Psych Videbeck Chapter 20: Eating Disorders

A nurse is developing a care plan for a client with anorexia nervosa. Which action should the nurse include in the plan?

Restrict visits with family members until the client begins to eat.
Provide privacy for the client during meals.
Set up a strict eating plan with the client.
Encourage the client to exercise, to reduce anxiety.
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A nurse is developing a care plan for a client with anorexia nervosa. Which action should the nurse include in the plan?

Restrict visits with family members until the client begins to eat.
Provide privacy for the client during meals.
Set up a strict eating plan with the client.
Encourage the client to exercise, to reduce anxiety.
Set up a strict eating plan with the client.
A nurse is caring for a client diagnosed with bulimia nervosa. The most appropriate initial goal for this client is to:

avoid shopping for large amounts of food.
control eating impulses.
identify a connection between anxiety and eating behaviors.
restrict eating to three meals per day.
identify a connection between anxiety and eating behaviors.
A 15-year-old client with anorexia nervosa has been admitted to a mental health unit. The client refuses to eat. Which statement is appropriate for the nurse to make?

"You don't have to eat."
"If you don't eat, it may be necessary to feed you by tube or I.V."
"Why do you think you're fat? You're underweight. Here — look in the mirror."
"You really look terrible at this weight. I hope you'll eat."
"If you don't eat, it may be necessary to feed you by tube or I.V."
A nurse is caring for a 17-year-old female client with bulimia. Which complication of this disease may the nurse see in this child?

Partial paralysis
Hernia
Severe acne
Menstrual problems
Menstrual problems
The nurse is assessing a client who has bulimia nervosa. The nurse would expect the assessment data to include that the client:

engages in binge eating.
weighs less than 85% of normal weight for height.
reports constipation, cold intolerance, and bradycardia.
engages in alcohol and substance abuse.
engages in binge eating.
A female client with anorexia nervosa tells the nurse that she has been experiencing amenorrhea. The nurse is aware that this is a result of:

Alteration of critical body fat-to-muscle ratio needed for menses to occur
Increased gonadotropin-releasing hormone (GnRH) production
Increased estrogen production that occurs in the body
A secondary decrease in sexual activity
Alteration of critical body fat-to-muscle ratio needed for menses to occur
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching?

"I can use laxatives and enemas but only once a week."
"A good breakfast for me will include milk and a couple of bananas."
"I will be sure to buy frozen vegetables when I grocery shop."
"I will take a potassium supplement daily as prescribed."
"I can use laxatives and enemas but only once a week."
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective?

"I know if I eat pasta, I'll binge."
"I'll eat small meals and snacks regularly."
"I'll take my medication when I feel the urge to binge."
"How I feel about my body has little to do with my binging."
"I'll eat small meals and snacks regularly."
The client is 16 years old and has an identical twin just diagnosed with anorexia nervosa. The client shares with the nurse a concern about also developing the disorder. Which response by the nurse is the most appropriate?

"Eating disorders have not been found to be genetic, so you do not have a particular risk."
"While eating disorders have been shown to have a genetic basis, other factors also play a role in its development."
"For identical twins, there is about a 5% chance that both twins develop an eating disorder."
"It is not genetics but the environment that increases your risk. Since you live together, you have the same risk as your twin."
"While eating disorders have been shown to have a genetic basis, other factors also play a role in its development."
A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment?

Heat intolerance
Complaints of heartburn
Hypertension
Bradycardia
Bradycardia
Anorexia nervosa, bulimia nervosa, and binge-eating disorder are becoming more and more common, with assessments for these disorders being made as young as 9 years of age. In the adult population, what means of controlling binge eating is most prevalent in men? Self-induced vomiting Compulsive exercise Laxative use Compulsive workingCompulsive exerciseThe nursing educator has completed an educational program for new nurses on eating disorders in teenagers. Which statement by a participant would indicate a need for further education? "We need to allow the client to participate in developing the treatment plan." "Meal time should be structured but pleasant and relaxed without distractions." "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." "We need to stay with them for at least 30 minutes after they eat so they don't try to vomit or dispose of the food.""If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something."An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent? Monitor the adolescent constantly to ensure that she is not binge eating. Administer antiemetics on a regular basis to reduce the urge to vomit after eating. Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Minimize or ignore any comments made by the adolescent about body image distortion or being overweight and dieting.Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals.An extremely thin preadolescent is being assessed by the nurse. Which client statement will cause the nurse to suspect the client is experiencing anorexia nervosa? "I would like to grow up to be a model." "My mom says I am obsessed with fashion." "I feel chubby no matter what I wear." "I am afraid that someone is poisoning my food.""I feel chubby no matter what I wear."An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? hypoglycemia metabolic alkalosis metabolic acidosis hyperkalemiametabolic alkalosisDuring postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response? "I trust you not to purge." "I need to know how and when you purge." "Don't worry. I won't allow you to purge today." "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat.""I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. At the beginning of the client's hospitalization, the most important nursing action is to: severely restrict the client's physical activities. weigh the client daily, after the evening meal. monitor the client's vital signs, serum electrolyte levels, and acid-base balance. instruct the client to keep an accurate record of food and fluid intake.monitor the client's vital signs, serum electrolyte levels, and acid-base balance.A client is experiencing anorexia related to the adverse effects of cancer treatment. Using Maslow's hierarchy, the nurse identifies this as a reflection of which need? Esteem and self-respect Safety and security Physiologic needs Belongingness and affectionPhysiologic needsWhen providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what? Presenting the information using language and terms the client will understand Interacting with the client in a nonthreatening, respectful manner Being careful not to overload the client with too much information at one time Giving the client ample opportunity to ask questionsPresenting the information using language and terms the client will understandA psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include? Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders Emphasis on the need for teachers to focus their prevention efforts on female students Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth gradesDiscussion of strategies the teachers can use to counteract the role media plays in encouraging eating disordersA client with anorexia experienced a severe reduction in body fat by extreme caloric restriction and exercise. Which female reproductive abnormalities could be acquired as a result of this reduction in body fat? Select all that apply. delay or cessation of menstruation impaired potential for the implantation of a fertilized ovum higher risk of fibrocystic breast disease polycystic ovarian syndromedelay or cessation of menstruation impaired potential for the implantation of a fertilized ovumWhen teaching a client with bulimia nervosa about possible complications, which condition should the nurse emphasize? allergies lung cancer diabetes mellitus hepatitis Adiabetes mellitusA nurse taking a health history from an adolescent female would become concerned about anorexia if the adolescent made which statement? "I try to eat three meals each day but don't always have enough time to sit down for each meal." "My monthly cycle is not always regular. Sometimes, I may skip a month or two between my cycles." "I exercise every day by running one mile in the late afternoon — or mornings on days that are really hot." "I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already.""I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already."The nurse is collecting data on a 16-year-old girl with the diagnosis of bulimia. What would the nurse most likely note in this child? The child is of normal weight for her height according to the growth charts. The child socializes with friends and shares all her dreams and secrets with them. The child has a ritualistic program of exercise that she does every day after school. The child is a perfectionist and tries hard to please her parents and teachers.The child is of normal weight for her height according to the growth charts.The nurse has been working for several days with an adolescent who has anorexia nervosa. What is an indication that the adolescent is developing trust in the nurse? The adolescent stating "You're the best nurse on the unit." The adolescent telling the nurse purging occurs after each meal. The adolescent stating the desire to eat again. Saying which nurse's orders the adolescent will follow.The adolescent telling the nurse purging occurs after each meal.The school nurse is assessing a 12-year-old client suspected of having bulimia. Which assessment finding would the nurse expect to see? Eroded dental enamel Thinning scalp hair Sparse body hair Dry skinEroded dental enamelA nurse is working in an eating disorder inpatient clinic. What does the nurse recognize as one of the most challenging aspects of treatment of anorexia nervosa? Recognizing that there is a problem Overcoming depression Socializing with other clients Gaining weightRecognizing that there is a problemThe nurse is caring for a girl with anorexia who has been hospitalized with unstable vital signs and food refusal. The girl requires enteral nutrition. The nurse is alert for which complications that signal refeeding syndrome? cardiac arrhythmias, confusion, seizures orthostatic hypotension and hypothermia hypothermia and irregular pulse bradycardia with ectopy and seizurescardiac arrhythmias, confusion, seizuresA 17-year-old child has been admitted with complications of anorexia nervosa. What diagnostic tests can be anticipated in the plan of care/treatment? Select all that apply. complete blood cell count MRI CT scan metabolic panel chest X-raycomplete blood cell count metabolic panelA nurse plans to include the parents of a client with anorexia nervosa in the client's therapy sessions. The nurse should anticipate that the parents will: tend to overprotect their child. have a history of substance abuse. maintain emotional distance from their child. alternate between expressing love for and rejection of their child.tend to overprotect their child.A 16-year-old girl is brought to the clinic by her mother because she has not had a menstrual period for the past 8 months. Which findings might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? Select all that apply. hyperthermia bradycardia hypotension reduced subcutaneous fat evidence of secondary sex characteristicsbradycardia hypotension reduced subcutaneous fatPeople diagnosed with bulimia nervosa have lower levels of which neurotransmitter? Serotonin Norepinephrine Dopamine AcetylcholineSerotoninA client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? Self-monitoring Guided imagery Distraction Music therapySelf-monitoringThe nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which findings are consistent with the condition? Select all that apply. hyperthermia orthostatic hypotension weak pulse hypertension hypothermiaorthostatic hypotension weak pulse hypothermiaAn adolescent female has been diagnosed with anorexia nervosa. Which of the following interventions should be included in the client's plan of care? a. Encourage the client to exercise in order to reduce anxiety. b. Provide frequent feedback to the client on her behaviors. c. Restrict visits with the family until the client begins to eat. d. Provide privacy during meals.b. Provide frequent feedback to the client on her behaviors. (Rationale: The client should be given frequent feedback on her behaviors. The family should be included in the client's care. The client should be monitored during meals and not given privacy. Exercise must be limited and supervised.)A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. She is 5'5" tall and weighs 75 pounds. Which of the following is the highest priority nursing intervention? a. Initiating total parenteral nutrition as ordered b. Assessing the client's food preferences c. Initiating cognitive-behavioral therapy as ordered d. Addressing the client's low self-esteema. Initiating total parenteral nutrition as ordered (Rationale: Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. Medical management focuses on weight restoration, nutritional rehabilitation, and correction of electrolyte imbalance. This acute physiologic need is prioritized over psychosocial assessments, even though these are important. Identifying food preferences is unlikely to change the client's eating patterns.)All but which of the following characteristics are associated with both bulimia and anorexia? a. Perfectionism b. Obsessive-compulsiveness c. Harm avoidance d. High impulsivityd. High impulsivity (Rationale: Clients with bulimia often have a history of impulsive behavior, such as substance abuse and shoplifting, as well as anxiety, depression, and personality disorders. Perfectionism, harm avoidance, and obsessive-compulsiveness are associated with both eating disorders. Clients with anorexia tend to be self-disciplined and methodical rather than impulsive.)The nurse is planning the care for a client with anorexia nervosa. The nurse should recognize that the client's behavior most likely has what motivation? a. Manipulating her family members or friends b. Diminishing the likelihood of conflict c. Gaining control of one part of her life d. Living up to her family's expectationsc. Gaining control of one part of her life (Rationale: A client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. The eating disorder carries with it a high incidence in families that emphasize achievement.)A client is being seen in the health clinic. During the nursing assessment, the client states that she has had amenorrhea for the last 6 months. She weighs 80 pounds and is 5'2" tall. She states that she usually eats salads so that she does not gain weight. The nurse suspects that the client most likely has what health problem? a. Anxiety disorder b. Bulimia nervosa c. Anorexia nervosa d. Depressionc. Anorexia nervosa (Rationale: Anorexia nervosa is a life-threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal bodyweight, 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. Bulimia nervosa 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. Although depression and anxiety may accompany eating disorders, this particular situation is indicative of anorexia.)An adolescent client is being admitted to the psychiatric unit for treatment of an eating disorder. Her admission interview reveals a history of recurrent episodes of binge eating and self-induced vomiting. The client states that she wants to go to the store "just to grab a quick snack." How should the nurse respond to the client's statement? a. Set a specific time for the client to return. b. Distract the client. c. Deny the client's request. d. Insist that the client choose a healthy snack.c. Deny the client's request. (Rationale: Clients with bulimia nervosa require firm limits around the content and setting of food intake. It would be inappropriate for the client to independently purchase food while receiving inpatient care.)A client has been diagnosed with anorexia nervosa. To assist the client to cope with her disease process, the client will complete which of the following actions? a. Keeping a journal and discussing it with the nurse b. Temporarily withdrawing from social contact c. Drinking 4 L of fluid per day d. Avoiding mirrors and reflective surfacesa. Keeping a journal and discussing it with the nurse (Rationale: Recording and discussing feelings are a constructive way to manage stress. Increasing fluid intake may be an attempt to artificially increase her weight. Withdrawal from social contact is not normally necessary, and the client is not required to avoid looking at her body.)A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5'8" tall and weighs only 90 pounds. Considering the client's unrealistic body image, which intervention should be included in the care plan? a. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy. b. Asking the client to compare her figure with magazine photographs of women of her age. c. Assigning the client to group therapy in which participants provide realistic feedback about her weight. d. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift.a. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy. (Rationale: The client needs assistance with making decisions about nutritious foods to keep her healthy. Attempts to help the client view her body realistically and rationally are frequently unsuccessful.)When working with a client who has bulimia nervosa, the nurse should recognize that the client likely has what comorbid diagnosis? a. Borderline personality disorder b. Psychosis c. Avoidant personality disorder d. Depressiond. Depression (Rationale: Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.)The nurse is planning the care for a client with an eating disorder. Which of the following should not be included in the client's care plan? a. Sitting with the client during meals and snacks b. Weighing the client after each meal c. Being alert for attempts to hide or discard food or to inflate weight d. Observing the client following meals and snack for 1 to 2 hoursb. Weighing the client after each meal (Rationale: Weighing the client frequently puts emphasis on weight and should not be included as an intervention for a client with an eating disorder. Interventions that should be implemented include sitting with the client during meals and snacks, observing the client following meals and snack for 1 to 2 hours, and being alert for attempts to hide or discard food or to inflate weight.)Which of the following is a typical characteristic of parents of clients diagnosed with anorexia nervosa? a. Maintenance of emotional distance from their children b. A tendency to overprotect their children c. Alternation between loving and rejecting their children d. A history of substance abuseb. A tendency to overprotect their children (Rationale: Some families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. This family characteristic is known to be a risk factor for anorexia nervosa.)The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder? a. The client is tachycardic. b. The client has moist skin. c. The client often performs excessive exercise. d. The client wears tight-fitting clothing.c. The client often performs excessive exercise. (Rationale: Clients with eating disorders utilize excessive exercise to burn as many calories as possible. Medical complications of eating disorders include bradycardia; hypotension; and dry, cracking skin due to dehydration. The client will typically wear loose-fitting clothes to hide his or her body.)The emergency department nurse is assessing a client who has a recent history of bulimia nervosa. What objective assessment should the nurse prioritize? a. Oxygen saturation b. Temperature c. White blood cell count d. Potassium leveld. Potassium level (Rationale: Purging can result in severe electrolyte imbalances, which would be evidenced by hypokalemia. The client's oxygen levels, white cells, and temperature are less likely to be affected.)The nurse is caring for a client diagnosed with bulimia. What is the most appropriate initial goal for a client diagnosed with bulimia? a. Avoid shopping for large amounts of food. b. Control eating impulses. c. Eat several small meals each day. d. Identify anxiety-causing situations.d. Identify anxiety-causing situations. (Rationale: Clients with eating disorders seem sad, anxious, and worried. Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping patterns is not a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the care plan after initially addressing stress and underlying issues. Eating frequent, small meals is not a component of treatment.)Which of the following is a metabolic complication related to excessive weight loss? a. Leukopenia b. Hypothyroidism c. Bradycardia d. Amenorrheab. Hypothyroidism (Rationale: Hypothyroidism is a metabolic complication related to weight loss. Bradycardia, amenorrhea, and leukopenia are not metabolic complications of weight loss.)The nurse is caring for a client who has been diagnosed with bulimia nervosa. All of the following behaviors are associated with purging in this disease process except which of the following? a. Misuse of diuretics b. Overuse of laxatives c. Excessive exercise d. Self-induced vomitingc. Excessive exercise (Rationale: Purging means the compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics. Exercise may be a compensatory behavior, but is not an example of purging.)Which of the following is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? a. Mood elevation b. Weight gain c. Increased activity d. Positive self-esteemb. Weight gain (Rationale: Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.)During a family meeting for a client with an eating disorder, it becomes apparent that the family lacks clear role boundaries. The nurse should recognize what phenomenon? a. Potential abuse b. Autonomy c. Enmeshment d. Satietyc. Enmeshment (Rationale: Enmeshment is a lack of clear role boundaries. Autonomy is exerting control over oneself. Satiety is satisfaction of appetite. Unclear boundaries do no necessarily suggest the presence of abuse.)A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which comment indicates that the client may be suffering from anorexia nervosa? a. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." b. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." c. "I do diet around my periods; otherwise, I just get so bloated." d. "I like the way I look, but I just need to keep my weight down because I'm a cheerleader."a. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." (Rationale: Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Most clients with anorexia nervosa do not like the way they look, and their self-perception may be distorted. Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.)Which of the following goals should guide the nursing care for a client with anorexia nervosa? a. The client will interact frequently with other clients. b. The client will acknowledge the pathophysiology of her disease. c. The client will acknowledge areas of personal strength. d. The client will demonstrate an ability to cook healthy meals.c. The client will acknowledge areas of personal strength. (Rationale: Nurses can assist in recovery from eating disorders by helping clients to recognize and acknowledge their positive qualities apart from body image and food. Cooking healthy meals does not necessarily equate to consuming healthy meals. Pathophysiology and frequent social interaction are not high priorities.)For a client with anorexia nervosa, which goal takes the highest priority? a. Verbalizing the possible physiologic consequences of self-starvation b. Developing a contract with the nurse that sets a target weight c. Establishing adequate daily nutritional intake d. Identifying self-perceptions about body size as unrealistica. Establishing adequate daily nutritional intake (Rationale: According to Maslow's hierarchy of needs, physiologic needs are the most basic. Adequate daily intake of food and fluids would be the highest priority for this client.)A client is receiving treatment for anorexia nervosa, and the nurse observes that the client has consumed a healthy meal without providing any resistance. How should the nurse respond? a. Directly acknowledge the client's positive behavior. b. Challenge the client to double his food intake the following day. c. Ask the client why he has not previously been eating this way. d. Document the client's apparent recovery in the electronic health record.a. Directly acknowledge the client's positive behavior. (Rationale: The nurse should give the client positive support and honest praise for accomplishments. A single meal does not constitute recovery, and it is likely unrealistic to expect the client to double his food intake the following day.)What is the percentage of clients who had been diagnosed with bulimia nervosa but who have fully recovered later relapse? a. 50% b. 23% c. 33% d. 10%c. 33% (Rationale: One third of fully recovered clients with bulimia nervosa eventually relapse.)A client is being assessed for suspected bulimia nervosa and admits to a pattern of binge eating. What further assessment finding would confirm a diagnosis of bulimia? a. A weight loss of more than 40 pounds over the previous 6 months b. Inappropriate behaviors aimed at avoiding weight gain c. Frequent physical exercise d. Persistent fluid and electrolyte imbalancesb. Inappropriate behaviors aimed at avoiding weight gain (Rationale: Bulimia is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain. Exercise is not necessarily considered to be an inappropriate compensatory behavior. Weight loss and electrolyte imbalances can have many causes apart from bulimia.)A client has been admitted to the psychiatry unit for the treatment of anorexia nervosa. How should the nurse best organize the client's initial nursing care? a. Ask the client which nurse she would prefer. b. Assign two nurses to the client for the first 3 to 4 days of treatment. c. Arrange for a different nurse to care for the client each day. d. Limit the number of staff assigned to and interacting with the client.d. Limit the number of staff assigned to and interacting with the client. (Rationale: Initially, limit the number of staff assigned to and interacting with the client, and then gradually increase the variety of staff interacting with the client. The client would not be invited to choose a nurse, and multiple nurses are not needed.)Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? Mood elevation Weight gain Positive self-esteem Increased activityWeight gain Rationale:Weight gain is most often the criterion used for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa.An adolescent diagnosed with anorexia nervosa is insistent on being allowed to take a laxative. Which response by the nurse best demonstrates the management of this client request? "Laxatives are not a part of your treatment plan." "Why do you want to take a laxative?" "Using a laxative to purge is not an acceptable way to manage your weight." "Using laxatives is bad for you because your electrolytes can become unbalanced.""Laxatives are not a part of your treatment plan." Rationale:The nurse should 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. A firm, accepting, and patient approach is important in working with these individuals. Providing a rationale for all interventions helps build trust, as does a consistent, nonreactive approach.Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse? "I'm sorry that you are angry but you cannot throw food at me." "I realize this must be very difficult for you but try to remember I'm not your enemy." "I'm not going to take your insults personally but you need to be more respectful." "I'm not the root of your problem.""I realize this must be very difficult for you but try to remember I'm not your enemy." Rationale:The client initially may view the nurse, who is responsible for making the client eat, as the enemy. The client may hide or throw away food or become overtly hostile as anxiety about eating increases. The nurse must remember that the client's behavior is a symptom of anxiety and fear about gaining weight and not personally directed toward the nurse. The other options are nurse rather than client focused.Which is a family risk factor for bulimia nervosa? Chaotic family Self-perception of being overweight Inability to deal with conflict Lack of emotional supportChaotic family Rationale:A chaotic family life is a risk factor for bulimia nervosa. Lack of emotional support, self-perception of being overweight, and inability to deal with conflict are family risk factors for anorexia nervosa.The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first? Provide small regular meals and snacks Control the eating responses Ask the client directly about thoughts of suicide or self-harm Identify the cues related to bingingAsk the client directly about thoughts of suicide or self-harm Rationale:The client's safety is a priority. The nurse must ask questions about suicide and related thoughts in order to determine the level of monitoring the client may need to ensure safety during treatment.A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder? "My strict dieting led to my problem with anorexia." "There are many factors involved with how I developed anorexia ." "There is a history of obsessive-compulsive disorder in my family." "Society told me I needed to be thin and I believed that.""There are many factors involved with how I developed anorexia ." Rationale:The etiology of anorexia nervosa is multidimensional. Some of the risk factors (discussed later) and the etiologic factors overlap. Initially, dieting may be the stimulus that leads to their development. Biologic vulnerability, developmental problems, and both family and social influences can be associated. However, the statement about many factors reflects the multidimensional nature of the disorder.A client with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. The nurse identifies this as reflecting what? Perfectionism Body image disturbance Drive for thinness Interoceptive awarenessBody image disturbance Rationale:Body image disturbance occurs when the individual perceives his or her body disparately from how the world or society views it. Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues. Interoceptive awareness is a term used to describe the sensory response to emotional and visceral cues, such as hunger. Perfectionism consists of personal standards (the extent to which the individual sets and tries to achieve high standards for oneself) and concern over mistakes and their consequences for their self-worth and others' opinions.Which is a metabolic complication related to weight loss? Hypothyroidism Leukopenia Amenorrhea BradycardiaHypothyroidism Rationale:Hypothyroidism is a metabolic complication related to weight loss. Bradycardia, amenorrhea, and leukopenia are not metabolic complications of weight loss.Exacerbation of anorexia nervosa results from the client's effort to do what? Live up to family expectations Manipulate family members Gain control of one part of life Diminish conflictGain control of one part of life Rationale:A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client's life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.A nurse is interviewing a client and suspects an eating disorder. Which client statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply. "Things being out of order really bothers me." "I'll stand up for what I want, regardless of what you say." "I want things to be the way I want them to be." "Everything about my school work needs to be perfect." "I consider myself a really laid-back individual.""Things being out of order really bothers me." "I want things to be the way I want them to be." "Everything about my school work needs to be perfect." Rationale:Both anorexia and bulimia are characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder. Depression and obsessive-compulsive disorders are commonly associated with eating disorders. Being self-assured or laid back would be least likely associated with an eating disorder.A client with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. Considering the client's unrealistic body image, which intervention should be included in the care plan? Confronting the client about the client's actual appearance during one-on-one sessions, scheduled during each shift Telling the client of the nurse's concern for the client's health and desire to help the client make decisions to keep the client healthy Assigning the client to group therapy in which participants provide realistic feedback about the client's weight Asking the client to compare the client's figure with magazine photographs of women the client's ageTelling the client of the nurse's concern for the client's health and desire to help the client make decisions to keep the client healthy Rationale: A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about nutritious foods to keep the client healthy.Which percentage accurately reflects the prevalence of anorexia and bulimia in the United States? 6% to 9% 10% to 12% 4% to 6% 2% to 4%2% to 4% Rationale:Estimates of the prevalence of anorexia nervosa and bulimia nervosa range from 1% to 4% of the U.S. general population.For a client diagnosed with anorexia nervosa, which goal takes priority? Identifying self-perceptions about body size as unrealistic Developing a contract with the nurse that sets a target weight Verbalizing the possible physiologic consequences of self-starvation Establishing adequate daily nutritional intakeEstablishing adequate daily nutritional intake Rationale:According to Maslow's hierarchy of needs, physiologic needs are the most basic. Adequate daily intake of food and fluids would be of the highest priority for this client.A client with anorexia weighs less than 85% of the client's normal body weight. The client says, "I'm so fat, I can't even get through this doorway, much less fit into any of my clothes." Which is the nurse's most therapeutic response? "You only weigh 100 pounds. It is just not true that you are fat." "You must try and stop thinking that way. Let's think of some alternative ideas for describing your body." "Let's talk about your ideas about your body and why you perceive yourself to be fat." "I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about.""I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about." Rationale:People with eating disorders tend to have perfectionistic personalities and to think in all-or-nothing terms. The nurse communicates caring to the client through a kind, firm, matter-of-fact approach, acknowledging the client's statement and at the same time, being honest and factual about the client's condition without being condescending or punitive.A nurse is assessing a client with anorexia nervosa. Which would the nurse be most likely to find? Oversensitivity to heat Hyperkalemia Dry skin TachycardiaDry skin Rationale:Dry skin is a physical problem of anorexia nervosa. Others include hypokalemia, bradycardia, and oversensitivity to cold.Which technique is a type of cognitive behavioral therapy implemented for bulimic clients? Self-monitoring Distraction Music therapy Guided imagerySelf-monitoring Rationale:Self-monitoring is a type of cognitive behavioral therapy. It is designed to help clients with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.Which is a dental complication associated with purging? Elevated blood urea nitrogen (BUN) Enlarged pancreas Seizures Erosion of dental enamelErosion of dental enamel Rationale:Erosion of dental enamel is a dental complication associated with purging. Seizures, elevated BUN, and enlarged pancreas are not dental complications associated with purging, but are overall complications.What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? engaging in severe dieting compulsively washing his or her hands socially withdrawing becoming sexually promiscuousengaging in severe dieting Rationale:Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: By continuing to lose, these clients exert control over one aspect of their lives. While the remaining options may demonstrative reactive behaviors, they are not generally associated with over-productive parenting.Following a series of visits to the primary care provider and the hospital, a 22-year-old retail clerk has been diagnosed with anorexia nervosa. Which of the client's statements demonstrate an accurate understanding of the diagnosis? "What no one seems to understand is that I'm concerned about my health, not ignoring it." "I guess it's probably safe to say that anorexia runs in my family." "What you don't understand is that it's way healthier to be skinny than fat, and it looks better." "I know that if I could lose this last 10 pounds I'd feel completely different about things.""I guess it's probably safe to say that anorexia runs in my family." Rationale:There are known to be both familial and genetic contributors to eating disorders. Weight loss does not relieve the thinking or behaviors that characterize the disorders, and there are serious health consequences to being underweight.What percentage of clients who have fully recovered from bulimia nervosa later experience a relapse? 50% 10% 23% 30%30% Rationale:Thirty percent of clients have fully recovered from bulimia nervosa later experience a relapse.%Which behaviors are associated with purging? Select all that apply. Self-induced vomiting Use of enemas Consuming large amounts of food Misuse of diuretics Use of laxativesSelf-induced vomiting Use of enemas Misuse of diuretics Use of laxatives Rationale:Purging means the compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics. Binge eating means consuming a large amount of food in a discrete period of usually 2 hours or less.An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? Encourage the client to exercise, which will reduce the client's anxiety Provide privacy during meals Restrict visits with the family until the client begins to eat Set up a strict eating plan for the clientSet up a strict eating plan for the client Rationale:Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals—not given privacy. Exercise must be limited and supervised.Which area of the brain has been associated with the symptoms of eating disorders? Pons Hypothalamus Medulla CerebellumHypothalamus Rationale:The hypothalamus has been associated with the symptoms of eating disorders.An obese client is admitted to the facility for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client? Teaching the client alternative ways to lose weight Reinforcing the client's concerns over physical appearance Using an abrupt, forceful manner to communicate with the client Encouraging the client to suppress feelings regarding obesityTeaching the client alternative ways to lose weightThe client with bulimia reports feeling helpless and says, "What's the use?" As the nurse plans the client's care, the priority diagnosis is which? Risk for self-directed violence Ineffective individual coping Anxiety Nutrition that is less than body requirementsRisk for self-directed violenceAfter complaining of weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client's nursing care and treatment, which outcome should be prioritized? The client will identify alternatives to current coping patterns. The client will verbalize fears relating to the client's health needs. The client will be free of self-induced vomiting. The client will acknowledge self-harm thoughts.The client will be free of self-induced vomiting.A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. The client doesn't want to feel fat in a bathing suit on vacation. The client's sodium level is 150 mEq/L; potassium level is 3.2 mEq/L. The client is 5 feet tall, weighs 100 pounds, and has lost 15 pounds in 3 weeks. Which goal is a priority at this time? Stabilize electrolyte levels. Assist client to begin gaining weight at the rate of 2 to 3 pounds per week until reaching 112 pounds. Develop a contract with the client to stop using laxatives and diuretics. Help build self-esteem.Stabilize electrolyte levels.The nurse is interviewing an 18-year-old client about eating behaviors. The client's parents have brought the client to treatment because the client's mother suspects that the client has been binge eating and vomiting. The nurse asks the client if the client ever feels that the client cannot control the client's eating. The client's mother states, "I know the client can't control it; the client ate an entire cake last night!" Which comment by the nurse is best? " Is what your mother said true?" "Do you often have to answer for your child?" "I see. Do you ever feel as though you cannot control your eating?" "I see. What are your thoughts on what your mother has said?""I see. Do you ever feel as though you cannot control your eating?"During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication? Ziprasidone Fluoxetine Risperidone OlanzapineFluoxetineWhen a 27-year-old is admitted for treatment of anorexia nervosa, the nurse prepares the client for diagnostic testing that includes what? Select all that apply. Serum amylase Serum uric acid Serum glucose Serum cortisol Electrocardiogram (ECG)Serum glucose Serum cortisol Serum amylase Electrocardiogram (ECG)When reviewing the documented history of an adult client with anorexia nervosa, what is the nurse most likely to find? (Select all that apply.) reported believing that friends were "jealous" of her body food restriction began at age 15 depression at age 16 lasting one month had successful outpatient treatment one year after onset of disorder reports strong relationship with parentsreported believing that friends were "jealous" of her body food restriction began at age 15 depression at age 16 lasting one monthA client's diagnosis of bulimia nervosa is supported when the psychiatric nurse documents assessment data that includes (Select all that apply.) Lanugo observed on forearms and face Serum potassium of 3.8 mEq/L History of purging "3 times a week for 2 years." Client reports of "being depressed" Often heard discussing "how hard it is to stay thin" with other clientsHistory of purging "3 times a week for 2 years." Client reports of "being depressed" Often heard discussing "how hard it is to stay thin" with other clientsA nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa? 1.The person judges worth based on a lack of fat. 2.The person has feeling of powerlessness 3.The person engages in episodic binge eating. 4.The person is preoccupied with body image.3.The person engages in episodic binge eating.A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected? Metabolic acidosis and constricted colon Respiratory distress and dyspnea Bacterial gastrointestinal infections and overhydration Dental erosion and chronic edemaDental erosion and chronic edemaA nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories? Paranoia Depression Aggression Primary insomniaDepressionThe client is 16 years old with an identical twin just diagnosed with anorexia nervosa. The client tells the nurse the client is concerned that the client may also develop the disorder. Which response by the nurse is the most appropriate? "It is not genetics but the environment that increases your risk. Since you live together, you have an equal chance." "Identical twins have about a 5% chance of both twins developing an eating disorder." "Eating disorders have not been found to be genetic, so you do not have a risk." "While eating disorders have shown a genetic link, other factors also play a role in its development.""While eating disorders have shown a genetic link, other factors also play a role in its development."A client has been purging to maintain weight loss. Which would be an important goal immediate for this client? Understanding that purging is an ineffective means of weight control Recognizing that purging promotes binge eating Using distraction to stop the urge to purge Being free of self-inflicted harmBeing free of self-inflicted harmThe nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what? Provide the client with a feeling of responsibility and control over the client's behavior Allow the client a tool by which to negotiate behavior Provide the therapist with a strategy for client compliance Provide the nurse with a tool for evaluating the plan of careProvide the client with a feeling of responsibility and control over the client's behaviorFluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? Antiparkinsonian Antidepressant Antianxiety AntimanicAntidepressantWhen working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason? To show the family evidence of the client's progress To raise self awareness and a sense of control For the nurse to be able to document in the client record accurately To document physical problems the client wants to share with the physicianTo raise self awareness and a sense of controlA nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which would the nurse expect to implement in conjunction with pharmacologic therapy? Family therapy Cognitive behavioral therapy Behavioral therapy Interpersonal therapyCognitive behavioral therapyWhen admitted to the inpatient unit, a client is 5 feet 10 inches tall and weighs 100 pounds. What is the initial goal in the client's care? To stop losing weight To be on bedrest To reduce fluid intake To assess for violence potentialTo stop losing weightA nurse is planning to explain the purpose of the behavioral therapy technique of self-monitoring to a client with bulimia nervosa. The nurse would emphasize keeping a diary to record what? Rigid rules about eating Feelings of hunger Efforts at distraction Environmental cuesEnvironmental cuesA college student has been referred to the college clinic for evaluation for anorexia nervosa. Which would help support the diagnosis? Oily skin Significantly low body weight Onset of symptoms during preadolescence Temper tantrumsSignificantly low body weightA client is diagnosed with anorexia nervosa. The client's body mass index is 16.75 kg/m2. The nurse interprets this as indicating which level of severity of the condition? Extreme Moderate Severe MildModerateA nurse is initiating a group for adolescent girls diagnosed with anorexia nervosa. Many of the clients in the group are irritable and resent having to attend. One of them comments, "This is a stupid waste of time!" Which response by the nurse would be most appropriate? "You sound irritated; tell me about what is bothering you." "You were assigned to this group by your therapist, so you must participate." "Sit down and be quiet; your peers would appreciate some peace and quiet." "If you feel that way, then you can just leave.""You sound irritated; tell me about what is bothering you."While caring for a client with anorexia nervosa, a nurse anticipates that the client would have difficulty making which comment? "I'm mad at you because you won't let me go on a pass unless I gain weight!" "I need to have everything in its place and perfect." "If I gain a pound, I'll just keep gaining weight." "I am very involved in preparing my food and counting calories.""I'm mad at you because you won't let me go on a pass unless I gain weight!"A college student has been referred to the clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what? Oily skin and acne Onset of symptoms in early adolescence Body weight significantly below ideal for height and age Temper tantrums and sleep disturbanceBody weight significantly below ideal for height and ageThe nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach? "Is there any way you can look at that sandwich as fuel for your body?" "You have to eat in moderation for good nutrition." "You seem to have a really hard time controlling your eating patterns." "Is this your way of showing your family that you can make decisions?""Is there any way you can look at that sandwich as fuel for your body?"The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? Careless Outspoken Defiance Eager to pleaseEager to pleaseWhich nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? Leave the client alone to relax during meals. Offer liquid protein supplements if the client is unable to complete meal. Observe the client for 30 minutes after all meals. Weigh the client weekly in the same clothing at the same time of day.Offer liquid protein supplements if the client is unable to complete meal.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? Coping skills are dependent on a supportive upbringing. When body image is positive, the client will develop better coping skills. Being able to cope in healthy ways improves the ability to accept a realistic body image. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills.Being able to cope in healthy ways improves the ability to accept a realistic body image.Which of the following interventions would be appropriate for a client with anorexia nervosa? Allowing the client to eat whenever she feels hungry Insisting that the client sit in the dining room until all food is eaten Having the client in view of staff for 90 minutes after each meal Permitting the client to eat any food she chooses, as long as she is eatingHaving the client in view of staff for 90 minutes after each mealWhich is the primary objective of nursing interventions in the care of a client with anorexia nervosa? Changing her irrational thinking about her body Establishing a target weight to be achieved by discharge Restoring nutritional status to normal Gaining insight into the effects of anorexia on her physical healthRestoring nutritional status to normalA 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? Dieting helps build a positive self-image in children. Dieting during childhood restricts essential nutrients needed for normal growth. Dieting at an early age teaches healthy eating habits. Dieting at an early age may lead to the development of eating disorders.Dieting at an early age may lead to the development of eating disorders.Which of the following would be most supportive for family and friends of a client with an eating disorder? Emotional support, love, and attention. Focus on food intake, calories, and weight. Unlimited access to unhealthy foods that the client enjoys. Positive reinforcement for weight gain.Emotional support, love, and attention.The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which intervention is indicated? Supervise the client closely for 2 hours after meals and snacks Increase the daily caloric intake from 1,500 to 2,000 calories Increase the client's fluid intake Request an order from the physician for fluoxetineSupervise the client closely for 2 hours after meals and snacksWhich of the following statements is true? Anorexia nervosa was not recognized as an illness until the 1960s Cultures in which beauty is linked to thinness have an increased risk for eating disorders Eating disorders are a major health problem only in the United States and Europe Individuals with anorexia nervosa are popular with their peers as a result of their thinness.Cultures in which beauty is linked to thinness have an increased risk for eating disordersWhich is not a goal for treating the severely malnourished client with anorexia nervosa? Correction of body image disturbance Correction of electrolyte imbalances Nutritional rehabilitation Weight restorationCorrection of body image disturbanceThe nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress? The client can identify calorie content for each meal The client identifies healthy ways of coping with anxiety The client spends time resting in her room after meals The client verbalizes knowledge of former eating patterns as unhealthy.The client identifies healthy ways of coping with anxiety.A teenager is being evaluated for an eating disorder. Which finding would suggest anorexia nervosa? Guilt and shame about eating patterns Lack of knowledge about food and nutrition Refusal to talk about food-related topics Unrealistic perception of body sizeUnrealistic perception of body sizeA client with bulimia is learning to use the technique of self-monitoring. Which intervention by the nurse would be most beneficial for this client? Ask the client to write about all feelings and experiences related to food Assist the client in making daily meal plans for 1 week Encourage the client to ignore feelings and impulses related to food Teach the client about nutrition content and calories of various foods.Ask the client to write about all feelings and experiences related to food.Which individual most clearly exhibits the characteristics of body image disturbance? 44-year-old who is committed to going to the gym every day both before work and after work 71-year-old who talks frequently about multiple health problems 20-year-old who weighs 98 pounds but who considers oneself obese 13-year-old who is in the fifth percentile of height and weight for age and sex20-year-old who weighs 98 pounds but who considers oneself obeseA 15-year-old female is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? Body weight less than normal for age, height, and overall physical health Amenorrhea for at least two cycles Absence of hunger feelings Erosion of dental enamelBody weight less than normal for age, height, and overall physical healthWhen 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? "I know I have a problem. I need help." "Others are just trying to keep me from looking good." "I know my weight is a little below normal." "Those weight charts are for normal people. I am not normal.""Others are just trying to keep me from looking good."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? Family members often need to learn role independence and autonomy. Family members need to learn to monitor for signs of client relapse. Family relationships need to be strengthened due to a lifetime of disengagement. Family members often feel jealous of the attention the client has been receiving in treatment.Family members often need to learn role independence and autonomy.Which nursing statement is most effective in communicating a positive expectation of the client? "I'll give you 90 minutes to eat." "I will allow you space to eat in peace." "I will sit here quietly with you while you eat." "There are people who would truly appreciate this food.""I will sit here quietly with you while you eat."The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next? Throat and esophagus Condition of mouth and gums Heart rate and rhythm Patterns of activity and restCorrect response: Heart rate and rhythm Explanation: Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.Which is the most common disorder found in clients diagnosed with bulimia nervosa? Depression Anxiety Psychosis Substance abuseCorrect response: Depression Explanation: Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss? Bulimia nervosa, purging type Anorexia nervosa, restricting type Anorexia nervosa, purging type Binge eating disorderCorrect response: Anorexia nervosa, purging type Explanation: The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests anorexia nervosa, purging type. Individuals with bulimia typically maintain normal weight. Binge eating disorder does not involve purging.A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis? Disturbed body image Anxiety Imbalanced nutrition: less than body requirements Ineffective copingCorrect response: Imbalanced nutrition: less than body requirements Explanation: A behavioral plan for increasing weight is part of a refeeding program that is instituted for a nursing diagnosis of imbalanced nutrition: less than body requirements. Interventions for disturbed body image and anxiety involve addressing interoceptive awareness, helping clients understand their feelings, and initiating interpersonal therapy. Interventions for ineffective coping would address integrating the clients back into school, renewing friendships and relationships, and promoting participation in family therapy.A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment? Complete blood count and differential Evidence of injury to skin by cutting Cardiac assessment and measurement of electrolyte levels Psychosocial assessment and determination of coping skillsCorrect response: Cardiac assessment and measurement of electrolyte levels Explanation: While this client would certainly receive a complete blood count and respiratory assessment, the priority assessment in this client with the client's short-term and long-term histories would be focused on electrolyte levels and cardiac abnormalities, both of which are common manifestations of the repeated vomiting that characterizes bulimia nervosa. Physical assessments would supersede psychosocial assessments and any injury to skin by intentional self-harm in the emergency setting.A client diagnosed with anorexia nervosa is being treated in an outpatient setting in the community. Which activity would be the priority? Improving nutritional status Acknowledging the severity of the illness Confirming beliefs about body size Establishing a therapeutic relationshipCorrect response: Establishing a therapeutic relationship Explanation: While improving nutritional status and acknowledging the severity of the illness are important, the client would be in relatively stable physical health if being treated in the community in an outpatient setting. The first priority, in this case, would be to establish a therapeutic relationship with the client. Establishing a therapeutic relationship with individuals with anorexia nervosa may be difficult initially because they tend to be suspicious and mistrustful especially of authority figures and health personnel whom they believe will intervene to disrupt their restricting and starvation behaviors placing them in a position of extreme fear of becoming fat.Which client being treated for anorexia displays assessment values that warrant hospitalization? A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL A 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurtCorrect response: A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL Explanation: A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL should be hospitalized because both values are troublesome. The values of the other clients do not meet the criteria for hospitalization.A client is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The client believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this client is what? Anorexia nervosa, binge eating, and purging type Anorexia nervosa, restricting type Bulimia nervosa, nonpurging type. Eating disorder not otherwise specifiedCorrect response: Anorexia nervosa, restricting type Explanation: Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories."A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which would the nurse include in the education plan? Knowing the calorie content of numerous foods Learning strategies to control impulses Describing physiologic consequences of anorexia nervosa Setting realistic goalsSetting realistic goals Explanation: Because these clients tend to be perfectionist and set unrealistic goals for themselves, the nurse should educate the client about setting realistic and attainable goals. Other topics such as weight monitoring, resources, and effects of restrictive eating should be included in the nurse's educational plan.what is self monitoringSelf-monitoring is a cognitive-behavioral technique designed to help clients with bulimia. It may help clients identify behavior patterns and then implement techniques to avoid or replace them (Richards, Shingleton, Goldman, Siegel, & Thompson-Brenner, 2016). Self-monitoring techniques raise client awareness about behavior and help them regain a sense of control. 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.Which intervention has been found to be most effective reducing the initial symptoms of bulimia? Cognitive behavior therapy and pharmacologic interventions Behavioral therapy and psychoeducation Daily monitoring of sound dietary principles and meditation sessions Clearly stated unit rules and a supportive milieuCorrect response: Cognitive behavior therapy and pharmacologic interventions Explanation: The combination of cognitive behavior therapy and pharmacologic interventions is best for producing an initial decrease in symptoms.For clients who purge, what is the most important goal? Stop the behavior Understand that purging is an ineffective means of weight control Recognize that purging promotes binge eating Develop the technique of distractionCorrect response: Stop the behavior Explanation: The most important goal for a client who purges is to stop the behavior. All other options would not be the most important goal.Which behavior is not associated with purging? Consuming large amounts of food Self-induced vomiting Use of laxative Misuse of diureticsConsuming large amounts of foodA nurse is assessing a client with anorexia nervosa. Which would the nurse be least likely to find? Hypokalemia Overly oily skin Salivary gland hypertrophy Dental enamel erosionOverly oily skinWhich statement best describes the biologic theories of the etiology of eating disorders? Eating disorders involve dysregulation of multiple neurotransmitter systems and may be influenced by behavioral, cultural, and familial factors. Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component. Eating disorders result from family dysfunction involving a controlling mother; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.A mental health nurse is caring for a client who is obsessed with a blemish on the client's face and states, "I am so ugly." The client has been unable to work for the past 2 days. The client is suffering from which medical problem? A) Body image disturbance B) Conversion disorder C) Hypochondriasis D) Somatization disorderA) Body image disturbanceA client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect? Anorexia nervosa Bulimia nervosa Binge eating disorder Eating disorder not otherwise specifiedBinge eating disorder Binge eating disorder is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese.A nurse is reviewing the plan of care for a client diagnosed with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis? Disturbed body image Anxiety Imbalanced nutrition: less than body requirements Ineffective copingImbalanced nutrition: less than body requirements: A behavioral plan for increasing weight is part of a refeeding program that is instituted for a nursing diagnosis of imbalanced nutrition: less than body requirements.A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge eating disorder (BED). The students demonstrate understanding when they identify which characteristics as specific to BED? Select all that apply. Clients typically are obese. Clients refrain from purging behaviors. Binge eating periods are shorter. Clients engage in overexercising. Feelings of guilt do not occur after binging.Clients typically are obese. Clients refrain from purging behaviors. BED is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors (such as overexercising). Individuals with BED also differ from those with other eating disorders in that most of them are obese. In addition, investigators have shown that individuals with BED have less dietary restraint and have a higher weight than those with bulimia nervosa. Binge-eating episodes are not shorter. Feelings of guilt occur with both bulimia nervosa and BED.Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? Antipsychotics Stimulants Mood stabilizers AntidepressantsAntidepressants: Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms.The nurse provides care to a client who is diagnosed with an eating disorder. Which strategy should the nurse include in the client's plan of care to increase the client's self-concept? Practice meditation. Increase social contact. Keep a list of accomplishments. Limit physical activity to a reasonable schedule.Keep a list of accomplishments: Wellness challenges must be addressed by the nurse when providing care to a client who is diagnosed with an eating disorder. Interventions that support increasing the client's self-concept include keeping a list of accomplishments, helping others, keeping busy, and counseling or therapy.For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? --One-on-one time with psychiatric staff and antidepressant medication therapy --Cognitive-behavioral therapy (CBT) including self-monitoring --Clearly stated unit rules and a supportive milieu --Daily reinforcement of sound dietary principles and meditation sessionsCognitive-behavioral therapy (CBT) including self-monitoring For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. The primary interventions include CBT, including self-monitoring.Individuals with anorexia nervosa concentrate on which body cue? Anxiety Controlling food intake Weakness HungerControlling food intake: Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.A client with bulimia is being discharged from care. The nurse considers which indicator most important when evaluating the effectiveness of the care plan? The client has lost weight over the past year. The client has not learned to accept the client's body type The client eats six small meals per day. The client has moved into the client's own apartment.The client eats six small meals per day. The nurse evaluates the client's physical and psychosocial responses to interventions. Desired physical outcomes include maintaining a healthy weight, normal laboratory values and vital signs, and return of secondary sexual characteristics and menstruation. Desired psychosocial outcomes include a realistic perception of body image, direct expression of feelings, improved self-esteem, a sense of control over self and environment, and constructive family process.During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic? --"I don't think you are fat." --"Has something occurred that caused you to measure your thighs?" --"You are exactly the right weight for your height." --"You have always been very focused on your thighs. Is that the part of your body you like least?""Has something occurred that caused you to measure your thighs?" The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.The nurse provides care for a client who is diagnosed with anorexia nervosa. Which question should the nurse ask to assess the client for neuropsychiatric complications associated with the diagnosed eating disorder? "Do you experience abnormal taste sensations?" "Is your skin dry and your nails brittle?" "Do you experience constipation or diarrhea?" "How often do you menstruate?""Do you experience abnormal taste sensations?" There are many complications associated with eating disorders, including anorexia nervosa. The neuropsychiatric complications include abnormal taste sensations, often due to zinc deficiency. Other neuropsychiatric complications include apathetic depression, fatigue, mild organic mental symptoms, and sleep disturbances.Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care? Anxiety related to inadequate coping mechanisms Deficient fluid volume related to refusal to drink Impaired social interaction related to aggressive behavior Hyperactivity related to restlessnessDeficient fluid volume related to refusal to drink: The risk of dehydration posed by the client's refusal to drink likely supersedes the risk of imbalanced nutrition in the short term.The dentist of a client noticed that the client's teeth were losing enamel. The client is of average weight. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with enamel loss? Bulimia nervosa, purging type Anorexia nervosa, restricting type Binge eating disorder Anorexia nervosa, purging typeBulimia nervosa, purging type: The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests bulimia nervosa, purging type.Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Bupropion Lithium Haloperidol FluoxetineFluoxetine: Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Adminstration approval for the treatment of bulimia nervosa.While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from? Anorexia nervosa Binge-eating disorder Bulimia nervosa Eating disorder not otherwise specifiedBulimia nervosa: Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental cavities from the frequent contact of tooth enamel with food and acidic gastric fluids.A nurse is discussing the plan of care with a client who has anorexia nervosa. The client's weight is 15% below ideal. The nurse and client are now discussing the client's activity level. The client would like to run 5 miles per day as the client normally does. Which response by the nurse is best? --"Five miles per day is too much. How about 3 miles per day?" --"Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass." --"No, exercise is not allowed until your weight is closer to normal." --"That's fine as long as you adhere to your eating program and do not use laxatives or purging.""Aerobic exercise is not the best choice now. Anaerobic exercise will help you increase lean body mass." Rigorous aerobic exercise generally is contraindicated when weight gain is a goal. Allowing the client to engage in moderate anaerobic exercise (e.g., weight lifting), however, would increase lean body mass as the client gains weight and minimize the gain in "fat weight," which is a great fear of the client.Which is a cardiac complication of an eating disorder? Bradycardia Hypertension Enlarged heart ThrombocytopeniaBradycardia Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle.A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? Increasing client's coping skills for anxiety Communicating aggressively with the client Encouraging client take time away from peers for a time Nurturing the client's need for dependencyIncreasing client's coping skills for anxiety Since clients with bulimia experience high anxiety levels and may use the binge-purge cycle as a coping mechanism, increasing coping skills for anxiety is a high priority nursing intervention.The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care? --The client will experience diminished episodes of delusional thinking. --The client will verbalize acceptance of appearance. --The client will demonstrate measures to reduce body mass index. --The client will demonstrate actions that promote health maintenance.The client will verbalize acceptance of appearance. Central to body image disturbance is a lack of acceptance of physical appearance. Consequently, acceptance of appearance is a priority in the care of a client with this problem. The thinking that characterizes the disorder is not classified as delusional. Promoting health maintenance is a relevant goal but is not specific to body image disturbance. Reducing body mass index does not address the etiology of this condition.At the prompting of friends, a 16-year-old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. During the nurse's assessment, the nurse has asked the client to describe the client's family. Which family process and characteristic is thought to contribute to eating disorders? Poor communication and enmeshed family dynamics The absence of a parent and/or the presence of a stepparent Passive parenting and lack of encouragement An overemphasis of peer relationships over family relationshipsPoor communication and enmeshed family dynamics Family systems theories emphasize the role of the family in the development of eating disorders. Among the characteristics that are thought to contribute are enmeshed patterns of relationship and impaired communication.A nurse is performing an admission assessment for an adolescent client diagnosed with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the client's diagnosis? "My father was always very thin." "I've never really liked myself." "I have a lot of confidence in myself." "I feel really close to my parents and my brother.""I've never really liked myself." Body dissatisfaction is strongly related to low self-esteem and is a key characteristic of anorexia nervosa. Results of numerous studies have shown that low self-esteem, body dissatisfaction, and feelings of ineffectiveness and inadequacy put individuals at risk for an eating disorder.Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? Overprotective of their children A history of substance abuse Maintenance of emotional distance from their children Alternation between loving and rejecting their childrenOverprotective of their children Some families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. Family therapy may be beneficial for families of clients younger than 18 years old. Families who demonstrate enmeshment, unclear boundaries among family members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication.When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what? Depression Anxiety Control DependencyControl Often, nurses feel the need to offer control for a client who is helpless in controlling food, anxiety, and life.A 30-year-old client is in therapy for bulimia, depression, and anxiety. The client relates that the client feels unable to cope with the demands of the client's job and that the client's partner recently ended their long-term relationship. The client states that the client frequently binges when stress levels are high. The client denies feeling suicidal but states, "I'm a mess. I'm just not smart enough to figure out how to run my life!" Which nursing diagnosis would best identify the client's problems? Social isolation related to recent loss of significant relationship Chronic low self-esteem related to unrealistic self-expectations Anxiety related to job stressors Risk for impulse control related to unidentified triggersChronic low self-esteem related to unrealistic self-expectations Clients with eating disorders generally have low self-esteem even though they achieve well at school, sports, and work. Most nursing diagnoses for clients with eating disorders center on psychosocial problems, such as chronic low self-esteem related to unrealistic expectations from self or others, lack of positive feedback, and striving to please others to gain acceptance.A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication? "Why do you prefer not to eat food?" "What do you think about how much you weigh right now?" "What do you believe has caused your anorexia?" "Is there anything that I can get you to eat right now?""What do you think about how much you weigh right now?" Open-ended questions that are not "loaded" or accusatory are most likely to elicit data from a client who has an eating disorder.The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks the student to step on the scale. The student asks if the student can go to the bathroom first to empty the student's bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has ... anorexia nervosa. binge-eating disorder. bulimia nervosa. eating disorder not otherwise specified.anorexia nervosa. Anorexia is characterized by a voluntary refusal to eat and typically a weight less than 85% of what is considered normal for height and age. Clients with anorexia have a distorted body image and, to the bewilderment of others, view their emaciated bodies as fat.The nurse is providing care to a client diagnosed with anorexia and notes that the client demonstrates behaviors that reflect an intense physical and emotional process that overrides all physiologic body cues. Which term would the nurse use to document this finding? Drive for thinness Body image distortion Interoceptive awareness PerfectionismDrive for thinness Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues.It is the result of body image distortion. Body image distortion occurs when an individual perceives his or her body disparately from how society views it. Interoceptive awareness is a term used to describe the sensory response to emotional and visceral cues, such as hunger.A nurse is reviewing the medical records of several clients being treated for eating disorders at the community mental health center. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa? The client is preoccupied with body image. The client has feelings of powerlessness. The client is of normal body weight. The client is preoccupied with food consumption.The client is of normal body weight.When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? Providing a supportive environment xamining intrapsychic conflicts and past issues Emphasizing social interaction with clients who withdraw Helping the client to examine dysfunctional thoughts and beliefsHelping the client to examine dysfunctional thoughts and beliefsThe nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings should the nurse expect to note? Select all that apply. Dental decay Moist, oily skin Loss of tooth enamel Electrolyte imbalances Body weight well below ideal rangeDental decay Loss of tooth enamel Electrolyte imbalancesThe nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? Interrupt the client and weigh her immediately. Interrupt the client and offer to take her for a walk. Allow the client to complete her exercise program. Tell the client that she is not allowed to exercise rigorously.Interrupt the client and offer to take her for a walkA client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a 2-bed room. A newly admitted client will be assigned to this client's room. Which client would be the best choice as a roommate for the client with anorexia nervosa? A client with pneumonia A client undergoing diagnostic tests A client who thrives on managing others A client who could benefit from the client's assistance at mealtimeA client undergoing diagnostic testsA client with anorexia nervosa is a member of a predischarge support group. The client verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate this behavior? Normal behavior Evidence of the client's disturbed body image Regression as the client is moving toward the community Indicative of the client's ambivalence about hospital dischargeEvidence of the client's disturbed body imageThe nurse is caring for a client with anorexia nervosa. Which behavior is characteristic of this disorder and reflects anxiety management? Engaging in immoral acts Always reinforcing self-approval Observing rigid rules and regulations Having the need always to make the right decisionObserving rigid rules and regulationsThe nurse has developed a plan of care for a client diagnosed with anorexia nervosa. Which client problem would the nurse select as the priority in the plan of care? Disrupted appearance because of weight Inability to feed self because of weakness Pain because of an inflamed gastric mucosa Nutritional imbalance because of lack of intakeNutritional imbalance because of lack of intakeDuring a home visit, the nurse suspects that a young daughter of the client is bulimic. The nurse bases this suspicion on which primary characteristics of bulimia? Refusing to eat and excessive exercising Eating only vegetables and fruits and fasting Hoarding of food and difficulty controlling food intake Eating a lot of food in a short period of time and misuse of laxativesEating a lot of food in a short period of time and misuse of laxativesThe nurse is performing an assessment on a 16-year-old female client who has been diagnosed with anorexia nervosa. Which statement, made by the client, would the nurse identify as necessitating further assessment on a priority basis? "I check my weight every day without fail." "I've been told that I am 10% below ideal body weight." "I exercise 3 to 4 hours every day to keep my slim figure." "My best friend was in the hospital with this disease a year ago.""I exercise 3 to 4 hours every day to keep my slim figure."A clinic nurse is monitoring a client with anorexia nervosa. Which client statement should indicate to the nurse that treatment has been effective? "I'll eat until I don't feel hungry." "I no longer have a weight problem." "I don't want to starve myself anymore." "My friends and I went out to lunch today.""My friends and I went out to lunch today."Which assessments should the nurse closely monitor when caring for a hospitalized client diagnosed with bulimia nervosa? Select all that apply. Electrolyte levels Exercise patterns Intake and output Pupillary response Elimination patterns Deep tendon reflexesElectrolyte levels Intake and output Elimination patternsA group of nurses is reviewing information about the complications associated with eating disorders. The group demonstrates understanding of the information when they identify which as a possible cardiac complication? Select all that apply. Loss of cardiac muscle Ventricular tachycardia Enlarged heart Bradycardia HypertensionBradycardia Ventricular tachycardia Loss of cardiac muscleA client's diagnosis of anorexia nervosa is supported when the psychiatric nurse documents assessment data that includes which finding? Select all that apply. Patient is overheard telling other patients "I weigh myself three times a day when I'm home." Patient reports "being depressed." Patient has a history of "sleeping 9 hours a night and taking frequent naps." Patient reports that she "hasn't had a menstrual period in over 2 years." Client consistently denies that she "has a problem with the way she looks."Client reports "being depressed." Client claims that she "hasn't had a menstrual period in over 2 years." Client is overheard telling other clients "I weigh myself three times a day when I'm home." Client consistently denies that she "has a problem with the way she looks."The nurse is assessing a client with bulimia nervosa. Which of the following symptoms would the nurse expect to find? Select all that apply. Cold intolerance Normal weight for height Dental erosion Hypotension Metabolic alkalosisNormal weight for height Dental erosion Metabolic alkalosisThe nurse understands that which biologic factors may influence the development of an eating disorder? Select all that apply. Family history of eating disorders Dysfunction of the hypothalamus Norepinephrine imbalances First-degree relatives with psychotic disorder Decreased serotonin levelsFamily history of eating disorders Dysfunction of the hypothalamus Norepinephrine imbalances Decreased serotonin levelsWhich factors may contribute to the frequency of eating disorders in adolescents? Select all that apply. Media portrayal of slimness as an ideal Body dissatisfaction in adolescent females Stress-free existence of adolescents Body image disturbance Seeking autonomy Seeking to develop a unique identityMedia portrayal of slimness as an ideal Body dissatisfaction in adolescent females Body image disturbance Seeking autonomy Seeking to develop a unique identityA nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply. Body dissatisfaction Feelings of control Obsessiveness Boundary problems Sexuality fears Cognitive distortionsBody dissatisfaction Obsessiveness Cognitive distortionsA patient referred to the eating disorders clinic has lost 35 pounds in 3 months and has developed amenorrhea. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply. Peripheral edema Parotid swelling Constipation Hypotension Dental caries LanugoPeripheral edema Constipation Hypotension LanugoA patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply. Flexible mealtimes Unscheduled weight checks Adherence to a selected menu Observation during and after meals Monitoring during bathroom trips Privileges correlated with emotional expressionAdherence to a selected menu Observation during and after meals Monitoring during bathroom tripsWhich of the following are criterion for hospitalization of patients with eating disorders? Select all that apply. blood pressure 110/60B. elevated serum potassium level decreased serum magnesium level heart rate 40 bpm statements of being hopelessHeart rate near 40 beats/min Hypokalemia Blood pressure less than 80/50 mm Hg Poor motivation to recover HypomagnesemiaA client is diagnosed with anorexia nervosa, restricting type. The nurse interprets this as indicating the use of which of the following? Select all that apply. Dieting Exercising Enemas Laxatives DiureticsDieting ExercisingA nurse is assessing a client who is suspected of having bulimia nervosa. Which psychological characteristic would the nurse most likely assess? Select all that apply. Boundary problems Maturity fears impulsivity Difficulties setting limits Ritualistic behaviorsBoundary problems Impulsivity Difficulties setting limitsA nurse is developing a teaching plan for a client with bulimia nervosa. Which topic would the nurse include in this plan? Select all that apply. Assertiveness Realistic goal setting Hydration Limit setting Isometric exerciseAssertiveness Realistic goal setting Hydration Limit settingIndividuals with anorexia nervosa often experience comorbid conditions. Which of the following would be most common? Select all that apply. Somatic symptom disorder Depression Panic disorder Obsessive compulsive disorder Factitious disorderDepression Panic disorder Obsessive compulsive disorderA nurse is reading a journal article about binge eating disorder and how it compares with bulimia nervosa. Which information would the nurse likely find being discussed? Select all that apply. Like those with bulimia, clients with binge eating disorder also purge. Clients with binge eating disorder use behaviors other than purging to compensate for binge eating. Clients with bulimia and binge eating disorder experience a feeling of loss of control Clients with binge eating disorder are typically obese, unlike those with bulimia Clients with binge eating disorder have lower dietary restraint than those with bulimiaClients with binge eating disorder are typically obese, unlike those with bulimia Clients with binge eating disorder have lower dietary restraint than those with bulimiaWhen considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa? Select all that apply. Provide scheduled portion-controlled meals and snacks Congratulate patients for weight gain and behaviors that promote weight gain Limit time spent in bathroom during periods when not under direct supervision Promote exercise as a method to increase appetite Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.Provide scheduled portion-controlled meals and snacks Limit time spent in bathroom during periods when not under direct supervision Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintainedSafety measures are of concern in eating-disorder treatments. Patients with anorexia nervosa are supervised closely to monitor: Select all that apply. Foods that are eaten Attempts at self-induced vomiting Relationships with other patients WeightFoods that are eaten Attempts at self-induced vomiting WeightA nurse doing an assessment with a client with anorexia nervosa would expect to find which of the following? (select all that apply. Belief that dieting behavior is not a problem Feelings of guilt and shame about eating behavior History of dieting at a young age Performance of rituals or compulsive behavior Strong desire to get treatment View of self as overweight or obeseBelief that dieting behavior is not a problem History of dieting at a young age Performance of rituals or compulsive behavior View of self as overweight or obeseA psychiatric-mental health nurse is reviewing the various theories related to anorexia nervosa. Which would the nurse identify as related to biologic theories? Select all that apply. Decreased serotonin activity Dieting leading to starvation Pursuit of thinness Genetic vulnerability Separation-individuation Role pressuresGenetic vulnerability Dieting leading to starvation Decreased serotonin activityA nurse doing an assessment with a client with bulimia would expect which findings? Select all that apply. Compensatory behaviors limited to purging Dissatisfaction with body shape and size Feelings of guilt and shame about eating behavior Near-normal body weight for height and age Performance of rituals or compulsive behavior Strong desire to please othersDissatisfaction with body shape and size Feelings of guilt and shame about eating behavior Near-normal body weight for height and age Strong desire to please othersWhich statement best describes the theories of the etiology of eating disorders? Eating disorders are caused by dysregulation of multiple neurotransmitter systems that predispose a dysfunctional response to certain environmental factors. Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors. Eating disorders result from family dysfunction; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component.Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.A 25-year-old client is brought in for treatment by the client's parents. The client has been restricting activities and avoiding social contacts because the client has become preoccupied with the client's thighs, calling them "hideous" and "disfiguring." The client believes that people can't stop staring at them because they are so "deformed." Which is the term used to describe these symptoms? Hypochondriasis Body image disturbance Hypervigilance Conversion disorderBody image disturbanceThe nurse provides care to an adolescent client who presents to the emergency department (ED) after losing consciousness during a marching band performance. A differential diagnosis of anorexia nervosa is documented by the practitioner. Which finding noted when reviewing the client's laboratory data indicates a need for hospitalization? hypokalemia hypermagnesemia hypoglycemiahypokalemia The criteria for hospitalization for the client who is diagnosed with an eating disorder include acute weight loss, < 85% below ideal; heart rate near 40 beats/min; temperature less than 97.0°F (36.1°C); blood pressure less than 80/50 mm Hg; poor motivation to recover; and electrolyte abnormalities, including hypokalemia, hypophosphatemia, and hypomagnesemia. Hypoglycemia would be expected with lack of intake and is not a criterion for hospitalization.