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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.

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

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

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity a. Amenorrhea b. Alopecia c. Lanugo d. Stupor

17. As a patient admitted to the eating-disorder unit undresses, a nurse observes that the patient’s body is covered by fine, downy hair. The patient weighs 70 pounds and is 5'4" tall. Which term should be documented?

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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 18-12, 54 (Table 18-1) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. Anxiety related to fear of weight gain b. Disturbed body image related to weight loss c. Ineffective coping related to lack of conflict resolution skills d. Imbalanced nutrition: less than body requirements related to self-starvation

18. A patient being admitted to the eating-disorder unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5'4". The patient says, “I won’t eat until I look thin.” Select the priority initial nursing diagnosis.

ANS: D

The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient’s self-starvation is the priority.

PTS: 1

DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 18-12, 13, 54 (Table 18-1) | Page 18-19 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Physiological Integrity

19. A nurse conducting group therapy on the eating-disorder 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.

ANS: 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.

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

REF: Pages 18-15, 30, 71 (Box 18-5) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

20. Physical assessment of a patient diagnosed with bulimia often reveals a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. 25% underweight.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 18-26, 55 (Table 18-2), 71 (Box 18-5) | Page 18-30 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity a. Carefree flexibility b. Rigidity, perfectionism c. Open displays of emotion d. High spirits and optimism

21. Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa?

ANS: B

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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 18-8, 12 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Urine output 40 mL/hour b. Pulse rate 58 beats/min c. Serum potassium 3.4 mEq/L d. Systolic blood pressure 62 mm Hg

22. Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?

ANS: D

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/hour. A potassium level of 3.4 mEq/L is within the normal range.

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

REF: Pages 18-7, 28, 68 (Box 18-2)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Assessment 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.”

23. 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?

ANS: 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.

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

REF: Page 18-19 (Case Study and Nursing Care Plan) | Page 18-71 (Box 18-5)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. Powerlessness b. Ineffective coping c. Disturbed body image d. Imbalanced nutrition: less than body requirements

24. 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?

ANS: D

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.

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

REF: Pages 18-58 (Table 18-3), 61 (Table 18-5), 67 (Box 18-1)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Physiological Integrity

25. 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.

ANS: 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.

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

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

MSC: Client Needs: Physiological Integrity a. The patient’s history of poly-substance abuse b. The patient’s preference for homeopathic remedies c. The patient’s family history of autoimmune disorders d. The patient’s comorbid diagnosis of a learning disability

26. The treatment team discusses adding a new prescription for lisdexamfetamine dimesylate to the plan of care for a patient diagnosed with binge eating disorder. Which finding from the nursing assessment is most important for the nurse to share with the team?

ANS: A

Lisdexamfetamine dimesylate is designed to suppress the appetite and presents a risk for abuse. The patient with a history of substance abuse is at risk to abuse this medication as well. The patient’s preference for homeopathic remedies is a consideration, but the history of substance abuse has a higher priority. Lisdexamfetamine dimesylate is commonly used to treat attention deficit hyperactivity disorder rather than learning disabilities. A history of autoimmune disorders in the family is irrelevant.

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

REF: Pages 18-37, 65 (Table 18-7) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity a. The child frequently eats newspapers and magazines. b. The child refuses to eat peanut butter and jelly sandwiches. c. The child often rechews and reswallows foods at mealtimes. d. The parents feed the child clay because of concerns about anemia.

27. A 7-year-old child was diagnosed with pica. Which assessment finding would the nurse expect associated with this diagnosis?

ANS: A

Pica refers to eating nonfood items after maturing past toddlerhood. Some cultures practice eating nonfood items; however, this factor is a cultural preference rather than a disorder. Refusing to eat peanut butter and jelly sandwiches is an example of a simple food preference in a child. Rumination refers to regurgitation with rechewing, reswallowing, or spitting.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 18-43, 44, 74 (Box 18-6) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? (Select all that apply.)

a. Peripheral edema b. Parotid swelling c. Constipation d. Hypotension e. Dental caries f. Lanugo

ANS: A, C, D, F eBay: testbanks_and_xanax

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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 18-12, 13, 54 (Table 18-1), 58 (Table 18-3), 68 (Box 18-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity a. Flexible mealtimes b. Unscheduled weight checks c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips f. Privileges correlated with emotional expression

2. A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? (Select all that apply.)

ANS: C, D, 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 other activities. There is strict adherence to menus. Observe patients during and after meals to prevent throwing away food or purging. Monitor all trips to the bathroom. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.

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

REF: Pages 18-19 (Case Study and Nursing Care Plan), 71 (Box 18-5)

TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment