NUR210CH16

Card Set Information

Author:
TomWruble
ID:
202040
Filename:
NUR210CH16
Updated:
2013-03-04 22:11:15
Tags:
nur210e2 Eating Disorders
Folders:

Description:
Eating Disorders
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user TomWruble on FreezingBlue Flashcards. What would you like to do?


  1. Which female patient should the nurse recognize as having the highest risk to have ordevelop bulimia nervosa? The one who:

    A. grew up in an underserved area.
    B. is 20 years old.
    C. is African-American.
    D. lives in a society influenced by Eastern cultural beliefs.
    B. is 20 years old.

    Bulimia nervosa rarely is seen in children younger than 12 years, whereas anorexianervosa may start as early as between the ages of 7 and 12. Caucasian, Hispanic, and NativeAmerican women, particularly those living in industrialized nations influenced by Westernculture, are more predisposed to development of eating disorders than African-American women.
    (this multiple choice question has been scrambled)
  2. The nurse is caring for a 16-year-old female patient with anorexia nervosa. What should theinitial nursing intervention be upon the patient’s admission to the unit?

    A. Build a therapeutic relationship.
    B. Increase the patient’s caloric consumption.
    C. Involve the patient in group therapy to build a support group.
    D. Self-assess to decrease tendencies towards authoritarianism.
    D. Self-assess to decrease tendencies towards authoritarianism.

    Without self-assessing, the nurse may inadvertently blame the patient for her health problems and assume a parental role rather than a therapeutic one. The nurse must first self assess to become aware of personal feelings about the patient’s condition and then proceed to act in a therapeutic manner. For the duration of the patient’s stay, building a therapeutic relationshipwill be important, as will development of a plan to increase the patient’s caloric intake and build a support group.
    (this multiple choice question has been scrambled)
  3. The nurse is caring for a patient with bulimia. Which nursing intervention is appropriate?

    A. Encourage patient to select foods that she likes.
    B. Provide meals whenever the patient requests them.
    C. Monitoring patient on bathroom trips after eating.
    D. Allow patient extensive private time with family members.
    C. Monitoring patient on bathroom trips after eating.

    The milieu of an eating disorder unit is purposefully organized to assist the patient in establishing more adaptive behavioral patterns, including normalization of eating. The highly structured milieu includes precise meal times, adherence to the selected menu, observation during and after meals, and regularly scheduled weighings. Close observation of patients includes monitoring all trips to the bathroom after eating to prevent self-induced vomiting. Patients may also need monitoring on bathroom trips after seeing visitors and after any hospital pass to ensure that the patient has not had access to and ingested any laxatives or diuretics.
    (this multiple choice question has been scrambled)
  4. The nurse is admitting patient who weighs 100 pounds, is 66 inches tall, and is below ideal body weight. The patient’s blood pressure is 130/80 mm Hg, pulse is 72 beats per minute, potassium is 2.5 mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands arevisibly shaking, and her parotid (largest salivary gland - wrapped around the mandibular ramus) gland is enlarged. The patient states, “I am really worked upabout coming to this unit.” What is the priority nursing diagnosis?

    A. Powerlessness
    B. Risk for injury
    C. Imbalanced nutrition: Less than body requirements
    D. Anxiety
    B. Risk for injury

    Although all diagnoses listed are appropriate to consider within the plan of care, the priority is Risk for injury related to the low potassium value (hers: 2.5, normal: 3.5 to 5.0 mEq/L), mildly elevated blood pressure, andabnormal ECG, which indicates hypokalemia. If left untreated, multiple complications—including cardiac arrhythmias and eventual respiratory depression—can occur.
    (this multiple choice question has been scrambled)
  5. The nurse is planning care for a patient with an eating disorder. What outcomes areappropriate? Select all that apply.

    1. The patient will experience a decrease in depression.
    2. The patient will identify four methods to control anxiety.
    3. The patient will collect different kinds of cookbooks.
    4. The patient will identify two people to contact if suicidal thoughts occur.
    1,2,4

    Patients with eating disorders are very likely to have depression, anxiety, higher suicide rates, and problems with substance abuse. Therefore, decreasing depression, controlling anxiety, and having a support system in place are reasonable outcomes for planning care. Hoarding items, especially cookbooks, is often associated with the comorbid condition of obsessive-compulsive disorder (OCD) and should not be encouraged.
  6. The client with bulimia differs from the client with anorexia nervosa by

    A. doing more rigorous exercising.
    B. maintaining normal weight.
    C. holding a distorted body image.
    D. purging to keep weight down.
    B. maintaining normal weight.

    Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight. Text page: 346
    (this multiple choice question has been scrambled)
  7. A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is

    A. hypotension.
    B. fear of gaining weight.
    C. lanugo.
    D. 25-lb weight loss.
    B. fear of gaining weight.

    This option is the only subjective data listed and it is universally true. Text page: 349
    (this multiple choice question has been scrambled)
  8. During assessment of a client with anorexia nervosa it is not likely that the nurse would note indications of:

    A. high self-esteem.
    B. introversion.
    C. social isolation.
    D. obsessive-compulsive tendencies.
    A. high self-esteem.

    Most clients with eating disorders have low self-esteem. Text page: 349
    (this multiple choice question has been scrambled)
  9. Biological theorists suggest the cause of eating disorders may be

    A. dopamine excess.
    B. serotonin imbalance.
    C. normal weight phobia.
    D. body image disturbance.
    B. serotonin imbalance.

    The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse. Text page: 347
    (this multiple choice question has been scrambled)
  10. T/F: Denial of excessive thinness is the mainstay coping mechanism of the client with anorexia nervosa.
    True
  11. A client reveals that she induces vomiting as many as a dozen times a day. The nurse would expect assessment findings to reveal

    A. hypokalemia.
    B. tachycardia.
    C. hypolipidemia.
    D. hypercalcemia.
    A. hypokalemia.

    Vomiting causes loss of potassium leading to hypokalemia. Text page: 350
    (this multiple choice question has been scrambled)
  12. A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is

    A. an increase in red blood cell count.
    B. elevated serum potassium.
    C. disruption in fluid and electrolyte balance
    D. elevated serum sodium.
    C. disruption in fluid and electrolyte balance

    Disruption in fluid and electrolyte is usually the result of excessive use of enemas and laxatives.Text page: 355
    (this multiple choice question has been scrambled)
  13. A realistic short-term goal for the first week of hospitalization for a client with anorexia nervosa whose weight is 65% of normal weight would be: By end of week 1 the client will

    A. verbalize awareness of sensation of hunger.
    B. develop a pattern of normal eating behavior.
    C. gain a maximum of 3 lb.
    D. discuss fears and feelings about gaining weight.
    C. gain a maximum of 3 lb.

    The critical outcome during hospitalization is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema.Text page: 360
    (this multiple choice question has been scrambled)
  14. Bupropion (Wellbutrin) while seemingly effective is contraindicated in patients who purge because of:

    A. an increased risk in seizures
    B. historically poor patient compliance
    C. long term effects on liver function
    D. the potential to cause gastric ulcers
    A. an increased risk in seizures

    Bupropion (Wellbutrin) while seemingly effective is contraindicated in patients who purge because of:A.historically poor patient compliance B.Correctan increased risk in seizures C.long term effects on liver function D.the potential to cause gastric ulcersBupropion (Wellbutrin) while seemingly effective is contraindicated in patients who purge because of an increased risk of seizures. Text page: 357
    (this multiple choice question has been scrambled)
  15. The nurse can determine that inpatient treatment for a client with an eating disorder would be warranted when the client

    A. weighs 10% below ideal body weight.
    B. has a heart rate less than 60 beats/min.
    C. has a serum potassium level of 3 mEq/L or greater.
    D. has systolic blood pressure less than 70 mm Hg.
    D. has systolic blood pressure less than 70 mm Hg.

    Systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise.

    All physical criteria are:
    Weight loss over 30% over 6 months
    Rapid decline in weight
    Inability to gain weight with outpatient treatment
    Severe hypothermia due to loss of subcutaneous tissue or dehydration (temperature lower than 36° C or96.8° F)
    Heart rate less than 40 beats per minute
    Systolic blood pressure less than 70 mm Hg
    Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances not corrected by oral supplementation
    Electrocardiographic changes (especially arrhythmias)
    (this multiple choice question has been scrambled)
  16. Physical Criteria for Hospital Admission of Patients with Eating Disorders
    • Weight loss over 30% over 6 months
    • Rapid decline in weight
    • Inability to gain weight with outpatient treatment
    • Severe hypothermia due to loss of subcutaneous tissue or dehydration (temperature lower than 36° C or96.8° F)
    • Heart rate less than 40 beats per minute
    • Systolic blood pressure less than 70 mm Hg
    • Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances not corrected by oral supplementation
    • Electrocardiographic changes (especially arrhythmias)
  17. Psychiatric Criteria for Hospital Admission of Patients with Eating Disorders
    • Suicidal or severely out-of-control, self-mutilating behaviors
    • Out-of-control use of laxatives, emetics, diuretics, or street drugs
    • Failure to comply with treatment contract
    • Severe depression
    • Psychosis
    • Family crisis or dysfunction
  18. Which assessment question should be asked of a client suspected of having anorexia nervosa?

    A. "Why do you choose to take laxatives?"
    B. "How often do you force yourself to vomit?"
    C. "Do you find yourself feeling hungry?"
    D. "How would you describe your body?"
    D. "How would you describe your body?"

    This question will reveal the cognitive distortion consistent with anorexia nervosa. Invariably the client will describe self as fat despite being excessively underweight.Text page: 349
    (this multiple choice question has been scrambled)
  19. Which statement is least likely to be made by a client with bulimia nervosa during the assessment interview?

    A. "When I eat I feel calm, but then I realize I have to make myself vomit or gain weight."
    B. "I'm concerned about what others think about my binging and purging."
    C. "I feel as though my eating and purging are out of my control."
    D. "I eat three meals each day and purge every evening."
    D. "I eat three meals each day and purge every evening."

    Most clients with bulimia purge after each meal.Text page: 346
    (this multiple choice question has been scrambled)
  20. Assessment of a client with suspected bulimia nervosa calls for the nurse to perform

    A. body fat analysis.
    B. inspection of body cavities.
    C. inspection of the oral cavity.
    D. a range of motion assessment.
    C. inspection of the oral cavity.

    Repeated vomiting often causes dental erosions and caries.Text page: 354
    (this multiple choice question has been scrambled)
  21. A client with bulimia nervosa has several nursing diagnoses. Which diagnosis from the list below would be given priority?

    A. Risk for injury: electrolyte imbalance
    B. Ineffective coping: impulsive responses to problems
    C. Disturbed body image
    D. Chronic low self-esteem
    A. Risk for injury: electrolyte imbalance

    The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss.Text page: 355
    (this multiple choice question has been scrambled)
  22. Which intervention would be least useful for accurate assessment of the weight of a client with anorexia nervosa?

    A. Do not reweigh client when client requests
    B. Permit no oral intake before weighing
    C. Weigh fully clothed before breakfast
    D. Weigh two times daily, then three times weekly
    C. Weigh fully clothed before breakfast

    Clients should be weighed wearing only bra and panties before ingesting any food or fluids in the morning.Text page: 360
    (this multiple choice question has been scrambled)
  23. Which intervention would be removed from the plan of care for a client with bulimia nervosa?

    A. Assist client to identify trigger foods
    B. Teach client to plan and eat regularly scheduled meals
    C. Teach that fasting sets one up to binge eat
    D. Support importance of avoiding forbidden foods
    D. Support importance of avoiding forbidden foods

    No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy.Text page: 364
    (this multiple choice question has been scrambled)
  24. The nurse working with clients with eating disorders can help families develop effective coping mechanisms by

    A. urging the family to demonstrate greater caring for the client.
    B. teaching the family about the disorder and the client's behaviors.
    C. encouraging the family to use their usual social behaviors at meals.
    D. stressing the need to suppress overt conflict within the family.
    B. teaching the family about the disorder and the client's behaviors.

    Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member. Text pages: 352 and 357
    (this multiple choice question has been scrambled)
  25. Medical complications of Anorexia Nervosa
    • Bradycardia
    • Hypokalemic alkalosis
  26. A nurse is caring for a female client who was recently admitted to the hospital with a diagnosis of anorexia nervosa. When the nurse enters the room, the client is engaged in rigorous push-ups. Which nursing actionwould be therapeutic?

    A. Interrupt the client and offer to take the client for a walk
    B. Interrupt the client and weigh the client immediately.
    C. Tell the client that she is not allowed to exercise rigorously.
    D. Allow the client to complete the exercise program.
    A. Interrupt the client and offer to take the client for a walk

    Clients with anorexia nervosa are frequently preoccupied with rigorous exercise and push themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise as well as place limits on rigorous activities. Allowing the client to complete the exercise program could be harmful. Weighing the client reinforces the altered self-concept that the client experiences and the client's need to control weight. Telling the client that she is not allowed to exercise rigorously will increase her anxiety.
    (this multiple choice question has been scrambled)
  27. Refeeding syndrome
    Any individual who has had negligible nutrient intake for 5 consecutive days is at risk of refeeding syndrome. Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications.
  28. Pharmacology for anorexia nervosa
    Non approved by FDA

    A SSRI, such a Prozac. has proven useful in reducing obsessive-compulsive bahavior, but only after the mainteance weight has been reached - for women: 90% of idea, the weight at which most women are able to menstruate.

    Atypical antipsychotics such as olanzapine (Zyprexa) are helpful in improvingmodd and obsessional behaviors.
  29. Bulimia Nervosa - not uncommon for pts. to have a history of ...
    impulsive stealing of items such as food, clothing and jewelry.
  30. Medical complications of Bulimia Nervosa
    • Sinus bradycardia
    • Orthostatic changes in pulse or blood pressure
    • Cardiac arrhythmias
    • Cardiac arrest from electrolyte disturbances or Ipecac intoxication
    • Cardiac murmur; mitral valve prolapse
    • Electrolyte imbalances
    • Elevated serum bicarbonate levels (although can below, which indicates a metabolic acidosis)
    • Hypochloremia
    • Hypokalemia
    • Dehydration, which results in volume depletion, leading to stimulation of aldosterone production, which inturn stimulates further potassium excretion from kidneys; thus there can be both an indirect renal loss of potassium and a direct loss through self-induced vomiting
    • Severe attrition and erosion of teeth, producing irritating sensitivity and exposing the pulp of the teeth
    • Loss of dental arch
    • Diminished chewing ability
    • Parotid gland enlargement associated with elevated serum amylase levels
    • Esophageal tears caused by self-induced vomiting
    • Severe abdominal pain indicative of gastric dilation
    • Russell's sign (callus on knuckles from self-induced vomiting)

What would you like to do?

Home > Flashcards > Print Preview