Varcarolis Ch 18 Eating Disorders

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?

a. Binge eating disorder

b. Anorexia nervosa

c. Bulimia nervosa

d. Pica

b. Anorexia nervosa

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

a. Weight, muscle, and fat are congruent with height, frame, age, and sex.

b. Calorie intake is within the required parameters of the treatment plan.

c. Weight reaches the established normal range for the patient.

d. Patient expresses satisfaction with body appearance.

d. Patient expresses satisfaction with body appearance.

A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patient's oral intake, 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?"

c. "What do you eat in a typical day?"

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and has 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 am grossly underweight, but that's what I want."

d. "I am a few pounds overweight, but I can live with it."

a. "I am fat and ugly."

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The patient's current 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. 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 malnutrition as evidenced by loss of 25% of body weight and hypokalemia

d. Imbalanced nutrition: less than body requirements, related to malnutrition as evidenced by loss of 25% of body weight and hypokalemia

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

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 2 pounds.

d. gain 1 to 2 pounds.

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

a. Assess for depression and anxiety.

b. Observe for adverse effects of re-feeding.

c. Communicate empathy for the patient's feelings.

d. Help the patient balance energy expenditure and caloric intake.

b. Observe for adverse effects of re-feeding.

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 must be routinely collected.

b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment.

c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met.

d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.

b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment.

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

a. Renal

b. Endocrine

c. Central nervous

d. Cardiovascular

d. Cardiovascular

A psychiatric clinical nurse specialist uses cognitive therapy techniques with 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 the food 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 does not seem to solve your problems. You are thin now but still unhappy."

d. "Being thin does not seem to solve your problems. You are thin now but still unhappy."

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient to:

a. eat a small meal after purging.

b. avoid skipping meals or restricting food.

c. concentrate oral intake after 4 PM daily.

d. understand the value of reading journal entries aloud to others.

b. avoid skipping meals or restricting food.

What behavior by a nurse caring for a patient diagnosed with an eating disorder indicates the nurse needs supervision?

a. The nurse's comments are nonjudgmental.

b. The nurse uses an authoritarian manner when interacting with the patient.

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.

b. The nurse uses an authoritarian manner when interacting with the patient.

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, "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."

d. identify two alternative methods of coping with loneliness."

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. Explore patient needs for health teaching.

d. Assess for signs of impulsive eating.

a. Assist the patient to identify triggers to binge eating.

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

a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9° C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg

b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36° C; pulse, 50 beats/min; blood pressure, 70/50 mm Hg

c. 110 to 70 pounds over a 4-month period. Vital signs: temperature, 36.5° C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg

d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7° C; pulse, 62 beats/min; blood pressure, 74/48 mm Hg

a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9° C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg

While providing health teaching for a patient diagnosed with bulimia nervosa, a nurse should emphasize information about:

a. self-monitoring of daily food and fluid intake.

b. establishing the desired daily weight gain.

c. recognizing symptoms of hypokalemia.

d. self-esteem maintenance.

c. recognizing symptoms of hypokalemia.

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 70 pounds and is 5 feet, 4 inches tall. Which condition should be documented?

a. Amenorrhea

b. Alopecia

c. Lanugo

d. Stupor

c. Lanugo

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet, 4 inches. The patient is quiet and says only, "I won't eat until I look thin." What is 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

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

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

a. maintaining patients' concentration and attention.

b. shifting the patients' focus from food to psychotherapy.

c. focusing on weight control mechanisms and food preparation.

d. processing the heightened anxiety associated with eating.

d. processing the heightened anxiety associated with eating.

Physical assessment of a patient diagnosed with bulimia nervosa often reveals:

a. prominent parotid glands.

b. peripheral edema.

c. thin, brittle hair.

d. amenorrhea.

a. prominent parotid glands.

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

b. Rigidity, perfectionism

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

a. Urine output: 40 ml/hr

b. Pulse rate: 58 beats/min

c. Serum potassium: 3.4 mEq/L

d. Systolic blood pressure: 62 mm Hg

d. Systolic blood pressure: 62 mm Hg

Which statement is a nurse most likely to hear from a patient diagnosed with anorexia nervosa?

a. "I would be happy if I could lose 20 more pounds."

b. "My parents don't pay much attention to me."

c. "I'm thin for my height."

d. "I have nice eyes."

a. "I would be happy if I could lose 20 more pounds."

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

a. Powerlessness

b. Ineffective coping

c. Disturbed body image

d. Imbalanced nutrition: less than body requirements

d. Imbalanced nutrition: less than body requirements

An outpatient diagnosed with anorexia nervosa has begun re-feeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should:

a. assess lung sounds and extremities.

b. suggest the 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.

a. assess lung sounds and extremities.

When a nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight, the nurse should state:

a. "You and I will have to sit down and discuss this problem."

b. "It bothers me to see you exercising. You'll lose more weight."

c. "Let's discuss the relationship between exercise and weight loss and how that affects your body."

d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

A patient diagnosed with anorexia nervosa has a body mass index (BMI) of 14.8 kg/m2. Which assessment finding is most likely to accompany this value?

a. Cachexia

b. Leukocytosis

c. Hyperthermia

d. Hypertension

a. Cachexia

A patient referred to the eating disorders clinic has lost 35 pounds in 3 months and has developed amenorrhea. 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

ANS: A, C, D, F

a. Peripheral edema

c. Constipation

d. Hypotension

f. Lanugo

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

ANS: C, D, E

c. Adherence to a selected menu

d. Observation during and after meals

e. Monitoring during bathroom trips