Eating Disorders, Abuse

Question 1

The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply.

A) The client has few friends.
B) The client holds a dominant role in the family.
C) The client is in charge of the family finances.
D) There is a moderate amount of alcohol use in the home.
E) The client reports that the father was abusive during childhood.

Answer 1

A) The client has few friends.
D) There is a moderate amount of alcohol use in the home.
E) The client reports that the father was abusive during childhood.

Rationale: One characteristic of violent families is social isolation. Members of these families keep to themselves and usually do not invite others into the home or tell them what is happening. If the client reports that the father was abusive during childhood, that would support the suspicion that the client is a victim of abuse. The abusive family member almost always holds a position of power and control over the victim. The abuser exerts not only physical power but also economic and social control. Substance abuse, especially alcoholism, has been associated with family violence.

Question 2

A young female immigrant presents in the rural health clinic with facial bruising and a fractured nose. The client is reluctant to give details of the nature of her injuries. Which of the following should be a consideration in providing care for this client?

A) Most views regarding domestic violence are universal across cultures.
B) She may fear deportation if she seeks public assistance.
C) Immigrants have expedited access to public legal services.
D) The nurse should ignore the details and focus on treatment.

Answer 2

B) She may fear deportation if she seeks public assistance.

Rationale: Battered immigrant women face legal, social, and economic problems different from US citizens who are battered and from people of other cultural, racial, and ethnic origins who are not battered: The battered woman may come from a culture that accepts domestic violence. She may believe she has less access to legal and social services than do US citizens. If she is not a citizen, she may be forced to leave the United States if she seeks legal sanctions against her husband or attempts to leave him. She is isolated by cultural dynamics that do not permit her to leave her husband; economically, she may be unable to gather the resources to leave, work, or go to school. Language barriers may interfere with her ability to call 911, learn about her rights or legal options, and obtain shelter, financial assistance, or food. The nurse must treat the whole person and encourage the client to share the details in order to protect the client’s safety and well- being.

Question 3

Which of the following is the best explanation for why family violence tends to occur over multiple generations of families?

A) A tendency toward violence is hereditary.
B) Family violence may be perpetuated between generations of families by role
modeling and social learning.
C) All persons who have become victims of family violence will grow up to
perpetrate family violence.
D) Family violence does not tend to have an intergenerational transmission process.

Answer 3

B) Family violence may be perpetuated between generations of families by role
modeling and social learning.

Rationale: The intergenerational transmission process shows that patterns of violence are perpetuated from one generation to the next through role modeling and social learning. Not all persons exposed to family violence, however, become abusive or violent as adults.

Question 4

Which of the following are common characteristics of violent families regardless of the type of abuse that exists? Select all that apply.

A) Abuse of power and control
B) Alcohol and other drug abuse
C) Intergenerational transmission
D) Social isolation
E) Victim instigates

Answer 4

A) Abuse of power and control
B) Alcohol and other drug abuse
C) Intergenerational transmission
D) Social isolation

Rationale: Research studies have identified some common characteristics of violent families regardless of the type of abuse that exists. They include social isolation, abuse of power and control, alcohol and other drug abuse, intergenerational transmission. The victim does not instigate abuse.

Question 5

Which of the following are common reasons why abused women remain with the abusive partner? Select all that apply.

A) The abused person is personally and financially dependent on the abuser.
B) The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work.
C) The abused person is convinced that she has been abusive toward the abuser at some point and that the abuse is her fault.
D) The abused person believes that she is unable to function without her husband.
E) The abused person is afraid that the abuser will kill her if she tries to leave.

Answer 5

A) The abused person is personally and financially dependent on the abuser.
B) The abused person has low self-esteem and defines her success as a person by the
ability to make the relationship work.
D) The abused person believes that she is unable to function without her husband.
E) The abused person is afraid that the abuser will kill her if she tries to leave.

Rationale: Dependency is the trait most commonly found in abused wives who stay with their husbands. Women often cite personal and financial dependency as a reason why they find leaving an abusive relationship extremely difficult. The victim may suffer from low self-esteem and defines her success as a person by her ability to remain loyal to her marriage and ìmake it work.î Some women internalize the criticism they receive and mistakenly believe they are to blame. Women also fear their abuser will kill them if they try to leave. An abuser often has feelings of low self-esteem and poor problem-solving and social skills and may interpret any attempts at defense or any behavior of the abused person as abuse of the perpetrator.

Question 6

Which of the following are typical characteristics of the perpetrator of intimate partner abuse? Select all that apply.

A) The perpetrator often believes that the partner is his own property.
B) The perpetrator is often irrationally jealous, even of his own children.
C) The perpetrator is emotionally immature and needy.
D) The perpetrator respects his partner.
E) The perpetrator is intimidated by his partner.

Answer 6

A) The perpetrator often believes that the partner is his own property.
B) The perpetrator is often irrationally jealous, even of his own children.
C) The perpetrator is emotionally immature and needy.

Rationale: The perpetrator often believes that the partner is his own property. The perpetrator is often irrationally jealous, even of his own children if the partner pays any attention to them. The perpetrator is emotionally immature and needy. The perpetrator does not respect his partner because if he did, he would not believe that the partner is his own property to do with as he wishes. The perpetrator wants to maintain control over his partner and is therefore not intimidated by the partner but by the thought of the partner not being available.

Question 7

The nurse is caring for a 16-year-old boy with a history of sexual abuse. What might the nurse expect to assess with this client?

A) The client will experience long-term emotional trauma.
B) The client will have no ill effects due to his age.
C) The client will have high self-esteem.
D) The client will easily share his concerns with the nurse.

Answer 7

A) The client will experience long-term emotional trauma.

Rationale: Nightmares and flashbacks are common in people who were abused as children regardless of their current age. The client may have ill effects irrespective of the age. The client will likely have low self-esteem. The client will likely have difficulty relating to anyone, including the nurse.

Question 8

Which of the following behaviors would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child?

A) The child has a preference for associating with peers, rather than adults.
B) The child has learning problems and shyness.
C) The child tells sexually explicit stories to peers.
D) The child wears dirty and threadbare clothing.

Answer 8

C) The child tells sexually explicit stories to peers.

Rationale: Children who have sexual knowledge not expected at their age have often been sexually abused. A child who has been sexually abused by an adult may feel more comfortable with peers than with adults. Learning problems, shyness, and wearing dirty and threadbare clothing may be related to many situations other than sexual abuse.

Question 9

Which characteristic of the abuser should the nurse look for when completing the family assessment of a victim on intimate partner violence?

A) Encourages the partner to have a life outside the intimate relationship
B) An inflated sense of self-esteem
C) Needy and possessive of the partner
D) An ability to feel remorse for the abuse

Answer 9

C) Needy and possessive of the partner

Rationale: An abusive husband often believes his wife belongs to him (like property) and becomes increasingly violent and abusive if she shows any sign of independence, such as getting a job or threatening to leave. Typically, the abuser has strong feelings of inadequacy and low self-esteem as well as poor problem-solving and social skills. He is emotionally immature, needy, irrationally jealous, and possessive. By bullying and physically punishing the family, the abuser often experiences a sense of power and control. Therefore, the violent behavior often is rewarding and boosts his self-esteem. A typical pattern of abuse exists: Usually, the initial episode of battering or violence is followed by a period of the abuser expressing regret, apologizing, and promising it will never happen again.

Question 10

Which one of the following statements regarding intimate partner violence is true?

A) Males are never the victim in intimate partner violence.
B) It is common for abusers to use one type of abuse only.
C) Intimate partner violence can exist with former partners.
D) Psychological abuse is not as harmful as physical abuse.

Answer 10

C) Intimate partner violence can exist with former partners.

Rationale: Intimate partner violence is the mistreatment or misuse of one person by another in the context of an emotionally intimate relationship. The relationship may be spousal, between partners, boyfriend, girlfriend, or an estranged relationship. Ninety to ninety- five percent of domestic violence victims are women. By deduction, this means that 5% to 10% of domestic violence victims are men. The abuse can be emotional or psychological, physical, sexual, or a combination (which is common). All abuse is harmful.

Question 11

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is which of the following?

A) Neglect
B) Physical abuse
C) Sexual abuse
D) Emotional abuse

Answer 11

A) Neglect

Rationale: Sixty-four percent of child maltreatment victims suffered neglect; 16% were physically abused; 8.8% were sexually abused; 6.6% were psychologically or emotionally abused; and 2.2% were medically neglected. Also, 15% suffered ìotherî types of maltreatment such as abandonment, physical threats, and congenital drug addiction.

Question 12

A coherent elderly woman has been financially and emotionally abused by her adult children for the past several years, but has failed to report the abuse to anyone. Which is the most likely reason that the woman neglects to report the abuse?

A) She cannot claim abuse if there is no evidence of physical harm.
B) Laws do not provide protection against abuse when the suspect(s) is/are family
members.
C) She has no financial resources to hire legal representation against her children.
D) She is emotionally close to her children and does not want to bring them harm.

Answer 12

D) She is emotionally close to her children and does not want to bring them harm.

Rationale: Elders are often reluctant to report abuse, even when they can, because the abuse usually involves family members whom the elder wishes to protect. Victims also often fear losing their support and being moved to an institution.

Question 13

A school nurse is educating a group of adolescent girls about rape and sexual assault. The nurse evaluates the students’ understanding when they report which of the following as a high-risk factor regarding the incidence of rape?

A) The highest incidence of rape occurs in adolescents and young adult women.
B) Most rapes are committed by strangers.
C) Most rapes are random acts of violence.
D) A victim is at highest risk in unfamiliar neighborhoods.

Answer 13

A) The highest incidence of rape occurs in adolescents and young adult women.

Rationale: Only 20% of rapes are committed by strangers. A phenomenon called date rape (acquaintance rape) may occur on a first date, on a ride home from a party, or when the two people have known each other for some time. It is more prevalent near college and university campuses. The highest incidence is in girls and women 16 to 24 years of age. Rape most commonly occurs in a woman’s neighborhood, often inside or near her home. Most rapes are premeditated.

Question 14

Which of the following are common behavioral and emotional responses to abuse? Select all that apply.

A) One third of abusive men are likely to have come from violent homes.
B) Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships.
C) Dependency on the abuser is a common trait found in victims of domestic violence.
D) The victim caused the abuse.
E) It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

Answer 14

A) One third of abusive men are likely to have come from violent homes.
B) Women who grew up in violent homes are 50% more likely to expect or accept
violence in their own relationships.
C) Dependency on the abuser is a common trait found in victims of domestic violence.
E) It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

Rationale: One third of abusive men are likely to have come from violent homes. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. Dependency on the abuser is a common trait found in victims of domestic violence. The victim may believe that he or she caused the abuse, but this is not accurate. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

Question 15

A woman is in treatment for an anxiety disorder. Her history reveals that she was sexually abused repeatedly by her husband. Which of the following interventions would be appropriate in relations to this piece of data?

A. Avoid discussing the abuse so as not to upset her
B. Encourage her to talk about feelings related to the abuse
C. Request an anxiolytic to reduce her anxiety levels
D. Help her explore her role in perpetuating the abuse

Answer 15

B. Encourage her to talk about feelings related to the abuse

Rationale: Encourage the client to talk about his or her experience(s); be accepting and nonjudgmental of the client’s accounts and perceptions. Retelling the experience can help the client to identify the reality of what has happened and help to identify and work through related feelings. Do not imply that the client is responsible for the abuse.

Question 16

The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. Which of the following data obtained during the assessment would raise the nurse’s suspicion that the child has suffered physical abuse?

A) The parents appearing overprotective of the child
B) Bruises over the child’s bony prominences
C) The injury occurring several days before the parents sought treatment
D) Both parents reporting the exact same details pertaining to the injurious event

Answer 16

C) The injury occurring several days before the parents sought treatment

Rationale: Warning signs of abused/neglected children include serious injuries such as fractures, burns, or lacerations with no reported history of trauma; delay in seeking treatment for a significant injury; the child or a parent giving a history inconsistent with severity of injury; inconsistencies or changes in the child’s history during the evaluation by either the child or the adult; unusual injuries for the child’s age and level of development, such as a fractured femur in a 2-month-old or a dislocated shoulder in a 2-year-old; high incidence of urinary tract infections; bruised, red, or swollen genitalia; tears or bruising of the rectum or vagina; and evidence of old injuries not reported, such as scars, fractures not treated, and multiple bruises that the parent/caregiver cannot explain adequately.

Question 17

A woman has just presented at the emergency department after being raped. The initial nursing action would be to:

A) provide emotional support.
B) refer her to a rape crisis hotline.
C) encourage her to file charges immediately.
D) perform a nursing history and physical as quickly as possible.

Answer 17

A) provide emotional support.

Rationale: In the emergency setting, the nurse is an essential part of the team in providing emotional support to the victim. The nurse should allow the woman to proceed at her own pace and not rush her through any interview or examination procedures. Giving back to the victim as much control as possible is important. Ways to do so include allowing her to make decisions, when possible, about whom to call, what to do next, what she would like done, and so on.

Question 18

The nurse is working in the emergency department with a woman who was raped 1 hour ago. Which of the following is most important for the nurse to remember when planning care?

A) The client should set aside any angry feelings until physical care is completed.
B) Evidence collection according to procedures is not as important as treating the client’s injuries.
C) The nurse will need to make decisions for this client.
D) The woman may feel threatened by some of the procedures.

Answer 18

D) The woman may feel threatened by some of the procedures.

Rationale: Many of the examination procedures, such as a pelvic exam, may cause the woman to feel violated again. The client needs emotional support and evidence collection as well as physical care. It would not be appropriate for the nurse to make decisions for this client.

Question 19

A young woman telephones the emergency department and loudly tells the nurse, “I’ve been raped! Please help me!” Which of the following is the priority for the nurse to determine?

A) If the client was in a safe place, her condition, and if transportation is available
B) If the client knew her assailant, knew her location, and had notified the police
C) If the client has insurance, if she could get to the hospital by herself, and if
pregnancy is a possibility
D) If the client had bathed, douched, or changed clothes

Answer 19

A) If the client was in a safe place, her condition, and if transportation is available

Rationale: If the client is injured, she may need immediate medical attention; if she is in a safe place, she can talk to the nurse on the phone. All other questions can wait until the client’s safety is ensured.

Question 20

The school nurse is teaching a health class about recognizing the signs of abusive relationships. The nurse describes the cycle of violence. The nurse would document effective teaching if the students identify the cycle of violence to be which of the following patterns? Select the order in which the events occur.

A. Tension building
B. Honeymoon period
C. Violent behavior
D. Period of remorse

Answer 20

A. Tension building
C. Violent behavior
D. Period of remorse
B. Honeymoon period

Rationale: The tension-building phase begins; there may be arguments, stony silence, or complaints from the husband. The tension ends in another violent episode after which the abuser once again feels regret and remorse and promises to change. This cycle continually repeats itself. Each time, the victim keeps hoping the violence will stop.

Question 21

The nurse is discussing expectations of raising a child with a pregnant teenager expecting her first baby. The father will not be a participant in the parenting. Which of the following statements made by the expectant mother would be of greatest concern to the nurse?

A) “I am going to rely on my sisters for a lot of help raising my baby.”
B) “I was raised with very strict discipline.”
C) “My child will love me unlike my parents ever did.”
D) “I am not sure how I am going to pay for all the things my child will need.”

Answer 21

C) “My child will love me unlike my parents ever did.”

Rationale: In some instances, the parent feels the need to have children to replace his or her own faulty and disappointing childhood; the parent wants to feel the love between child and parent that he or she missed as a child. The reality of the tremendous emotional, physical, and financial demands that comes with raising children usually shatters these unrealistic expectations. When the parent’s unrealistic expectations are not met, abuse often follows. Having a support system and a sense of discipline can contribute to effective parenting. Financial worries may be a concern, but relying on a baby to meet emotional needs is a high-risk dynamic for child abuse.

Question 22

The community health nurse meets with the family members of an elderly client. The nurse includes which of the following in the plan of care as a preventive measure to guard against elder abuse?

A) Reassure the primary caregiver that he or she in the best position to provide care
to the elder
B) Teach the primary caregiver skills to meet all of the elder’s needs
C) Assist in the transfer of legal authority for elder care to the primary caregiver
D) Provide the primary caregiver with additional resources to meet the elder’s needs

Answer 22

D) Provide the primary caregiver with additional resources to meet the elder’s needs

Rationale: Elder abuse may develop gradually as the burden of care exceeds the caregiver’s physical or emotional resources. Relieving the caregiver’s stress and providing additional resources may help to correct the abusive situation and keep the caregiving relationship intact.

Question 23

The nurse at a university health services clinic has been asked to meet with a freshman class of women about warning signs of relationship violence. The nurse points out which of the following danger signs the students should be alert for in a date?

A) Dislikes your fiends
B) Acts indifferent to your life choices
C) Is excessively jealous
D) Views you as superior to himself

Answer 23

C) Is excessively jealous

Rationale: Warning signs of relationship violence include gets jealous for no reason; tells you with whom you may be friends or how you should dress, or tries to control other elements of your life; does not view you as an equal: sees himself as smarter or socially superior; is angry or threatening to the point that you have changed your life or yourself so you would not anger him.

Question 24

A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, “He is so jealous and overprotective; he wants to know where I am and who I’m with every minute.” Which of the following is most likely true of the situation?

A) The student is overreacting.
B) This is a situation requiring a restraining order.
C) The student’s boyfriend is simply insecure and needs reassurance.
D) This is characteristic of the tension-building phase of the violence cycle.

Answer 24

D) This is characteristic of the tension-building phase of the violence cycle.

Rationale: In tension building, the abuser attempts to establish complete control over all the person’s actions. It is more appropriate for the nurse to listen to the client, rather than to judge whether the client is overreacting. This may or may not require a restraining order. The student’s boyfriend is insecure and needs reassurance, but that is not the only concern.

Question 25

The nurse is working with a client at the battered women’s shelter who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, “What do you think about that?” Which is the best response by the nurse?

A) “Batterers never change, so it would be best for you to leave.”
B) “If you don’t leave, he’ll think you’re going to continue to endure his abuse.”
C) “If you leave, maybe he’ll see that he has to change his behavior.”
D) “You may be in more physical danger after you leave him.”

Answer 25

D) “You may be in more physical danger after you leave him.”

Rationale: Statistics indicate that violence increases when the victim attempts to leave or end the relationship. It is not appropriate for the nurse to offer advice such as this. It is not the victim’s fault whether the victim stays or not. ìIf you leave, maybe he’ll see that he has to change his behavior,î is not appropriate as it minimizes the situation.

Question 26

The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next?

A) Ask the client when and how the bruises occurred
B) Call the nursing supervisor immediately
C) Follow the facility’s policy and procedures for reporting abuse
D) Notify the physician that abuse is suspected

Answer 26

A) Ask the client when and how the bruises occurred

Rationale: The nurse should not assume the bruises were caused by abuse; the client’s explanation is an important step in the assessment of potential abuse. A nurse must assess for abuse prior to getting the supervisor and physician involved. Reporting abuse would be initiated after a thorough assessment.

Question 27

A nurse is working with a client who has a history of repeated abusive intimate relationships. The nurse has difficulty understanding why a woman would repeatedly enter into relationships with abusive partners. When working with this client, the nurse can best maintain a therapeutic relationship through which of the following approaches?

A) Keeping focused on the client’s feelings about her life situation
B) Honestly asking the client why she repeats the cycles of victimization
C) Convincing the client to develop a self-rescue plan
D) Not prying into the details of the client’s private life

Answer 27

A) Keeping focused on the client’s feelings about her life situation

Rationale: Nurses may believe that a woman who stays in an abusive relationship might deserve or enjoy the abuse or that abuse between husband and wife is private. The nurse may also feel horror or revulsion. Because clients often watch for the nurse’s reaction, containing these feelings and focusing on the client’s needs are important. The nurse must be prepared to listen to the client’s story, no matter how disturbing, and support and validate the client’s feelings with comments such as “That must have been terrifying” or “Sounds like you were afraid for your life.” The nurse must remember that he or she cannot fix or change things; the nurse’s role is to listen and convey acceptance and support for the client.

Question 28

A 15-year-old female is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa?

A) Body weight less than normal for age, height, and overall physical health
B) Amenorrhea for at least two cycles
C) Absence of hunger feelings
D) Erosion of dental enamel

Answer 28

A) Body weight less than normal for age, height, and overall physical health

Rationale: Anorexia nervosa is a life-threatening eating disorder characterized by the client’s refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. Clients with anorexia have a body weight that is less than the minimum expected weight, considering their age, height, and overall physical health. In addition, clients have a preoccupation with food and food-related activities and can have a variety of physical manifestations. Physical problems or anorexia nervosa include amenorrhea, constipation, overly sensitive to cold, lanugo hair on body, hair loss, dry skin, dental caries, pedal edema, bradycardia, enlarged parotid glands, hypothermia, and electrolyte imbalance. These clients do not lose their appetites. They still experience hunger but ignore it and signs of physical weakness and fatigue. Dental erosion is characteristic of bulimia nervosa.

Question 29

The nurse is assessing a client with bulimia nervosa. Which of the following symptoms would the nurse expect to find? Select all that apply.

A) Cold intolerance
B) Normal weight for height
C) Dental erosion
D) Hypotension
E) Metabolic alkalosis

Answer 29

B) Normal weight for height
C) Dental erosion
E) Metabolic alkalosis

Rationale: The weight of clients with bulimia usually is in the normal range, although some clients are overweight or underweight. Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these clients. Metabolic alkalosis often results from vomiting. Cold intolerance and hypotension are symptoms associated with emaciation seen in anorexia nervosa.

Question 30

Which eating disorder is characterized by consuming an amount of food much larger than a person would normally eat and of near-normal weight? Afterward, the client may purge the food or exercise excessively, and between binges, the client may eat low- calorie foods or fast.

A) Anorexia nervosa
B) Bulimia nervosa
C) Pica
D) Rumination

Answer 30

B) Bulimia nervosa

Rationale: Bulimia nervosa, often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. The amount of food consumed during a binge episode is much larger than a person would normally eat. Between binges, the client may eat low-calorie foods or fast. Anorexia nervosa is a life- threatening eating disorder characterized by the client’s refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. The weight of clients with bulimia usually is in the normal range. Pica is persistent ingestion of nonfood substances. Rumination is repeated regurgitation of food that is then rechewed, reswallowed, or spit out.

Question 31

When working with the family of a client with anorexia nervosa, which of the following issues must be addressed?

A) Codependence
B) Control issues
C) Self-discipline
D) Sexual identity

Answer 31

B) Control issues

Rationale: Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self- discipline, and sexual identity are not pertinent issues to address with the family.

Question 32

During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which would indicate to the nurse that this client might have anorexia nervosa?

A) Episodes of overeating and excessive weight gain
B) Expressions of a positive self-concept
C) Flexible thought patterns and spontaneity
D) Severe weight loss due to self-imposed dieting

Answer 32

D) Severe weight loss due to self-imposed dieting

Rationale: Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.

Question 33

What is the primary difference between anorexia nervosa and bulimia nervosa?

A) Anorexia has a psychological basis, whereas the cause of bulimia is biologic.
B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior.
C) Bulimia can be life threatening, whereas anorexia is seldom so.
D) There is no real difference between these two types of disorders.

Answer 33

B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior.

Rationale: Clients with bulimia know their behavior is pathologic and are ashamed of it; clients with anorexia think they are fine and see no problem with their weight-control efforts. Anorexia nervosa is a life-threatening eating disorder. Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families.

Question 34

While assessing the family dynamics of a client with an eating disorder, which of the following does the nurse most likely discover?

A) Multiple siblings
B) Lack of interest in the client by other family members
C) Supportive and encouraging relationships
D) Over controlling parents

Answer 34

D) Over controlling parents

Rationale: Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy 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.

Question 35

The nurse understands that which biologic factors may influence the development of an eating disorder? Select all that apply.

A) Family history of eating disorders
B) Dysfunction of the hypothalamus
C) Norepinephrine imbalances
D) First-degree relatives with psychotic disorder
E) Decreased serotonin levels

Answer 35

A) Family history of eating disorders
B) Dysfunction of the hypothalamus
C) Norepinephrine imbalances
E) Decreased serotonin levels

Rationale: Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families, or it may directly involve a dysfunction of the hypothalamus. A family history of mood or anxiety disorders (e.g., obsessive compulsive disorder) places a person at risk for an eating disorder. Low norepinephrine levels are seen in clients during periods of restricted food intake. Also, low epinephrine levels are related to the decreased heart rate and blood pressure seen in clients with anorexia. Low levels of serotonin as well as low platelet levels of monoamine oxidase have been found in clients with bulimia and the binge and purge subtype of anorexia nervosa.

Question 36

Which factors may contribute to the frequency of eating disorders in adolescents? SATA.

A. Media portrayal of slimness as an ideal
B. Body dissatisfaction in adolescent females
C. Stress-free existence of adolescents
D. Body image disturbance
E. Seeking autonomy
F. Seeking to develop a unique identity

Answer 36

A. Media portrayal of slimness as an ideal
B. Body dissatisfaction in adolescent females
D. Body image disturbance
E. Seeking autonomy
F. Seeking to develop a unique identity

Rationale: Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. In families in which enmeshment exists, adolescents begin to control their eating through severe dieting and thus gain control over their weight. Adolescent girls who express body dissatisfaction are most likely to experience adverse outcomes. The need to develop a unique identity, or a sense of who one is as a person, is another essential task of adolescence. It coincides with the onset of puberty, which initiates many emotional and physiologic changes. Self-doubt and confusion can result if the adolescent does not measure up to the person she or he wants to be. Advertisements, magazines, and movies that feature thin models reinforce the cultural belief that slimness is attractive. Body image disturbance occurs when there is an extreme discrepancy between one’s body image and the perceptions of others and extreme dissatisfaction with one’s body image.

Question 37

Several medications are prescribed for a client who has anorexia. Which medication may be prescribed to help treat the client’s distorted body image?

A) Amitriptyline (Elavil)
B) Cyproheptadine (Periactin)
C) Olanzapine (Zyprexa)
D) Fluoxetine (Prozac)

Answer 37

C) Olanzapine (Zyprexa)

Rationale: Several classes of drugs have been studied, but few have shown clinical success. Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses (up to 28 mg/day) can promote weight gain in clients with anorexia nervosa. Olanzapine (Zyprexa) has been used with success because of its antipsychotic effect (on bizarre body image distortions) and associated weight gain. Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has been partially or completely restored. However, close monitoring is needed because weight loss can be a side effect.

Question 38

The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach?

A) “Is there any way you can look at that sandwich as fuel for your body?”
B) “You have to eat in moderation for good nutrition.”
C) “You seem to have a really hard time controlling your eating patterns.”
D) “Is this your way of showing your family that you can make decisions?”

Answer 38

A) “Is there any way you can look at that sandwich as fuel for your body?”

Rationale: CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual to guide treatment. Strategies designed to change the client’s thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept.

Question 39

When documenting the mental status exam findings in the chart of a client with anorexia, the nurse notes poor judgment and insight. Which client statement would support this impression?

A) “I know I have a problem. I need help.”
B) “Others are just trying to keep me from looking good.”
C) “I know my weight is a little below normal.”
D) “Those weight charts are for normal people. I am not normal.”

Answer 39

B) “Others are just trying to keep me from looking good.”

Rationale: Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. Facts about failing health status are not enough to convince these clients of their true problems.

Question 40

All of the following nursing diagnoses are appropriate for the care of a client with anorexia. Which nursing diagnosis has the highest priority?

A) Activity intolerance
B) Ineffective coping
C) Chronic low self-esteem
D) Imbalanced nutrition: less than body requirements

Answer 40

D) Imbalanced nutrition: less than body requirements

Rationale: Nursing diagnoses for clients with eating disorders include imbalanced nutritionóless than/more than body requirements, activity intolerance, ineffective coping, and chronic low self-esteem. When prioritizing nursing diagnoses, physical needs must be met before psychosocial needs (apply Maslow’s hierarchy of needs). Of the physical needs, nutritional imbalances pose a more acute threat than decreased activity levels. When addressing psychosocial needs, improving coping skills will eventually lead to rise in self-esteem.

Question 41

Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns?

A) Leave the client alone to relax during meals.
B) Offer liquid protein supplements if the client is unable to complete meal.
C) Observe the client for 30 minutes after all meals.
D) Weigh the client weekly in the same clothing at the same time of day.

Answer 41

B) Offer liquid protein supplements if the client is unable to complete meal.

Rationale: Nursing interventions designed to establish nutritional eating patterns include sitting with the client during meals and snacks, giving a liquid protein supplement to replace any food not eaten to ensure consumption of the total number of prescribed calories, adhering to treatment program guidelines regarding restrictions, observing the client following meals and snacks for 1 to 2 hours, weighing client daily in uniform clothing, and being alert for attempts to hide or discard food or inflate weight.

Question 42

The nurse is assisting the client with anorexia to express feelings more openly. Which response by the nurse would be most likely to encourage expression of feelings?

A) “Are you sad?”
B) “You look anxious.”
C) “Tell me what you are feeling right now.”
D) “Tell me when you feel bad.”

Answer 42

C) “Tell me what you are feeling right now.”

Rationale: Because clients with anorexia have problems with self-awareness, they often have difficulty identifying and expressing feelings. Therefore, they often express these feelings in terms of somatic complaints such as feeling fat or bloated. The nurse can help clients begin to recognize emotions by asking them to describe how they are feeling and allowing adequate time for response. The nurse should not ask, “Are you sad?” or “Are you anxious?” because a client may quickly agree rather than struggle for an answer. The nurse encourages the client to describe her or his feelings. This approach can eventually help clients to recognize their emotions and to connect them to their eating behaviors.

Question 43

The nurse is teaching a client with bulimia to use self-monitoring techniques. Which client statement would let the nurse know that this has been effective?

A) “I am learning to recognize events and emotions that trigger my binges and am
working on responses other than binging and purging.”
B) “I am beginning to understand how my lack of self-control is hurting me.”
C) “I am keeping a record of everything I eat and how I am feeling every day.”
D) “I am getting more comfortable confronting people when I have conflict with
them.”

Answer 43

A) “I am learning to recognize events and emotions that trigger my binges and am
working on responses other than binging and purging.”

Rationale: Self-monitoring is a cognitiveñbehavioral technique designed to help clients with bulimia. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions, thoughts, circumstances, and interactions surrounding eating and binging or purging episodes. In this way, clients begin to see connections between emotions and situations and eating behaviors. The nurse can then help clients to develop ways to manage emotions such as anxiety by using relaxation techniques or distraction with music or another activity.

Question 44

The nurse understands that before a client with an eating disorder can accept their body image, he or she must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills?

A) Coping skills are dependent on a supportive upbringing.
B) When body image is positive, the client will develop better coping skills.
C) Being able to cope in healthy ways improves the ability to accept a realistic body image.
D) Neurotransmitters that are deficient in clients with eating disorders prohibit the
development of effective coping skills.

Answer 44

C) Being able to cope in healthy ways improves the ability to accept a realistic body image.

Rationale: When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image.

Question 45

When preparing a client with bulimia for discharge, the nurse suggests that the client and family continue with family therapy on an outpatient basis. Which of the following is the rationale for this suggestion?

A. Family members often need to learn role independence and autonomy.
B. Family members need to learn to monitor for signs of client relapse.
C. Family relationships need to be strengthened due to a lifetime of disengagement.
D. Family members often feel jealous of the attention the client has been receiving in treatment.

Answer 45

A. Family members often need to learn role independence and autonomy.

Rationale: Dysfunctional relationships with significant others often are a primary issue for clients with eating disorders. In addition, support groups in the community or via the internet can offer support, education, and resources to clients and their families or significant others.

Question 46

Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa?

A) Imbalanced nutrition: less than body requirements
B) Disturbed body image
C) Deficient knowledge (nutritious eating patterns)
D) Social isolation

Answer 46

B) Disturbed body image

Rationale: The client’s dissatisfaction with body image is an enduring belief pattern that is firmly ingrained and, therefore, very difficult to change. Imbalanced nutritionóless than body requirements, deficient knowledge (nutritious eating patterns), and social isolation are nursing diagnoses that can be worked through with education and support more easily than the diagnosis of disturbed body image.

Question 47

Which of the following interventions would be appropriate for a client with anorexia nervosa?

A) Allowing the client to eat whenever she feels hungry
B) Insisting that the client sit in the dining room until all food is eaten
C) Having the client in view of staff for 90 minutes after each meal
D) Permitting the client to eat any food she chooses, as long as she is eating

Answer 47

C) Having the client in view of staff for 90 minutes after each meal

Rationale: Many clients with anorexia also have purging behavior; even those who have not purged previously may begin to do so when they are unable to restrict their eating. Answer choices A, B, and D do not promote healthy eating behaviors.

Question 48

Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa?

A) Changing her irrational thinking about her body
B) Establishing a target weight to be achieved by discharge
C) Restoring nutritional status to normal
D) Gaining insight into the effects of anorexia on her physical health

Answer 48

C) Restoring nutritional status to normal

Rationale: Physiologic safety and homeostasis are the priority concerns. Changing of thought pattern, establishing a target weight, and gaining insight into the effects of anorexia on her physical health are not immediate goals in the management of anorexia nervosa.

Question 49

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 49

C) “I will sit here quietly with you while you eat.”

Rationale: This statement reflects the nurse’s expectation that the client will eat, yet the nurse still will provide adequate supervision. The other choices are not appropriate means of assuming a positive expectation of the client.

Question 50

A 16-year-old female with anorexia nervosa is admitted to the unit. Which is the most appropriate short-term outcome?

A) The client will accept herself as having value and worth.
B) The client will admit she has a fear of gaining weight.
C) The client will follow a nutritionally balanced diet for her age.
D) The client will identify her problems and potential alternative coping strategies.

Answer 50

B) The client will admit she has a fear of gaining weight.

Rationale: Admitting her fears is an initial step in recovery. Accepting herself as having value and worth, following a nutritionally balanced diet, and identifying problems and potential alternative coping strategies are examples of long-term outcomes.

Question 51

A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children?

A) Dieting helps build a positive self-image in children.
B) Dieting during childhood restricts essential nutrients needed for normal growth.
C) Dieting at an early age teaches healthy eating habits.
D) Dieting at an early age may lead to the development of eating disorders.

Answer 51

D) Dieting at an early age may lead to the development of eating disorders.

Rationale: A specific cause for eating disorders is unknown. Initially, dieting may be the stimulus that leads to their development. Dieting is also associated with the risk factor of dissatisfaction with body image. Children need well-balanced diets rather than calorie restriction diets. Eating patterns during childhood are often carried into adulthood.

Question 52

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 52

B) Encourage the entire family to engage in a balanced and regular dietary pattern.

Rationale: The nurse provides extensive teaching about basic nutritional needs and the effects of restrictive eating, dieting, and the binge and purge cycle. Clients need encouragement to set realistic goals for eating throughout the day. 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 for family and friends to force the client to eat.

Question 53

Which of the following would be most supportive for family and friends of a client with an eating disorder?

A. Emotional support, love, and attention
B. Focus on food intake, calories, and weight
C. Unlimited access to unhealthy foods that the client enjoys
D. Positive reinforcement for weight gain

Answer 53

A. Emotional support, love, and attention

Rationale: The nurse explains to family and friends that they can be most helpful by providing emotional support, love, and attention. They can express concern about the client’s health, but it is rarely helpful to focus on food intake, calories, and weight. Eating disorders can be viewed on a continuum with clients with anorexia eating too little or starving themselves, clients with bulimia eating chaotically, and clients with obesity eating too much.

Question 54

The nurse has been teaching the client’s family about the client’s eating disorder, anorexia nervosa. Which statement would indicate that teaching was effective?

A) “We will eat our evening meals together with no exceptions.”
B) “We will negotiate resolutions to family conflicts.”
C) “We will spend less time discussing troublesome family members.”
D) “We will give her frequent encouragement for eating well and maintaining her weight.”

Answer 54

B) “We will negotiate resolutions to family conflicts.”

Rationale: Families of clients with eating disorders typically put too much emphasis on food and are less skilled at discussing family conflicts and allowing the client to begin gaining independence. “We will eat our evening meals together with no exception,” allows little or no compromise; the client needs to be able to make decisions for him or herself. “We will spend less time discussing troublesome family members,” indicates that the client is a problem to the family. “We will give her frequent encouragement for eating well and maintaining her weight” indicates that family members can express concern about the client’s health, but it is rarely helpful to focus on food intake, calories, and weight.

Question 55

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the teaching 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) “I’ll limit my intake of carbohydrates and fats.”

Answer 55

B) “I’ll eat small meals and snacks regularly.”

Rationale: Teaching is effective when the client recognizes the need to return to nutritious eating patterns. Answer choices A, C, and D would not be appropriate responses to teaching regarding bulimia nervosa.

Question 56

A client who has an eating disorder is becoming dependent on the nurse for direction in food choices. Which approach by the nurse would demonstrate the nurse’s self- awareness?

A) Approach the client with an adult-like objectivity.
B) Give the support and direction that the client is seeking.
C) Give approval for positive changes seen in the client.
D) Take care of the needs that the client is neglecting.

Answer 56

A) Approach the client with an adult-like objectivity.

Rationale: Avoid sounding parental when teaching about nutrition or why laxative use is harmful. Presenting information factually without chiding the client will obtain more positive results. Be empathetic and nonjudgmental, although this is not easy. Remember the client’s perspective and fears about weight and eating. Do not label clients as “good” when they avoid purging or eat an entire meal. Otherwise, clients will believe they are “bad” on days when they purge or fail to eat enough food.