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d. A team approach to planning the diet ensures that physical and emotional needs will be met.

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 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 18-19 (Case Study and Nursing Care Plan), 58 (Table 18-3)

TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity a. Renal b. Endocrine c. Integumentary d. Cardiovascular

9. The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention “monitor for complications of refeeding.” Which system should a nurse closely monitor for dysfunction?

ANS: D

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 18-14, 54 (Table 18-1) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. “What are your feelings about not eating foods 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 are thin now but still unhappy.”

10. A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?

ANS: D

The correct response is the only strategy that questions the patient’s distorted thinking.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 18-19 (Case Study and Nursing Care Plan), 29, 30

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

11. An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient a. to eat a small meal after purging. b. not to skip meals or restrict food. c. to increase oral intake after 4 PM daily. d. the value of reading journal entries aloud to others.

ANS: B eBay: testbanks_and_xanax

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 18-29, 30 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 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.

12. 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?

ANS: 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 18-12, 13, 27 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

13. 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.

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 18-30 (Case Study and Nursing Care Plan), 36, 61 (Table 18-5)

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity 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.

14. Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa?

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.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 18-30 (Case Study and Nursing Care Plan) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

15. One bed is available on the inpatient eating-disorder 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 Hg b. 120 to 90 pounds over a 3-month period. Vital signs are 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 are 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 are 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.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 18-7, 28, 68, (Box 18-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment

16. A nurse provides health teaching for a patient diagnosed with bulimia nervosa. 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.

ANS: C