CHAPTER 22

Question 1

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.

Answer 1

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.

Question 2

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.

Answer 2

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.

Question 3

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.

Answer 3

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.

Question 4

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.

Answer 4

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.

Question 5

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.”

Answer 5

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.

Question 6

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.”

Answer 6

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.

Question 7

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.

Answer 7

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.

Question 8

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)

Answer 8

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.

Question 9

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.

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

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

Answer 11

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.

Question 12

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.”

Answer 12

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.

Question 13

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

Answer 13

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.