Anorexia
Healthy BMI range is:
A) 25-28
B) 19-24
C) 30-40
D) 15-18
B) 19-24 is health BMI ranges. <18 is underweight which is where anorexics will fall.
Assessment findings of a bulimic client include:
A) underweight, and confidence in personal appearance.
B) normal weight and electrolyte imbalances
C) overweight and intact teeth
D) underweight and food restrictions.
B) normal weight and electrolyte imbalances. Bulimic patients are often of normal weight and will exhibit electrolyte imbalances r/t binging and purging. Teeth erosion occurs as a result of acidic vomitus eating away at the enamel. They are often excessively concerned over their personal appearance.
Which of the following is considered an obese BMI.
A) BMI 31
B) BMI 24
C) BMI 17
D) BMI 21
A) BMI 31. any BMI >30 is considered obese.
What time is best to weigh a patient with an eating disorder?
A) before bedtime after voiding
B) in morning after voiding
C) Before bedtime before voiding
D) in morning before voiding
B) in the morning after voiding. Important to do same time of the day using the same scale with patients with eating disorders for consistency and accuracy.
Theories suggest family plays a role in the development of eating disorders. This is most likely r/t focus on ___ in the family.
A) acceptance & criticism
B) support & rebellion
C) lack of control & disgust
D) overprotection & perfectionism
D) overprotection & perfectionism. Predisposing factors for eating disorders result from elements of power and control in the family. High value is placed on perfectionism & child feels need to satisfy parents. Child often is overprotected by parents. Eating disorders are a way for the child to regain their own control.
Assessment findings of a client with anorexia may include:
A) normal weight, regular menses
B) underweight, regular menses
C) amenorrhea, bradycardia
D) amenorrhea, tachycardia
C) amenorrhea and bradycardia. Menses often cease, cold intolerances develop, hypotension, lanugo and variety of metabolic changes occur in the body as a result of anorexia.
Which is an appropriate LTG of a patient with an eating disorder.
A) client will demonstrate increase in self-esteem
B) client will perform own ADL's
C) client will achieve IBW within 1 pound
D) client will use laxatives instead of vomiting.
A) client will demonstrate increase in self- esteem ADL's usually not a problem but if it was this is more appropriate for a STG not long term goal. Would not want to have IBW within 1 pound as you do not want to focus on the weight.
The nurse is teaching about weight loss to an obese client. The nurse should teach the client
A) to do a rapid weight loss program
B) to avoid stress at all cost
C) to deal with stress with alternative measures
D) eat very low calorie diet
C) to deal with stress using alternative ways other than eating. Rationale: eating/ overeating is often a coping mechanism used when clients are faced with stressful situations. They will eat even when they aren't hungry.
NI for clients with eating disorders include (select all that apply).
A) limit time to eat to 30 min
B) discuss best food choices
C) remain with client 1 hour after meals
D) help client to develop realistic body image
E) help obtain BMI of 17
A + C + D= limit mealtime to 30 min remain with client 1 hour after meals, and develop realistic body image. RATIONALE: BMI of 17 is underweight and you do not want to focus on food rather you would want to focus on emotional aspects of food and how they respond to food.
Family characteristics of clients who have anorexia place a focus on......
A) freedom & creativity
B) rules & independence
C) overprotection & perfectionism
D) passive mother & domineering father
C) overprotection & perfectionism Rationale: high value placed on being perfect and child is often overprotected. Child feels like they need to satisfy parents & begins to feel ambivalent toward parents and eating disorder is way to gain control and rebel against parents. Usually have passive fathers and domineering mothers.
Main issues leading to anorexia include:
A) autonomy & control
B) Isolation & independence
C) self actualization & safety
D) generativity vs stagnation
A) autonomy & control Clients who suffer from anorexia often have an intense need to control their weight as a result of feelings of helplessness and inadequacy (autonomy & control)
A nurse is responding to a bulimic client who is concerned about gaining weight. The nurse states to the client "Try not to think about your weight right now you need to focus on not vomiting". This is a therapeutic statement
TRUE OR FALSE????
FALSE: It would be better to state "I understand that you are concerned about your weight but right now tell me about what you accomplished today in therapy. This statement acknowledges the clients concern and changes focus from the clients weight to what they are accomplishing or working on.
An appropriate weight loss goal for an obese client would be:
A) client will lose 6 pounds in one week
B) client will lose 10 pounds in one week
C) client will lose 2 pounds in one week
D) client will lose 2 pounds in 3 weeks.
C) client will lose 2 pounds in one week. Rationale: a realistic goal for weight loss is 1-2 pounds per week. Rapid amounts of weight loss in short period of time pose risks of client regaining the weight back.
Nursing interventions for caring for an obese client include (select all that apply).....
A) provide privacy for self-care
B) determine motivation for weight loss
C) set realistic weight loss goals
D) tell client they look great just how they are
E) identify alternative methods of handling stress
A + B + C+ E Telling the client they look great just how they are undermines trust in the nurse client relationship.
Pharmacological interventions for patients with Bulimia often includes an order for:
A) ephedrine
B) fluoxetine
C) Inderal
D) lithium
B) fluoxetine (Prozac). FDA approved for bulimia. Fluoxetine is not always beneficial in treating binge eating disorders in the long term due to regaining the weight when the med is stopped.
Stimulant Lisdexamfetamine dimesylae (Vyvanase) is a stimulant used for binge eating disorder to lower risk of binge episodes.
Clients with anorexia may exhibit the following behaviors:
A) realistic outlook of body image, normal weight
B) compulsive behaviors & depression/anxiety
C) focused on nutrient value in food and BMI 22
D) consumption of sugary foods & vomiting
B) compulsive behaviors and depression/anxiety. s/s of anorexia often include gross distortion of body image, preoccupation with food, refusing to eat, hoarding/concealing food, preparing elaborate meals for others but don't eat much themselves.
When admitting a client with bulimia the nurse finds suppositories in the clients property. The client states "I take them for nausea" The best response by the nurse would be....
A) "Tell me about your nausea"
B) "these look like laxatives"
C) "you shouldn't need suppositories for nausea"
D) "you can't have these while you are here"
A) "Tell me about your nausea" This is an open ended question and allows the client to expand more about their nausea. The nurse will most likely get more information by using this statement. The others are accusatory and may put the client on the defensive.
A morbidly obese client is placed on a 1600 calorie diet. The nurse instructs the client that adding exercise will facilitate weight loss. What is an appropriate exercise goal?
A) client will job 2 miles 3 times a week
B) client will do cross fit 5 days a week
C) client will swim 1 hour a day at the local gym
D) client will walk 30 min a day 5 days a week
D) client will walk 30 min a day 5 days a week. Rationale: not realistic to run 2 miles for morbidly obese patient nor is cross fit. Swimming at gym assumes client has money for a gym membership. Walking is best because it can be done anywhere.
Nursing interventions for eating disorders include: (select all that apply)
A) establish trust
B) focus on food choices
C) focus on emotional issues of food
D) reinforce positive eating behaviors
E) don't discuss food with client when protocol established
A) establish trust
C) focus on emotional issues of food
D) reinforce positive eating behaviors
E) Don't discuss food with the client when protocol established. Rationale: you do not want to focus on food and eating rather more important to focus on the emotional issues that precipitate the food behaviors.
Behavior therapy for the anorexic client involves:
A) isolating client from other eating disorder clients B) privileges are based on gaining weight
C) ensure client eats 100% of all meals.
D) exposure to other anorexic clients to compare different body types.
B) privileges are based on gaining weight. Rationale: behavior therapy is based on the premise that the client must perceive they are in control of the treatment. Staff and client agree about goals and systems of rewards. Ultimate goal is weight gain in an anorexic client so privileges are based on weight gain.
A client who is 5 ft 6 in weighs 52 pounds is refusing to eat. A priority intervention for this client is:
A) strict I & O
B) detailed food diary
C) restricted exercise regimen
D) administer doc ordered tube feedings.
D) Administer tube feedings. This client is severely malnourished and is refusing to eat meeting nutritional needs is a must to prevent multi-system failures. I & O is important but not a priority at this point in time.
Assessment findings of bulimic clients can include (select all that apply)
A) dehydration
B) tooth erosion
C) mood disorders
D) anxiety disorders
E) eating regular portions
A + B+ C+ D: dehydration, tooth erosion, mood and anxiety disorders. Bulimic clients are more prone to mood and anxiety disorders & substance abuse particularly stimulants or ETOH. They binge on large portions of food that usually occurs secretively and then purging occurs.
Teaching for an obese client requires planning reduced calorie nutrient dense diet, establishing realistic weight loss plan, establishing a realistic planned program of physical exercise.
TRUE or FALSE ???
TRUE all of the above are important in teaching weight loss also adding how to read a food label is helpful in helping client make nutrient dense food choices. Many people do not understand how to do this.
There are no specific medications indicated for bulimia.
TRUE or FALSE ????
FALSE: The only FDA approved medication to treat bulimia is fluoxetine (SSRI) It helps reduce binge/purge behaviors. Those doses tend to be higher than the standard dosing for depression.
Assessment of a client with anorexia includes (select all that apply).
A) gross distortion of body image
B) mild weight loss
C) depression & anxiety often present
D) focus on food E) eats large quantities of food secretively
A + C + D : gross distortion of body image, depression & anxiety often present, focus on food. Anorexic clients have extreme weight loss and are preoccupied with food, may hoard food, talk about food or recipes but don't eat.