Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa?

Which assessment finding would the nurse document as subjective evidence of anorexia nervosa? a. Lanugo b. Bradycardia c. 25-lb weight loss d. Patient states fear of gaining weight.

ANS: D Fear of weight gain is a subjective symptom, because it is voiced by the patient. The distracters are objective signs.

A patient diagnosed with anorexia nervosa has the nursing diagnosis imbalanced nutrition, less than body requirements, related to inadequate food intake. The long-term goal of the treatment plan is that the patient will: a. gain 1 to 3 lb weekly. b. exhibit fewer signs of malnutrition. c. restore healthy eating patterns and normalize weight. d. identify cognitive distortions about weight and shape.

ANS: C The goal directly related to the nursing diagnosis is to restore healthy eating patterns and normalize weight. The distracters are short-term or vague or are not directly related to the nursing diagnosis.

The nurse interviews a patient who restricts food and is 25% underweight. The patient says, “I still need to lose weight. I’m not thin enough.” The patient is using which defense mechanism? a. Rationalization b. Projection c. Splitting d. Denial

ANS: D When the individual with anorexia nervosa insists that being 25% underweight is not a problem (and thinking that she is too fat, when in fact she is emaciated), the defense mechanism responsible is denial. Rationalization involves making excuses, projection involves blaming others, and splitting involves the inability to integrate good and bad in one concept.

A patient is 5 feet 4 inches tall and weighs 85 lb, a 20% loss of body weight over the past year. The patient reports amenorrhea for 9 months. Vital signs are temperature (T) 96.6°F; pulse (P) 38 beats/min; blood pressure (BP) 70/42 mm Hg; respirations (R) 20 breaths/min. Skin turgor is poor. Lanugo is present. She says, “I need to lose 10 more pounds.” These assessment findings indicate which medical diagnosis? a. Bulimia nervosa b. Anorexia nervosa c. Binge-eating disorder d. Dissociative identity disorder

ANS: B Data are consistent with the medical diagnosis of anorexia nervosa, a disorder in which intense fear of being fat leads to a body weight 15% or more below normal. Bulimic patients are usually near normal weight. Individuals who have binge-eating disorder tend to be overweight. Dissociative identity disorder refers to individuals who have multiple personalities.

An initial step in the nurse–patient relationship for a patient diagnosed with anorexia nervosa should be: a. formulate the nurse–patient contract. b. exclude the family from treatment. c. recommend a therapeutic group. d. use intense confrontation.

ANS: A Trust is the foundation to the nurse’s effectiveness. A contract is formulated early in therapy to give the patient the opportunity to participate in treatment. This increases the patient’s sense of control. By establishing contractual behavioral limits, manipulation and power struggles can be minimized. Recommending a therapeutic group and using confrontation to attack denial are later interventions. Family members are encouraged to take part actively in the treatment of the patient.

A patient diagnosed with anorexia nervosa spills milk over a plate of partially eaten food. Select the nurse’s best response. a. “That won’t work. You are manipulating.” b. “You are deliberately making mealtime difficult.” c. “I will get you a fresh plate of food so you can finish.” d. “You are required to eat your meal. I’ll wait until you finish.”

ANS: C Patients with anorexia nervosa often use strategies to hide food, spill food, or discard it to avoid eating. The nurse can best handle these behaviors with nonjudgmental confrontation and adherence to established limits. Only the correct answer is a nonjudgmental response. The other options are judgmental or punitive.

A nurse planning care for a patient diagnosed with bulimia nervosa should recommend the use of: a. psychodynamic group therapy. b. cognitive-behavioral therapy. c. pharmacotherapy. d. psychodrama.

ANS: B Research findings indicate that cognitive-behavioral therapy is effective in the treatment of both anorexia nervosa and bulimia nervosa. There is no evidence to suggest that the other options are as useful.

Which personality characteristic would the nurse expect in a patient diagnosed with an eating disorder? a. Grandiosity b. Impulsivity c. Perfectionism d. Suspiciousness

ANS: C Often, the individual with an eating disorder is seen as compliant, perfectionist, introverted, and having self-esteem and relationship problems. The other characteristics are rarely seen among patients with eating disorders.

Which information about a patient diagnosed with bulimia nervosa should the nurse document as subjective data? a. Scarred fingers b. Sores around mouth c. Loss of tooth enamel d. Feeling out of control

ANS: D The distracters represent objective data, whereas the correct answer reflects feelings the patient has revealed.

A nurse teaches a class about bulimia nervosa to high school biology students. The nurse should explain that a possible cause is: a. hypersensitivity of norepinephrine. b. excessive dopamine activity. c. overproduction of GABA. d. serotonin deficits.

ANS: D Based on a few research studies, current thinking suggests that deficits in serotonin might play a role in bulimia nervosa. There is no research to support the correctness of any of the other options

Which finding indicates that a patient diagnosed with anorexia nervosa has met a major objective of psychotherapeutic management? a. The patient’s residual volume is less than 30 ml before tube feedings. b. The patient says, “I am no longer fearful of gaining weight.” c. The patient reads cookbooks and plans nutritious meals. d. The patient weighs 90% of average body weight.

ANS: D The three objectives are increasing self-esteem, increasing weight to 90% of average body weight, and reestablishing appropriate eating behavior. Reading cookbooks or planning nutritious meals may be evidence of manipulation. A low residual volume simply indicates that the patient is utilizing the feedings and there is no intestinal obstruction. Lack of fear does not translate to proper eating or an improved self-esteem.

A patient diagnosed with an eating disorder asks to be excused from a meal to use the restroom. Select the nurse’s best response. a. “No one is permitted to leave the table during meals.” b. “You may go after you’ve finished your meal.” c. “I will go with you to the restroom.” d. “No. I know you want to vomit.”

ANS: C Close observation is necessary to prevent patients with eating disorders from purging during and after meals. Patients should be accompanied to the bathroom and observed while in the bathroom to prevent purging. Bargaining, lying, and judgmental confrontation are not appropriate responses.

A nurse is engaged in psychoeducational activities with a hospitalized patient diagnosed with bulimia nervosa. The nurse says, “When you feel the need to vomit, a. do vigorous aerobic exercise until the urge goes away.” b. seek out a staff member to talk about your feelings.” c. call your parents on the phone to show you care.” d. allow yourself to vomit, but avoid purging.”

ANS: B Resistance to the urge to vomit or purge can be strengthened by reporting it to a nurse and talking about the feelings that the individual experienced before the urge and the feelings being experienced presently. Once feelings are identified, the patient can begin to work on alternate coping strategies. The other options are not helpful.ANS: B Resistance to the urge to vomit or purge can be strengthened by reporting it to a nurse and talking about the feelings that the individual experienced before the urge and the feelings being experienced presently. Once feelings are identified, the patient can begin to work on alternate coping strategies. The other options are not helpful.

To meet DSM-V criteria for bulimia nervosa, the patient’s history must reveal episodes of binge eating and compensatory behaviors occurring at least: a. once a week for 6 months. b. once weekly for 3 months. c. three times weekly for a year. d. four times weekly for 6 months.

ANS: B This information is taken from the DSM-V criteria.

School nurses should be particularly vigilant for signs of eating disorders: a. in fourth-graders. b. in rebellious, aggressive girls. c. during summer breaks and around holidays. d. at transitions between elementary, middle, and high school.

ANS: D Junior high and high school students are at particular risk for eating disorders, based on our culture’s emphasis on thinness and the adolescent’s need for peer approval. Stress makes the adolescent more vulnerable. Times of particular stress are moving from one school to another—thus, the need for vigilance on the part of the school nurse. Risk is lower in the other options.

How do assessment findings in individuals with bulimia and anorexia differ? a. Persons with bulimia tend to have lower body weights than those with anorexia. b. Fluid and electrolyte imbalance is more common in anorexia than in bulimia. c. Hormonal imbalance is more common in bulimia than in anorexia. d. Anorexia tends to begin at an earlier age than bulimia.

ANS: D Anorexia tends to begin at an earlier age than bulimia. The other options are incorrect.

A patient diagnosed with bulimia nervosa has not responded to psychotherapeutic management. The health care provider is likely to prescribe a drug from which classification? a. Mood stabilizer b. Selective serotonin reuptake inhibitor (SSRI) antidepressant c. Typical antipsychotic d. Monoamine oxidase inhibitor antidepressant

ANS: B There is some evidence that SSRIs might be effective as adjunctive treatment of bulimia. The other drugs would not be considered appropriate.

A patient diagnosed with an eating disorder refuses to be weighed and says, “I just drank a big glass of water.” Select the nurse’s best response. a. “Call me after you have emptied your bladder.” b. “This is weight day. Please step on the scale.” c. “I will weigh you tomorrow.” d. “You know the rules.”

ANS: B This response is matter-of-fact and reinforces the established limits. The distracters allow the patient to manipulate the nurse, are overly controlling, or use bargaining.

A nurse assesses a 25-year-old man with a suspected eating disorder. Which comment is most likely from this patient when the nurse asks about the patient’s sexuality? a. “Sometimes I feel attracted to other men.” b. “I’m here because my girlfriend is worried about how much I exercise.” c. “I am sexually active, but I sometimes have trouble maintaining an erection.” d. “I’ve been involved in a satisfying relationship with my girlfriend for 3 years.”

ANS: A Some research indicates that men with eating disorders have a higher incidence of concerns about sexual or gender identity. Homosexuality may also play a role. None of the remaining options reflect this concern

One bed is available on the inpatient eating disorders unit. Assessment findings for four patients are listed as follows. Which patient should receive the bed? a. Weight decreased from 150 to 102 lb in 4 months. Vital signs are T 96.9°F; P 46 beats/min; BP 68/48 mm Hg. Amenorrhea for 8 months. b. Weight decreased from 110 to 86 lb in 4 months. Vital signs are T 97.5°F; P 60 beats/min; BP 80/66 mm Hg. Amenorrhea for 2 months. c. Weight decreased from 120 to 90 lb in 3 months. Vital signs are T 98°F; P 50 beats/min; BP 70/50 mm Hg. Menstruation scant for 3 months. d. Weight decreased from 90 to 78 lb in 5 months. Vital signs are T 97.7°F; P 62 beats/min; BP 74/52 mm Hg. Menstruation irregular for 6 months.

ANS: A Physical findings indicative of an acute status include amenorrhea for 3 consecutive menstrual cycles, weight loss more than 30% of body weight within 6 months, hypothermia, pulse less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.

What priority nursing assessments should be made early in the refeeding process for a patient with anorexia nervosa? Select all that apply. a. Vital signs b. Skin integrity c. Peripheral edema d. Lung and heart sounds e. Level of consciousness

ANS: A, C, D, E If refeeding results in too rapid weight gain the cardiovascular system might be compromised, giving rise to symptoms such as pulse irregularities, peripheral edema, abnormal heart sounds, and moist lung sounds. Alterations in oxygenation and cardiac perfusion would produce changes in the level of consciousness. Changes in skin integrity would not be a priority.

What is an appropriate goal for a patient with anorexia nervosa?

What is the first goal of nutrition therapy for patients with anorexia nervosa?

What interventions are effective for individuals with anorexia?

What is the immediate goal of treatment for anorexia nervosa?