Vomiting causes loss of potassium, leading to hypokalemia.

Nancy, age 14, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Nancy? a. complicated grieving b. imbalanced nutrition, less than body requirements c. interrupted family processes d. anxiety (severe)

b. imbalanced nutritition: less than body requirements

From a physiological point of view, the most common cause of obesity is probably: a. lack of nutritional education b. more calories consumed than expended c. impaired endocrine functioning d. low basal metabolic rate

b. more calories consumed than expended

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.Weigh fully clothed before breakfast. Clients should be weighed wearing only bra and panties before ingesting any food or fluids in the morning.

Treatment modalities for eating disorders include...

behavior modification, individual psychotherapy, cognitive-behavioral therapy, family therapy, and psychopharmacology

What is characterized by the consumption of huge amounts of food by an individual who feels a lack of control over the eating behavior?

binge-eating disorder (BED)

What is characterized by the consumption of large amounts of food, usually in a short period of time, and often in secret?

bulimia nervosa

A hospitalized patient with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. "Don't worry. The dietitian will ensure you don't get too many calories in your diet." b. "Don't worry about your weight. We are going to work on other problems while you are in the hospital." c. "I understand that you are concerned about your weight, and we will talk about the important of good nutrition; but for now, I want you to tell me about your recent invitation to join the national Honor Society. that's quite an accomplishment." d. "You are not fat and the staff will ensure that you do not gain weight while you are in the hospital because we know that is important to you."

c.

Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? a. bradycardia b. amenorrhea c. tolerance d. convulsions

c.

Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belviq) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Carbamazepine (Tegretol)

c.

Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. tachycardia, hypertension, hyperthermia b. bradycardia, hypertension, hyperthermia c. bradycardia, hypotension, hypothermia d. tachycardia, hypotension, hypothermia

c.

A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. Don't worry. The dietitian will ensure you don't get too many calories in your diet. b. Don't worry about your weight. We are going to work on other problems while you are in the hospital. c. I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now I want you to tell me more about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital because we know that is important to you."

c. I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now I want you to tell me more about your recent invitation to join the National Honor Society. That's quite an accomplishment."

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. Risk for injury: electrolyte imbalance The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss.

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. Support importance of avoiding forbidden foods. No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy.

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. are possibly influenced by sociocultural factors. 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 of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. tachycardia, hypertension, hyperthermia b. bradycardia, hypertension, hypethermia c. bradycardia, hypotension, hypothermia d. tachycardia, hypotension, hypothermia

c. bradycardia, hypotension, hypothermia

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. fits more easily into the family. 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.

During assessment of a client with anorexia nervosa, it is not likely that the nurse would note indications of a. introversion. b. social isolation. c. high self-esteem. d. obsessive-compulsive tendencies.

c. high self-esteem. Most clients with eating disorders have low self-esteem.

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. inspection of the oral cavity. Repeated vomiting often causes dental erosions and caries.

Which medication has been used with some success in clients with anorexia nervosa? a. lorcaserin (Belviq) b. diazepam (valium) c. fluoxetine (prozac) d. carbamazepine (Tegretol)

c. prozac

Biological theorists suggest that the cause of eating disorders may be a. normal weight phobia. b. body image disturbance. c. serotonin imbalance. d. dopamine excess.

c. serotonin imbalance. The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse.

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 Incorrect c. Anxiolytics d. Atypical antipsychotics

d. Atypical antipsychotics 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.

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. fear of gaining weight. 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. has systolic blood pressure less than 70 mm Hg. 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 client who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meal daily and engages in a rigorous exercise program. The nursing diagnosis for this client would be a. death anxiety. b. ineffective denial. c. disturbed sensory perception. d. imbalanced nutrition: less than body requirements.

d. imbalanced nutrition: less than body requirements. A body weight of 80 pounds for a 16-year-old who is 5 foot, 3 inches tall is ample evidence of this diagnosis.

How does a bulimic person relieve tension and feel pleasure?

during the time of binge, but is soon followed by feelings of guilt and depression

Studies on primary hypothalamic dysfunction in anorexia nervosa have revealed:

elevated cerbrospinal fluid cortisol levels and possible impairment of dopaminergic regulation. *additional evidence to support this is that many people with anorexia have amenorrhea before they even lose significant amounts of weight

What are predisposing factors to eating disorders?

genetics, physiological factors, family dynamics, and environmental and lifestyle factors

what do people with anorexia nervosa believe?

that they are fat even when emaciated.

How does BED differ from bulimia?

the individual does not engage in behaviors to rid the body of the excess calories

True or False: Obesity predisposes the individual to many health concerns, and at the morbid level (at a BMI of 40), the weight alone can contribute to increases in morbidity and mortality

true

True or False: People with anorexia nervosa can literally starve themselves to death

true

True or False: bulimic people are subject to mood and anxiety disorders

true

True or False: compulsive eating can result in obesity

true