Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/141

Click to flip

141 Cards in this Set

  • Front
  • Back
The increase in eating disorders in the late 20th century has coincided with 3 major cultural trends.
Name these 3 cultural trends.

1-
2-
3-
1- fashon industry
2- diet & fitness industry
3- womens movement
Characterized primarily by binge eating & purging behavior:

a) anorexia nervosa
b) bulimia nervosa
b) bulimia nervosa
Characterized primarily by self starvation & distorted body imaage:

a) anorexia nervosa
b) bulimia nervosa
a) anorexia nervosa
Sociocultural factors that contribute greatly to the growing trend of eating disorders are all of the following except:

a) diet & fitness industry
b) fashion industry
c) women’s liberation movement
d) perfectionism
e) developmental peer pressure
d) perfectionism

This is a psychogenic factor
Psychogenic factors that are associated with eating disorders are all of the following except:

a) Family HX of depression
b) Low self-esteem
c) Perfectionism
d) Affective instability
e) "people pleaser” mentality
a) Family HX of depression

This is considered a biological factor
Familial factors associated with eating disorders are all of the following except:

a) Enmeshment
b) Affective instability
c) Poor conflict resolution
d) Separation issues
e) Alcoholism or sexual abuse
b) Affective instability

This is considered to be a a psychogenic factor
The etiology of eating disorders is broken down into 4 categories. Identify which of the following categories is not associated with the etiology of eating disorders:

a) biologic factors
b) sociocultural factors
c) cultural factors
d) psychologic factors
e) familial factors
c) cultural factors

this is a factor in the epidemiology
Rapidly fluctuating moods is termed:

a) social insecurity
b) alexythemia
c) affective instability
d) interpersonal distrust
e) interoceptive deficits
f) dichotomous thinking
g) erroneous control
h) personalization
c) affective instability
Difficulty naming & expressing emotions is referred to as:

a) social insecurity
b) alexythemia
c) affective instability
d) interpersonal distrust
e) interoceptive deficits
f) dichotomous thinking
g) erroneous control
h) personalization
b) alexythemia
The inability to correctly identify & respond to bodily sensations is called:

a) social insecurity
b) alexythemia
c) affective instability
d) interpersonal distrust
e) interoceptive deficits
f) dichotomous thinking
g) erroneous control
h) personalization
e) interoceptive deficits
Individuals who view situations as either all good or all bad:

a) social insecurity
b) alexythemia
c) affective instability
d) interpersonal distrust
e) interoceptive deficits
f) dichotomous thinking
g) erroneous control
h) personalization
f) dichotomous thinking
Individuals that feel soley responsible for the happiness & failure of others:

a) social insecurity
b) alexythemia
c) affective instability
d) interpersonal distrust
e) interoceptive deficits
f) dichotomous thinking
g) erroneous control
h) personalization
g) erroneous control
Individuals who compare themselves endlessly with others & believe everything other people do is a reaction to them:

a) social insecurity
b) alexythemia
c) affective instability
d) interpersonal distrust
e) interoceptive deficits
f) dichotomous thinking
g) erroneous control
h) personalization
h) personalization
The high co-mormidity of depression & eating disorders has been carefully studied for a bilogic linl. Which abnormality has been noted in both anorexia & bulemia, & even in recovered bulemics:

a) interoceptive deficits
b) dichomtomuosness
c) DSM-IV-TR
d) serotonergic
b)
d) serotonergic

Bulemia nervosa responds favorably to SSRI's, ESPECIALLY PROZAC
Nowadays, eating disorders can be found in all socioeconomica levels, races, & cultures with a range of interactive styles. HOwever, many family environments of persons w/eating disorders are tense, rigid, & ____?

a) fashonable
b) have a educational level of 13+ years formal education
c) emeshed
d) detached
c) emeshed
Emeshed familires are generally characterized by all of the following except:

a) have poor boundaries
b) expressing inner feelings is discouraged
c) overinvolment among members
d) individuality is encouraged
e) conformity is expected
c) individuality is encouraged

individuality is NOT encouraged
Emeshed families often put a great deal of importance on what 3 things?

1-
2-
3-
1-emphasis on outward appearance
2-emphasis on social acceptance
3-emphasis on achievement
Girls who do not identify with their mothers are:

a) at higher risk for low self esteem & eating disorders
b) at lower risk for low self esteem & eating disorders
a) at higher risk for low self esteem & eating disorders
The average age of onset of anorexia nervosa is:

a) 6-12 yrs of age
b) 12-14 yrs of age
c) 14-18 yrs of age
d) 16-18 yrs of age
c) 14-18 yrs of age
Eating disorders are predominatly "emale" disorders.

True or False
True
The average on set of bulemia is age:

a) 12 yrs of age
b) 14 yrs of age
c) 16 yrs of age
d) 18 yrs of age
d) 18 yrs of age

with 80% of cases reported between 15 & 30 yrs of age
It is generally believed that abundance of food is a necessary sociocultural factor of an outbreak of eating disorders.

True or False
True
In past decades eating disorders were predominantly found in:

a) equatorial regions
b) far eastern hemispheres
c) low socioeconomical levels
d) caucasian upper-middle class
d) caucasian upper-middle class
Th elifetime mortality rate of anorexia is lower than in bulemia.

True /False
False

The mortality rate in anorexia is higher than in any other psychiatric diagnosis & are reported from 5-20%.
The lower estimates of mortality from bulemia than in anorexia in some studies likely reflect:

a) anorexic behaviors begin to diminish when young women marry
b) anorexics are more easily identified & seek TX than bulimics
c) deaths from purging are recorded as cardiac arrest or cardiomyopathy & never directly connected to bulimia
d) suicide is frequently the cause of death for those with eating disorders
c) deaths from purging are recorded as cardiac arrest or cardiomyopathy & never directly connected to bulimia
Comorbidity is:

a) a term used in epidemiology studies to distinguish & estimate potential causes for death in 2 oppositional studies
b) the secondary effect of a disease process
c) the potential for death occuring in offspring as caused by the death of an elder member (familial)
d) the concurrent existence of 2 or more disorders
d) the concurrent existence of 2 or more disorders
Diagnosed in 40-75% of individuals with eating disorders:

a) cardiomyopathy
b) widening gap in the neuromuscular juction
c) metabolic disorders
d) depression
e) anxiety
d) depression
More commonly diagnosed in patients with bulimia than in patients with anorexia:

a) depression
b) anxiety
a) depression
The most frequent Axis I diagnosis in anorexia:

a) depression
b) anxiety
c) obsessive-compulsive
d) substance abuse
c) obsessive-compulsive
With patients having anorexia, all of the following symptoms dissapear with weight restoration except:

a) depression
b) anxiety
c) obsessive -compulsive behavior
NONE

these symptoms may improve but do not disappear
Well-controlled research studies report a high incidence (25-30%) of clients with eating disorders, impulsive, & self-injurious hehavior have a history of:

a) sexual abuse
b) substance abuse
c) maternal conflicts
d) paternal conflicts
a) sexual abuse
Obesity is not included as an eating disorder in the DSM-IV-TR classification system because:

a) characteristics used to distinguish excess weight gain vs. obesity have yet not been established
b) it has not yet been established that all cases of obesity involve underlying psychiatric illnessesin all cases
c) obesity is closely associated with interoreceptive deficits
b) it has not yet been established that all cases of obesity involve underlying psychiatric illnessesin all cases
Described specifically as recurrent episodes of eating more than most people would eat during a similar period & feels out of control when doing it:

a) bulimia
b) alexithymia
c) binging
d) dichotomia
c) binging
Binge eating disorder results in:

a) distress
b) guilt
c) disgust
All of these
Many low-weight anorexics binge & purge occasionaly & many bulimics:

a) fast & exercise but not purge
b) purge & fast but not exercise
c) exercise & purge but not fast
a) fast & exercise but not purge
Studies show that a few persons may fully recover from a single, time-limited episode of anorexia or bulimia. Some anorexic teens who recover their normal weight later develop:

a) narcissism
b) bulimia
c) cardiomyopathy
d) recurrent oral lesions
b) bulimia
Many persons w/eating disorders follow a course or a pattern of relapses & remissions while others show slow improvement after severa; years of TX. Long term studies show a more promising prognosis for:

a) anorexics
b) bulimics
c) those who get TX at an early age
d) those who seek & continue TX
d) those who seek & continue TX

50% show improvement after 5 years
Pharmacologic TX is most effective as an adjucnt to psychotherapy in:

a) anorexia
b) bulimia
b) bulimia
Pharmacologic TX is most effective as a relapse prevention tool for:

a) anorexics
b) bulimics
a) anorexics
Symptoms for anorexia are generally all of the following except:

a) weight loss below 20% of ideal weight
b) slow pulse, decreased body temperature
c) lanugo on face
constipation
a) weight loss below 20% of ideal weight

criteria is 15% below ideal body weight
Self starvation, reported intake restriction & refusal to eat & rituals or compusive behaviors regarding food, eating, &/or weight loss:

a) anorexia
b) bulimia
a) anorexia
Mortality rates for anorexia are high & deaths will occur in:

a) 1-2%
b) 4-10%
c) 6-20%
d) 10-25%
c) 6-20%
Amenorrhea, growth of lanugo on face & preoccupation with food:

a) anorexia
b) bulemia
a) anorexia
Persistant overconcern w/body weight, shape & proportion, hypokalemia, & hypoglycemia:

a) anorexia
b) bulemia
b) bulemia
Constipation or diarrhea my be experienced in addition to dehydration, & Mallory-Weiss syndrome:

a) anorexia
b) bulemia
b) bulemia
May engage in vomiting, laxatives, excessive exercise & wear baggy clothing:

a) anorexia
b) bulemia
a) anorexia
Parotid gland enlargement & cardiac arrhythmia or dysrhythmia, & isiopathic edema:

a) anorexia
b) bulemia
b) bulemia
Engages in binging & purging, uses laxatives, enemas, etc, & may have enamel erosion.

a) anorexia
b) bulemia
b) bulemia
Both anorexics & bulimics have risk for constipation (perceived & actual), imbalanced fluid volume, imbalanced nutition (less than body req), & risk for self-mutilation. However, anorexia presents additional risks such as all of the following except:

a) imbalanced body temperature
b) delayed growth & development
c) Mallory-Weiss Syndrome
c) Mallory-Weiss Syndrome
Disruptions in coping abilities are generally more along the lines of ineffective coping versus compromised family coping:

a) anorexia
b) bulimia
a) anorexia
Disruptions in coping abilities are generally more along the lines of ineffective coping versun ineffective denial:

a) anorexia
b) bulimia
b) bulimia
Though deficient knowledge regarding nutrition & medical side effects of the behavior is a focus in both disorders, client & family teaching needs are generally geared more towards noncompliance w/refeeding process than with noncompliance with TX program:

a) anorexia
b) bulimia
a) anorexia
Though outcome identification includes participation in therapeutic contact w/staff, maintaining fluid & electrolyte balance, & consuming adequate calorie choices for age, height, & metabolic needs, this disorder would include outcome identification goals with percieving body shape & weight as normal & acceptable verses demonstrating improvement in body image w/a more realistic view of body shape & size:

a) anorexia
b) bulimia
b) bulimia
Though both symptoms of these disorders are much alike, outcome idetifications for this disorder would be acheiving minimum normal weight & resuming a normal menstrual cycle:

a) anorexia
b) bulimia
a) anorexia
Ineffective coping, deficient fluid volume, & chronic low self esteem are collaborative diagnoses for this disorder:

a) anorexia
b) bulimia
b) bulimia
Anxiety, disturbed body image, imbalanced nutrition less than body requirements are all collaborative diagnoses for this disorder:

a) anorexia
b) bulimia
a) anorexia
Amennorhea is defined with:

a) missing 3 periods in 1 yr
b) missing 3 periods 3 successive months
b) missing 3 periods 3 successive months
During the current episode of illness, the restricting type of anorexia is:

a) short periods of purging
b) intermittant periods of binging
c) does not engage in purging
d) engages in normal eating behavior
c) does not engage in purging
This is considered a safe goal for gaining weight:

a) 1-2 lbs a week
b) 2-3 lbs a week
c) 3-4 lbs a week
d) 4-5 lbs a week
b) 2-3 lbs a week
The focus of client & family teaching about eating disorders includes:

a) benefits of nutition & eating well balanced meals
b) the health risks associated with eating disorders
c) high mortality rates associated with these disorders
d) understand the behaviors are symptomatic of underlying psychologic issues
d) understand the behaviors are symptomatic of underlying psychologic issues
Family teaching for a patient with an eating disorder includes:

a) the importance of maintaining control over the patient until the patient has developed a realistic view of self
b) relinquish control over the patients behavior &/or how much the client eats & weighs
c) help the familiy learn to praise the client for internalizing conflicts rather than taking their frustrations out on them
d) stop setting age-appropriate limits
b) relinquish control over the patients behavior &/or how much the client eats & weighs
Reefeeding, a potentially life threatening complication of is high in the early TX for anorexia & can cause what 3 conditions?

1) e_ _ _ _

2) c_ _ _ _ _ _ _ _ _ h_ _ _ _ f_ _ _ _ _ _

3) h_ _ _ _ _ _ _ _ _ _ _ _ _
1- edema
2- congestive heart failure
3- hypophosatemia
Reefeeding with meals, supplements, &/or nasogatric tube should begin with aproximately:

a) 250-500 kcal/day & slowly increase to 2000-4000 kcal/day
b) 500-800 kcal/day & slowly increase to 2000-4000 kcal/day
c) 800-1200 kcal/day & slowly increase to 2000-4000 kcal/day
d) 1000-1600 kcal/day & slowly increase to 2000-4000 kcal/day
d) 1000-1600 kcal/day & slowly increase to 2000-4000 kcal/day
Initial assessments for a client with bulimia is:

a) starvation
b) fluid & electrolyte imbalance
c) bone density
d) esophageal errosion
b) fluid & electrolyte imbalance
This electolyte is of special concern with bulimia:

a) Ca++
b) Na++
c) K+
d) Cl-
c) K+
This drug is particularly effective in TX for bulimia:

a) fluoxetine/Prozac 60mg/day
b) bupropion/Wellbutrin
c) sertraline/Zoloft
d) paroxetine/Paxil
a) fluoxetine/Prozac 60mg/day

all of the others listed are also used with eating disorders
This drug is not recommended in the TX of eating disorders by relieving depression & anxiety because it lowers the threshold of seizures:

a) celexa
b) lexapro
c) wellbutrin
d) olanzpine/Zyprexa
c) wellbutrin
ANtianxiety medications are used sparingly with patients with eating disorders because:

a) antianxiety medications can exacebate depression
b) antianxiety medications lower the threshold of seizures in some patients w/ eating disorders
c) antianxiety medications can alter the effects of other medications that are necessary in TX for associated psychological issues
d) clients need to learn to tolerate their feelings & cope in more adaptive ways
d) clients need to learn to tolerate their feelings & cope in more adaptive ways
In patients with eating disorders, nutitional anemia is TX with:

a) multivitamins
b) iron
c) K+
d) erythrpoiten
b) iron
Pharmacological TX for gastroparesis or delayed gastric emptying is:

a) B12
b) Folic acid
c) Reglan
d) cobalamin
c) Reglan
In patients with eating disorders, infected parotid glands are TX w/antibiotics & laxative dependence is TX w/ all of the following except:

a) stool softeners
b) withdrawal
c) decreasing doses of laxatives
d) fluids
b) withdrawal

abrubt withdrawal is dangerous & is done under very close supervision
The preferred TX for patients with eating disorders is:

a) SSRI's
b) wellbutrin
c) psychotherapy
c) psychotherapy
Psychotherapy that will likely recommend mends long-term, insight-oriented therapy to repair early development failures or traumas:

a) cognitive therapsts
b) psychiatric therapists
c) psychoanalytic therapy
c) psychoanalytic therapy
Psychotherapy that will likely recommend an active therapeutic stance & encourage the use of behavioral tecniques for symptom management & cognitive restructuring to alter distorted thinking patterns:

a) cognitive therapsts
b) psychiatric therapists
c) psychoanalytic therapy
c) psychoanalytic therapy
Psychotherapy that will likely recommend structured, short-term therapy with less insight orientation & more focus on thought patterns:

a) cognitive therapsts
b) psychiatric therapists
c) psychoanalytic therapy
a) cognitive therapsts
Name 6 therapuetic modalities used for patients with eating disorders:

1) B_ _ _ _ _ _ _ _ _ Therapy
2) I_ _ _ _ _ _ _ _ _ Therapy
3) G_ _ _ _ Therapy
4) F_ _ _ _ _ Therapy
5) E_ _ _ _ _ _ _ _ _ Therapy
6) C_ _ _ _ _ _ _ _ Therapy
BigFec
Behavioral therapy
individual therapy
group therapy
famility therapy
expressive therapy
cognitive therapy
Exposure plus response prevention, in which clients eat "scary" or binge foods & are then prevented from purging, is an effective intervention for:

a) anorexia
b) bulimia
b) bulimia
A type of therapy in which contracts for weight gain, for regulating eating & exercise behavior & for diminishing binge/purge behaviors are commonly used tools in inpatient & outpatient TX:

a) behavioral therapy
b) individual therapy
c) group therapy
d) family therapy
e) expressive therapy
f) cognitive therapy
a) behavioral therapy
Techniques such as reframing & rational-emotive therapy is commonly used therapy for eating disorders from which most clients demonstrate distorted thoughts & beliefs related to food, weight, & self concept:

a) behavioral therapy
b) individual therapy
c) group therapy
d) family therapy
e) expressive therapy
f) cognitive therapy
f) cognitive therapy
Because eating disorder symptoms are an indirrect physical expression of emotional pain, many pt's have difficulty translating their pain into words therefore this type of therapy allows for greater self-disclosure & exploration of underlying issues:

a) behavioral therapy
b) individual therapy
c) group therapy
d) family therapy
e) expressive therapy
f) cognitive therapy
e) expressive therapy
Because the eating disorder behavior often becomes the focal point of the family which leads to overinvolvment & power struggles that inadvertetly reinforce the behavior this therapy is neccessary:

a) behavioral therapy
b) individual therapy
c) group therapy
d) family therapy
e) expressive therapy
f) cognitive therapy
d) family therapy
A safe place to self-disclose, be accepted, & be understood while preventing manipulation & secondary gains related to being different:

a) behavioral therapy
b) individual therapy
c) group therapy
d) family therapy
e) expressive therapy
f) cognitive therapy
c) group therapy
Exposure plus response prevention, in which the clients eat "scary" or binge foods & are then prevented from purging, is an effective intervention for bulimia & is a technique used in which of the following types of therapy

a) behavioral therapy
b) individual therapy
c) group therapy
d) family therapy
e) expressive therapy
f) cognitive therapy
a) behavioral therapy
The use of non verbal techniques in art, music, & dance in addition to journal writing & poetry is the focus of this type of therapy:

a) behavioral therapy
b) individual therapy
c) group therapy
d) family therapy
e) expressive therapy
f) cognitive therapy
e) expressive therapy
Name 2 adjunctive therapies used for patients w/eating disorders:

Clue ......."NO"
N = nutritional edu & counseling

O = occuational therapy
Many clients w/eating disorders need assistance in learning how to plan meals, shop, & cook for themselves especially if they have not eaten for many years. In this therapy the dietician will do the actual meal planning but helps the patient carry out the plan. This type of therapy will include education concerning healthy moderate exercise:

a) nutrition edu & counseling
b) occupational therapy
b) occupational therapy
This type of therapy includes determining the clients ideal weight using the basal metabolic index & other calculations, planning a refeeding program, & meal planning:

a) nutrition edu & counseling
b) occupational therapy
a) nutrition edu & counseling
The initial goals of family therapy is:

a) to express thoughts & feelings
b) transform feelings of guilt, frustration, anger into concrete concerns
c) improve family interaction
d) decrease secondary gains & uncover underlying family dysfunction
d) decrease secondary gains & uncover underlying family dysfunction

Improving family interaction is the LONG TERM goal
Clients with chronic eating disorders often:

a) try to establish family type relationships with the parents of their peers

b) do not function well in society
b) do not function well in society
Nursing is taking more of a leadership role in the coordination of a treatment team on behalf of patients with eating disorders.

true/false
true
Th enurse evaluates the progress of pat's w/eatign disorders in an organized & timely manner & in accordance w/the outcomes delineated in the care plan. For the client with an eating disorder the evaluation includes 5 evaluations. Name them.

1) S_ _ _ _ _
2) B_ _ _ _ _ _ _
3) P_ _ _ _ _ _ _ _ _ _
4) P_ _ _ _ _ _ _ _ _ _
5) C_ _ _ _ _ _ _
Remember:

"Social Behavior is in Physiologic & Psycholical Cultures"
Monitoring laboratory values, vital signs, weight, & food/fluid intake provides the data to:

a) evaluate physiologic resposes
b) track behavioral responses
c) evaluate the psychologic & behavioral responses to TX
a) evaluate physiologic resposes
Listening to & interacting with the client in group therapy, in milieu activities, & during individual interactions regarding specific issues, the TX plan, or the behavioral contract iis necesary to:

a) evaluate physiologic resposes
b) track behavioral responses
c) evaluate the psychologic & behavioral responses to TX
c) evaluate the psychologic & behavioral responses to TX
Observing & recording the clients affect, level of program participation, specific eating behaviors, peer interactions, & responses to staff provide data to:

a) evaluate physiologic resposes
b) track behavioral responses
c) evaluate the psychologic & behavioral responses to TX
b) track behavioral responses
Eating disorders are syndromes with 1)_____, 2)_____ & 3) _____ features.

a)
1) physiologic
2) behavioral
3) psychologic
The recent outbreak of eating disorders is related to 3 current cultural trends.
Name them.
1) fashon industry
2) diet industry
3) womens movement
The etiology of eating disorders include biologic, possible genitic, & 3 other factors.
Name them.
1) sociocultural
2) psychological
3) familial
There is a high incidence of _______ among clients with eating disorders & their families.
depression
Name 6 personality traits that are common with eating disorders.
Name them.
1- low-self esteem
2- perfectionism
3- affective instability
4- interoceptive deficits
5- inefectiveness
6- people pleasing
Name 7 of the common dynamics in families of origin of persons with eating disorders.
1- enmeshment
2- poor conflict resolution
3- incomplete separation
4- alcoholism
5- physical abuse
6- sexual abuse
Of the 2 eating disorders, which is the most common.

a) anorexia
b) bulimia
b) bulimia
Eating disorders are most common in:

a) middle school
b) high school
c) college students
d) women between 20-30 years
b) high school
and...
c) college students
Common Axis I psychiatric diagnoses are all of the following except:

a) obsessive-compulsive personality disorders
b) depressive
c) anxiety
d) dissociative
a) obsessive-compulsive personality disorders

This is an Axis II diagnoses
Common Axis II psychiatric diagnoses would include all of the following except:

a) obsessive-compulsive
b) avoidant
c) anxiety
d) dissociative
c) anxiety
and...
d) dissociative

These are Axis I diagnoses
Common family interrelationship characteristics of clients with eating disorders are:

a) preoccupation w/rituals regarding food
b) parental neglect & abandonment
c) constant changing of rules & family roles
d) poor boundaries, overinvolement among members, & conflict avoidance
d) poor boundaries, overinvolement among members, & conflict avoidance
An appropriate nursing outcome for a client diagnosed w/anorexia the 1st week of hospitalization is that the client will:

a) remain on bed rest
b) gain 1-2 lbs per/wk
c) verbalize a realistic body image
d) demonstrate elevated self-concept
b) gain 1-2 lbs per/wk
A 15-yr-old female is brought to ER after fainting during gym class. She is grossly underweight, wears baggy clothes, & her skin is dry. She complains of feeling cold despite wearing 2 sweaters. To further assess for the possibility that she has anorexia, you would ask:

a) do you often wear such heavy clothing during warm weather?
b) do you ever lose lapses of time?
c) when was your last menstrual period?
d) do you use any drugs or alcohol?
c) when was your last menstrual period?
A 23 yr-old client was admitted to the partial hospitalization program for bulimia. The most appropriate nursing intervention would be:

a) educate the pt regarding the dangers of purging
b) observe the client 1hr after meals
c) discourage the client from eating sweets
d) encourage the client to attend a yoga class
b) observe the client 1hr after meals
A 20 yr-old college student goes to the ER w/complaints of fatigue & dizziness. After further assessment the nurse discovers the enamel on her teeth has eroded. The most important nursing intervention would be to:

a) discuss w/the physician the need to obtain electrolyte & glucose levels & an electrocardiogram
b) have a social worker talk to her
c) admit her to the psychiatric unit
d) bring her luch since she probably hasnt eaten
a) discuss w/the physician the need to obtain electrolyte & glucose levels & an electrocardiogram
Diagnostic studies for anorexia often show iron deficiency anemmia & ?

e_ _ _ _ _ _ _ blood u_ _ _ n_ _ _ _ _ _ _
elevated blood urea nitoge
WIth anorexia, an elevtaed blood urea nitogen level is reflective of what?
marked intravasular volume depletion & prerenal azotemia
WIth anorexia, muscle weakness, cardiac arrhythmias, & renal failure are manifestations of:

a) hyperchloremia
b) hypochloremia
c) hyperphosphotemia
d) hypophosphatemia
d) hypophosphatemia
Characterized by frequent binge eating & self induced vomiting associated with loss over control of eating & a persistant concern w/body image.

a) anorexia
b) bulimia
b) bulimia
These individuals are typically of normal weight for height, or may fluctuate.

a) anorexia
b) bulimia
b) bulimia
Macerated knuckles , swollen salivary glands, broken blood vessels in eyes & dental problems are characteristic of this eating disorder:

a) anorexia
b) bulimia
b) bulimia
Female college students seem to be most susceptible to this eating disorder:

a) anorexia
b) bulimia
b) bulimia
SUbstance abuse, anxiety, affective disorders & personality disturbances have been reported w/this disorder:

a) anorexia
b) bulimia
b) bulimia
The nurse identifies a need for dietary teaching for the client whose daily intake of food groups consists of:

a) 2-4 servings of the fruit group
b) 2-3 servings of the dairy group
c) 4-5 servings of breads, cerea, rice, & pasta group
d) 2-3 servings of the meat, poultry, fish beans, egg & nut group
c) 4-5 servings of breads, cerea, rice, & pasta group
During the 1st 24 hrs of starvation, the order in which the body obtains substrate for enrgy is:

a) glycogen, skeletal protein
b) visceral protein, fat stores, glycogen
c) fat stores, skeletal protein, visceral protein
d) liver protein, muscle protein, visceral protein
a) glycogen, skeletal protein
The nurse recgnizes that the major goal of TX for a patient w.anorexia is being met when the patient:

a) demonstrates a rapid weight gain
b) consumes the required daily intake of nutrients
c) commits to long-term individual & family counseling
d) verbalizes feelings regarding self image & fears of becoming obese
c) commits to long-term individual & family counseling
The nurse is caring for a hospitalized patient w/ anorexia. When the nurse is weighing this client, which of the following would be most appropriate?

a) discussing the effects of not eating correctly on the body
b) decreasing weight by one pound because of the x-tra clothing the patient is wearing
c) obtaining the weight 3x on the clients admission day, & averaging the weights to get an accurate weight
d) having the client remove x-tra layers of clothes & emptying pockets
d) having the client remove x-tra layers of clothes & emptying pockets
A 14 yr-old adolescent w/bulemia has been admitted to the hospital for evaluation & TX. The nurse is planning care & includes which of the following to help the client control purging behavior:

a) place mittens on the clients hands to discourage purging
b) allow the client to go to the bathroom after meals
c) follow every meal w/12 oz of water
d) observe the client for 1 hr or at least 30 minutes after meals
d) observe the client for 1 hr or at least 30 minutes after meals
The DSM-IV criteria for ANOREXIA:

1- refusal to maintain body weight at or above a minimally normal weight for age & height

2- intense fear of gaining weight or becoming fat even though underweight

3- disturbance in the way in which one's weight or shape is experienced

4- in postmenarcheal females, amennorhea

Concerning #1, weight loss or failure to make expected weight gain leading to body weight of less than:
a) 70%
b) 75%
c) 80%
d) 85%
a)
d) 85%

weight loss of 15% or more of normal body weight for age & height
Briefly state DSM-IV criteria for anorexia:

1-
2-
3-
4-
1-refusal
2-fear
3-disturbed perception
4-amennorhea
DSM-IV criteria for BULIMIA is:

1-recurrent episodes of binging

2- recurrent compensatory behavior

3- binging & binging behaviors occur 2x a week or more for 3 mo's

4-perception of self is unduly influenced by weight & shape

5-the disturbance does not occur only during episodes of anorexia

Binging is:
1) making one-self vomit after eating
2) eating more than a normal person would consume in a 24hr period & purging
3) consuming more food than a normal person in a 2 hr period of time with a sense of no control
4) consuming more food in a 2 hr period of time than a normal person with a sense of no control
4) consuming more food than a normal person in a 2 hr period of time with a sense of no control

Binging refers to episodes of out of control & excessive eating.
Purging is only one of many forms of compensatory behavior, but not necessarily a specific criteria for diagnoses of bulemia. However, compensatory behaviors of some sort, must be present in addition to out of control & excessive eating for DSM-IV criteria.
Nursing care for anorexic patients includes providing referral to appropriate sources, & administering medications. Name 3 other measures of care:
1- meeting nutritional needs

2- meeting fluid needs

3- preventing complications
Nursing interventions in caring for a patient with anorexia to meet nutritional & fluid needs includes monitoring food & fluid intake & observing eating behaviors at mealtime in addition to monitoring what other 3 things?
Monitor:

1- elimination patterns
2- daily electrolytes
3- if TPN, monitor for circulatory overload, hyperglycemia or hypoglycemia
In addition to monitoring nutritional & fluid needs in patients with anorexia, it is also important to monitor vital signs if the adolescent patient is receiving antidepressants. It is also important to be especially watchful for signs of what 2 conditions?

1) hy_ _ tension

2) _ _ _ _ _cardia
1-hypetension

2- tachycardia
In anorexia, changes in the central nervous system, vital signs, & other findings may indicate?
**substance abuse

**excess use of laxatives or ephedra

** OTC herbal drig use
Expected outcomes for patients with anorexia include weight gain & maintenance of adequate fluid volume in addition to what other 3 things?
1- beginning of positive self-esteem

2- intake of nutritionally balanced diet

3- use of psychologic counseling to understand the disorder
Causes for anorexia & bulimia are similar in that both demonstrate a sensitivity to social pressure for thiness, body image difficulties, & long-standing dysfunctional family patterns. However there is usually a distinct difference in the family dynamics between the 2 disorders. What is it?
ANOEXIA - OVERinvolvement (enmeshed, rigid structure, rigid expectations)

BULEMIA - UNDERinvolment(chaotic structure, neglect)
Bulimics & anorexics are alike in that both are preoccupied with shape, size, weight. Both may be evidenced by a broad range of body weight over a number of years. Physical evidence however is usually different in that Bulmics may often be seen with what signs that are not generally seen in anorexics.
Name at least 3.
1-calluses & maceration of the knuckles
2- erosion of tooth enamel
3- increased dental caries
4- gum recession
5- abd distention
6- esophageal tears & inflammation
A comprehensive history is necessary for buleics because they often appear normal in weight or only slightly underweight. What diagnostic tests are performed?
**hematocrit

**hemoglobin

**serum electrolytes
Diagnosis of Bulimia & Anorexia is based on:

a) self report
b) weight loss/less than body requirements
c) lab values
d) DSM-IV
d) DSM-IV
Most bulimic adolescents do not require hospitalization.

true/false
true
What indicators suggest hospitalization is neccessary for bulimics?
serious abnormalities in fluid & electrolyte levels caused from uncontrollable cycles of binging & vomiting accompanied by depression or suicidal activity
Identify 6 assessments you would make for a patient suspected of bulemia?
1- family history
2- daily diet
3- weight fluctuations
4- abd pain & distention
5- damaged teeth & oral mucosa
6- callused/macerated knuckles
What activities would you recomend to a bulimic patient to make connections between emotional states, stress, & the impulse to binge or purge?
kepp a log or food journal
Setting up a dietary routine for nulimics would include:

a) using different foods for each meal every day for 3 meals a day & one snack between the 2nd & 3rd meal of the day
b) using the same foods for each meal every day for 3 meals a day & one snack between the 2nd & 3rd meal of the day
c) using different foods for 3 meals a day every day & 3 of the same snacks every day
d) using same foods for 3 meals a day every day & 3 of the same snacks every day
d) using same foods for 3 meals a day every day & 3 of the same snacks every day
To change misconceptions about the weight gaining potential of certain foods & to decrease anxiety about what food must be eaten at the next meal, how should you set up a daily dietary routine for a bulimic patient?
use same foods for all 3 meals every day & 3 of the same snacks every day
Identify 5 expected outcomes you will expect for a bulimic partient.
1- healthy mucous membranes & skin

2- adequate intake of ffods & fluids

3- balanced food intake

4- maintenance of normal weight

5- absence of binging & purging