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The nurse is preparing a teaching plan for a client diagnosed with bulimia nervosa. What would be included in the teaching plan?
- A. Change eating locations frequently
- B. Consume no more than 2000 to 3000 calories/day.
- C. Eat alone to concentrate on food intake.
- D. Consume high-caloric foods.
Correct Answer: B
Rationale: Included in the teaching plan should be that the client will consume no more than 2000 to 3000 calories/day divided among three meals plus or minus snacks. There should be a restriction of eating locations. Binging takes place when the client with bulimia is alone and when there is a low potential for being discovered. Consuming low-caloric foods may create less anxiety and reduce the potential for purging.
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Clients with anorexia nervosa frequently use methods to avoid eating or to prevent weight gain. Which documentation most accurately describes the behavior of a client with anorexia?
- A. Client observed to move food around the plate arranged in various patterns.
- B. Client stares frequently into space and has to be prompted to participate in the mealtime conversation.
- C. Client talks about food likes and dislikes and reminisces about holiday foods.
- D. Client states feeling depressed and does not feel like eating right now.
Correct Answer: A
Rationale: Clients with anorexia practice various rituals such as cutting food into small pieces and rearranging food on the plate without actually eating.
The nurse understands that a client with an eating disorder will eat outside the range of normal. Which is the primary reason that eating disorders remain underreported?
- A. Eating disorders are poorly defined.
- B. Not reported as a medical problem
- C. Behaviors are kept secret.
- D. Body shapes vary.
Correct Answer: C
Rationale: Often, clients with eating disorders strive to keep their illness secret. Eating disorders range from extreme thinness to obesity with variations in body shapes and sizes. Many Americans are on some form of 'diet,' which makes it more difficult to identify a disorder. Even though the disorder may result in physiologic imbalances and medical complications, eating disorders are considered mental health disorders that are accompanied by anxiety and guilt.
The nurse is caring for a client who is struggling with weight loss issues, without apparent physical cause. Which is the most likely nursing assessment for this nutritional disorder in which normal body weight is not maintained?
- A. Bulimia
- B. Anorexia nervosa
- C. Kwashiorkor
- D. Crohn's disease
Correct Answer: B
Rationale: Anorexia nervosa is a nutritional disorder that is characterized by a refusal to maintain normal body weight in the absence of physical cause. Anorexia nervosa is considered a psychiatric disorder in a relentless pursuit of thinness. Bulimia is an eating disorder in which voracious appetite is followed by purging and is most likely found in normal to overweight individuals. Kwashiorkor is a severe protein deficiency associated with lack of protein in the diet. Crohn's disease can result in nutritional deficiencies but has apparent physiological cause.
A teenager who is attending a clinic for eating disorders has shown improvement in weight, but the laboratory values remain poor. Which behavior would the nurse identify as the likely cause of this finding?
- A. Pushing food around the plate
- B. Inducing vomiting after meals
- C. Drinking water before weighing
- D. Disposing of food
Correct Answer: C
Rationale: Drinking large volumes of water prior to being weighed is manipulative behavior that is likely the cause of improved weight without improved laboratory values. Pushing food around the plate to distort amount of food eaten, inducing vomiting, and disposing of food are all forms of manipulation but would not account for improvement of weight.
A client is being evaluated for an eating disorder. Which nursing assessment finding(s) is most indicative of a client with bulimia nervosa? Select all that apply.
- A. Younger onset than anorexia nervosa
- B. Denial of abnormal eating habits
- C. Overweight or normal weight
- D. Admits to purging and binging
- E. Eroded teeth enamel
- F. Appears thin but feels fat
Correct Answer: C,D,E
Rationale: In contrast to clients with anorexia nervosa, clients with bulimia nervosa are generally overweight or of normal weight, admit to their eating behavior of binging and purging, and often have erosion of teeth enamel from gastric acid contact. Bulimics are generally older at the onset of the disorder than anorexics. Anorexics are obsessed with thinness and view themselves as fat even when emaciated.