Deck 17: Eating Disorders

Question 1

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 32 kg and is 162 cm. Which term should be documented?

A) Amenorrhea
B) Alopecia
C) Lanugo
D) Stupor

Answer 1

Lanugo

Question 2

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 32 kg; height is 172 cm. The patient says, "I won't eat until I look thin." Select the priority initial nursing diagnosis.

A) Anxiety related to fear of weight gain
B) Disturbed body image related to weight loss
C) Ineffective coping related to lack of conflict resolution skills
D) Imbalanced nutrition: less than body requirements related to self-starvation

Answer 2

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

Question 3

A patient referred to the eating disorders clinic has lost 15 kg during the past 3 months. To assess eating patterns, which of the following should the nurse should ask the patient?

A) "Do you often feel fat?"
B) "Who plans the family meals?"
C) "What do you eat in a typical day?"
D) "What do you think about your present weight?"

Answer 3

"What do you eat in a typical day?"

Question 4

Physical assessment of a patient diagnosed with bulimia often reveals which of the following:

A) Prominent parotid glands
B) Peripheral edema
C) Thin, brittle hair
D) Twenty-five percent underweight

Question 5

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

A) Weigh self accurately using balanced scales
B) Limit exercise to less than 2 hours daily
C) Select clothing that fits properly
D) Gain 1 to 1.5 kg

Question 6

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

A) "I am fat and ugly."
B) "What I think about myself is my business."
C) "I'm grossly underweight, but that's what I want."
D) "I'm a few pounds overweight, but I can live with it."

Question 7

Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight?

A) Assess for depression and anxiety.
B) Observe for adverse effects of refeeding.
C) Communicate empathy for the patient's feelings.
D) Help the patient balance energy expenditures with caloric intake.

Question 8

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

A) Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss
B) Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia
C) Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia
D) Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

Question 9

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 42 kg, a loss of 14 kg. Which medical diagnosis is most likely?

A) Binge eating
B) Bulimia nervosa
C) Anorexia nervosa
D) Eating disorder not otherwise specified

Question 10

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

A) Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable.
B) Patient involvement in decision making increases sense of control and promotes compliance with treatment.
C) Because of increased risk of physical problems with refeeding, the patient's permission is needed.
D) A team approach to planning the diet ensures that physical and emotional needs will be met.

Question 11

One bed is available on the inpatient eating disorders unit. The patient with which of the following weight decrease should be admitted to this bed?

A) From 70 to 45 kg over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg
B) From 55 to 40 kg over a 3-month period. Vital signs are temperature, 36° C; pulse, 50 beats/min; blood pressure 70/50 mm Hg
C) From 50 to 32 kg over a 4-month period. Vital signs are temperature 36.5° C; pulse, 60 beats/min; blood pressure 80/66 mm Hg
D) From 40 to 35 kg over a 5-month period. Vital signs are temperature, 36.7° C; pulse, 62 beats/min; blood pressure 74/48 mm Hg

Question 12

A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to which of the following?

A) Self-monitoring of daily food and fluid intake
B) Establishing the desired daily weight gain
C) How to recognize hypokalemia
D) Self-esteem maintenance

Question 13

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

A) Assist the patient to identify triggers to binge eating.
B) Provide corrective consequences for weight loss.
C) Assess for signs of impulsive eating.
D) Explore needs for health teaching.

Question 14

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

A) Weight, muscle, and fat congruence with height, frame, age, and sex
B) Calorie intake is within required parameters of treatment plan
C) Weight reaches established normal range for the patient
D) Patient expresses satisfaction with body appearance

Question 15

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

A) Renal
B) Endocrine
C) Integumentary
D) Cardiovascular

Question 16

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

A) Maintaining patients' concentration and attention
B) Shifting the patients' focus from food to psychotherapy
C) Promoting processing of anxiety associated with eating
D) Focusing on weight control mechanisms and food preparation

Question 17

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

A) "What are your feelings about not eating foods that you prepare?"
B) "You seem to feel much better about yourself when you eat something."
C) "It must be difficult to talk about private matters to someone you just met."
D) "Being thin doesn't seem to solve your problems. You are thin now but still unhappy."

Question 18

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient which of the following?

A) To eat a small meal after purging
B) Not to skip meals or restrict food
C) To increase oral intake after 4 p.m. daily.
D) The value of reading journal entries aloud to others

Question 19

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

A) Appropriately express angry feelings
B) Verbalize two positive things about self
C) Verbalize the importance of eating a balanced diet
D) Identify two alternative methods of coping with loneliness

Question 20

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

A) The nurse interacts with the patient in a protective fashion.
B) The nurse's comments to the patient are compassionate and nonjudgemental.
C) The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene.
D) The nurse refers the patient to a self-help group for individuals with eating disorders.

Question 21

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?

A) Olanzapine (Zyprexa)
B) Fluoxetine (Prozac)
C) Chlorpromazine (Thorazine)
D) Fat soluble vitamins

Question 22

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

A) Carefree flexibility
B) Rigidity, perfectionism
C) Open displays of emotion
D) High spirits and optimism

Question 23

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

A) Flexible mealtimes
B) Unscheduled weight checks
C) Adherence to a selected menu
D) Observation during and after meals
E) Monitoring during bathroom trips

Question 24

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.

A) Peripheral edema
B) Parotid swelling
C) Constipation
D) Hypotension
E) Dental caries
F) Lanugo

Question 25

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?

A) Assess lung sounds and extremities
B) Suggest use of an aerobic exercise program
C) Positively reinforce the patient for the weight gain
D) Establish a higher goal for weight gain the next week

Question 26

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

A) "You and I will have to sit down and discuss this problem."
B) "It bothers me to see you exercising. I am afraid you will lose more weight."
C) "Let's discuss the relationship between exercise, weight loss, and the effects on your body."
D) "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

Question 27

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

A) Urine output 40 mL/hr
B) Pulse rate 58 beats/min
C) Serum potassium 3.4 mEq/L
D) Blood pressure 78/58 mm Hg

Question 28

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?

A) Powerlessness
B) Ineffective coping
C) Disturbed body image
D) Imbalanced nutrition: less than body requirements

Question 29

Which of the following is a complication of bulimia nervosa?

A) Tachycardia
B) Hyperchloremia
C) Hyperkalemia
D) Esophageal tears