Deck 18: Eating Disorders: Anorexia Nervosa and Bulimia Nervosa

Question 1

A patient who is hospitalized with anorexia nervosa states during a one-to-one session with the nurse,"I'm freaking out.I'm losing it." Which nurse response would be most therapeutic at this time?

A) "Would you feel better if I called your parents?"
B) "Just sit here and relax that will help you regain control."
C) "May I sit with you while you think about what is happening?"
D) "Please tell me what thoughts are going through your head right now."

Answer 1

"Please tell me what thoughts are going through your head right now."

Question 2

Which patient statement demonstrates the expected emotional response to bingeing?

A) "I know it's bad but I can't help bingeing."
B) "Everyone indulges in bingeing some times."
C) "After I binge I feel happy for a little while."
D) "Bingeing isn't bad if I do it only when I'm stressed."

Answer 2

"After I binge I feel happy for a little while."

Question 3

Which statement is the basis for the cross-cultural assessment practices of eating disorders?

A) Mediterranean cultures are more likely to exhibit symptoms.
B) Male-dominated cultures are more likely to accept this disorder.
C) Westernized cultures tend to have similar numbers of diagnosed cases.
D) Access to food is the primary factor in determining incidence of the disorder.

Answer 3

Westernized cultures tend to have similar numbers of diagnosed cases.

Question 4

The interdisciplinary care team has suggested family-based therapy as a part of the care plan of a teenager diagnosed with an eating disorder.Which statement is the basis for this recommendation?

A) This approach encourages family involvement in the patient's recovery.
B) The family is often dysfunctional, enmeshed, and in need of counseling.
C) This approach has shown a significant impact on successful long-term prognosis.
D) The family implements the behavioral contract as established by the plan of care.

Question 5

The nurse observes a distorted thinking pattern in a teenage patient diagnosed with an eating disorder.Which statement characterizes personalization by the patient?

A) "I've got to be thin to get a good job."
B) "There is no such thing as a healthy carbohydrate."
C) "My mother and dad fight all the time because I'm fat."
D) "My whole family will be disgraced if I don't get into a good college."

Question 6

The nurse is identifying outcomes for a teenager diagnosed with anorexia nervosa.Which outcome has the greatest impact on long-term prognosis?

A) Verbalize underlying psychological issues.
B) Demonstrate effective coping skills related to conflict management.
C) Demonstrate improvement in body imagine reflecting a realistic viewpoint.
D) Consume adequate calories appropriate for age, height, and metabolic needs.

Question 7

A 14-year-old patient newly admitted to the eating disorders unit refuses to eat meals and angrily shouts at the nurse,"You can't make me eat! I'll do whatever I want to do." Which nursing intervention demonstrates an understanding of the priority safety issue for this anorexic patient?

A) Placing the patient's favorite low calorie beverages in open view
B) Assigning a staff member to one-on-one observation of the patient
C) Unlocking the patient's bathroom only at specific times during the day
D) Explaining to the patient that they will be required to keep an eating journal

Question 8

The nurse is caring for a patient who is being treated for comorbid eating and affective disorders.For which medication would the nurse expect to prepare a patient teaching plan?

A) Fluoxetine (Prozac)
B) Diazepam (Valium)
C) Lorazepam (Ativan)
D) Lithium

Question 9

Long-term prognosis for eating disorders is improved dramatically when treatment includes long-term cognitive-behavioral therapy.What statement provides the best explanation to the patient for this component to the treatment plan?

A) "This will help you identify a healthy, weight restoration diet."
B) "Medication alone will not help you from relapsing back to your old habits."
C) "In order to manage your disorder, you have to understand the root problems."
D) "Prognosis has been proven to be much better with both medication and therapy."

Question 10

A patient is being assessed for a binge-eating-associated eating disorder.Which assessment question is directed towards collecting data on the most commonly abused substance among this patient population?

A) "How much alcohol do you drink on a weekly basis?"
B) "Do you use amphetamines to help control your weight?"
C) "Do you rely on laxatives to control your bowel movements?"
D) "How many packs of cigarettes do you smoke on a daily basis?"

Question 11

A teenager admitted to the eating disorders unit has begun displaying behaviors that reflect possible secondary gains related to the hospitalization.What is the basis for this behavioral change?

A) The patient has moved into the guilt phase of the recovery process.
B) The attention has reinforced the initial food-focusing behaviors.
C) The medication therapy has not yet brought about the expected results.
D) The increase of calories had help clarify the patient's thought processes.

Question 12

In an art therapy session,a patient with anorexia nervosa was asked to draw a picture of herself.Which drawing would likely depict the patient's view of herself?

A) A tall, slim girl with obvious muscle definition
B) A shapely figure of a model who she really admires
C) A malnourished teenager with thin, lanky extremities
D) A grossly obese figure lacking feminine characteristics

Question 13

A parent of a teenager being treated for anorexia nervosa asks the nurse what,"Being an enmeshed family" means.Which question provides the best response to the question?

A) "What do you think that statement means?"
B) "Who told you your family was enmeshed?"
C) "Are the members of your family expected to be independent and self-reliant?"
D) "Does your family place importance on being successful and accepted by others?"

Question 14

Accomplishment of which expectation should be considered most critical prior to discharging a patient with anorexia nervosa?

A) Attainment of minimum normal weight
B) Resumption of normal menstrual cycle
C) Reduction of periods of active exercise to three times daily
D) Knowledge of nutritional value of foods required for a balanced diet

Question 15

A patient being treated for an eating disorder is prescribed refeeding.Which outcome is the primary reason a patient receiving this treatment is closely monitored by the nursing staff?

A) Complies with treatment commendation made by treatment team
B) Regularly consumes and tolerates between 3000 to 4000 kcal/day
C) No physical signs or symptoms of an electrolyte imbalance are observable
D) Discharge depends on patient's ability to demonstrate a gain of 3 pounds per week

Question 16

Which intervention best monitors the health status of a patient newly admitted for a diagnosis of bulimia nervosa?

A) Scheduling a bone mineral density screening
B) Performing a portable electrocardiogram (ECG)
C) Obtaining a urine sample for a urine analysis
D) Arranging for a serum potassium level to be drawn

Question 17

A nursing intervention that will be planned to occur early in the nurse-patient relationship with a patient with an eating disorder is:

A) Using confrontation to attack denial
B) Placing the patient in a therapeutic group
C) Formulating a therapeutic nurse-patient alliance
D) Attacking enmeshment by separating patient and family

Question 18

The mother of a teen with an eating disorder expresses a concern that the family is responsible for the problem.Which question will best help the nurse identify another influence that is likely to have played a role in the teenager's eating disorder?

A) "Does she have an after-school job?"
B) "Does she have access to nutritious foods?"
C) "Is there a family history of underweight adults?"
D) "Is your daughter interested in clothes and fashion?"

Question 19

A 16-year-old patient has anorexia nervosa.Which term used to describe the menstrual history is characteristic of this disorder?

A) Amenorrhea
B) Dysmenorrhea
C) Premenstrual syndrome
D) Heavy menstrual flow

Question 20

How does the mortality rate among patients diagnosed with eating disorders compare to those with other psychiatric diagnoses?

A) More deaths are attributed to substance abuse than to eating disorders.
B) This disorder is associated with the highest death rate among all other disorders.
C) This disorder has fewer associated deaths that any other impulse control disorder.
D) More related deaths are recorded compared to those associated with schizophrenia.

Question 21

A patient's plan of care is being managed by an interdisciplinary team familiar with the etiology of eating disorders.Which team principle is most important to the successful treatment of this patient population?

A) The team must preserve the patient's sense of autonomy.
B) The patient must be an active member of the care planning team.
C) The patient's family must be included in the decision-making process.
D) The plan of care must demonstrate collaboration and consistency by the team.

Question 22

A patient with severe weight loss as a result of anorexia nervosa has refused meal trays and supplemental feedings for 3 days since being admitted to the hospital and so refeeding has been ordered.Which intervention will initiate this treatment?

A) Scheduling a nutrition consult with the hospital dietitian
B) Tube feedings until the patient eats 90% of all meals for 1 day
C) IV infusions beginning immediately and continuing for 48 hours
D) Placing the patient on suicide precautions and one-to-one observation

Question 23

A patient diagnosed with bulimia nervosa is hospitalized for treatment of electrolyte imbalance.Which response by the nurse to the patient's request to use the bathroom immediately after eating lunch is most therapeutic?

A) "No one is allowed to leave the dining room during meals."
B) "Okay, but as you know I will accompany you to the bathroom."
C) "We've discussed that there are other options than to induce vomiting."
D) "I think I understand your plan, and I cannot permit you to carry it out."

Question 24

A patient is being assessed for possible anorexia nervosa.Which behaviors are supportive of such a diagnosis? Select all that apply.

A) Eats only red apples and green grapes
B) Exercises 3 times a day every day
C) Has lost 25 pounds but wears only pre-loss clothing
D) Becomes extremely agitated whenever expected to eat
E) Reports fantasies about being able to eat without gaining weight

Question 25

The mother of a teenager is concerned that the child may be anorexic.Which report of the teenager's behavior is support of such a diagnosis?

A) Insists she likes "really baggy clothes"
B) Will eat only lean protein, fruits, and vegetables
C) Has had one menstrual period in the last 2 years
D) Although she has grown 3 inches, she has gained no weight
E) Regularly claims that she will "eat later" but seldom does

Question 26

After ignoring a unit rule regarding being weighed,a patient receiving treatment for an eating disorder tells the nurse,"I can't get weighed this morning,because I drank a glass of juice a few minutes before breakfast." Which statement by the nurse is consistent with treatment principles?

A) "I'm pleased that you took in some calories."
B) "This is weight day. Please step on the scale."
C) "We need to discuss why you chose to ignore the rules about being weighed."
D) "The rule is 'weigh before eating'; now we have to put it off until tomorrow."

Question 27

Which concern has the greatest priority for a patient admitted with a diagnosis of bulimia nervosa?

A) Social isolation
B) Imbalanced fluid volume
C) Compromised family coping
D) Disturbed perception of body image

Question 28

Which reports describe behaviors that meets the criteria for a diagnosis of binge eating? Select all that apply.

A) Sister reports, "She is so sad after she finishes."
B) Claims, "I can't control myself when I get that way."
C) The patient reports, "making myself vomit" at least twice a week.
D) Mother reports seeing the patient, "eat entire loaf of bread for lunch."
E) Maintains that, "I look okay now but I do this so I don't gain any weight."

Question 29

Which assessment findings support a diagnosis of bulimia nervosa? Select all that apply.

A) Loose watery stool
B) Red rash on extremities
C) Blood pressure of 88/58
D) A potassium level of 2.8 mEq/L
E) Reports of mild muscle cramping