Chapter 32: Eating Disorders: Nursing Care of Persons with Eating and Weight-Related Disorders

While caring for a client diagnosed with anorexia nervosa, a nurse anticipates that the client would have difficulty making which comment?

A) "I'm mad at you because you won't let me go on a pass unless I gain weight!"

B) "I need to have everything in its place and perfect."

C) "If I gain a pound, I'll just keep gaining weight."

D) "I am very involved in preparing my food and counting calories."

Ans: A

Feedback:

Most clients with anorexia nervosa avoid conflict and have difficulty expressing negative emotions, such as anger. Perfectionism and a drive for thinness are key for a client with anorexia. The behavior of clients with anorexia becomes organized around food-related activities such as preparing food, counting calories, and reading cookbooks.

A nurse is performing an admission assessment for an adolescent client diagnosed with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the client's diagnosis?

A) "My father was always very thin."

B) "I've never really liked myself."

C) "I have a lot of confidence in myself."

D) "I feel really close to my parents and my brother."

Ans: B

Feedback:

Body dissatisfaction is strongly related to low self-esteem and is a key characteristic of anorexia nervosa. Results of numerous studies have shown that low self-esteem, body dissatisfaction, and feelings of ineffectiveness and inadequacy put individuals at risk for an eating disorder. A father's body type has little impact on the development of this disorder. Families of individuals with anorexia are often labeled as overprotective, enmeshed, unable to resolve conflicts, and rigid

related to boundaries. Thus, a close relationship would not be associated with this disorder.

A client diagnosed with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following would the nurse include when teaching the client about the prescribed medication?

A) Closely monitor your fluid intake while taking this medication.

B) Stop taking this medication if it causes weight gain.

C) Expect menstrual irregularities, particularly if they've occurred previously.

D) Report any weight changes that occur

Ans: D

Feedback:

The most important concern when using SSRIs is decreased appetite and weight loss during the first few weeks of administration. Weight should be monitored, especially during this period. The intake of medication must be monitored for possible purging after administration. The effect of the medication will depend on whether it has had time to absorb. Monitoring fluid intake and menstrual irregularities are not associated with this group of medications.

A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories?

A) Paranoia

B) Primary insomnia

C) Depression

D) Aggression

Ans: C

Feedback:

Depression is common in individuals with anorexia nervosa, and these individuals are at risk to attempt suicide. Paranoia and insomnia are not comorbid conditions associated with anorexia nervosa. Clients with anorexia nervosa have difficulty expressing anger, so aggression would be unlikely.

A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which objective would the nurse include in the education plan?

A) Knowing the calorie content of numerous foods

B) Learning strategies to control impulses

C) Describing physiologic consequences of anorexia nervosa

D) Setting realistic goals

Ans: D

Feedback:

Because these clients tend to be perfectionist and set unrealistic goals for themselves, the nurse should educate the client about setting realistic and attainable goals. Other topics such as weight monitoring, resources, and effects of restrictive eating should be included in the nurse's educational plan.

A client diagnosed with bulimia nervosa is scheduled for a visit to the clinic. Which assessment of the client would a nurse expect to find?

A) Impulsivity

B) Panic

C) Hyperactivity

D) Delusions

Ans: A

Feedback:

Clients with bulimia often demonstrate impulsivity. Situations that produce feelings of being overwhelmed and powerless need to be explored, as does the client's ability to set boundaries, control impulsivity, and maintain quality relationships. These underlying issues precipitate binge eating. Panic, hyperactivity, and delusions are not associated with bulimia nervosa.

A nurse is planning to explain the purpose of the behavioral therapy technique of self-monitoring to a client diagnosed with bulimia nervosa. The nurse would emphasize keeping a diary to record which item?

A) Feelings of hunger

B) Efforts at distraction

C) Environmental cues

D) Rigid rules about eating

Ans: C

Feedback:

Self-monitoring is accomplished using a diary in which the client records binges and purges, precipitating emotions, and environmental cues. Emotional and environmental cues are identified, and alternative responses are suggested, tried, and reinforced. When a cue or stimulus leads to a dysfunctional or unhealthy response, the response can be eliminated or an alternate, healthier response to the cue can be substituted, tried, and then reinforced.

A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which item would the nurse include?

A) Discussion of strategies the teachers can use to counteract the role of media plays in encouraging eating disorders

B) Emphasis on the need for teachers to focus their prevention efforts on female students

C) Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns

D) Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades

Ans: A

Feedback:

Counteracting the influence of media should be stressed; both boys and girls are at risk for developing eating disorders. Other preventive educational strategies include the need to improve self-esteem and the importance of the influence of peer pressure on eating and weight.

A nurse is initiating a group for adolescent girls diagnosed with anorexia nervosa. Many of the clients in the group are irritable and resent having to attend. One of them comments, "This is a stupid waste of time!" Which response by the nurse would be most appropriate?

A) "If you feel that way, then you can just leave."

B) "You sound irritated; tell me about what is bothering you."

C) "You were assigned to this group by your therapist, so you must participate."

D) "Sit down and be quiet; your peers would appreciate some peace and quiet."

Ans: B

Feedback:

A nonjudgmental, accepting approach is best when working with clients with anorexia. This response is nonjudgmental and accepting; it also gives the client feedback about how the client is perceived by others and conveys that the nurse is interested in what the client is feeling. It is best to avoid a power struggle over control issues. Telling the client to leave or to sit down and be quiet is not therapeutic.

A nurse is reviewing the plan of care for a client diagnosed with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis?

A) Disturbed body image

B) Anxiety

C) Imbalanced nutrition: less than body requirements

D) Ineffective coping

Ans: C

Feedback:

A behavioral plan for increasing weight is part of a refeeding program that is instituted for a nursing diagnosis of imbalanced nutrition: less than body requirements. Interventions for disturbed body image and anxiety involve addressing interoceptive awareness, helping clients understand their feelings, and initiating interpersonal therapy. Interventions for ineffective coping would address integrating the clients back into school, renewing friendships and relationships, and promoting participation in family therapy.

A nurse is interviewing a client diagnosed with bulimia nervosa about family relationships. Which statement by the client would the nurse least likely associate with bulimia nervosa?

A) "My mother is my confidante for everything."

B) "My mother's happiness depends on me."

C) "My family basically has very few rules."

D) "My mother and I are close but not joined at the hip."

Ans: D

Feedback:

The statement about being close but not joined at the hip is not reflective of a family associated with bulimia. The families of individuals who experience bulimia nervosa are reported to be chaotic, with few rules and unclear boundaries. Often there is an overly close or enmeshed relationship between the daughter and mother. Daughters may relate that their mother is their "best friend." The boundaries are blurred in that the mother may interact with the daughter as a confidante, and this unhealthy relating further impedes the separation-individuation process. The daughters often feel guilty about separation and responsible for their mother's happiness and emotional well-being.

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which type of therapy would the nurse expect to implement in conjunction with pharmacologic therapy?

A) Behavioral therapy

B) Cognitive behavioral therapy

C) Interpersonal therapy

D) Family therapy

Ans: B

Feedback:

Although behavioral, interpersonal, and family therapy may be used, the combination of cognitive behavioral therapy and pharmacologic interventions is best for producing an initial decrease in symptoms.

When describing the similarities and differences between anorexia nervosa and bulimia nervosa, which characteristic would the nurse identify as specific to bulimia?

A) Boundary problems

B) Low self-esteem

C) Perfectionism

D) Obsessiveness

Ans: A

Feedback:

Boundary problems are specific to bulimia nervosa. Low self-esteem, perfectionism, and obsessiveness are characteristics of both disorders.

The psychiatric nurse is caring for a teenager with anorexia nervosa. The teenager has a body mass index of 15.2 kg/m2. Which assessment would be the priority for this client?

A) Asking the client, "Do you ever think about hurting yourself?"

B) Checking the client for a Russell's sign

C) Observing the client for obsessive-compulsive symptomology

D) Monitoring the client's vital signs

Ans: A

Feedback:

The priority is to assess for self-harm. Suicide and cardiopulmonary arrest are the leading cause of death for individuals with anorexia nervosa. These individuals tend to commit suicide with highly lethal means in which rescue is unlikely. Nurses need to pay special attention to the risk of suicide with these individuals. A significant number of individuals with eating disorders also self-injure without suicide attempts. Although assessing for Russell's signs, an indication of self-vomiting behavior, monitoring vital signs, and observing for obsessive-compulsive symptoms are important, they are not the priority.

An adolescent client who is brought to the emergency department appears emaciated and pale. The parents tell the nurse that the client has been diagnosed with anorexia nervosa. A history, physical examination, and laboratory testing are completed. Which assessment finding would lead the nurse to suspect that the client will be admitted to the hospital? Select all that apply.

A) Blood pressure of 110/60 mm Hg

B) Elevated serum potassium concentration

C) Decreased serum magnesium concentration

D) Heart rate of 40 beats/min

E) Statements of being "hopeless"

Ans: C, D, E

Feedback:

Indicators for hospitalization include a heart rate near 40 beats/min, blood pressure less than 80/50 mm Hg, decreased serum potassium concentrations, decreased serum magnesium concentrations, and severe depression and risk for suicide.

A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge eating disorder (BED). The students demonstrate understanding when they identify which characteristics as specific to BED. Select all that apply.

A) Clients typically are obese during childhood.

B) Clients refrain from purging behaviors.

C) Binge eating periods are shorter.

D) Clients engage in over-exercising.

E) Feelings of guilt do not occur after binging.

Ans: A, B

Feedback:

BED is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors (such as over-exercising). Individuals with BED also differ from those with other eating disorders in that most of them are or were obese. In addition, investigators have shown that individuals with BED have less dietary restraint and have a higher weight than those with bulimia nervosa. Binge-eating episodes are not shorter. Feelings of guilt occur with both bulimia nervosa and BED.

A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which characteristic would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply.

A) Body dissatisfaction

B) Feelings of control

C) Obsessiveness

D) Boundary problems

E) Sexuality fears

F) Cognitive distortions

Ans: A, C, F

Feedback:

Characteristics common to both anorexia and bulimia nervosa include body dissatisfaction, powerlessness (lack of control), obsessiveness, and cognitive distortions. Boundary problems are associated with bulimia nervosa. Sexuality fears and obssessiveness are associated with anorexia nervosa.

18. A client diagnosed with an eating disorder is to be hospitalized. When reviewing the client's medical record, which documentation would the nurse expect to find? Select all that apply.

A) Blood pressure of 100/60 mm Hg

B) Hypokalemia

C) Hyperphosphatemia

D) Heart rate of 44 beats/minute

E) Suicidal ideation

Ans: B, D, E

Feedback:

Criteria for hospitalization for eating disorders includes acute weight loss (<85% below ideal), temperature less than 36.1°C, heart rate near 40 beats/minute, hypokalemia, hypophosphatemia, hypomagnesemia, poor motivation to recover, blood pressure less than 80/50 mm Hg, risk for suicide, severe depression, failure to comply with treatment, and inadequate response to treatment at another level of care.

A nurse is conducting a class about eating disorders for a group of adolescents. One of the adolescents asks, 'What can I do if I think my friend has an eating disorder?' Which response by the nurse would be most appropriate? Select all that apply.

A) "Confront your friend and say, 'You have an eating disorder.'"

B) "Try reaching out to an adult if your friend refuses help."

C) "Frequently ask your friend about how many calories she or he is eating."

D) "Try to talk about other things besides food and weight"

E) "If your friend won't eat, be strong and force her to eat."

Ans: B, D

Feedback:

Helpful strategies for family and friends of individuals with eating disorders include telling the person of the concern and offering assistance, suggesting they seek help from a professional, reaching out to an adult if the person refuses to seek help, not discussing weight or the number of calories being consumed, talking about things other than food, and avoiding power struggles (not forcing the person to eat).