Question 1

Care planning requires that a nurse recognize that the dynamic focus directing care of a patient with anorexia nervosa is:

Accepted Answer

For a patient with anorexia nervosa,the major issue is about control of the person's life and fears.Whether the fear is of maturity,independence,failure,sexuality,or parental demands,patients with anorexia nervosa believe the solution to the problem lies in controlling their food intake and their bodies.With increasing family concern,patients with anorexia nervosa also control the focus of significant others.

Question 2

What is the central concept around which a family education plan for preventing childhood eating problems is constructed?

Accepted Answer

The education plan should be built around the concept that self-demand feeding in children promotes adaptive eating regulation responses.This is often difficult to accept for parents who have acquired maladaptive eating regulation responses or who believe various myths about feeding.

Question 3

A nurse has recently been assigned to a unit that specializes in the care of patients diagnosed with eating disorders.The nurse should consider which action as having priority when preparing for this new assignment?

Accepted Answer

Before working with patients with maladaptive eating regulation responses,nurses must closely examine their own feelings and prejudices about weight and body size.Nurses who suspect that they have an eating disorder or are in some way prejudiced may not be able to provide care for patients who cannot regulate their eating responses.

Question 4

The first step in the creation of a therapeutic alliance between a nurse and a patient with a maladaptive response to eating regulation is:

Accepted Answer

A nurse-patient contract obtains commitment to the treatment process.By signing a contract,the patient will understand the treatment he or she will be receiving and will be able to make informed decisions about treatment and honoring the contract.

Question 5

A short-term goal for a patient with anorexia nervosa is "Patient will select and eat a balanced diet." The nurse includes which nursing intervention in the care plan that will foster attainment of this goal?

Accepted Answer

Nursing interventions that help to achieve this goal involve the use of protocols that specify the number of meals and their timing and that the diet is balanced.Exercise for the purpose of compensating for additional caloric intake is discouraged.Contracts should be enforced 100% of the time.The frequency of weighing is also determined as part of a treatment protocol and is not used as a reward for eating.

Question 6

After assessing a patient with anorexia nervosa,a nurse writes the following nursing diagnosis: imbalanced nutrition,less than body requirements related to refusal to eat as evidenced by being 25% below body weight for height.The expected outcome should be listed as "Patient will:

Accepted Answer

The outcome is a more comprehensive statement than short-term goals that contribute to eventual outcome attainment.The other options should be considered short-term goals.

Question 7

Which information would be most important to a nurse assessing a patient's motivation to change behavior associated with maladaptive eating regulation responses?

Accepted Answer

This information relates directly to a means of determining the patient's motivation for change.Identifying the disadvantages of the maladaptive behavior as well as the factors that were the basis of the disorder assists in evaluating patient insight.Naming a supportive person relates to environmental support for change.

Question 8

A major difference in assessment findings between a patient with anorexia nervosa and a patient with bulimia nervosa is that the patient with bulimia:

Accepted Answer

Patients with anorexia nervosa are underweight; the patient with bulimia has experienced less weight loss.Both may be malnourished.Patients with anorexia nervosa deny hunger; patients with bulimia do not deny feeling hungry.Patients with anorexia nervosa have body-image distortion; patients with bulimia are more likely to experience body-image dissatisfaction.

Question 9

The coping mechanism patients with anorexia nervosa use maladaptively is:

Accepted Answer

Patients with anorexia nervosa use denial about the appropriateness of body weight,their nutritional intake,their insistence of normalcy,and their need for help.

Question 10

When undertaking care for patients with eating disorders,a nurse should first:

Accepted Answer

Self-examination before beginning therapeutic work is wise.If the nurse suspects that he or she has an eating disorder,it may be difficult to provide care for patients who cannot regulate their eating responses.

Question 11

A nurse assesses that which individual is most likely to engage in binge-eating behaviors characteristic of bulimia? A person who:

Accepted Answer

A person with bulimia typically is of average weight or is slightly overweight and has a history of unsuccessful dieting.

Question 12

Which statement would help the nurse conclude that a patient with an eating disorder is exhibiting cognitive distortion?

Accepted Answer

Cognitive distortions are personal beliefs that lack logic and are not reflective of reality.Bingeing is a maladaptive eating response to feelings of isolation and loneliness and is not a cure for those feelings in spite of the patient's belief.The other statements do not represent cognitive distortions since they are logical and based in reality.

Question 13

An individual is seeking treatment for bulimia nervosa.The therapist decides to use cognitive behavioral therapy and medication.For what medication can a nurse expect to develop a patient education program?

Accepted Answer

Antidepressant medications have been shown to have a therapeutic benefit for many patients with bulimia and binge-eating disorder.Because the side-effect profile is least troublesome for SSRI antidepressants,this is the type of medication the nurse can expect to be used.

Question 14

A patient has a maladaptive response to eating regulation.Findings include the following: T,96.6° F; BP,68/40; P,40; R,20; poor skin turgor; admits to restricting intake to 350 calories daily; and diagnostic testing reveals serum potassium of 2.9 mEq/L and urine specific gravity of 1.028.What is the highest priority nursing diagnosis for this patient?

Accepted Answer

The patient is malnourished and is experiencing dehydration,as evidenced by the low BP,poor skin turgor,and high urine specific gravity.For this reason,highest priority should be placed on restoring circulating volume,followed by increasing caloric intake.When the primary physiological needs are being met (according to Maslow),secondary needs such as body image can be addressed,and powerlessness can be explored if it applies.

Question 15

A patient is diagnosed with anorexia nervosa.A nurse who is assessing for co-morbid psychiatric disorders should begin by looking for signs of which common,concurrent diagnosis?

Accepted Answer

Co-morbid major depression or dysthymia has been reported in 50% to 75% of people with anorexia and bulimia,and obsessive-compulsive disorder may be found in as many as 25% of patients with anorexia nervosa.Anxiety disorders and substance abuse also occur,but their incidence is lower than depression.Individuals who have binge-eating disorder,not anorexia nervosa,are more likely to have a personality disorder.Schizophrenia is not reported to be associated with anorexia nervosa.

Question 16

Which therapy is shown through evidence to be most effective for a patient with an eating disorder?

Accepted Answer

Eating disorders clearly involve cognitive distortions and faulty thinking about body shape,body weight,and food.Research has shown that cognitive behavioral therapy is superior to other types of psychotherapy.

Question 17

What is the rationale for establishing a contract with a patient with an eating disorder at the beginning of treatment?

Accepted Answer

It is often difficult to secure patient cooperation with treatment.A contract helps engage the patient in the therapeutic alliance and obtains commitment to the treatment process.

Question 18

A nurse has completed the assessment for a patient who has a maladaptive response to eating regulation.Findings include: height,5 feet 3 inches; current weight,80 pounds with weight loss of 30% of body weight; poor skin turgor; lanugo; amenorrhea of 6 months' duration; and admits to restricting intake to 350 calories daily.These assessment findings are most consistent with the medical diagnosis of:

Accepted Answer

The assessment data are most consistent with the medical diagnosis of anorexia nervosa,a disorder in which intense fear of gaining weight leads to a body weight 15% below normal for height and amenorrhea.Disturbed body image is not a medical diagnosis.

Question 19

Which goal has priority for a patient with anorexia nervosa undergoing nutritional stabilization?

Accepted Answer

The first goal is that the patient is able to eat meals that are served.Only then may the patient assume some control over scheduling of meals and food selection.Finally,the patient can shop for food and prepare it under supervision.

Question 20

A patient who has a maladaptive response to eating regulation says,"I know my parents are already upset about me losing so much weight,but I need to lose a lot more to be at a weight that doesn't make me feel fat." This statement suggests that the best treatment setting for this patient would be:

Accepted Answer

Hospitalization would be appropriate because reinstatement of physiological stability is a high priority and may not be possible on an outpatient basis because of the patient's reluctance to accept treatment.

Quiz 24: Eating Regulation Responses and Eating Disorders