B: One goal of health teaching is 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 eat a large breakfast but no lunch and increase intake after 4 PM will lead to late-day bingeing. Journal entries are private.A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed?a. The nurse interacts with the patient in a protective fashion.b. The nurse’s comments to the patient are compassionate and nonjudgmental.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.A: 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 assumption of a parental role. Protective behaviors are part of the parent’s role. The helpful nurse uses a problem-solving approach and focuses on the patient’s feelings of shame and low self-esteem. Referring a patient 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 that 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.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. Assess for signs of impulsive eating.d. Explore needs for health teaching.A: For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. Often the triggers are anxiety-producing situations. Identification of 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 highest priority.One bed is available on the inpatient eating disorders unit. Which patient should be admitted to this bed? The patient whose weight decreased from:a. 150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hgb. 120 to 90 pounds over a 3-month period. Vital signs are temperature, 36° C; pulse, 50 beats/min; blood pressure 70/50 mm Hgc. 110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5° C; pulse, 60 beats/min; blood pressure 80/66 mm Hgd. 90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7° C; pulse, 62 beats/min; blood pressure 74/48 mm HgA: 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.A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to:a. self-monitoring of daily food and fluid intake.b. establishing the desired daily weight gain.c. how to recognize hypokalemia.d. self-esteem maintenance.C: Hypokalemia results from potassium loss associated with vomiting. Physiological integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the dangers associated with hypokalemia.As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient’s body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet 4 inches tall. Which term should be documented?a. Amenorrheab. Alopeciac. Lanugod. Stupor
C: The fine, downy hair noted by the nurse is called lanugo. It is frequently seen in patients with anorexia nervosa. None of the other conditions can be supported by the data the nurse has gathered.A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, “I won’t eat until I look thin.” Select the priority initial nursing diagnosis.a. Anxiety related to fear of weight gainb. Disturbed body image related to weight lossc. Ineffective coping related to lack of conflict resolution skillsd. Imbalanced nutrition: less than body requirements related to self-starvationD: The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient’s self-starvation is the priority.A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of:a. maintaining patients’ concentration and attention.b. shifting the patients’ focus from food to psychotherapy.c. promoting processing of anxiety associated with eating.d. focusing on weight control mechanisms and food preparation.C: Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to be successful in attaining therapeutic goals. Shifting the patients’ focus from food to psychotherapy and focusing on weight control mechanisms and food preparation are not desirable. Maintaining patients’ concentration and attention is important, but not the primary purpose of the schedule.Physical assessment of a patient diagnosed with bulimia often reveals:a. prominent parotid glands.b. peripheral edema.c. thin, brittle hair.d. 25% underweight.A: Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and not usually seen in bulimia.Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa?a. Carefree flexibilityb. Rigidity, perfectionismc. Open displays of emotiond. High spirits and optimismB: Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients with eating disorders. The incorrect options are rare in a patient with an eating disorder. Inflexibility, controlled emotions, and pessimism are more the rule.Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?a. Urine output 40 mL/hrb. Pulse rate 58 beats/minc. Serum potassium 3.4 mEq/Ld. Systolic blood pressure 62 mm HgD: Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 mL/hr. A potassium level of 3.4 mEq/L is within the normal range.A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate?a. “You and I will have to sit down and discuss this problem.”b. “It bothers me to see you exercising. I am afraid you will lose more weight.”c. “Let’s discuss the relationship between exercise, weight loss, and the effects on your body.”d. “According to our agreement, no exercising is permitted until you have gained a specific amount of weight.”D: A matter-of-fact statement that the nurse’s perceptions are different will help to avoid a power struggle. Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients must be held accountable for required behaviors.Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges?a. Powerlessnessb. Ineffective copingc. Disturbed body imaged. Imbalanced nutrition: less than body requirementsD: The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should:a. assess lung sounds and extremities.b. suggest use of an aerobic exercise program.c. positively reinforce the patient for the weight gain.d. establish a higher goal for weight gain the next week.A: Weight gain of more than 2 to 5 pounds weekly may overwhelm the heart’s capacity to pump, leading to cardiac failure. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are undesirable because they increase the risk for cardiac complications.Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach? The patient:a. now weighs 196 pounds.b. says, “I am using contraceptives.”c. says, “I feel full after eating a small meal.”d. reports problems with dry mouth and constipation.A: Lorcaserin is designed to make people feel full after eating smaller meals by activating a serotonin 2c receptor in the brain and blocking appetite signals. According to the FDA, this drug should be stopped if a patient does not have 5% weight loss after 12 weeks of use. If the patient now weighs 196 pounds, the medication has not been effective. The distracters indicate patient learning was effective and expected side effects of this medication.A 5-year-old child was diagnosed with encopresis. Which assessment finding would the nurse expect associated with this diagnosis? The child:a. frequently smears feces on clothing and toys.b. experiences frequent nocturnal episodes of bedwetting.c. has accidents of defecation at kindergarten three times a week.d. has occasional episodes of voiding accidents at the day care center.C: Encopresis refers to unsuccessful bowel control. Bowel control is expected by age 5, so frequent involuntary defecation is associated with this diagnosis. Smearing feces is behavioral. Enuresis refers to the voiding of urine during the day (diurnal) or at night (nocturnal).What is the most important intervention for a client with bulimia?When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.
What intervention works best for bulimia nervosa overall?Cognitive behavioral therapy and interpersonal psychotherapy remain most efficacious for treatment of adults with bulimia nervosa, and treatment delivered in a stepped-care approach may be promising.
What is the first goal for treatment for patients with bulimia nervosa?The goals of treatment are as follows: Reduce and, where possible, eliminate binge eating and purging. Treat physical complications and restore nutritional health. Enhance patients' motivation to cooperate in the restoration of healthy eating patterns and participate in treatment.
What is most important when first treating a patient for anorexia nervosa?Restoring a healthy weight
The first goal of treatment is getting back to a healthy weight. You can't recover from anorexia without returning to a healthy weight and learning proper nutrition.
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