CHAPTER 18 Feeding, Eating, and Elimination Disorders

Question 1

Chapter Review

1. While on an inpatient unit, you are caring for newly admitted Alyssa, a 16-year-old diagnosed with anorexia nervosa. Number the following nursing interventions in order of priority:
   a. ___ Initiate a therapeutic relationship.
   b. ___ Promote caloric consumption.
   c. ___ Assess for suicidal ideation
   d. ___ Review accomplishments made during treatment.
   e. ___ Explore feelings of underlying anxiety and low self-esteem.

Answer 1

1: a. Initiate a therapeutic relationship.
2: c. Assess for suicidal ideation
3: b. Promote caloric consumption.
4: e. Explore feelings of underlying anxiety and low self-esteem.
5: d. Review accomplishments made during treatment.

Chapter 18 Feeding, eating, and elimination disorders
Chapter Review

Question 2

2. Brittany is caring for a patient with bulimia. She recognizes which of the following nursing interventions as being most appropriate?
   a. Monitor the patient on bathroom trips after eating.
   b. Allow the patient extensive private time with family members.
   c. Provide meals whenever the patient requests them.
   d. Encourage the patient to select foods that she likes.

Answer 2

a. Monitor the patient on bathroom trips after eating.

Chapter 18 Feeding, eating, and elimination disorders
Chapter Review

Question 3

3. The nurse is admitting a patient who weighs 100 pounds, is 66 inches tall, and is below ideal body weight. The patient’s blood pressure is 130/80 mm Hg, pulse is 72 beats per minute, potassium is 2.5 mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands are shaking, and her parotid gland is enlarged. The patient states, “I am really nervous about coming to this unit.” What is the priority nursing diagnosis?
   a. Powerlessness
   b. Risk for injury
   c. Imbalanced nutrition: Less than body requirements
   d. Anxiety

Answer 3

c. Imbalanced nutrition: Less than body requirements

Chapter 18 Feeding, eating, and elimination disorders
Chapter Review

Question 4

4. The nurse is planning care for a patient with a binge eating disorder. What outcomes are appropriate? Select all that apply.
   a. The patient will identify stressors that lead to binge eating.
   b. The patient will identify four alternate coping skills.
   c. The patient will increase dietary intake.
   d. The patient will experience satisfaction in eating alone.

Answer 4

a. The patient will identify stressors that lead to binge

Chapter 18 Feeding, eating, and elimination disorders
Chapter Revieweating.

Question 5

5. Which of the following are true regarding feeding disorders in children? Select all that apply.
   a. Feeding disorders usually reflect poor parenting.
   b. Feeding disorders are often manifested in children with developmental delays.
   c. Feeding disorders are most often treated with a punishment system.
   d. In many cases, toddler mealtime difficulties spontaneously resolve with no intervention.
   e. Behavior modification has been found to be effective in treating feeding disorders.

Answer 5

b. Feeding disorders are often manifested in children with developmental delays.
d. In many cases, toddler mealtime difficulties spontaneously resolve with no intervention.
e. Behavior modification has been found to be effective in treating feeding disorders.

Chapter 18 Feeding, eating, and elimination disorders
Chapter Review

Question 6

1. 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.

Answer 6

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 7

2. 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.

Answer 7

d. fear of gaining weight.

Option D is the only subjective data listed, and it is universally true.

Chapter 18 Feeding, eating, and elimination disorders
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Question 8

3. 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.

Answer 8

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 9

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

Answer 9

a. denial.

Denial of excessive thinness is the mainstay of the client with anorexia nervosa.

Chapter 18 Feeding, eating, and elimination disorders
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Question 10

5. 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.

Answer 10

b. an increased risk of seizures.

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

Chapter 18 Feeding, eating, and elimination disorders
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Question 11

6. 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.

Answer 11

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 12

7. 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.

Answer 12

a. maintaining a normal weight.

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

Chapter 18 Feeding, eating, and elimination disorders
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Question 13

*** 8. 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.

Answer 13

b. hypokalemia.

Vomiting causes loss of potassium, leading to hypokalemia.

Chapter 18 Feeding, eating, and elimination disorders
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Question 14

9. 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.

Answer 14

c. high self-esteem.

Most clients with eating disorders have low self-esteem.

Chapter 18 Feeding, eating, and elimination disorders
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Question 15

10. 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.

Answer 15

c. serotonin imbalance.

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

Chapter 18 Feeding, eating, and elimination disorders
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Question 16

1. 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.

Answer 16

b. Weigh fully clothed before breakfast.

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

Chapter 18 Feeding, eating, and elimination disorders
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Question 17

2. 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.

Answer 17

c. inspection of the oral cavity.

Repeated vomiting often causes dental erosions and caries.

Chapter 18 Feeding, eating, and elimination disorders
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Question 18

3. 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.

Answer 18

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 19

4. 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.

Answer 19

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 20

5. 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.”

Answer 20

a. “I eat three meals each day and purge every evening.”

Most clients with bulimia purge after each meal.

Chapter 18 Feeding, eating, and elimination disorders
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Question 21

6. 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.

Answer 21

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 22

7. 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?”

Answer 22

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 23

*** 8. 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

Answer 23

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.

Chapter 18 Feeding, eating, and elimination disorders
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Jeff E.

Question 24

9. 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.

Answer 24

c. Support importance of avoiding forbidden foods.

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

Chapter 18 Feeding, eating, and elimination disorders
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Question 25

10. 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.

Answer 25

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 26

*** 1. 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.

Answer 26

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.

Chapter 18 Feeding, eating, and elimination disorders
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Question 27

2. Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met?
   a. “I purge only once a day now instead of twice.”
   b. “I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers.”
   c. “I am a hard worker and I am very compassionate toward others.”
   d. “I always purge when I’m alone so that I’m not a bad role model for my younger sister.”

Answer 27

c. “I am a hard worker and I am very compassionate toward others.”

An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is incorrect because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging.

Chapter 18 Feeding, eating, and elimination disorders
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Question 28

3. 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
   c. Anxiolytics
   d. Atypical antipsychotics

Answer 28

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.

Chapter 18 Feeding, eating, and elimination disorders
EVOLVE NCLEX Review

Question 29

4. Which of the following statements is true of bulimia?
   a. Patients with bulimia often appear at a normal weight.
   b. Patients with bulimia binge eat but do not engage in compensatory measures.
   c. Patients with bulimia severely restrict their food intake.
   d. One sign of bulimia is lanugo.

Answer 29

a. Patients with bulimia often appear at a normal weight.

Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

Chapter 18 Feeding, eating, and elimination disorders
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Question 30

5. When you are educating Erin and her mother about the medication dosage and side effects, Erin becomes upset and tearful, stating, “No! I will not take that medication!” Which of the following is the most likely reason for Erin’s feelings?
   a. Erin feels embarrassed to be taking psychiatric medication.
   b. Erin is upset about the possible side effect of weight gain.
   c. Erin is worried about the common adverse effect of sexual problems.
   d. Erin’s resistance is typical of her characteristics of rigidity and needing control.

Answer 30

b. Erin is upset about the possible side effect of weight gain.

Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain but are not well accepted by patients who are frightened by the side effect of weight gain. There is nothing in the scenario to suggest Erin is embarrassed. Sexual side effects are more common with SRRI medication than atypical antipsychotics. Erin may have the characteristics described in option d, which are typical of patients with anorexia; however, during medication education it is more likely for her to be upset over the possibility of a side effect.

Chapter 18 Feeding, eating, and elimination disorders
EVOLVE NCLEX Review