Deck 16: Eating Disorders

Question 1

A student transfers from a hometown college to a university 200 miles away after breaking up with her boyfriend of 2 years.She was slow to make friends at the university.The history shows a close relationship with her mother and sister.She began eating large quantities when she felt sad,and then she induced vomiting.When the student's schoolwork declined,she sought help from the university health clinic.During the initial interview,what priority issue should the nurse address?

A) Losses
B) Sleep patterns
C) School activities
D) Menstrual flow

Answer 1

Losses

Question 2

A patient's body is covered by fine,downy hair.The patient weighs 70 pounds and is 5 feet 4 inches tall.Which term should be documented?

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

Answer 2

Lanugo

Question 3

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

A) Severe anxiety concerning eating is expected,so objective and subjective data must be routinely collected.
B) Patient involvement in decision making increases sense of control and promotes adherence.
C) Because of risks of physical problems from refeeding,the patient's consent is essential.
D) A team approach to treatment planning ensures that physical and emotional needs are met.

Answer 3

Patient involvement in decision making increases sense of control and promotes adherence.

Question 4

An 18-year-old referred to the mental health center often cooks gourmet meals but eats only tiny portions.The patient wears layers of loose clothing saying,"I like the style." The patient's weight dropped from 130 to 95 pounds.She has amenorrhea.Which diagnosis is most likely?

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

Question 5

A patient referred to the eating disorders clinic lost 35 pounds over 3 months.To assess eating patterns,the nurse should ask:

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?"

Question 6

What behavior signals that a nurse caring for a patient with bulimia nervosa is experiencing rescue feelings? The nurse:

A) makes nonjudgmental comments.
B) refers the patient to a self-help group for persons with eating disorders.
C) teaches the patient about signs of increased anxiety and ways to intervene.
D) determines the patient has poor eating habits and provides a diet to follow.

Question 7

Disturbed body image is the nursing diagnosis for a patient with an eating disorder.Which outcome indicator is most applicable to this diagnosis?

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

Question 8

A nursing diagnosis for a patient with bulimia nervosa is Ineffective coping related to feelings of loneliness and isolation,as evidenced by use of overeating and self-induced vomiting to comfort self.Select the best outcome related to this diagnosis.Within 2 weeks,the patient will:

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 and isolation.

Question 9

A nurse monitors a patient with anorexia nervosa for complications of refeeding.Which assessment is most important?

A) Pupillary reaction to light
B) Temperature measurements
C) Reports of serum electrolytes
D) Complaints of sleep disturbances

Question 10

A nurse conducts group therapy on the eating disorders unit.Sessions are scheduled immediately after meals.What is the rationale?

A) Provide a forum for journaling about foods eaten.
B) Shift the patients' focus from food to psychotherapy.
C) Promote processing of anxiety associated with eating.
D) Focus on weight control mechanisms and food preparation.

Question 11

A history reveals that a patient virtually stopped eating 5 months ago and lost 25% of body weight.The nurse says,"Describe what you think about your present weight and how you look." Which response would be most consistent with anorexia nervosa?

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

Question 12

Which assessment finding is most associated with bulimia nervosa?

A) Prominent parotid glands
B) Peripheral edema
C) Thin,brittle hair
D) Amenorrhea

Question 13

A patient has anorexia nervosa.The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight.The serum potassium is 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) Ineffective health maintenance related to self-induced vomiting,as evidenced by swollen parotid glands and hyperkalemia
C) Disturbed energy field related to physical exertion in excess of energy produced through caloric intake,as evidenced by weight loss and hyperkalemia
D) Imbalanced nutrition: less than body requirements related to refusal to eat,as evidenced by loss of 25% of body weight and hypokalemia

Question 14

A patient has recently been under significant stress and worked long hours.At home,the patient watches television and eats until going to bed.The patient is too tired to exercise and has gained 25 pounds in 1 month.A desired outcome for the patient is to recognize anxiety that precedes binge eating and reduce it.Which intervention addresses the outcome?

A) Teach stress-reduction techniques such as relaxation and imagery.
B) Encourage the patient to design and implement an exercise program.
C) Explore ways in which the patient may feel more in control of the environment.
D) Encourage the patient to attend a support group such as Overeaters Anonymous.

Question 15

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

A) "What are your feelings about not eating foods 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 problems.You're thin now but still unhappy."

Question 16

A patient admitted to the eating disorders unit has yellow skin,the extremities are cold,and the heart rate is 42 bpm.The patient weighs 70 pounds;height is 5 feet 4 inches.The patient is quiet during the assessment saying only,"I will not eat until I lose enough weight to look thin." Select the best 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

Question 17

Therapeutic nutrition begins for a patient with anorexia nervosa who is 70% of ideal body weight.Which nursing intervention is most important to add to the plan of care?

A) Communicate empathy for the patient's feelings.
B) Observe for adverse effects associated with refeeding.
C) Teach patient about psychological origins of the disorder.
D) Direct the patient to balance energy expenditure and caloric intake.

Question 18

One bed is available on the eating disorders unit.Which patient should be admitted? The patient whose assessment findings show the weight dropped from:

A) 150 to 102 pounds over a 4-month period.Vital signs: temperature,96.1° F;pulse,38 beats/min;blood pressure 64/42 mm Hg.
B) 120 to 90 pounds over a 3-month period.Vital signs: temperature,97.2° F;pulse,50 beats/min;blood pressure 70/50 mm Hg.
C) 110 to 70 pounds over a 4-month period.Vital signs: temperature 97.6° F;pulse,60 beats/min;blood pressure 80/66 mm Hg.
D) 90 to 78 pounds over a 5-month period.Vital signs: temperature,98.6° F;pulse,62 beats/min;blood pressure 74/48 mm Hg.

Question 19

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

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

Question 20

A patient with anorexia nervosa is treated as an outpatient.Select the desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements.Within 1 week,the patient will:

A) gain 1 to 2 pounds.
B) exercise 1 hour daily.
C) take a laxative every 3 days.
D) weigh self accurately using balanced scales.

Question 21

Which finding for a patient with an eating disorder most clearly indicates the need for hospitalization?

A) Weight 15% below ideal weight
B) Urine output less than 30 mL/hr
C) Serum potassium 3.4 mEq/L
D) Pulse rate 54 beats/min

Question 22

A patient with anorexia nervosa in outpatient treatment has begun refeeding.Between the first and second appointment,the patient gained 8 pounds.The nurse should:

A) praise the weight gain.
B) assess lung sounds and extremities.
C) suggest implementation of an exercise program.
D) establish a higher target for weight gain for the next week.

Question 23

Which statement(s)by the parent of a teen with anorexia nervosa indicate(s)that teaching was effective? Select all that apply.

A) "We will find enough money for family counseling if it is needed."
B) "The entire family has benefited from our improved eating habits."
C) "Will treatment affect my teenager's standing on the gymnastics team?"
D) "We will work out our differences without getting into power struggles."
E) "I learned it is important to closely monitor all aspects of my teenager's life."

Question 24

When teaching a patient with binge-purge bulimia,the nurse should give priority to information about:

A) self-monitoring of daily food and fluid intake.
B) establishing the desired daily weight gain.
C) symptoms of hypokalemia.
D) self-esteem maintenance.

Question 25

Which nursing diagnosis is more relevant for a patient with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient with bulimia nervosa who purges?

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

Question 26

A nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight.Select the nurse's best comment.

A) "It bothers me to see you exercising."
B) "You and I will have to sit down and discuss this problem."
C) "Let's discuss the relationship between exercise and weight loss and how that affects your body."
D) "According to our agreement,exercising is not permitted until you have gained a specific amount of weight."

Question 27

Which statement is most likely from a patient with anorexia nervosa?

A) "I'm fat and ugly."
B) "I have nice eyes."
C) "I'm thin for my height."
D) "My mother is doesn't pay much attention to me."

Question 28

Prioritize these nursing diagnoses for a patient with bulimia nervosa.

A) Imbalanced nutrition: less than body requirements
B) Chronic low self-esteem
C) Loneliness
D) Risk for imbalanced fluid volume

Question 29

Which personality characteristic is most likely in a patient with anorexia nervosa?

A) Open displays of emotion
B) Perfectionism
C) Optimism
D) Flexibility

Question 30

Appropriate teaching for a patient with bulimia nervosa who binges and purges is:

A) not to skip meals or restrict food.
B) to eat a small meal after purging.
C) eat a large breakfast but no lunch.
D) increase nutritional intake after 4 PM.

Question 31

Which statement by a patient with an eating disorder reflects a correct understanding of the condition?

A) "Gaining 1 pound is as much of a disaster as gaining 100 pounds."
B) "I was happy when I was a size 4,so I must diet to that size."
C) "I've been coping with my feelings by overeating."
D) "Binging is the only way I can soothe myself."

Question 32

Which theme is most likely during family therapy with parents,siblings,and a teen patient with anorexia nervosa who engages in provocative behavior?

A) Stable coalitions between family members
B) Interpreting negative messages as positive
C) Competition between the patient and father
D) Lack of trust in the patient by family members