Eating disorder

Question 1

A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected?

a. Respiratory distress and dyspnea
b. Bacterial gastrointestinal infections and overhydration
c. Metabolic acidosis and constricted colon
d, Dental erosion and chronic edema

Answer 1

d

In bulimia, dental erosion (from frequent vomiting) and chronic edema (from fluid imbalances) are common. Dyspnea, bacterial gastrointestinal infections, and metabolic acidosis are not characteristics of bulimia.

Question 2

The nurse is assessing a client with bulimia nervosa. Which finding(s) supports this diagnosis? Select all that apply.
a. callous on the dorsal hand surface
b. erosion of dental enamel
c. thin, emaciated appearance
d. poor skin turgor
e. electrocardiogram changes

Answer 2

a, b, d, e

Physical findings seen in individuals with bulimia nervosa are related to the effects of altered nutrition and the results of the purging methods. Medical problems related to bulimia nervosa include dehydration (manifested by poor skin turgor), hypokalemia, menstrual irregularities, and electrocardiogram changes from the hypokalemia. Over time, a callus can develop on the dorsal hand surface from the rubbing of the teeth against the skin during induced vomiting. A typical finding seen in an individual who regularly vomits is the erosion of dental enamel from the acidic stomach contents. The individual with bulimia nervosa is typically within a normal weight range for height and age, which is different from the individual with anorexia nervosa.

Question 3

For a client diagnosed with anorexia nervosa, which goal takes priority?

a. Establishing adequate daily nutritional intake
b. Developing a contract with the nurse that sets a target weight
c. Identifying self-perceptions about body size as unrealistic
d. Verbalizing the possible physiologic consequences of self-starvation

Answer 3

a

According to Maslow’s hierarchy of needs, physiologic needs are the most basic. Adequate daily intake of food and fluids would be of the highest priority for this client.

Question 4

Exacerbation of anorexia nervosa results from the client’s effort to do what?

a. Gain control of one part of life
b. Manipulate family members
c. Diminish conflict
d. Live up to family expectations

Answer 4

a

A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client’s life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.

Question 5

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective?

a. “I know if I eat pasta, I’ll binge.”
b. “I’ll eat small meals and snacks regularly.”
c. “I’ll take my medication when I feel the urge to binge.”
d. “How I feel about my body has little to do with my binging.”

Answer 5

b

Clients with bulimia need to normalize their eating patterns. Therefore, the statement about eating small meals and snacks regularly indicates understanding of the need to normalize eating patterns. Emotional and environmental cues, not specific foods, influence the eating patterns in bulimia. Medication, if prescribed, is taken regularly, not just when the client experiences the urge to binge. Body image dissatisfaction is an underlying factor associated with bulimia.

Question 6

The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client’s weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and reports that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what?

a. Provide the client with a feeling of responsibility and control over the client’s behavior
b. Provide the therapist with a strategy for client compliance
c. Allow the client a tool by which to negotiate behavior
d. Provide the nurse with a tool for evaluating the plan of care

Answer 6

a

Refeeding involves establishing a contract that spells out expected behaviors, rewards, privileges, and consequences of noncompliance. Such a contract may be useful in eliminating power struggles with the client. Even though clients may rebel against contract terms, it reassures them to know that consistent limits are being maintained and that they can trust the staff to help maintain control, and ultimately it enables the client to feel more in control.

Question 7

Which technique is a type of cognitive behavioral therapy implemented for bulimic clients?

a. Self-monitoring
b. Guided imagery
c. Distraction
d. Music therapy

Answer 7

a

Self-monitoring is a type of cognitive behavioral therapy. It is designed to help clients with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.

Question 8

The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia?

a. Provide the client a diet of mainly vegetables and salads.
b. Encourage the entire family to engage in a balanced and regular dietary pattern.
c. Encourage autonomy by allowing the client to have total control over food choices.
d. Insist that the client complete all meals provided.

Answer 8

b

Clients with eating disorders can benefit when the entire family makes positive changes. This shows solidarity and makes it easier for the client to maintain healthy behaviors. Eating only salads and vegetables during the day may set up clients for later binges as a result of too little dietary fat and carbohydrates. The client with an eating disorder will not make healthy food choices independently. It is also not possible or beneficial for family and friends to force the client to eat.

Question 9

A client diagnosed with anorexia nervosa weighs 78% of their ideal body weight and continues to state that they are “fat.” Which symptom does the nurse identify?
a. negative self-concept
b. low self-esteem
c. body image distortion
d. drive for thinness

Answer 9

c

Clients diagnosed with anorexia nervosa have a distorted body image. The clients can be very thin and still perceive that they are heavy and need to lose weight. The drive for thinness prompts the client in an urgent way to “undo” or frantically work toward weight loss. Negative self-concept is the negative idea of the self, created from the beliefs someone holds about themselves and the responses of others. Low self-esteem is the negative perception of one’s own worth or abilities.

Question 10

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include?

a. Increasing client’s coping skills for anxiety
b. Communicating aggressively with the client
c. Encouraging client take time away from peers for a time
d. Nurturing the client’s need for dependency

Answer 10

a

Since clients with bulimia experience high anxiety levels and may use the binge-purge cycle as a coping mechanism, increasing coping skills for anxiety is a high priority nursing intervention. A perception of lack of control and helplessness is at the source of eating disorders. . A firm, accepting, and patient approach is important in working with these individual, not an aggressive approach, which could render the nurse-client relationship ineffective. Since the client already tends to isolate when bingeing and purging, increasing involvement with others would be a positive treatment modality. Meeting dependency needs is nontherapeutic; the nurse does not need to rescue the client but rather to teach the client to be less helpless.

Question 11

A nurse has conducted an education session for parents with children at risk for eating disorders. Which topic would be included in the education session for the parents?
a. identifying signs and symptoms of eating disorders
b. peer pressure regarding weight and eating habits
c. how puberty affects weight
d. adapting and coping with problems

Answer 11

a

Education is important for parents with children at risk for developing eating disorders. The topic to be included in the education session includes identifying signs and symptoms of eating disorders, so that the parent can safely intervene and support the child. Education topics such as peer pressure regarding weight and eating habits, how puberty affects weight, and adapting and coping with problems are topics that should be taught to the children at risk for eating disorders.

Question 12

An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client’s plan of care?

a. Set up a strict eating plan for the client
b. Restrict visits with the family until the client begins to eat
c. Provide privacy during meals
d. Encourage the client to exercise, which will reduce the client’s anxiety

Answer 12

a

Establishing a consistent eating plan and monitoring the client’s weight are important for this disorder. The family should be included in the client’s care. The client should be monitored during meals—not given privacy. Exercise must be limited and supervised.

Question 13

A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. The client doesn’t want to feel fat in a bathing suit on vacation. The client’s sodium level is 150 mEq/L; potassium level is 3.2 mEq/L. The client is 5 feet tall, weighs 100 pounds, and has lost 15 pounds in 3 weeks. Which goal is a priority at this time?

a. Stabilize electrolyte levels.
b. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds.
c. Help build self-esteem.
d. Develop a contract with the client to stop using laxatives and diuretics.

Answer 13

a

Restoring nutritional balance is a priority for clients with severe eating disorders. Clients who are clearly malnourished need to become physiologically stabilized until they are no longer at risk for severe medical complications related to starvation. Refeeding the very low-weight client with anorexia means that nurses must carefully monitor cardiac function; another important intervention is to carefully monitor electrolytes. These clients are at risk for developing a “refeeding syndrome” with accompanying hypokalemia.

Question 14

Which is a cardiac complication of an eating disorder?

a. Bradycardia
b. Hypertension
c. Enlarged heart
d. Thrombocytopenia

Answer 14

a

Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.

Question 15

Individuals with anorexia nervosa concentrate on which body cue?

a. Controlling food intake
b. Hunger
c. Weakness
d. Anxiety

Answer 15

a

Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.

Question 16

A nurse is performing an admission assessment for an adolescent client diagnosed with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as likely to support the client’s diagnosis?

a. “My parent was always very thin.”
b. “I’ve never really liked myself.”
c, “I have a lot of confidence in myself.”
d. “I feel really close to my parents and my sibling.”

Answer 16

b

Individuals with eating disorders are usually struggling with their self-concept. It is important to determine their self-concept and self-esteem. In many instances, these individuals appear to be very competent, but when queried about their views, they often feel that they are not good enough and will describe their perceived faults in great detail. A parent’s body type has little impact on the development of this disorder. Families of individuals with anorexia are often labeled as overprotective, enmeshed, unable to resolve conflicts, and rigid related to boundaries. Thus, a close relationship would not be associated with this disorder.

Question 17

The dentist of a client noticed that the client’s teeth were losing enamel. The client is of average weight. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with enamel loss?

a. Bulimia nervosa, purging type
b. Anorexia nervosa, restricting type
c, Anorexia nervosa, purging type
d. Binge eating disorder

Answer 17

a

The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client’s appearance, suggests bulimia nervosa, purging type. Individuals with bulimia typically maintain normal weight. Binge eating disorder does not involve purging.

Question 18

A client diagnosed with anorexia nervosa is being prescribed a medication. Which medication would the nurse prepare for the client?
a. olanzapine
b. fluoxetine
c. lorazepam
d. haloperidol

Answer 18

b

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is Food and Drug Administration (FDA) approved for anorexia nervosa. Olanzapine and haloperidol are antipsychotics, and lorazepam is a benzodiazepine, none of which are FDA approved for the treatment of anorexia nervosa.

Question 19

A psychiatric-mental health nurse is self-reflecting on their own feelings while caring for clients diagnosed with an eating disorder. Which point is important to consider when self-reflecting as a health care professional?
a. Praise the client for being good after the client resists purging.
b. Become upset when the client does not take the nurse’s advice on a situation.
c. Keep in mind the client’s perspective and fears while gaining weight.
d. Act as the client’s authority figure when educating the client.

Answer 19

c

There are important points to consider when working with clients with eating disorders including being empathetic and nonjudgmental and remembering the client’s perspective and fears about weight and eating; avoiding sounding parental when teaching about nutrition or behaviors, instead present information as factual; and avoiding labeling clients as “good” when they avoid unacceptable behavior. Praising the client for being good after the client resists purging, becoming upset when the client does not take the nurse’s advice on a situation, and acting as the client’s authority figure when educating the client are not therapeutic and do not promote a therapeutic relationship. Therefore, the nurse should keep in mind the client’s perspective and fears while gaining weight.

Question 20

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions?

a. Cognitive–behavioral therapy (CBT) including self-monitoring
b. One-on-one time with psychiatric staff and antidepressant medication therapy
c. Daily reinforcement of sound dietary principles and meditation sessions
d. Clearly stated unit rules and a supportive milieu

Answer 20

a

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. The primary interventions include CBT, including self-monitoring.

Question 21

An outpatient client diagnosed with anxiety, depression, and anorexia nervosa is receiving treatment to develop healthy coping skills. The client has recently lost more weight. Which statement made by the nurse would be appropriate?
a. “What stressors are you currently experiencing?”
b. “Who can you reach out to in times of crisis?”
c. “Why are you losing more weight?”
d. “Are you using the coping skills that you learned in our last session?”

Answer 21

a

Clients with an eating disorder often cope with stress and anxiety through controlling eating. In times of perceived stressful events, the dysfunctional eating pattern often becomes worse. Therefore, the nurse should assess for current stressors by asking the client, “What stressors are you currently experiencing?” The nurse’s question, “Who can you reach out to in times of crisis?” assesses the client’s support system, not addressing the cause of the recent weight loss. The nurse’s questions, “Why are you losing more weight?”, and “Are you using the coping skills that you learned in our last session?” are not therapeutic and do not address the current stressors in the client.

Question 22

Which nursing statement is most effective in communicating a positive expectation of the client?

a. “I’ll give you 90 minutes to eat.”
b. “I will allow you space to eat in peace.”
c. “I will sit here quietly with you while you eat.”
d. “There are people who would truly appreciate this food.”

Answer 22

c

This statement reflects the nurse’s expectation that the client will eat, yet the nurse still will provide adequate supervision. Setting a deadline establishes a conflictual, rules-based dynamic between the nurse and client which is not likely to be therapeutic. The nurse should be present, both to supervise and promote therapeutic relationship; it would be inappropriate to leave the client alone during a meal. Instilling guilt about how others would like the food is inappropriate because guilt does not lead to a positive self-concept.

Question 23

A client diagnosed with anorexia nervosa has regained weight and is being discharged to an outpatient program. Which statement made by the client would indicate the need for further teaching?

a. “I will use my breathing techniques when I feel anxious.”
b. “I will go to all my support groups so that I don’t need to go to therapy.”
c. “I can engage in physical activity within my schedule when I feel anxious or restless.”
d. “I will reach out to my friends to develop connection.”

Answer 23

b

After discharge, support groups are helpful for the client but cannot replace therapy sessions. Therefore, the client’s statement, “I will go to all my support groups so that I don’t need to go to therapy” would indicate a need for further teaching. The client’s statements, “I will use my breathing techniques when I feel anxious”, “I can engage in physical activity within my schedule when I feel anxious or restless”, and “I will reach out to my friends to develop connection” are demonstrating that the teaching was effective.

Question 24

During a therapy session, a client with anorexia tells the nurse, “I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I’m so fat.” Which potential response by the nurse is most therapeutic?

a. “I don’t think you are fat.”
b. “Has something occurred that caused you to measure your thighs?”
c. “You are exactly the right weight for your height.”
d. “You have always been very focused on your thighs. Is that the part of your body you like least?”

Answer 24

b

The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.

Question 25

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

a. Depression
b. Anxiety
c. Psychosis
d. Substance use disorder

Answer 25

a

Mood disorders, anxiety disorders, and substance use disorders are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.

Question 26

Which intervention has been found to be most effective reducing the initial symptoms of bulimia?

a. Cognitive behavior therapy and pharmacologic interventions
b. Behavioral therapy and psychoeducation
c. Daily monitoring of sound dietary principles and meditation sessions
d. Clearly stated unit rules and a supportive milieu

Answer 26

a

The combination of cognitive behavior therapy and pharmacologic interventions is best for producing an initial decrease in symptoms.

Question 27

What behavior is likely a result of an adolescent’s attempt to manage the effects of over-productive parenting?

a. engaging in severe dieting
b. socially withdrawing
c. compulsively washing hands becoming
d. sexually promiscuous

Answer 27

a

Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members’ efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: By continuing to lose, these clients exert control over one aspect of their lives. While the remaining options may demonstrative reactive behaviors, they are not generally associated with over-productive parenting.

Question 28

A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which characteristic would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply.

a. Body dissatisfaction
b. Feelings of control
c. Obsessiveness
d. Boundary problems
e. Sexuality fears
f. Cognitive distortions

Answer 28

a, c, f

Characteristics common to both anorexia and bulimia nervosa include body dissatisfaction, powerlessness (lack of control), obsessiveness, and cognitive distortions. Boundary problems are associated with bulimia nervosa. Sexuality fears are associated with anorexia nervosa.

Question 29

The nurse provides care to a client who is diagnosed with an eating disorder. Which strategy should the nurse include in the client’s plan of care to increase the client’s self-concept?

a. Practice meditation.
b. Increase social contact.
c. Keep a list of accomplishments.
d. Limit physical activity to a reasonable schedule.

Answer 29

c

Wellness challenges must be addressed by the nurse when providing care to a client who is diagnosed with an eating disorder. Interventions that support increasing the client’s self-concept include keeping a list of accomplishments, helping others, keeping busy, and counseling or therapy. Practicing meditation is a strategy that address stress management. Increasing social contact is a strategy for developing a sense of connection, belonging, and a support system. Limiting physical activity to a reasonable schedule addresses the recognition for the need for moderate physical activity.

Question 30

The nurse provides care to an adolescent client who presents to the emergency department (ED) after losing consciousness during a marching band performance. A differential diagnosis of anorexia nervosa is documented by the practitioner. Which finding noted when reviewing the client’s laboratory data indicates a need for hospitalization?
a, hypokalemia
b. hypoglycemia
c, hypermagnesemia
d. hyperphosphatemia

Answer 30

a

The criteria for hospitalization for the client who is diagnosed with an eating disorder include acute weight loss, < 85% below ideal; heart rate near 40 beats/min; temperature less than 97.0°F (36.1°C); blood pressure less than 80/50 mm Hg; poor motivation to recover; and electrolyte abnormalities, including hypokalemia, hypophosphatemia, and hypomagnesemia. Hypoglycemia would be expected with lack of intake and is not a criterion for hospitalization.

Question 31

A community health nurse is conducting an educational session for a group of high-school community members. The community health nurse is educating the community about positive body image. Which statement made by a community member would indicate the need for further education?
a. “No particular diet, weight, or body size will automatically lead to happiness.”
b. “I will regularly reflect and appreciate all the things that my body can do.”
c. “I will wear ill-fitting clothes to remind me about my health goals.”
d. “I will surround myself with supportive, positive, and real people.”

Answer 31

c

The National Eating Disorders Association provides the following suggestions to promote positive body image including eliminating the idea that a particular diet, weight, or body size will automatically lead to happiness and fulfillment; appreciating all the things that your body can do; keeping a list of the top 10 things that the individual likes about themselves; doing something nice for yourself; surrounding yourself with positive people; wearing comfortable clothes that make you feel good about your body; not judging yourself and others based on body weight or shape; limiting time on social media and surrounding yourself with positive, supportive, and real people; and filtering through the media and its messages about self-esteem and body image. Therefore, the statement, “I will wear ill-fitting clothes to remind me about my health goals” would require further teaching from the nurse.

Question 32

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect?

a. Anorexia nervosa
b. Bulimia nervosa
c. Binge eating disorder
d. Eating disorder not otherwise specified

Answer 32

c

Binge eating disorder is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese. The client does not restrict eating so anorexia is not appropriate. Eating disorder not otherwise specified refers to partial syndromes but does not met the criteria for anorexia or bulimia.

Question 33

A psychiatric nurse working in a community is planning an educational program for fifth grade teachers. Which would the nurse include?

a. Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders
b. Emphasis on the need for teachers to focus their prevention efforts on female students
c. Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns
d. Clarification that peer pressure is not typically problematic in children who are in the fifth grade

Answer 33

a

Counteracting the influence of media should be stressed; both males and females are at risk for developing eating disorders. Other preventive educational strategies include the need to improve self-esteem and the importance of the influence of peer pressure on eating and weight.

Question 34

A client with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which instruction(s) would a nurse include when teaching the client about the prescribed medication? Select all that apply.

a. “Closely monitor your fluid intake while taking this medication.”
b. “Stop taking this medication if it causes weight gain.”
c, “Expect menstrual irregularities, particularly if they’ve occurred previously.”
d. “Note that the drug may take up to 4 weeks to get a full effect.”
e. “This medication may cause drowsiness or dizziness.”

Answer 34

d, e

The client needs to be aware that the drug may take up to 4 weeks for the client to get the drug’s full effect. These medications also may cause drowsiness or dizziness. In the meantime, the client should monitor weight loss caused by drug-induced nausea and vomiting. Because the client has a diagnosis of bulimia nervosa, the intake of medication must be monitored for possible purging after administration. Monitoring fluid intake and menstrual irregularities are not associated with this group of medications.

Question 35

The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client’s history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next?

a. Throat and esophagus
b. Condition of mouth and gums
c. Heart rate and rhythm
d. Patterns of activity and rest

Answer 35

c

Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.

Question 36

Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits?

a. Lithium
b. Haloperidol
c. Fluoxetine
d. Bupropion

Answer 36

c

Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Administration approval for the treatment of bulimia nervosa.

Question 37

The nurse is providing care to a client diagnosed with anorexia and notes that the client demonstrates behaviors that reflect an intense physical and emotional process that overrides all physiologic body cues. Which term would the nurse use to document this finding?

a. Drive for thinness
b. Body image distortion
c. Interoceptive awareness
d. Perfectionism

Answer 37

a

Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues.It is the result of body image distortion. Body image distortion occurs when an individual perceives their body disparately from how society views it. Interoceptive awareness is a term used to describe the sensory response to emotional and visceral cues, such as hunger. Perfectionism consists of personal standards (the extent to which the individual sets and tries to achieve high standards for oneself) and concern over mistakes, and the consequences for their self-worth and others’ opinions. Perfectionism is often involved in a drive for thinness, but it is not the primary physical and emotional process in this disorder.

Question 38

While a nurse talks to the parent of a 15-year-old client, the parent expresses concern over the client’s eating and exercise habits. The parent says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. The parent says the client eats very little at dinner, but in the morning they notice that large amounts of food are missing from the kitchen. The client was reporting tooth pain, and when the parent took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from?

a. Anorexia nervosa
b. Binge-eating disorder
c. Bulimia nervosa
d. Eating disorder not otherwise specified

Answer 38

c

Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental cavities from the frequent contact of tooth enamel with food and acidic gastric fluids.

Question 39

An adult client is diagnosed with bulimia nervosa. Which outcome would be appropriate for the client in the immediate phase of care?
a. “The client will be free from self-inflicted harm throughout hospitalization.”
b. “The client will demonstrate more satisfying interpersonal relationships.”
c. “The client will demonstrate alternative methods of dealing with stress or crises.”
d. “The client will express feelings in non-food–related ways.”

Answer 39

a

In the immediate phase of care, outcomes are related to physiological stability and safety. The outcome, “The client will be free from self-inflicted harm throughout hospitalization” is appropriate for the client in the immediate phase of care. The outcomes, “The client will demonstrate more satisfying interpersonal relationships,” “The client will demonstrate alternative methods of dealing with stress or crises,” and “The client will express feelings in non-food–related ways” are appropriate in the stabilization phase of care.

Question 40

When working with the client with bulimia, the nurse should be aware that the nurse’s own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what?

a. Depression
b. Anxiety
c. Control
d. Dependency

Answer 40

c

Often, nurses feel the need to offer control for a client who is helpless in controlling food, anxiety, and life. This client should not evoke feelings of depression any more than any other client should. The client is likely to experience an accompanying depressed state. Although anxiety may arise in the nurse, this is not the best answer. The client is likely to be dependent in this hospital setting. Control or rescue issues are more likely to surface in the nurse.

Question 41

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find?

a. Impulsivity
b. Panic
c. Hyperactivity
d. Delusions

Answer 41

a

Clients with bulimia often demonstrate impulsivity. Situations that produce feelings of being overwhelmed and powerless need to be explored, as does the client’s ability to set boundaries, control impulsivity, and maintain quality relationships. These underlying issues precipitate binge eating. Panic, hyperactivity, and delusions are not associated with bulimia nervosa.

Question 42

A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge eating disorder (BED). The students demonstrate understanding when they identify which characteristic(s) as specific to BED? Select all that apply.

a. Clients typically are obese.
b, Clients refrain from purging behaviors.
c. Binge eating periods are shorter.
d. Clients engage in overexercising.
e. Feelings of guilt do not occur after binging.

Answer 42

a, b

BED is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors (such as overexercising). Individuals with BED also differ from those with other eating disorders in that most of them are obese. In addition, investigators have shown that individuals with BED have less dietary restraint and have a higher weight than those with bulimia nervosa. Binge-eating episodes are not shorter. Feelings of guilt occur with both bulimia nervosa and BED.

Question 43

A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication?

a. “Why do you prefer not to eat food?”
b. “What do you think about how much you weigh right now?”
c. “What do you believe has caused your anorexia?”
d. “Is there anything that I can get you to eat right now?”

Answer 43

b

Open-ended questions that are not “loaded” or accusatory are most likely to elicit data from a client who has an eating disorder. Offering food at this early stage of care is likely to inhibit rather than enhance rapport between the nurse and the client.

Question 44

A client with anorexia nervosa self-describes as “a whale.” However, the nurse’s assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. Considering the client’s unrealistic body image, which intervention should be included in the care plan?

a. Telling the client of the nurse’s concern for the client’s health and desire to help the client make decisions to keep the client healthy
b. Asking the client to compare the client’s figure with magazine photographs of people the client’s age
c. Assigning the client to group therapy in which participants provide realistic feedback about the client’s weight
d. Confronting the client about the client’s actual appearance during one-on-one sessions, scheduled during each shift

Answer 44

a

A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about nutritious foods to keep the client healthy.

Question 45

A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which would the nurse include in the education plan?

a. Knowing the calorie content of numerous foods
b. Learning strategies to control impulses
c, Describing physiologic consequences of anorexia nervosa
d. Setting realistic goals

Answer 45

d

Because these clients tend to be perfectionist and set unrealistic goals for themselves, the nurse should educate the client about setting realistic and attainable goals. Other topics such as weight monitoring, resources, and effects of restrictive eating should be included in the nurse’s educational plan.

Question 46

When working with a client with bulimia, the nurse should encourage the client to keep a diary or journal for what reason?

a, to improve coping through behavioral changes
b. to document evidence of the client’s progress
c. to record problems to share with the health care provider
d. to be read by the nurse to set achievable goals

Answer 46

a

For the client with bulimia, journaling or writing in a diary is a cognitive behavioral technique designed to help clients improve coping skills and find the triggers that cause them to lose control and binge eat. These techniques raise awareness about behavior and help the client regain a sense of control. The nurse should encourage the client to keep a record to make connections between emotions, situations, and eating behaviors. The journal is intended for the client to use as a therapeutic treatment tool, not to document the client’s progress or to share with the health care provider. The journal is not intended for the nurse to read to set goals; goals should be set by the client, the nurse, and the health care team.

Question 47

For clients who purge, what is the most important goal?

a. Stop the behavior
b. Understand that purging is an ineffective means of weight control
c. Recognize that purging promotes binge eating
d. Develop the technique of distraction

Answer 47

a

The most important goal for a client who purges is to stop the behavior. All other options would not be the most important goal.

Question 48

A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find?

a. Hyperkalemia
b. Dry skin
c. Tachycardia
d, Oversensitivity to heat

Answer 48

b

Dry skin is a physical problem of anorexia nervosa. Others include hypokalemia, bradycardia, and oversensitivity to cold.

Question 49

During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication?

a. Olanzapine
b. Ziprasidone
c. Risperidone
d. Fluoxetine

Answer 49

d

Atypical antipsychotics are often associated with weight gain, while some antidepressants such as fluoxetine tend to induce weight loss.

Question 50

Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client’s care?

a. Deficient fluid volume related to refusal to drink
b. Impaired social interaction related to aggressive behavior
c. Anxiety related to inadequate coping mechanisms
d. Hyperactivity related to restlessness

Answer 50

a

The risk of dehydration posed by the client’s refusal to drink likely supersedes the risk of imbalanced nutrition in the short term. Both diagnoses are more immediate concerns than the client’s social interactions. There is no evidence of anxiety or hyperactivity related to restlessness.

Question 51

The school nurse is evaluating a 16-year-old student who came to the office reporting dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks the student to step on the scale. The student asks if the student can go to the bathroom first to empty the student’s bladder, stating, “That can make a big difference.” The student’s comment raises the nurse’s suspicion that the student has …

a. anorexia nervosa.
b. binge-eating disorder.
c. bulimia nervosa.
d. eating disorder not otherwise specified.

Answer 51

a

Anorexia is characterized by a voluntary refusal to eat and typically a weight less than 85% of what is considered normal for height and age. Clients with anorexia have a distorted body image and, to the bewilderment of others, view their emaciated bodies as fat.

Question 52

A nurse is interviewing a client and suspects an eating disorder. Which client statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply.

a. “Everything about my school work needs to be perfect.”
b. “I want things to be the way I want them to be.”
c. “I’ll stand up for what I want, regardless of what you say.”
d. “Things being out of order really bothers me.”
e. “I consider myself a really laid-back individual.”

Answer 52

a, b, d

Both anorexia and bulimia are characterized by perfectionism, obsessive–compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder. Depression and obsessive-compulsive disorders are commonly associated with eating disorders. Being self-assured or laid back would be least likely associated with an eating disorder.

Question 53

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa?

a. Overprotective of their children
b. A history of substance use disorder
c. Maintenance of emotional distance from their children
d. Alternation between loving and rejecting their children

Answer 53

Some families do not support members’ efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. Family therapy may be beneficial for families of clients younger than 18 years old. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.

Question 54

A client diagnosed with anorexia nervosa is experiencing bradycardia, cold intolerance, and fatigue. Which complication of anorexia nervosa does the nurse identify?
a. hypoglycemia
b. osteoporosis
c. hypothyroidism
d. acrocyanosis

Answer 54

c

Eating disorders can cause long-term complications in the client. Symptoms of bradycardia, cold intolerance, and fatigue are indicative of the complication, hypothyroidism. Hypoglycemia would cause a decrease in the client’s blood glucose levels. Osteoporosis would cause decreased bone density. Acrocyanosis causes blue discoloration to the client’s hands and feet, which are not present.

Question 55

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client’s typical, initial reaction to the nurse?

a. “I’m sorry that you are angry but you cannot throw food at me.”
b. “I realize this must be very difficult for you but try to remember I’m not your enemy.”
c. “I’m not the root of your problem.”
d. “I’m not going to take your insults personally but you need to be more respectful.”

Answer 55

b

The client initially may view the nurse, who is responsible for making the client eat, as the enemy. The client may hide or throw away food or become overtly hostile as anxiety about eating increases. The nurse must remember that the client’s behavior is a symptom of anxiety and fear about gaining weight and not personally directed toward the nurse. The other options are nurse rather than client focused.

Question 56

A client diagnosed with anorexia nervosa is mistrustful of health care professionals. What intervention by the nurse would establish trust with the client?
a. Explain the reason that treatment is necessary for the client.
b. Include family members in the care planning process.
c. Wait for the client to trust the health care professionals before treatment.
d. Provide rationales to the client for each intervention.

Answer 56

d

Establishing a therapeutic relationship with clients diagnosed with anorexia nervosa may be difficult initially because the client may be suspicious or mistrustful. The clients believe that health care professionals will intervene and disrupt their restricting and starvation behaviors, further increasing the client’s fear of gaining weight. A firm, accepting, and patient approach is important for the clients. Providing rationales for each intervention and having a consistent, non-reactive approach helps build trust with the client. Explaining the reason that treatment is necessary, including family members in the care planning process, and waiting for the client to trust the health care professionals will not develop trust within the client.

Question 57

A 30-year-old client is in therapy for bulimia, depression, and anxiety. The client relates that the client feels unable to cope with the demands of the client’s job and that the client’s partner recently ended their long-term relationship. The client states that the client frequently binges when stress levels are high. The client denies feeling suicidal but states, “I’m a mess. I’m just not smart enough to figure out how to run my life!” Which nursing diagnosis would best identify the client’s problems?

a. Social isolation related to recent loss of significant relationship
b. Chronic low self-esteem related to unrealistic self-expectations
c. Anxiety related to job stressors
d. Risk for impulse control related to unidentified triggers

Answer 57

b

Clients with eating disorders generally have low self-esteem even though they achieve well at school, sports, and work. Most nursing diagnoses for clients with eating disorders center on psychosocial problems, such as chronic low self-esteem related to unrealistic expectations from self or others, lack of positive feedback, and striving to please others to gain acceptance.

Question 58

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client’s history includes anorexia nervosa and a 15-pound weight loss in the last month. The client is 5 feet 5 inches tall and weighs 75 pounds. Which is the priority nursing intervention?

a. Initiating total parenteral nutrition as ordered
b. Initiating cognitive behavioral therapy as ordered
c. Addressing the client’s low self-esteem
d. Monitoring vital signs and weight

Answer 58

a

Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. Medical management focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalance.

Question 59

A client diagnosed with anorexia nervosa is experiencing bradycardia, cold intolerance, and fatigue. Which complication of anorexia nervosa does the nurse identify?
a. hypoglycemia
b. osteoporosis
c. hypothyroidism
d. acrocyanosis

Answer 59

c

Eating disorders can cause long-term complications in the client. Symptoms of bradycardia, cold intolerance, and fatigue are indicative of the complication, hypothyroidism. Hypoglycemia would cause a decrease in the client’s blood glucose levels. Osteoporosis would cause decreased bone density. Acrocyanosis causes blue discoloration to the client’s hands and feet, which are not present.

Question 60

A client diagnosed with bulimia nervosa is seeking counseling after a relapse. The client states to the counselor, “I began binging and purging a week ago; I’ll never recover.” What cognitive distortion does the counselor identify?
a. all-or-nothing thinking
b. overgeneralizing
c. catastrophizing
d. magnification

Answer 60

c

Cognitive distortions may be present in clients with eating disorders and may interfere with the client’s healthy coping ability. The client’s statement, “I began binging and purging a week ago; I’ll never recover” is an example of catastrophizing. A client statement such as, “I binged last night, so I can’t go out with anyone” is an example of magnification. A client statement such as, “I’ve gained 2 pounds, so I’ll be up to 100 pounds soon” is an example of all-or-nothing thinking. A client statement such as, “I didn’t eat anything yesterday and did okay, so I don’t think not eating for a week or two will harm me” is an example of overgeneralization.

Question 61

After reporting weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client’s nursing care and treatment, which outcome should be prioritized?

a. The client will verbalize fears relating to the client’s health needs.
b. The client will acknowledge self-harm thoughts.
c. The client will be free of self-induced vomiting.
d. The client will identify alternatives to current coping patterns.

Answer 61

The client’s self-induced vomiting is the direct cause of the present health crisis. There is no evidence of fear or deliberate self-harm in this client’s case. The client likely has ineffective coping skills, but the immediacy of the need to prevent any subsequent vomiting supersedes the client’s need to develop new coping skills.

Question 62

A nurse is discussing the plan of care with a client who has anorexia nervosa. The client’s weight is 15% below ideal. The nurse and client are now discussing the client’s activity level. The client would like to run 5 miles per day as the client normally does. Which response by the nurse is best?

a. “That’s fine as long as you adhere to your eating program and do not use laxatives or purging.”
b. “No, exercise is not allowed until your weight is closer to normal.”
c. “Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass.”
d. “Five miles per day is too much. How about 3 miles per day?”

Answer 62

c

Rigorous aerobic exercise generally is contraindicated when weight gain is a goal. Allowing the client to engage in moderate anaerobic exercise (e.g., weight lifting), however, would increase lean body mass as the client gains weight and minimize the gain in “fat weight,” which is a great fear of the client.

Question 63

The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first?

a. Ask the client directly about thoughts of suicide or self-harm
b. Identify the cues related to binging
c. Control the eating responses
d. Provide small regular meals and snacks

Answer 63

a

The client’s safety is a priority. The nurse must ask questions about suicide and related thoughts in order to determine the level of monitoring the client may need to ensure safety during treatment.

Question 64

The nurse is interviewing an 18-year-old client about eating behaviors. The client’s parents have brought the client to treatment because one of the client’s parents suspects that the client has been binge eating and vomiting. The nurse asks the client if the client ever feels that the client cannot control the client’s eating. The client’s parent states, “I know the client can’t control it; the client ate an entire cake last night!” Which comment by the nurse is best?

a. “I see. What are your thoughts on what your parent has said?”
b. “Do you often have to answer for your child?”
c. “ Is what your parent said true?”
d. “I see. Do you ever feel as though you cannot control your eating?”

Answer 64

d

Parents in enmeshed families frequently try to protect their children by speaking for them, as in, “My child feels happy most of the time.” Members are not accustomed to identifying and expressing their own feelings and need frequent prompting from the nurse. The nurse encourages members to speak for themselves and not for one another.

Question 65

A client with anorexia weighs less than 85% of the client’s normal body weight. The client says, “I’m so fat, I can’t even get through this doorway, much less fit into any of my clothes.” Which is the nurse’s most therapeutic response?

a. “Let’s talk about your ideas about your body and why you perceive yourself to be fat.”
b. “You must try and stop thinking that way. Let’s think of some alternative ideas for describing your body.”
c. “I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about.”
d. “You only weigh 100 pounds. It is just not true that you are fat.”

Answer 65

c

People with eating disorders tend to have perfectionistic personalities and to think in all-or-nothing terms. The nurse communicates caring to the client through a kind, firm, matter-of-fact approach, acknowledging the client’s statement and at the same time, being honest and factual about the client’s condition without being condescending or punitive.

Question 66

A client’s diagnosis of bulimia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.)

a. Client reports of “being depressed”
b. History of purging “3 times a week for 2 years.”
c. Often heard discussing “how hard it is to stay thin” with other clients
d. Lanugo observed on forearms and face
e. Serum potassium of 3.8 mEq/L

Answer 66

a, b, c

Having mood disturbances, binging and purging, and demonstrating undue concern of body shape and weight are characteristics of bulimia. Lanugo is characteristic of anorexia, not bulimia, and a serum potassium level of 3.8 is low normal and is also not suggestive of bulimia.