NCLEX Eating Disorders: Anorexia Nervosa & Bulimia Nervosa Flashcards
The mother of a teen with an eating disorder expresses a concern that the family is responsible for the problem. Which question will best help the nurse identify another influence that is likely to have played a role in the teenager’s eating disorder?
a. “Does she have an after-school job?”
b. “Does she have access to nutritious foods?”
c. “Is there a family history of underweight adults?”
d. “Is your daughter interested in clothes and fashion?”
ANS: D
Women in this culture are bombarded by the fashion industry and media messages equating beauty with thinness. Although it is true that eating disorders are less common in countries where food is not abundant, in this culture persons with eating disorders tend not to choose nutritious foods. Workplace competition with men would be of greater significance than this broad statement. The biologic tendency to be overweight may influence some persons.
Long-term prognosis for eating disorders is improved dramatically when treatment includes long-term cognitive-behavioral therapy. What statement provides the best explanation to the patient for this component to the treatment plan?
a. “This will help you identify a healthy, weight restoration diet.”
b. “Medication alone will not help you from relapsing back to your old habits.”
c. “In order to manage your disorder, you have to understand the root problems.”
d. “Prognosis has been proven to be much better with both medication and therapy.”
ANS: C
Individuals need to resolve the core problems related to their eating behavior as well as the underlying psychological issues. Outcome literature indicates that long-term cognitive-behavioral, family, or interpersonal therapy, often in combination with antidepressant medication, results in the most sustained improvement. Long-term outcome studies show a more promising prognosis for those patients who continue treatment. Weight restoration is necessary but not sufficient for recovery. The options that discuss the components of treatment do not sufficiently explain the reasoning behind cognitive and behavior therapy.
The nurse is identifying outcomes for a teenager diagnosed with anorexia nervosa. Which outcome has the greatest impact on long-term prognosis?
a. Verbalize underlying psychological issues.
b. Demonstrate effective coping skills related to conflict management.
c. Demonstrate improvement in body imagine reflecting a realistic viewpoint.
d. Consume adequate calories appropriate for age, height, and metabolic needs.
ANS: B
Long-term prognosis is dependent on the patient’s ability to cope with the stressors that are at the root of the emotional problems such as conflict with family. Verbalization of underlying stressors is not a guarantee that there will be progress towards managing them. Acceptance of one’s body and adequate calorie intake is possible only after coping skills are learned and used.
Which statement is the basis for the cross-cultural assessment practices of eating disorders?
a. Mediterranean cultures are more likely to exhibit symptoms.
b. Male-dominated cultures are more likely to accept this disorder.
c. Westernized cultures tend to have similar numbers of diagnosed cases.
d. Access to food is the primary factor in determining incidence of the disorder.
ANS: C
The incidence and prevalence of eating disorders around the world are similar among European countries, the United States, Canada, Mexico, Japan, Australia, and other Westernized countries. Access to food is not necessarily a cultural factor
The nurse observes a distorted thinking pattern in a teenage patient diagnosed with an eating disorder. Which statement characterizes personalization by the patient?
a. “I’ve got to be thin to get a good job.”
b. “There is no such thing as a healthy carbohydrate.”
c. “My mother and dad fight all the time because I’m fat.”
d. “My whole family will be disgraced if I don’t get into a good college.”
ANS: C
The basis of personalization of thinking is that an individual compare themselves endlessly with others and perceive others’ behavior as a direct reaction to them. Believing the problems the parents are experiencing is a direct result of the patient’s weight is an example of such thinking. The thought that a job depends solely on weight or that all carbohydrates are bad are examples of dichotomous thinking. Feeling responsible for the family’s reputation is a reflection of control fallacy thinking.
A 16-year-old patient has anorexia nervosa. Which term used to describe the menstrual history is characteristic of this disorder?
a. Amenorrhea
b. Dysmenorrhea
c. Premenstrual syndrome
d. Heavy menstrual flow
ANS: A
Amenorrhea is common in patients with eating disorders, possibly due to altered hypothalamic function. The remaining options are not usually related to changes resulting from an eating disorder.
A 14-year-old patient newly admitted to the eating disorders unit refuses to eat meals and angrily shouts at the nurse, “You can’t make me eat! I’ll do whatever I want to do.” Which nursing intervention demonstrates an understanding of the priority safety issue for this anorexic patient?
a. Placing the patient’s favorite low calorie beverages in open view
b. Assigning a staff member to one-on-one observation of the patient
c. Unlocking the patient’s bathroom only at specific times during the day
d. Explaining to the patient that they will be required to keep an eating journal
ANS: B
The patient, especially when stressed, is capable of self-mutilation and needs to be protected from doing so. The issues of hydration, purging, and therapy work do not have the priority that physical safety has.
A nursing intervention that will be planned to occur early in the nurse-patient relationship with a patient with an eating disorder is:
a. Using confrontation to attack denial
b. Placing the patient in a therapeutic group
c. Formulating a therapeutic nurse-patient alliance
d. Attacking enmeshment by separating patient and family
ANS: C
An alliance is formulated early to give the patient an opportunity to participate in treatment and increase the patient’s sense of control, thus eliminating power struggles. Confrontation is rarely used early in the relationship. Placement in a group and anti-enmeshment techniques would normally take place after the contract has been agreed on
A patient is being assessed for a binge-eating–associated eating disorder. Which assessment question is directed towards collecting data on the most commonly abused substance among this patient population?
a. “How much alcohol do you drink on a weekly basis?”
b. “Do you use amphetamines to help control your weight?”
c. “Do you rely on laxatives to control your bowel movements?”
d. “How many packs of cigarettes do you smoke on a daily basis?”
ANS: A
Eating disorder symptoms predict the type of drug use, with bingeing associated more with alcohol and tranquilizer abuse, purging associated more with the abuse of multiple drugs, and restricting associated more with amphetamine.
The nurse is caring for a patient who is being treated for comorbid eating and affective disorders. For which medication would the nurse expect to prepare a patient teaching plan?
a. Fluoxetine (Prozac)
b. Diazepam (Valium)
c. Lorazepam (Ativan)
d. Lithium
ANS: A
SSRIs are effective in treatment of depression and have been found to be useful in treatment of eating disorders. Benzodiazepines like Valium and Ativan are used for anxiety reduction. Lithium is used for bipolar disorder.
A patient who is hospitalized with anorexia nervosa states during a one-to-one session with the nurse, “I’m freaking out. I’m losing it.”” Which nurse response would be most therapeutic at this time?
a. “Would you feel better if I called your parents?”
b. “Just sit here and relax that will help you regain control.”
c. “May I sit with you while you think about what is happening?”
d. “Please tell me what thoughts are going through your head right now.”
ANS: D
Helping the patient identify thoughts will facilitate the learning of effective coping mechanisms to deal with the stress. The patient needs to learn to bear and deal effectively with her own discomfort. The nurse is taking control without allowing the patient the opportunity to deal with her own issues. The nurse should encourage the patient to deal with her feelings and issues, rather than sit passively with her.
Accomplishment of which expectation should be considered most critical prior to discharging a patient with anorexia nervosa?
a. Attainment of minimum normal weight
b. Resumption of normal menstrual cycle
c. Reduction of periods of active exercise to three times daily
d. Knowledge of nutritional value of foods required for a balanced diet
ANS: A
Attaining the desired weight is the priority discharge goal because it best indicates patient compliance with the treatment plan. Resumption of the menstrual period may take an extended time. Having knowledge of nutrition does not ensure that the patient will apply it. Exercising three times aday is considered excessive.
Which patient statement demonstrates the expected emotional response to bingeing?
a. “I know it’s bad but I can’t help bingeing.”
b. “Everyone indulges in bingeing some times.”
c. “After I binge I feel happy for a little while.”
d. “Bingeing isn’t bad if I do it only when I’m stressed.”
ANS: C
Serotonin levels and mood both improve with bingeing. This affect on serotonin would not result in rationalization, denial, or a sense of guilt and hopelessness.
Which intervention best monitors the health status of a patient newly admitted for a diagnosis of bulimia nervosa?
a. Scheduling a bone mineral density screening
b. Performing a portable electrocardiogram (ECG)
c. Obtaining a urine sample for a urine analysis
d. Arranging for a serum potassium level to be drawn
ANS: D
Patients with bulimia nervosa require initial assessment for acute fluid and electrolyte imbalances (particularly serum potassium) for the presence of life-threatening imbalances. Bone mineral density screening for osteopenia and osteoporosis and assessment is appropriate but it does not have priority over of the blood work to identify an acute life-threatening condition. The remaining options are not diagnostic tests that are generally required of this diagnosis.
In an art therapy session, a patient with anorexia nervosa was asked to draw a picture of herself. Which drawing would likely depict the patient’s view of herself?
a. A tall, slim girl with obvious muscle definition
b. A shapely figure of a model who she really admires
c. A malnourished teenager with thin, lanky extremities
d. A grossly obese figure lacking feminine characteristics
ANS: D
Patients with eating disorders have alexithymia (i.e., difficulty naming their feelings) and they often have difficulty finding the words needed for talk therapy. Therefore, the use of expressive arts therapy allows for nonverbal self-disclosure and the experiential exploration of the inner experience. It also bypasses intellectual defenses and helps the patient to be more present in his or her bodily experience. The patient would be able to draw what she is unable to verbally describe. The other options do not reflect the anorexic patient’s self-view of their body.
