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Essentials of Psychiatric Mental Health Nursing 1st Edition Varcarolis Test Bank

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Essentials of Psychiatric Mental Health Nursing 1st Edition Varcarolis Test Bank

ISBN-13: 978-1416000518

ISBN-10: 1416000518

 

Description

Essentials of Psychiatric Mental Health Nursing 1st Edition Varcarolis Test Bank

ISBN-13: 978-1416000518

ISBN-10: 1416000518

 

 

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Varcarolis: Essentials of Psychiatric Mental Health Nursing

 

Test Bank

 

Chapter 11: Eating Disorders

 

MULTIPLE CHOICE

 

  1. A patient is referred to the mental health center by the family health care provider. Over the past year, the patient has cooked gourmet meals for family members, but eats only tiny portions of the food. The patient wears layers of loose clothing, saying, “It’s just my style.” The patient’s weight has dropped from 130 to 95 pounds. The patient has amenorrhea. The history and symptoms are most consistent with which medical diagnosis?
a. Anorexia nervosa
b. Bulimia nervosa
c. Binge eating
d. Eating disorder not otherwise specified

 

ANS: A

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. The patient with eating disorder not otherwise specified may be obese.

 

DIF:   Cognitive Level: Application        REF:  Text Pages: 198-199

TOP:  Nursing Process: Diagnosis           MSC: NCLEX: Physiological Integrity

 

  1. Disturbed body image is the nursing diagnosis for a patient with an eating disorder. Which outcome indicator is most appropriate to monitor?
a. Weight, muscle, and fat congruence with height, frame, age, and sex
b. Calorie intake within required parameters of treatment plan
c. Weight at established normal range for the patient
d. Patient 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 is a subjective consideration. The other indicators are more objective but less related to the nursing diagnosis.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 201

TOP:  Nursing Process: Outcomes Identification

MSC: NCLEX: Psychosocial Integrity

 

  1. A patient referred to the eating disorders clinic has lost 35 pounds during one summer. To assess the patient’s eating patterns, 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 patient’s 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 patient’s thoughts on present weight explores the patient’s feelings about weight.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 200

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. A patient is diagnosed with anorexia nervosa. The history reveals the patient virtually stopped eating 5 months ago and lost 25% of body weight. A nurse tells the patient, “Describe what you think about your present weight and how you think you look.” Which response would be most consistent with the diagnosis?
a. “I’m fat and ugly.”
b. “What I think about myself is my business.”
c. “I’m grossly underweight, but thin is interesting.”
d. “I’m a few pounds overweight, but I can live with it.”

 

ANS: A

Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually tell people perceptions of self. The patient with anorexia does not recognize his or her thinness, and will persist in trying to lose more weight.

 

DIF:   Cognitive Level: Analysis             REF:  Text Pages: 199-200

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. A patient is diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The 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 refusal to eat, as evidenced by loss of 25% of body weight and hypokalemia

 

ANS: D

The patient’s history and lab result support the fourth nursing diagnosis. Data are not present that the patient uses laxatives, induces vomiting, or exercises excessively. The patient is hypokalemic, not hyperkalemic.

 

DIF:   Cognitive Level: Analysis             REF:  Text Pages: 199, 201-202

TOP:  Nursing Process: Diagnosis           MSC: NCLEX: Physiological Integrity

 

  1. A patient diagnosed with anorexia nervosa will be treated as an outpatient. A desired outcome related to the nursing diagnosis of Imbalanced nutrition: less than body requirements would be that within 1 week, the patient will:
a. gain 1 to 2 pounds.
b. weigh self accurately using balanced scales.
c. exercise 1 hour daily.
d. take a laxative every 3 days.

 

ANS: A

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 would not be on the patient weighing self. Exercising 1 hour daily and taking a laxative every 3 days are not desirable outcomes.

 

DIF:   Cognitive Level: Application        REF:  Text Pages: 201-202

TOP:  Nursing Process: Outcomes Identification

MSC: NCLEX: Physiological Integrity

 

  1. What nursing intervention best supports the outcome that a patient with anorexia nervosa will gain 1 to 2 pounds per week?
a. Assess for depression and suicidal ideation.
b. Observe for adverse side effects of refeeding.
c. Communicate empathy for the patient’s feelings.
d. Direct the patient to balance energy expenditure and caloric intake.

 

ANS: B

The nursing intervention of observing for adverse side effects of refeeding most directly relates to the goal of weight gain. Assessing for depression and suicidal ideation and communicating empathy for the patient’s feelings would relate to goals dealing with coping. Directing the patient to balance energy expenditure and caloric intake is an inappropriate intervention.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 202

TOP:  Nursing Process: Planning             MSC: NCLEX: Physiological Integrity

 

  1. A patient with anorexia nervosa is particularly resistant to the idea of 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 to be expected, objective and subjective data must be routinely collected.
b. A team approach to planning the diet ensures that physical and emotional needs will be met.
c. Patient involvement in decision making increases sense of control and promotes compliance with treatment.
d. Because of increased risk of physical problems with refeeding, patient permission is essential.

 

ANS: C

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 too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an additional aspect of treatment.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 201

TOP:  Nursing Process: Planning             MSC: NCLEX: Psychosocial Integrity

 

  1. A nursing care plan contains the intervention “monitor for complications of refeeding.” Which system should a nurse closely monitor for dysfunction?
a. Renal
b. Central nervous
c. Endocrine
d. Cardiovascular

 

ANS: D

Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse; thus focused assessment becomes a necessity to ensure patient physiological integrity. The other body systems are not initially involved in the refeeding syndrome.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 201

TOP:  Nursing Process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient with anorexia nervosa. Which statement by the 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 doesn’t seem to solve your problems. You’re thin now but still unhappy.”

 

ANS: D

The fourth statement is the only strategy that attempts to question the patient’s distorted thinking.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 205

TOP:  Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

 

  1. A student transferred from a hometown community college to a university 100 miles from home. She was slow to make new friends at the university. The history shows a close relationship with her mother and sister and that she broke up with her boyfriend of 2 years. She began to eat large quantities when she felt sad, and then induce vomiting. These cycles continued until they interfered with her schoolwork. She sought help from the university health clinic. During the initial interview, what other priority issue should a nurse address?
a. Sleep patterns
b. School activities
c. Losses
d. Menstrual flow

 

ANS: C

The patient has a significant history of losses: her mother and sister are no longer available as supports, she has terminated the relationship with her boyfriend, and she has moved from her hometown. Feelings of loss and depression are often associated with bulimia. The other options are of lesser relevance.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 197

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. What behavior might signal that a nurse caring for a patient with bulimia nervosa is experiencing rescue feelings?
a. The nurse’s comments are nonjudgmental.
b. The nurse refers the patient to a self-help group for individuals with eating disorders.
c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene.
d. The nurse assesses the patient’s problem as poor eating habits and provides a diet to follow.

 

ANS: D

Rescue feelings stem from the nurse’s wish to take over for or control a patient who is recognized by the nurse as feeling out of control. When a nurse experiences rescue feelings, the nurse tries to provide simple answers rather than use a problem-solving approach and focus on the patient’s feelings of shame and low self-esteem. The other options reflect appropriate interventions that do not signal a particular need for supervision.

 

DIF:   Cognitive Level: Comprehension  REF:  Text Pages: 203-204, 207

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. A nursing diagnosis for a patient with bulimia nervosa is Ineffective coping related to feelings of loneliness and isolation as evidenced by use of overeating to comfort self followed by self-induced vomiting. The 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 and isolation.

 

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.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 207

TOP:  Nursing Process: Outcomes Identification

MSC: NCLEX: Psychosocial Integrity

 

  1. Which nursing intervention has highest priority for a patient with bulimia nervosa?
a. Assist the patient to identify triggers to binge eating.
b. Provide remedial consequences for weight loss.
c. Assess for signs of impulsive eating.
d. Explore needs for health teaching.

 

ANS: 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.

 

DIF:   Cognitive Level: Analysis             REF:  Text Pages: 206-207

TOP:  Nursing Process: Planning             MSC: NCLEX: Psychosocial Integrity

 

  1. 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. V\ital 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.

 

DIF:   Cognitive Level: Analysis             REF:  Text Page: 200

TOP:  Nursing Process: Assessment        MSC: NCLEX: Safe, Effective Care Environment

 

  1. A patient with an eating disorder has been under significant stress and works long hours. At home, the patient watches television and eats until going to bed. The patient is too tired to exercise and has gained 25 pounds in 1 month. The patient is 5 feet tall and weighs 175 pounds. A desired outcome for the patient is to recognize the anxiety that precedes binge eating and reduce it with a constructive strategy. Which intervention addresses the outcome?
a. Teach stress reduction techniques such as relaxation and imagery.
b. Explore the patient’s need to single-handedly make up for a staff shortage.
c. Explore ways in which the patient may feel in control of the environment.
d. Encourage the patient to attend a support group such as Overeaters Anonymous.

 

ANS: A

Teaching alternative stress reduction techniques that may be substituted for overeating most directly addresses the goal of replacing binge eating with a constructive anxiety-releasing activity. The other options offer interventions that better relate to other outcomes.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 207

TOP:  Nursing Process: Planning             MSC: NCLEX: Psychosocial Integrity

 

  1. 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. Amenorrhea
b. Alopecia
c. Lanugo
d. Stupor

 

ANS: 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.

 

DIF:   Cognitive Level: Comprehension  REF:  Text Page: 200

TOP:  Nursing Process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A patient being admitted to the eating disorders unit has a yellow cast to the skin, has hair that is limp and dry, and has fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet and sullen during the physical assessment saying only, “I don’t intend to eat until I lose enough weight to look thin.” What is the best initial nursing diagnosis?
a. Disturbed body image related to weight loss
b. Anxiety related to fear of weight gain
c. Ineffective coping related to lack of conflict resolution skills
d. Imbalanced nutrition: less than body requirements related to self-starvation

 

ANS: D

The physical assessment by the nurse revealed cachexia; thus the diagnosis of Imbalanced nutrition. No defining characteristics support the other diagnoses.

 

DIF:   Cognitive Level: Analysis             REF:  Text Pages: 200-201

TOP:  Nursing Process: Diagnosis           MSC: NCLEX: Physiological Integrity

 

  1. A nurse responsible for conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of:
a. promoting processing of anxiety associated with eating.
b. shifting the patients’ focus from food to psychotherapy.
c. preventing the use of maladaptive behavior such as purging.
d. focusing on weight control mechanisms and food preparation.

 

ANS: A

Eating produces high anxiety for all 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. Preventing the use of maladaptive behavior such as purging is an outcome that is subsumed under the primary purpose.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 204

TOP:  Nursing Process: Planning             MSC: NCLEX: Psychosocial Integrity

 

  1. Nursing physical assessment of a patient with bulimia often reveals:
a. prominent parotid glands.
b. peripheral edema.
c. thin, brittle hair.
d. amenorrhea.

 

ANS: A

Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and are not usually seen in bulimia.

 

DIF:   Cognitive Level: Comprehension  REF:  Text Page: 199

TOP:  Nursing Process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. Which characteristic is a nurse most likely to assess in a patient with anorexia nervosa?
a. Carefree flexibility
b. Open displays of emotion
c. Rigidity, perfectionism
d. High spirits and optimism

 

ANS: C

Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients with eating disorders. Each of the other options is rarely seen in a patient with an eating disorder, for which inflexibility, controlled emotions, and pessimism are more the rule.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 197

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. Which finding for a patient with an eating disorder signals a nurse that the patient should be hospitalized for treatment?
a. Pulse less than 60 beats/min
b. Weight 15% below ideal weight
c. Urine output less than 30 mL/hr
d. Serum potassium 3.4 mEq/L

 

ANS: C

Severely reduced urinary output indicates dehydration, reduced kidney function, or retention caused by cardiac malfunction. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Weight loss of more than 30% of ideal body weight would call for hospitalization. A potassium level of 3.4 mEq/L is within the normal range.

 

DIF:   Cognitive Level: Analysis             REF:  Text Page: 200

TOP:  Nursing Process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. Which statement is a nurse is most likely to hear during an interview session from a patient with anorexia nervosa?
a. “I’m thin for my height.”
b. “I’m fat and ugly.”
c. “I have nice eyes.”
d. “My parents don’t pay much attention to me.”

 

ANS: B

Patients with eating disorders have distorted body images and usually see themselves as overweight, even when their weight is woefully subnormal. “I’m thin for my height” is therefore unlikely to be heard from a patient with anorexia nervosa. Poor self-image precludes making positive statements about self, such as “I have nice eyes.” Many patients with eating disorders see supportive others as intrusive and out of tune with their needs.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 198

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. Which nursing diagnosis is more relevant for a patient with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient with bulimia nervosa who purges?
a. Powerlessness
b. Disturbed body image
c. Imbalanced nutrition: less than body requirements
d. Ineffective coping

 

ANS: C

The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The remaining options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.

 

DIF:   Cognitive Level: Analysis             REF:  Text Page: 198

TOP:  Nursing Process: Diagnosis           MSC: NCLEX: Physiological Integrity

 

  1. Which theme might be expected during family therapy with two parents, two siblings, and a teen patient with anorexia nervosa who engages in provocative behavior?
a. Building stable coalitions
b. Interpreting negative messages as positive
c. Competition of the patient with the father
d. Lack of trust in the patient by the family

 

ANS: D

The theme of lack of trust in the patient by the family is frequently noted when the patient does provocative things such as going to the bathroom and remaining there after meals. The patient is unable to fathom the concern of the family about possible purging behaviors. Patients with anorexia nervosa frequently shift coalitions, perceive positive messages as negative, and usually compete with their mothers.

 

DIF:   Cognitive Level: Analysis             REF:  Text Page: 205

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. When a nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed upon weekly weight, the nurse should state:
a. “It bothers me to see you exercising. You’ll lose more weight.”
b. “You and I will have to sit down and discuss this problem.”
c. “According to our agreement, no exercising is permitted until you have gained a specific amount of weight.”
d. “Let’s discuss the relationship between exercise and weight loss and how that affects your body.”

 

ANS: C

Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients must be held accountable for required behaviors.

 

DIF:   Cognitive Level: Application        REF:  Text Pages: 202-204

TOP:  Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

 

  1. Which statement by a patient with an eating disorder reflects correct understanding of the condition rather than a cognitive distortion?
a. “Gaining 1 pound is as much of a disaster as gaining 100 pounds.”
b. “I was happy when I was a size 4, so I must diet to that size.”
c. “Bingeing is the only way I can soothe myself.”
d. “I’ve been coping with disappointment by overeating.”

 

ANS: D

This statement reflects understanding of the condition. Cognitive distortions often used by patients with eating disorders include “catastrophizing,” overgeneralization, all-or-none thinking, personalization, and emotional reasoning.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 202

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. A patient with anorexia nervosa being treated on an outpatient basis has begun refeeding. Between the first and second appointments the patient gains 8 pounds. The nurse should:
a. praise the patient for the weight gain.
b. assess lung sounds and extremities.
c. suggest use of an exercise program.
d. establish a higher target for weight gain for the next week.

 

ANS: B

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 other options are undesirable because they increase the risk for cardiac complications.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 201

TOP:  Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

 

  1. Which statement made by the parent of a teen with anorexia nervosa signals to a nurse that teaching needs exist?
a. “Will treatment affect my child’s number one standing on the gymnastics team?”
b. “We’ll find the money for family counseling if it is needed.”
c. “The entire family has benefited from improved eating habits.”
d. “We’ll work out our differences without getting into power struggles.”

 

ANS: A

This remark suggests the parent places a high value on the child’s gymnastics standing, which to a great extent depends on thinness. The other options suggest thinking synchronous with therapeutic goals.

 

DIF:   Cognitive Level: Analysis             REF:  Text Pages: 201-202, 205

TOP:  Nursing Process: Assessment        MSC: NCLEX: Psychosocial Integrity

 

  1. While providing health teaching for a patient with binge-purge bulimia, a nurse should prioritize information about:
a. self-monitoring of daily food and fluid intake.
b. establishing the desired daily weight gain.
c. symptoms of hypokalemia.
d. self-esteem maintenance.

 

ANS: 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 risk for hypokalemia.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 207

TOP:  Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

 

  1. An appropriate intervention for a patient with bulimia nervosa who binges and purges is to teach the patient:
a. not to skip meals or restrict food.
b. to eat a small meal after purging.
c. eat a large breakfast but no lunch and concentrate intake after 4 PM.
d. substitute laxative use once daily to replace induced vomiting.

 

ANS: A

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 concentrate intake after 4 PM will lead to late-day bingeing. It is highly undesirable for a patient to substitute a laxative for induced vomiting.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 207

TOP:  Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

 

  1. Which statement by a nurse caring for a patient with an eating disorder signals a need for supervision?
a. “I am working to encourage the patient to be healthier.”
b. “I understand that the patient is terrified of gaining weight.”
c. “The patient’s perfectionism and resistance often make me angry.”
d. “I have had to make sure I do not come across as a parent figure.”

 

ANS: C

Frustration is common when patient personality traits of perfectionism, obsessive thinking, and the need to control therapy are present. Anger and frustration signal a need for supervision. Stating that work is being done to encourage patient health or that it is important not to come across as a parent figure is appropriate. Stating an understanding of the patient’s fear is empathic and important to reflect to the patient.

 

DIF:   Cognitive Level: Analysis             REF:  Text Pages: 203-204

TOP:  Nursing Process: Assessment        MSC: NCLEX: Safe, Effective Care Environment

 

MULTIPLE RESPONSE

 

  1. A patient referred to the eating disorders clinic has lost 35 pounds during the summer and developed amenorrhea. For which physical manifestations of anorexia nervosa should a nurse assess? (More than one answer is correct.)
a. Peripheral edema
b. Parotid swelling
c. Constipation
d. Hypotension
e. Dental caries
f. Lanugo

 

ANS: A, C, D, F

Peripheral edema is often present because of hypoalbuminemia. Constipation related to starvation is often present. Hypotension is often present because of dehydration. Lanugo is often present and is related to starvation. Parotid swelling is associated with bulimia. Dental caries are associated with bulimia.

 

DIF:   Cognitive Level: Application        REF:  Text Page: 199

TOP:  Nursing Process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. When a patient with anorexia is admitted for treatment, what should the milieu provide? (More than one answer is correct.)
a. Flexible mealtimes
b. Adherence to a selected menu
c. Observation during and after meals
d. Unscheduled weight checks
e. Monitoring during bathroom trips
f. Privileges correlated with affective display

 

ANS: B, C, E

Priority milieu interventions support restoration of weight and normalization of eating patterns. This requires close supervision of the patient’s eating and prevention of exercise, purging, and so forth. Menus are strictly adhered to. Observation is maintained during and after meals to prevent throwing away food or purging. All trips to the bathroom are monitored. Mealtimes are precisely observed, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.

 

DIF:   Cognitive Level: Application        REF:  Text Pages: 201-202, 204-205

TOP:  Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

 

MATCHING

 

Prioritize these nursing diagnoses for a patient with bulimia nervosa.

a. Imbalanced nutrition: less than body requirements
b. Chronic low self-esteem
c. Risk for loneliness
d. Risk for imbalanced fluid volume

 

 

  1. 1

 

  1. 2

 

  1. 3

 

  1. 4

 

  1. ANS: D                   DIF:   Cognitive Level: Analysis             REF:  Text Pages: 200-201

TOP:  Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity; Psychosocial Integrity

NOT: Prioritize diagnoses using Maslow’s pyramid. Physiological needs come first: fluid balance pre-cedes nutritional balance as a priority. The next level of the pyramid is safety and security, but none of the diagnoses relate to that level. The next level is love and belonging, which is com-promised by loneliness. The next level is self-esteem.

 

  1. ANS: A                   DIF:   Cognitive Level: Analysis             REF:  Text Pages: 200-201

TOP:  Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity; Psychosocial Integrity

NOT: Prioritize diagnoses using Maslow’s pyramid. Physiological needs come first: fluid balance pre-cedes nutritional balance as a priority. The next level of the pyramid is safety and security, but none of the diagnoses relate to that level. The next level is love and belonging, which is com-promised by loneliness. The next level is self-esteem.

 

  1. ANS: C                    DIF:   Cognitive Level: Analysis             REF:  Text Pages: 200-201

TOP:  Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity; Psychosocial Integrity

NOT: Prioritize diagnoses using Maslow’s pyramid. Physiological needs come first: fluid balance pre-cedes nutritional balance as a priority. The next level of the pyramid is safety and security, but none of the diagnoses relate to that level. The next level is love and belonging, which is com-promised by loneliness. The next level is self-esteem.

 

  1. ANS: B                    DIF:   Cognitive Level: Analysis             REF:  Text Pages: 200-201

TOP:  Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity; Psychosocial Integrity

NOT: Prioritize diagnoses using Maslow’s pyramid. Physiological needs come first: fluid balance pre-cedes nutritional balance as a priority. The next level of the pyramid is safety and security, but none of the diagnoses relate to that level. The next level is love and belonging, which is com-promised by loneliness. The next level is self-esteem.