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Chapter 31

Nursing

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Chapter 31. Eating Disorders

Multiple Choice

1) A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice?

A. This therapy will increase the client’s motivation to gain weight.

B. This therapy will reward the client for perfectionist achievements.

C. This therapy will provide the client with control over behavioral choices.

D. This therapy will protect the client from parental overindulgence.

 

2. Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client’s home environment should a nurse associate with the development of this disorder?

A. The home environment maintains loose personal boundaries.

B. The home environment places an overemphasis on food.

C. The home environment is overprotective and demands perfection.

D. The home environment condones corporal punishment.

3. A client’s altered body image is evidenced by claims of “feeling fat,” even though the client is emaciated. Which is the appropriate outcome criterion for this client’s problem?

A. The client will consume adequate calories to sustain normal weight.

B. The client will cease strenuous exercise programs.

C. The client will perceive an ideal body weight and shape as normal.

D. The client will not express a preoccupation with food.

4. A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding?

A. The emesis produced during purging is acidic and corrodes the tooth enamel.

B. Purging causes the depletion of dietary calcium.

C. Food is rapidly ingested without proper mastication.

D. Poor dental and oral hygiene leads to dental caries.

 

 

 

5. Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders?

A. These programs help clients correct distorted body image.

B. These programs address underlying client anger.

C. These programs help clients manage uncontrollable behaviors.

D. These programs allow clients to maintain control.

 

6. A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects a theory about the underlying etiology of this disorder?

A. “I was just trying to be like everyone else.”

B. “All the skaters on the team are following an approved 1,200-calorie diet.”

C. “When I lose skating competitions, I also lose my appetite.”

D. “I am angry at my mother. I can get her approval only when I win competitions.”

 

7. The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply?

A. “Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions.”

B. “Family intervention and support are important in your child’s recovery.”

C. “Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support.”

D. “Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed.”

 

8. A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change?

A. The client gains 2 pounds in 1 week.

B. The client focuses conversations on nutritious food.

C. The client demonstrates healthy coping mechanisms that decrease anxiety.

D. The client verbalizes an understanding of the etiology of the disorder.

 

 

9. A morbidly obese client is prescribed an anorexiant medication. The nurse should prepare to teach the client about which medication?

A. Diazepam (Valium)

B. Dexfenfluramine (Redux)

C. Lorcaserin (Belviq)

D. Pemoline (Cylert)

 

 

 

10. A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred?

A. “Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.”

B. “Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not.”

C. “Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not.”

D. “Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.”

 

 

 

11. A client diagnosed with bulimia nervosa is to receive fluoxetine (Prozac) by oral solution. The medication is supplied in a 100-mL bottle. The label reads 20 mg/5 mL. The doctor orders 60 mg q day. Which dose of this medication should the nurse dispense?

A. 25 mL

B. 20 mL

C. 15 mL

D. 10 mL

 

 

12. A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time?

A. Ineffective coping R/T food obsession

B. Altered nutrition: less than body requirements R/T inadequate food intake

C. Risk for injury R/T suicidal tendencies

D. Altered body image R/T perceived obesity

 

 

13. A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client?

A. The client will use stress-reducing techniques to avoid purging.

B. The client will discuss chaos in personal life and be able to verbalize a link to purging.

C. The client will gain 2 pounds prior to the next weekly appointment.

D. The client will remain free of signs and symptoms of malnutrition and dehydration.

 

14. When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this client’s symptoms?

A. Increased creatinine and blood urea nitrogen (BUN) levels

B. Abnormal electroencephalogram (EEG)

C. Metabolic acidosis

D. Metabolic alkalosis

 

 

15. A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients?

A. The nurse who understands the importance of three balanced meals a day

B. The nurse who permits children to have dessert only after finishing the food on their plate

C. The nurse who refuses to engage in power struggles related to food consumption

D. The nurse who grew up poor and frequently did not have enough food to eat

 

16. A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention?

A. To gain additional information about the progression of the disease process

B. To emphasize that the client is capable of consuming food without purging

C. To incorporate specific foods into the meal plan to reflect pleasant memories

D. To assist the client to become more compliant with the treatment plan

 

 

17. A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis?

A. “I do not use any laxatives or diuretics to lose weight.”

B. “I am losing lots of hair. It’s coming out in handfuls.”

C. “I know that I am thin, but I refuse to be fat!”

D. “I don’t know why people are worried. I need to lose this weight.”

 

 

18. A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis?

A. The client will identify two alternative methods of dealing with isolation by day 3.

B. The client will appropriately express angry feelings about lack of control by week 2.

C. The client will verbalize two positive self attributes by day 3.

D. The client will list five ways that the body reacts to bingeing and purging.

 

 

19. A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the best rationale for scheduling group therapy at this time?

A. To shift the clients’ focus from food to psychotherapy

B. To prevent the use of maladaptive defense mechanisms

C. To promote the processing of anxiety associated with eating

D. To focus on weight control mechanisms and food preparation

 

 

20. Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa?

A. Provide privacy during meals.

B. Remain with the client for at least 1 hour after the meal.

C. Encourage the client to keep a journal to document types of food consumed.

D. Restrict client privileges when provided food is not completely consumed.

 

Multiple Response

 

21. A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? Select all that apply.

A. Binge eating with obesity

B. Bingeing and purging with a diagnosis of bulimia nervosa

C. Weight loss with a diagnosis of anorexia nervosa

D. Amenorrhea with a diagnosis of anorexia nervosa

E. Emaciation with a diagnosis of bulimia nervosa