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A young adult diagnosed with the restricting form of anorexia nervosa has identified “getting fat” as a “huge concern.” Which question provides the nurse with information that best assesses the client's view of how the concern is being managed?
A. What is it about your weight that causes you such a “huge concern”?
B. How often do you purge as a means of minimizing the risk of “getting fat”?
C. Has your weight loss given you a sense of control over not “getting fat”?
D. Are there alternative ways to managing your “huge concern” about your weight?
Answer: C
Rationale: The person with anorexia nervosa has an extreme fear of gaining weight or “becoming fat” that is not relieved by weight loss. This fear may actually intensify as weight loss accumulates and so it is important to assess the client's perception of current management strategies. While the other options provide insight into the client's views about weight, purging, and coping strategies, they do not provide information on how the client views the effectiveness of the current strategy of severely limiting food intake.
A 14-year-old female client is brought to the clinic by their parent for possible depression. The client’s parent reports that, “On several occasions, I’ve found her in the middle of the night eating a whole pizza and a carton of ice cream.” When asked to discuss the situation, the client begins to cry. The nurse interprets this behavior as supporting which diagnosis?
A. Anorexia nervosa, restricting subtype
B. Anorexia nervosa, binge-eating subtype
C. Bulimia nervosa
D. Purging
Answer: C
Rationale: With bulimia nervosa, there is a seeming lack of control or inability to stop eating during a binge episode. The type of food consumed varies, but typically is an indulged craving for high-calorie, sweet, or carbohydrate foods such as pastry, ice cream, cake, or pizza. Clients with bulimia nervosa are usually ashamed of their eating problem and attempt to hide their symptoms. Anorexia nervosa involves the restriction of calories. Purging is the periodic evacuation of the digestive tract by self-induced vomiting or excessive use of laxatives and diuretics.
The nurse is caring for a 14-year-old diagnosed with an eating disorder. Which interview question would the nurse use to focus on the most relevant issue associated with family dynamics and the development of eating disorders?
A. “How many brothers and sisters do you have?”
B. “How old were you when your parents divorced?”
C. “How would you describe the relationship you have with your parents?”
D. “How are your parents handling your views on eating and your weight?”
Answer: C
Rationale: In a family with an adolescent with an eating disorder, the early appearance is one of a loving, cohesive family with model compliant, obedient, and perfectionist children who aim to please parents and teachers. Further evidence usually reveals unresolved family conflicts with inconsistent patterns of overprotective and rigid parenting in which the child remains in a dependent state with the eating disorder being a desperate attempt by the adolescent to separate from the family system. While the other options can provide insight into the stress the client may be experiencing, none provides information regarding the vital parental–child relationship.
A young adult diagnosed with bulimia nervosa presents at the mental health clinic telling the nurse, “I just can’t seem to keep any close relationships with people. Why is this so?” When responding to the client, which information about behavior and interpersonal relationships would the nurse incorporate into the response?
A. Need to control
B. Need to lie and keep secrets
C. Obsession with the weight
D. Binging and purging behaviors
Answer: B
Rationale: In clients with bulimia nervosa, social skills are inadequate and interpersonal relationships suffer from the person’s lying and secretive behaviors. The client’s need to control, obsession with the weight, and binging and purging behaviors are not research-documented reasons for problems associated with interpersonal relationships.
A nurse is reviewing the family history of a client diagnosed with anorexia nervosa. Which parental behavior would the nurse identify as being most relevant?
A. Child is encouraged to be “popular.”
B. Parents stress the belief that “looks are everything.”
C. Child is made to be dependent on the parents.
D. Parents provide little guidance for the child.
Answer: C
Rationale: Evidence usually reveals unresolved family conflicts with inconsistent patterns of overprotective and rigid parenting in which the child remains in a dependent state. Children who develop anorexia are not pushed to be independent nor are the parents lacking in guidance. They are not necessarily raised to believe that “looks are everything” or that popularity is important.
A nurse is working with a client diagnosed with an eating disorder. The nurse is gathering data about the client. Which intervention would be most appropriate for the nurse to use initially to minimize the risk of client bias?
A. Share with the client that truthfulness is vital to the client's recovery.
B. Interview the client about the client's feelings about the body.
C. Encourage the client to include the client's family in the therapy.
D. Complete a self-examination of feelings about food, dieting, and body image.
Answer: D
Rationale: The nurse’s attitude and approach when interacting with the client, whether in an emergency room or other clinical situation, is essential to earning the trust of the client. Many individuals with eating disorders are ashamed of their behaviors and may want to divulge the magnitude of their problem but may refrain because of negative or blocking statements made by the nurse or if the client perceives the nurse is uncaring or judgmental. It is important for the nurse to self-examine their own feelings about food, dieting, and body image to maintain an objective view of the client’s situation. None of the other options are directly associated with obtaining unbiased data from the clients.
A nurse is providing care to a client newly diagnosed with an eating disorder. The client asks, “Why are you checking my bowel movements and urine?” When responding to the client, the nurse integrates knowledge of which information?
A. Multisystem organ failure is common with this diagnosis.
B. Laxative or diuretic use is commonly associated with this diagnosis.
C. Disruption of all organ systems occurs as a result of this condition.
D. Kidney failure is often brought on by starvation level eating habits.
Answer: B
Rationale: The nurse should determine any changes in bowel elimination or decreased urine output because they relate to the laxative or diuretic use commonly associated with eating disorders. A client with an eating disorder would be stable and exhibit no physiologic signs or symptoms of kidney or organ failure. At this point, there would be no acute physiologic response to the disease process itself.
Assessment of a client with an eating disorder reveals that the client has altered oral mucous membranes. Based on this finding, the nurse would suspect the client engages in which behavior?
A. Limiting calorie intake
B. Engaging in poor oral hygiene
C. Frequent self-induced vomiting
D. Routine purging with laxatives
Answer: C
Rationale: The usual problems encountered in the care of clients with eating disorders may include altered oral mucous membranes, related to frequent vomiting. None of the other options have as a direct impact on oral mucous membrane health as does frequent vomiting.
A client is diagnosed with an eating disorder. Which intervention would the nurse implement to effectively refocus the client's attention on eating and food?
A. Weighing the client daily, before breakfast, using the same scale
B. Discussing the initiation of a behavior modification program with the client
C. Restricting time devoting to meals to 30 minutes
D. Using a firm and supportive approach to eating and related behaviors
Answer: C
Rationale: Although a plan of care for the client with an eating disorder should include all noted options, restricting time for meals to 30 minutes, however, is the only option intended to reduce the client's focus on food and eating.
A client diagnosed with anorexia nervosa asks, “How do I learn to be a perfectly normal person?” When updating the client's plan of care, the nurse should include which intervention to best address the client's request?
A. Use a firm and supportive approach to eating and related behaviors.
B. Provide ways to reinforce the client's strengths and positive attributes.
C. Assist the client in setting practical limits on expectations for self-standards.
D. Avoid discussions that focus on food and weight.
Answer: C
Rationale: A plan of care for the client with an eating disorder should include the following action: assist the client in setting practical limits on expectations for self-standards. All options are appropriate nursing interventions when caring for clients with eating disorders. However, with the statement by the client, the nurse knows that it is time to focus on setting limits on expectations.
A client is diagnosed with an eating disorder. When evaluating the client’s progress toward recovery, which behavior would the nurse identify as reflecting outcome achievement?
A. Client agrees to be weighed only once daily.
B. Client independently makes healthy eating choices regularly.
C. Client verbalizes the impact shame associated with purging has on self-worth.
D. Client voices interest in learning about the role of support groups.
Answer: B
Rationale: It is important to evaluate family interaction patterns and progress of the client toward autonomy and independent decision making such as making healthy eating choices. While promising, the other options demonstrate the beginnings of self-reflection and insight but not autonomy.
The client is diagnosed with an eating disorder. When developing outcomes for this client, which outcome would the nurse use to best indicate the client's progress with treatment?
A. Client demonstrates a stable body image.
B. Client demonstrates stable coping skills.
C. Client embraces a realistic self-image.
D. Client demonstrates less dependence on parents.
Answer: C
Rationale: Progress with treatment is seen as the client embraces a realistic self-image and sets reasonable expectations and standards for achievement. An improved sense of control over self and coping skills to confront environmental stressors with self-confidence will result in a more positive self-esteem. The remaining options state a stable degree of self-image and coping skills not necessarily realistic or healthy. While less dependence is an improvement, it does not indicate independence.
Documentation for a client diagnosed with anorexia nervosa, restricting subtype, reveals that the client is now able to self-reflect and recognize the relationship between eating patterns and the disorder. The nurse understands that this insight demonstrates the achievement of which treatment goal?
A. Repair of family relationships
B. Reasonable expectations met.
C. Understanding of disease process on physical health.
D. Release of guilt and shame over previous behavior
Answer: D
Rationale: As the guilt and shame over previous behavior are released, the client is able to recognize the relationship between food, eating patterns, and the ill-fated journey of the disorder. The other options are not associated with self-reflection regarding the disorder.
When reinforcing teaching with the parents of the client diagnosed with binge-eating disorder, the nurse suggests screening for which comorbid mental health condition(s)? Select all that apply.
A. A somatic disorder
B. Obsessive-compulsive disorder
C. Substance use disorder
D. Aggression and violence
E. Depression
Answer: C, E
Rationale: Approximately 75% of individuals with binge-eating disorder have at least one or more mental disorders including specific phobias, social anxiety disorder, depression, posttraumatic stress disorder, attention deficit hyperactivity disorder, or substance use or dependence, usually with alcohol. Personality disorders are seen in about 30% of individuals with binge-eating disorder.
Neither somatic disorders nor obsessive-compulsive symptoms are generally associated with binge-eating disorder. Aggression and violence are generally associated with this condition
Which assessment data would a nurse identify as supporting a diagnosis of binge-eating disorder? Select all that apply.
A) Maladaptive social skills
B. Self-professed “loner”
C. Overweight at a young age
D. Evidence of a low self-image
E. History of impulsive behaviors
Answer: C, D, E
Rationale: Although it is not known exactly what causes the binge-eating, most individuals with the disorder tend to have a low self-image and impulsive behaviors. The individual with binge-eating disorder tends to be overweight or obese as a result of the binge-eating. A family history of an eating disorder increases the risk for an individual to develop binge-eating disorder. Media emphasis on weight and appearance is considered an underlying stigma that adds to the self-criticism, shame, and guilt. Being a “loner” and having maladaptive social skills are not associated with this condition.
A nurse is reviewing the medical record of a client diagnosed with an eating disorder. Which assessment data would the nurse identify as supporting this diagnosis? Select all that apply.
A. Intolerance to heat
B. Reports of insomnia
C. Sensitivity to cold
D. Increased fatigue
E. Increased anxiety level
Answer: B, C, D, E
Rationale: Data to support this diagnosis would include reports of insomnia or fatigue, increased feelings of anxiety, and sensitivity to cold temperatures. An intolerance to heat is not associated with eating disorders.
The nurse in a clinic is providing care for a 16-year-old female client who is underweight. When gathering information from this client, which sign would lead the nurse to suspect that the client is possibly experiencing anorexia nervosa? Select all that apply.
A. Calluses on the back of the hands
B. Eroded tooth enamel
C. Menses that began at age 10
D. Brittle dry nails
E. Decreased hair growth
Answer: A, B, D, E
Rationale: The nurse would observe the body for general signs of inadequate nutrition, decreased hair growth, brittle dry nails or skin, and erosion of tooth enamel as well as abrasions or calluses on the back of the hands related to induced purging. Early menses is not associated with an eating disorder.
A nurse is providing care for a group of clients diagnosed with eating disorders. Which intervention(s) would be appropriate to implement? Select all that apply.
A. Meeting the clients' need for interpersonal interaction
B. Introducing them to proper nutritional habits
C. Acting as a group leader for an appropriate support group
D. Monitoring their physiologic functions
E. Determining pharmacotherapeutic dosages
nswer: A, B, C, D
Rationale: The nurse may implement a variety of interventions when working with a client who has an eating disorder. In addition to meeting the physiologic and psychological needs of the client, the nurse may also function to provide interventions that include teaching, counseling, and being a group leader. Nurses do not independently determine pharmacotherapeutic dosages.
Discharge planning for a client diagnosed with an eating disorder includes a referral to a support group. The nurse explains to the client the reason for the referral. Which information would the nurse include? Select all that apply.
A. Aids in the prevention of a relapse.
B. Provides social interaction.
C. Helps reinforce treatment outcomes.
D. Prevents return to maladaptive eating habits.
E. Reinforces healthy coping skills.
Answer: A, C, D, E
Rationale: Referrals to support groups are helpful to reinforce treatment outcomes including relapse prevention, healthy coping skills and prevention of a return to maladaptive eating habits. These referrals are not meant to provide social support.
A nurse is reviewing the physical examination findings of an adolescent diagnosed with anorexia nervosa. Which data would the nurse expect to find? Select all that apply.
A. Bradycardia
B. Elevated white blood cell (WBC) count
C. Elevated liver enzymes
D. Hypertension
E. Impaired kidney function
Answer: A, C, E
Rationale: Physical examination findings associated with anorexia nervosa include arrhythmias, including bradycardia, decreased WBC count, elevated liver enzymes, hypotension, and impaired kidney function.