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. 

ANS: C
The nurse should identify that behavior modification therapy will be used because it provides the client with control over behavioral choices. Clients diagnosed with anorexia nervosa are often allowed to contract privileges based on weight gain. The client maintains control over eating and exercise. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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.

ANS: C
The nurse should assess that a home environment that is overprotective and demands perfection may be an influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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.

ANS: C
The nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self on the basis of self-attributes instead of appearance and to realize that perfection is unrealistic. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

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. 

ANS: A
The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

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.

ANS: D
Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders because the programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques aid in restoring healthy body weight. 

KEY: Cognitive Level: Application | Integrated Processes: Planning | Client Need: Psychosocial Integrity

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.” 

ANS: D
This client statement reflects a possible underlying etiology of anorexia nervosa. The client is expressing feelings about family dynamics that may have influenced the development of this disorder. Families who are overprotective and perfectionistic can contribute to a family member’s development of anorexia nervosa. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

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.”

ANS: B
The nurse should educate the family on the importance of family dynamics, involvement, and support in the treatment of anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of this disorder or impede the progress of recovery.

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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.

ANS: C
The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behaviors. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

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)

ANS: C
Lorcaserin was approved by the FDA in 2012. It suppresses the appetite by altering various 5-HT2C serotonin receptors. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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.”

ANS: A
The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food, followed by purging. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Physiological Integrity

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

ANS: C
Twenty mg of Prozac multiplied by three results in the calculated 60-mg daily dose ordered by the physician. Each 5 mL contains 20 mg. Five mL multiplied by three equals the liquid dosage of 15 mL. 

KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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

ANS: B
Based on Maslow’s hierarchy, the priority nursing diagnosis for this client must address physical needs prior to emotional considerations. This client must be immediately physically stabilized due to the life-threatening nature of his or her nutritional status.

KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Safe and Effective Care Environment: Management of Care

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. 

ANS: C
The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, and measurable and also include a time frame.

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Physiological Integrity

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

ANS: C
Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. The nurse should attribute this client’s fainting to the loss of alkaline stool due to laxative abuse, which would lead to a relative metabolic acidotic condition. 

KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

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

ANS: C
The nurse who refuses to engage in power struggles related to food consumption will probably be most effective when dealing with clients diagnosed with eating disorders. Because of this attitude the nurse recognizes that the real issues have little to do with food or eating patterns. The nurse will be able to focus on the control issues that precipitated these behaviors.

KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

ANS: B
By asking the client to recall a time in life when food could be consumed without purging, the nurse is assessing previously successful coping strategies. This information can be used by the client to modify maladaptive behaviors in the present and future.

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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.”

ANS: D
When the client states, “I don’t know why people are worried. I need to lose this weight,” the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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.

ANS: A
The ability to identify alternative methods of dealing with isolation will provide the client with effective coping strategies to use instead of bingeing and purging.

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

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

ANS: C
When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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. 

ANS: B
A nurse should remain with clients diagnosed with either anorexia nervosa or bulimia nervosa for at least 1 hour after meals. This allows the nurse to monitor for food discarding (anorexia nervosa) and/or self-induced vomiting (bulimia nervosa).

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity

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

ANS: A, B
The nurse should identify that topiramate (Topamax) is the drug of choice when treating binge eating with obesity and treating bingeing and purging with a diagnosis of bulimia nervosa. Topiramate (Topamax) is a novel anticonvulsant used in the long-term treatment of binge-eating disorder with obesity. The use of Topamax results in a significant decline in mean weekly binge frequency and significant reduction in body weight. With the use of this medication, episodes of bingeing and purging were decreased in clients diagnosed with bulimia nervosa. 

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies