mental-eating disorder 4q

Question 1

1. A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice?

A. This therapy will increase the clients motivation to gain weight.

B. This therapy will reward the client for perfectionist achievements.

C. This therapy will provide the client with control over behavioral choices.

D. This therapy will protect the client from parental overindulgence.

Answer 1

C. This therapy will provide the client with control over behavioral choices.

The nurse should identify that behavior modification therapy will be used because it provides the client with control over behavioral choices. Clients diagnosed with anorexia nervosa are often allowed to contract privileges based on weight gain. The client maintains control over eating and exercise.

Question 2

2. Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a clients home environment should a nurse associate with the development of this disorder?

A. The home environment maintains loose personal boundaries.

B. The home environment places an overemphasis on food.

C. The home environment is overprotective and demands perfection.

D. The home environment condones corporal punishment.

Answer 2

C. The home environment is overprotective and demands perfection.

The nurse should assess that a home environment that is overprotective and demands perfection may be an influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents.

Question 3

3. A clients altered body image is evidenced by claims of feeling fat, even though the client is emaciated. Which is the appropriate outcome criterion for this clients problem?

A. The client will consume adequate calories to sustain normal weight.

B. The client will cease strenuous exercise programs.

C. The client will perceive an ideal body weight and shape as normal.

D. The client will not express a preoccupation with food.

Answer 3

C. The client will perceive an ideal body weight and shape as normal.

the nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self on the basis of self-attributes instead of appearance

Question 4

A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding?

A. The emesis produced during purging is acidic and corrodes the tooth enamel.

B. Purging causes the depletion of dietary calcium.

C. Food is rapidly ingested without proper mastication.

D. Poor dental and oral hygiene leads to dental caries.

Answer 4

A. The emesis produced during purging is acidic and corrodes the tooth enamel.

The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.

Question 5

Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders?

A. These programs help clients correct distorted body image.

B. These programs address underlying client anger.

C. These programs help clients manage uncontrollable behaviors.

D. These programs allow clients to maintain control.

Answer 5

D. These programs allow clients to maintain control.

Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders because the programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques aid in restoring healthy body weight.

Question 6

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects a theory about the underlying etiology of this disorder?

A. I was just trying to be like everyone else.
B. All the skaters on the team are following an approved 1,200-calorie diet.
C. When I lose skating competitions, I also lose my appetite.
D. I am angry at my mother. I can get her approval only when I win competitions.

Answer 6

D. I am angry at my mother. I can get her approval only when I win competitions.

This client statement reflects a possible underlying etiology of anorexia nervosa. The client is expressing feelings about family dynamics that may have influenced the development of this disorder. Families who are overprotective and perfectionistic can contribute to a family members development of anorexia nervosa.

Question 6

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply?

A. Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions.

B. Family intervention and support are important in your childs recovery.

C. Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support.

D. Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed.

Answer 6

B. Family intervention and support are important in your childs recovery.

The nurse should educate the family on the importance of family dynamics, involvement, and support in the treatment of anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of this disorder or impede the progress of recovery.

Question 7

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change?

A. The client gains 2 pounds in 1 week.

B. The client focuses conversations on nutritious food.

C. The client demonstrates healthy coping mechanisms that decrease anxiety.

D. The client verbalizes an understanding of the etiology of the disorder.

Answer 7

C. The client demonstrates healthy coping mechanisms that decrease anxiety.

The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behaviors.

Question 8

A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred?

A. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.

B. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not.

C. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not.

D. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

Answer 8

A. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.

The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food, followed by purging.

Question 9

A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time?

A. Ineffective coping R/T food obsession
B. Altered nutrition: less than body requirements R/T inadequate food intake
C. Risk for injury R/T suicidal tendencies
D. Altered body image R/T perceived obesity

Answer 9

B. Altered nutrition: less than body requirements R/T inadequate food intake

Question 10

A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client?

A. The client will use stress-reducing techniques to avoid purging.
B. The client will discuss chaos in personal life and be able to verbalize a link to purging.
C. The client will gain 2 pounds prior to the next weekly appointment.
D. The client will remain free of signs and symptoms of malnutrition and dehydration.

Answer 10

C. The client will gain 2 pounds prior to the next weekly appointment.

The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, and measurable and also include a time frame.

Question 11

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients?

C. The nurse who refuses to engage in power struggles related to food consumption
A. The nurse who understands the importance of three balanced meals a day
B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption
D. The nurse who grew up poor and frequently did not have enough food to eat

Answer 11

C. The nurse who refuses to engage in power struggles related to food consumption

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

Question 12

A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention?

A. To gain additional information about the progression of the disease process

B. To emphasize that the client is capable of consuming food without purging

C. To incorporate specific foods into the meal plan to reflect pleasant memories

D. To assist the client to become more compliant with the treatment plan

Answer 12

B. To emphasize that the client is capable of consuming food without purging

Question 13

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis?

A. I do not use any laxatives or diuretics to lose weight.
B. I am losing lots of hair. Its coming out in handfuls.
C. I know that I am thin, but I refuse to be fat!
D. I dont know why people are worried. I need to lose this weight.

Answer 13

D. I dont know why people are worried. I need to lose this weight.

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

Question 14

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the best rationale for scheduling group therapy at this time?

A. To shift the clients focus from food to psychotherapy
B. To prevent the use of maladaptive defense mechanisms
C. To promote the processing of anxiety associated with eating
D. To focus on weight control mechanisms and food preparation

Answer 14

C. To promote the processing of anxiety associated with eating

When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.

Question 15

Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa?

A. Provide privacy during meals.
B. Remain with the client for at least 1 hour after the meal.
C. Encourage the client to keep a journal to document types of food consumed. D. Restrict client privileges when provided food is not completely consumed.

Answer 15

B. Remain with the client for at least 1 hour after the meal.

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

Question 16

Varcarolis

1. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?

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

Answer 16

c. Anorexia nervosa

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

Question 17

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?

a. Weight, muscle, and fat congruence with height, frame, age, and sex
b. Calorie intake is within required parameters of treatment plan
c. Weight reaches established normal range for the patient
d. Patient expresses satisfaction with body appearance

Answer 17

d. Patient expresses satisfaction with body appearance

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

Question 18

A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating
patterns, the nurse should ask the patient:

a. Do you often feel fat?
b. Who plans the family meals?
c. What do you eat in a typical day?
d. What do you think about your present weight?

Answer 18

c. What do you eat in a typical day?

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

Question 19

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, Describe what you think about your present weight and how you look. Which response by the patient is most consistent with the diagnosis?

a. I am fat and ugly.
b. What I think about myself is my business.
c. Im grossly underweight, but thats what I want.
d. Im a few pounds overweight, but I can live with it.

Answer 19

a. I am fat and ugly.

Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually tell people perceptions of self. The patient with anorexia does not recognize his or her thinness and will persist in trying to lose more weight.

Question 20

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?

a. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and
weight loss

b. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia

c. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia

d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

Answer 20

d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

The patients history and lab result support the nursing diagnosis Imbalanced nutrition: less than body requirements. Data are not present that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.

Question 21

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the patient will:

a. weigh self accurately using balanced scales.

b. limit exercise to less than 2 hours daily.

c. select clothing that fits properly.

d. gain 1 to 2 pounds.

Answer 21

d. gain 1 to 2 pounds.

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

Question 22

7. Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to

a. Assess for depression and anxiety.

b. Observe for adverse effects of refeeding.

c. Communicate empathy for the patients feelings.

d. Help the patient balance energy expenditures with caloric intake.

Answer 22

b. Observe for adverse effects of refeeding.

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

Question 23

8. A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain?

a. Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable.

b. Patient involvement in decision making increases sense of control and promotes compliance with treatment.

c. Because of increased risk of physical problems with refeeding, the patients permission is needed.

d. A team approach to planning the diet ensures that physical and emotional needs will be met.

Answer 23

b. Patient involvement in decision making increases sense of control and promotes compliance with treatment.

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

Question 24

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention monitor for complications of refeeding. Which system should a nurse closely monitor for dysfunction?

a. Renal
b. Endocrine
c. Integumentary
d. Cardiovascular

Answer 24

d. Cardiovascular

Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment is a necessity to ensure the patients physiological integrity. The other body systems are no initially involved in the refeeding syndrome.

Question 25

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?

a. What are your feelings about not eating foods that you prepare?

b. You seem to feel much better about yourself when you eat something.

c. It must be difficult to talk about private matters to someone you just met.

d. Being thin doesnt seem to solve your problems. You are thin now but still unhappy.

Answer 25

d. Being thin doesnt seem to solve your problems. You are thin now but still unhappy.

The correct response is the only strategy that attempts to question the patients distorted thinking.

Question 26

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient:

a. to eat a small meal after purging.
b. not to skip meals or restrict food.
c. to increase oral intake after 4 PM daily.
d. the value of reading journal entries aloud to others.

Answer 26

b. not to skip meals or restrict food.

One goal of health teaching is normalization of eating habits. Food restriction and skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce vomiting. Teaching the patient to eat a large breakfast but no lunch and increase intake after 4 PM will lead to late-day bingeing. Journal entries are private.

Question 27

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed?

a. The nurse interacts with the patient in a protective fashion.
b. The nurses comments to the patient are compassionate and nonjudgmental.
c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene.
d. The nurse refers the patient to a self-help group for individuals with eating disorders.

Answer 27

a. The nurse interacts with the patient in a protective fashion.

In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assumption of a parental role. Protective behaviors are part of the parents role. The helpful nurse uses a problem-solving approach and focuses on the patients feelings of shame and low self-esteem. Referring a patient to a self-help group is an appropriate intervention.

Question 28

A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will:

a. appropriately express angry feelings.
b. verbalize two positive things about self.
c. verbalize the importance of eating a balanced diet.
d. identify two alternative methods of coping with loneliness.

Answer 28

d. identify two alternative methods of coping with loneliness.

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

Question 29

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa?

a. Assist the patient to identify triggers to binge eating.

b. Provide corrective consequences for weight loss.
c. Assess for signs of impulsive eating.

d. Explore needs for health teaching.

Answer 29

a. Assist the patient to identify triggers to binge eating.

Question 30

A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to:
a. self-monitoring of daily food and fluid intake.
b. establishing the desired daily weight gain.
c. how to recognize hypokalemia.
d. self-esteem maintenance.

Answer 30

c. how to recognize hypokalemia.

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

Question 31

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

Answer 31

c lanugo

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

Question 32

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, I wont eat until I look thin.
Select the priority initial nursing diagnosis.

a. Anxiety related to fear of weight gain
b. Disturbed body image related to weight loss
c. Ineffective coping related to lack of conflict resolution skills
d. Imbalanced nutrition: less than body requirements related to self-starvation

Answer 32

d. Imbalanced nutrition: less than body requirements related to self-starvation

The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patients self- starvation is the priority.

Question 33

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of:

a. maintaining patients concentration and attention.

b. shifting the patients focus from food to psychotherapy.

c. promoting processing of anxiety associated with eating.

d. focusing on weight control mechanisms and food preparation.

Answer 33

c. promoting processing of anxiety associated with eating.

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

Question 34

Physical assessment of a patient diagnosed with bulimia often reveals:

a. prominent parotid glands.

b. peripheral edema.
c. thin, brittle hair.

d. 25% underweight.

Answer 34

a. prominent parotid glands.

Question 35

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

Answer 35

b. Rigidity, perfectionism

Question 36

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed- upon weekly weight. Which response by the nurse is appropriate?

a. You and I will have to sit down and discuss this problem.
b. It bothers me to see you exercising. I am afraid you will lose more weight.
c. Lets discuss the relationship between exercise, weight loss, and the effects on your body.
d. According to our agreement, no exercising is permitted until you have gained a specific amount of weight.

Answer 36

d. According to our agreement, no exercising is permitted until you have gained a specific amount of weight.

A matter-of-fact statement that the nurses perceptions are different will help to avoid a power struggle. Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients must be held accountable for required behaviors.

Question 37

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges?

a. Powerlessness
b. Ineffective coping
c. Disturbed body image
d. Imbalanced nutrition: less than body requirements

Answer 37

. Imbalanced nutrition: less than body requirements

Question 38

An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should:

a. assess lung sounds and extremities.
b. suggest use of an aerobic exercise program.
c. positively reinforce the patient for the weight gain.
d. establish a higher goal for weight gain the next week.

Answer 38

a. assess lung sounds and extremities.