Question 1

Two years ago, a patient was diagnosed with bulimia nervosa, and she has weighed 90 kg for the past 12 months. The patient is generally happy with her life and indicates that she has no resistance to weight gain. Which is the best medication to help control the obsessive-compulsive behaviour, now that the patient has reached a maintenance weight?

Accepted Answer

The selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) has been found clinically useful in reducing obsessive-compulsive behaviour after the patient has reached a maintenance weight. Conventional antipsychotics such as chlorpromazine (Thorazine) may be helpful for delusional or overactive patients (Halmi, 2008). Atypical antipsychotic agents such as olanzapine (Zyprexa) are helpful in improving mood and decreasing obsessional behaviours and resistance to weight gain; although this may be a choice, it is not the best choice because the patient is not experiencing mood problems or resistance to weight gain.

Question 2

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa?

Accepted Answer

Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients with eating disorders. The incorrect options are rare in a patient with an eating disorder. Inflexibility, controlled emotions, and pessimism are more the rule.

Question 3

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply.

Accepted Answer

Priority milieu interventions support restoration of weight and normalization of eating patterns. This requires close supervision of the patient's eating and prevention of exercise, purging, and other activities. There is strict adherence to menus. Patients are observed during and after meals to prevent throwing away food or purging. All trips to the bathroom are monitored. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.

Question 4

A patient referred to the eating disorders clinic has lost 16 kg in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply.

Accepted Answer

Peripheral edema is often present because of hypoalbuminemia. Constipation related to starvation is often present. Hypotension is often present because of dehydration. Lanugo is often present and is related to starvation. Parotid swelling is associated with bulimia. Dental caries are associated with bulimia. See relationship to audience response question.

Question 5

An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 3.5 kg. The nurse should do which of the following?

Accepted Answer

Weight gain of more than 2.25 kg in 1 week may result in pulmonary edema. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are undesirable because they increase the risk for cardiac complications.

Question 6

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

Accepted Answer

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

Question 7

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?

Accepted Answer

Blood pressure less than 90/60 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 mL/hr. A potassium level of 3.4 mEq/L is within the normal range.

Question 8

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a patient diagnosed with bulimia nervosa who weighs 60 kg and who purges?

Accepted Answer

The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.

Question 9

Which of the following is a complication of bulimia nervosa?

Accepted Answer

A complication of bulimia nervosa is esophageal tears caused by self-induced vomiting. Others include bradycardia, hypochloremia, and hypokalemia.

Quiz 17: Eating Disorders