Chapter 14: Eating Disorders Flashcards
Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?
a. Binge eating disorder
b. Anorexia nervosa
c. Bulimia nervosa
d. Pica
ANS: B
Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. Pica refers to eating nonfood items.
Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?
a. Weight, muscle, and fat are congruent with height, frame, age, and sex.
b. Calorie intake is within the required parameters of the treatment plan.
c. Weight reaches the established normal range for the patient.
d. Patient expresses satisfaction with body appearance.
ANS: D
Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This consideration is subjective. The other indicators are more
objective but less related to the nursing diagnosis.
A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patients oral intake, the nurse should ask:
a. Do you often feel fat?
b. Who plans the family meals?
c. What do you eat in a typical day?
d. What do you think about your present weight?
ANS: C
Although all the questions might be appropriate to ask, only What do you eat in a typical day? focuses on the eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family meal planning are unrelated to eating patterns. Asking for the patients thoughts on present weight explores the patients feelings about weight.
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and has lost 25% of body weight. A nurse asks, Describe what you think about your present weight and how you look. Which response by the patient is most consistent with the diagnosis?
a. I am fat and ugly.
b. What I think about myself is my business.
c. I am grossly underweight, but thats what I want.
d. I am a few pounds overweight, but I can live with it.
ANS: A
Patients diagnosed with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually disclose perceptions about self to others. The patient with anorexia will persist in trying to lose more weight.
A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The patients current serum potassium is 2.7 mg/dl. Which nursing diagnosis applies?
a. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss
b. Disturbed energy field, related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia
c. Ineffective health maintenance, related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia
d. Imbalanced nutrition: less than body requirements, related to malnutrition as evidenced by loss of 25% of body weight and hypokalemia
ANS: D
The patients history and laboratory results support the correct nursing diagnosis. Available data do not confirm that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.
Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important
outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will:
a. weigh self accurately using balanced scales.
b. limit exercise to less than 2 hours daily.
c. select clothing that fits properly.
d. gain 1 to 2 pounds.
ANS: D
Only the outcome of a gain of 1 to 2 pounds can be accomplished within 1 week when the patient is an
outpatient. The focus of an outcome is not on the patient weighing self. Limiting exercise and selecting proper clothing are important, but weight gain takes priority.
Which nursing intervention has priority as a patient diagnosed with anorexia nervosa begins to gain weight?
a. Assess for depression and anxiety.
b. Observe for adverse effects of re-feeding.
c. Communicate empathy for the patients feelings.
d. Help the patient balance energy expenditure and caloric intake.
ANS: B
The nursing intervention of observing for adverse effects of re-feeding most directly relates to weight gain and is a priority. Assessing for depression and anxiety and communicating empathy relate to coping. Helping the patient balance energy expenditure and caloric intake is an inappropriate intervention.
A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain?
a. Because severe anxiety concerning eating is expected, objective and subjective data must be routinely
collected.
b. Patient involvement in decision-making increases a sense of control and promotes compliance with the
treatment.
c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met.
d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.
ANS: B
A sense of control for the patient is vital to the success of therapy. A diet that controls weight gain can allay
patient fears of a too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that the patients needs will be met. Permission for treatment is a separate issue. The
contract for weight gain is an additional aspect of treatment.
The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention Monitor for complications of re-feeding. Which body system should a nurse closely monitor for dysfunction?
a. Renal
b. Endocrine
c. Central nervous
d. Cardiovascular
ANS: D
Re-feeding resulting in a too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment becomes a necessity to ensure patient physiologic integrity. The other body systems are not initially involved in the re-feeding syndrome.
A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient diagnosed with
anorexia nervosa. Which statement by the staff nurse supports this type of therapy?
a. What are your feelings about not eating the food that you prepare?
b. You seem to feel much better about yourself when you eat something.
c. It must be difficult to talk about private matters to someone you just met.
d. Being thin does not seem to solve your problems. You are thin now but still unhappy.
ANS: D
The correct response is the only strategy that attempts to question the patients distorted thinking.
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient to:
a. eat a small meal after purging.
b. avoid skipping meals or restricting food.
c. concentrate oral intake after 4 PM daily.
d. understand the value of reading journal entries aloud to others.
ANS: B
One goal of health teaching is the normalization of eating habits. Food restriction and skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce vomiting. Teaching the patient to concentrate intake after 4 PM will lead to late-day bingeing. Journal entries are private.
What behavior by a nurse caring for a patient diagnosed with an eating disorder indicates the nurse needs
supervision?
a. The nurses comments are nonjudgmental.
b. The nurse uses an authoritarian manner when interacting with the patient.
c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene.
d. The nurse refers the patient to a self-help group for individuals with eating disorders.
ANS: B
In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assume the role of a parent. The helpful nurse uses a problem-solving approach and focuses on the patients feelings of shame and low self-esteem. Referral to a self-help group is an appropriate intervention.
A nursing diagnosis for a patient diagnosed with bulimia nervosa is: Ineffective coping, related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is, Within 2 weeks the patient will:
a. appropriately express angry feelings.
b. verbalize two positive things about self.
c. verbalize the importance of eating a balanced diet.
d. identify two alternative methods of coping with loneliness.
ANS: D
The outcome of identifying alternative coping strategies is most directly related to the diagnosis of Ineffective coping. Verbalizing positive characteristics of self and verbalizing the importance of eating a balanced diet are outcomes that might be used for other nursing diagnoses. Appropriately expressing angry feelings is not measurable.
Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa?
a. Assist the patient to identify triggers to binge eating.
b. Provide corrective consequences for weight loss.
c. Explore patient needs for health teaching.
d. Assess for signs of impulsive eating.
ANS: A
For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. The triggers are often anxiety-producing situations. Identifying these triggers makes it possible to break the binge-
purge cycle. Because binge eating and purging directly affect physical status, the need to promote physical
safety assumes the highest priority. The question calls for an intervention rather than an assessment.
One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from:
a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9 C; pulse, 38 beats/min; blood
pressure, 60/40 mm Hg
b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36 C; pulse, 50 beats/min; blood pressure,
70/50 mm Hg
c. 110 to 70 pounds over a 4-month period. Vital signs: temperature, 36.5 C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg
d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7 C; pulse, 62 beats/min; blood
pressure, 74/48 mm Hg
ANS: A
Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months, temperature below 36 C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.
