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NCM 105 - CARE OF CLIENTS WITH MALADAPTIVE
PATTERNS OF BEHAVIOR
INSTRUCTION:
Please choose the correct answer. Color RED your chosen answer. Add rationalization to your chosen answer and color it BLUE. EATING DISORDERS
- The Nurse is developing a plan of care for a female client with anorexia nervosa. Which action should the nurse include in the plan? A.Provide privacy during meals B.Set-up a strict eating plan for the client C.Encourage client to exercise to reduce anxiety D.Restrict visits with the family - Establishing a consistent eating plan and monitoring client’s weight are important to this disorder.
- The Nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is? A.Encourage to avoid foods B.Identify anxiety causing situations C.Eat only three meals a day D. Avoid shopping plenty of groceries - Bulimia disorder generally is maladaptive coping response to stress and underlying issues. The client should identify anxiety causing situation that stimulate the bulimic behavior and then learn new ways of coping with the anxiety
- The Nurse is working in a mental health facility; the nurse priority nursing intervention for a newly admitted client with bulimia nervosa would be to? A.Teach client to measure I & O B.Involve client in planning daily meal C.Observe client during meals D.Monitor client continuously
- Measuring intake and output includes number of meals and snacks per day, types and amount of foods and liquids consumed and situations, when and where eating occurs. By teaching the client proper measurements of intake and output, they would be able to self-imposed calorie restriction and dieting behaviour which is very important so that they would be aware of their current situation. Also,
- For clients struggling with bulimia and binge eating, this is a common personality trait. Setting very high standards for yourself personally, and then beating yourself up when you don’t achieve them. Setting unrealistic, unachievable goals, then failing to reach them and feeling rotten about you.
- Typical goals of inpatient hospitalization for an anorectic patient do not include: A.stabilization of the patient’s immediate condition. B.limited weight restoration. C.determination of the causes for the eating disorder. D.restoration of normal electrolyte balance. - An adequate outpatient eating disorder clinic needs to provide individual psychotherapy with cognitive behavioral techniques specific for anorexia nervosa and bulimia nervosa, family therapy, pharmacological treatment and the resources to obtain appropriate laboratory tests. Eating disorder patients requiring inpatient care are best treated in a specialized eating disorder inpatient unit.
- Which patient with an eating disorder would be at greatest risk for hypokalemia? A patient with: A.anorexia who loses weight by restricting food intake. B.anorexia or bulimia who purges to promote weight loss. C.bulimia whose predominant pathological behavior is excessive nocturnal eating. D.an eating disorder who exercises intensely more than 4 hours per day but maintains a normal electrolyte balance. - The low frequency of hypokalemia in this group of eating disordered outpatients suggests that routine electrolyte determination is a poor screening tool for occult or denied bulimia. Hypokalemia occurred almost invariably in lower- weight bulimic (or anorectic/bulimic) patients who were vomiting and/or abusing laxatives. Indeed, the study suggests that hypokalemia in a patient with an eating disorder is virtually certain evidence that the patient is purging at least daily. In addition, it appears that a patient with purely restricting anorexia nervosa is not at risk for hypokalemia even if his or her weight is very low.
- Which medication is likely to be used in the treatment of
patients with eating disorders? An:
the interaction between the nervous system and
the endocrine system that is how the brain regulates the hormonal activity in the body. And letter D talks about alterations in the nervous system and since patient is anorexic, endocrine system is also being affected.
- A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? A. 5 to 10 years old. B. 10 to 14 years old. C. 18 to 22 years old. D. 40 to 45 years old. - The onset of bulimia nervosa commonly occurs in late adolescence or early adulthood. Bulimia nervosa is more prevalent than anorexia nervosa. Research suggests that bulimia occurs primarily in societies that place emphasis on thinness as the model of attractiveness for women and in which an abundance of food is available
- A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client’s symptoms? A.Mood disorders, which often accompany the diagnosis of bulimia nervosa. B.Nutritional deficits, which are characteristic of bulimia nervosa. C.Vomiting, which may lead to dehydration and electrolyte imbalance. D. Binging, which causes abdominal discomfort. - An extreme and potentially considered life-threatening eating disorder known as bulimia or bulimia nervosa refers to a condition in which an individual develops a habit of consuming large amounts of food and exhibits no control overeating. However, it also attempts to shed away the extra added calories in a manner, which is not considered healthy, that is, by purging or vomiting. In the given case, the dry mucous membranes show dehydration, and restlessness and hallucinations could be the signs of electrolyte imbalance.
- Which anorexia nervosa symptom is physical in nature? A.Dry, yellow skin.
C.Frequent weighing. D.Preoccupation with food.
- Due to a lack of nutrients and hydration, hair and nails quickly become dry, weak and brittle. The skin, too, becomes dry, yellow and more susceptible to bruising and discoloration. Anorexia nervosa can even cause lanugo, which is the growth of fine hairs all over the body and face in an effort to maintain body heat.
- A client diagnosed with anorexia nervosa has a short-term outcome that states, “The client will gain 2 pounds in 1 week.” Which nursing diagnosis reflects the problem that this outcome addresses? A.Ineffective coping R/T lack of control. B.Altered nutrition: less than body requirements R/T decreased intake. C.Self-care deficit: feeding R/T fatigue. D.Anxiety R/T feelings of helplessness. - To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.
- A client with cachexia states, “I don’t care what you say, I am horribly fat and will continue to diet.” The client is experiencing arrhythmias and bradycardia. Based on this client’s symptoms, which nursing diagnosis takes priority? A.Ineffective denial. B.Imbalanced nutrition: less than body requirements. C. Disturbed body image. D. Ineffective coping. - In women exhibit a higher incidence regarding voluntary restriction of food intake secondary to anorexia, bulimia, and self-constructed fad dieting.
- A client is leaving the in-patient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? A.Client will accept refeeding as part of a daily routine. B.Client will perform nasogastric tube feeding independently. C.Client will verbalize recognition of “fat” body
misperception.
interactions.
C.Assessment of the client’s knowledge of selective serotonin reuptake inhibitors used in treatment. D.Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems
- Monitoring the vital signs of the patient is very important, because it is the baseline data for the nurse with regards for her/his patient’s condition.
- A client diagnosed with anorexia nervosa has a nursing diagnosis of disturbed body image. Which nursing intervention addresses this problem? A.Help client to realize that perfection is unrealistic. B.Stay with client during mealtime and for at least 1 hour after meals. C.Help the client to identify and set weight loss goals. D. Explain to client that privileges and restrictions will be based on weight gain. - Helping to clients often realize that unrealistic expectations don’t motivate them to strive, like they thought they did.
- When using a behavioral modi7cation approach to the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? A. A matter-of-fact, directive approach with the input of the entire treatment team. B.Clients should perceive that they are in control of clearly communicated treatment choices. C.Appropriate treatment choices are presented to the client’s family for consideration. D.The treatment team develops a system of rewards and privileges that can be earned by the client. - Patients with a positive outcome after taking the medication feels normally and can control their emotions or feelings and continue their treatment.
- A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, “What do you like better, hamburgers or spaghetti?” Which is the best response by the nurse? A.“I’m Italian, so I really enjoy a large plate of spaghetti.” B.“I’ll weigh you after your meal.” C.“Let’s focus on your continued improvement. You ate 80% of
D.“Why do you always talk about food? Let’s talk about swimming.”
- As a nurse you should be focus on the intervention to your client and be true to the client and encourage that can motivate the client to improve his/her condition.
- A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, “I’m going to the bathroom and will be back in a few minutes.” Which nursing response is most appropriate? A.“Thanks for checking in.” B.“I will accompany you to the bathroom.” C.“Let me know when you get back to the day room.” D.“I’ll stand outside your door to give you privacy.” - The best response to the client is by saying that you will accompany the client to the bathroom because the nurse is knowledgeable that bulimic clients are prone to purging and by going to the bathroom, the client must be using that as an excuse to vomit.
- A client diagnosed with an eating disorder has a nursing diagnosis of low self-esteem. Which nursing intervention would address this client’s problem? A.Offer independent decision-making opportunities. B.Review previously successful coping strategies. C.Provide a quiet environment with decreased stimulation. D.Allow the client to remain in a dependent role throughout treatment. - Offering to independent decision making will help the client think and will have to contemplate something different from what they’re used to and help the client indulge his/herself in the treatment regimen
- A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements R/T altered bodyperception AEB client’s being 5 feet 4 inches tall and weighing 75 pounds. Which nursing intervention would address this client’s problem? A.Encourage the client to keep a diary of food intake. B.Plan exercise tailored to individual choice. C.Help the client to identify triggers to self-induced purging. D.Monitor physician-ordered nasogastric tube feedings. - Client has an altered body perception that means that
initiating movement and function is reduced. Since the
neurotransmitters serotonin and norepinephrine. D. There is an association between bulimia nervosa and a malfunction of the thalamus.
- Serotonin, a neurotransmitter thought to play a key role in mood, feeding, and impulse regulation, may influence BN. Medicines known as serotonin reuptake inhibitors increase the amount of serotonin available in the brain. It has been shown to decrease the frequency of binging and purging episodes. Norepinephrine neurotransmitter is known to be associated with other psychiatric conditions.
- Which medication is used most often in the treatment of clients diagnosed with anorexia nervosa? A.Fluphenazine decanoate (Prolixin Decanoate ). B.Clozapine (Clozaril ). C.Fluoxetine (Prozac ). D.Methylphenidate (Ritalin ). - Fluoxetine affects chemicals in the brain that may be unbalanced in people with depression, panic, anxiety, or obsessive-compulsive symptoms. SSRIs such as fluoxetine have not been shown to treat weight loss or prevent relapses in anorexia. Nevertheless, they are sometimes used to treat symptoms of depression or anxiety in people with anorexia. PERSONALITY DISORDERS
- A 22-year-old client was diagnosed with dependent personality disorder. Which behavior is not likely to be evidence of ineffective individual coping? A. Recurrent self-destructive behavior B. Avoiding relationship C. Showing interest in solitary activities D. Inability to make choices and decision without advise - Individual with dependent personality disorder typically shows indecisiveness submissiveness and clinging behavior so that others will make decisions with them
