Unit 9 Eating Disorders Practice Nclex Questions with Answers & Rationales-1 PDF

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NUR 253 – Unit 9, Eating Disorders Questions *adapted from NurseLabs.com

! 1. Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: A. Avoid shopping for large amounts of food B. Control eating impulses C. Identify anxiety-causing situations D. Eat only three meals per day 2. During postprandial monitoring, a female client with bulimia nervosa tells the nurse, “You can sit with me, but you’re just wasting your time. After you had sat with me yesterday, I was still able to purge. Today, my goal is to do it twice.” What is the nurse’s best response? A. “I trust you not to purge.” B. “How are you purging and when do you do it?” C. “Don’t worry. I won’t allow you to purge today.” D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.” 3. For a female client with anorexia nervosa, Nurse Jimmy is aware that which goal takes the highest priority? A. The client will establish adequate daily nutritional intake B. The client will make a contract with the nurse that sets a target weight C. The client will identify self-perceptions about body size as unrealistic D. The client will verbalize the possible physiological consequences of selfstarvation

4. For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa? A. They tend to overprotect their children B. They usually have a history of substance abuse C. They maintain emotional distance from their children D. They alternate between loving and rejecting their children 5. Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? A. Fill out the client’s menu and make sure she eats at least half of what is on her tray. B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count. 6. A 24-year old client with anorexia nervosa tells the nurse, “When I look in the mirror, I hate what I see. I look so fat and ugly.” Which strategy should the nurse use to deal with the client’s distorted perceptions and feelings? A. Avoid discussing the client’s perceptions and feelings B. Focus discussions on food and weight C. Avoid discussing unrealistic cultural standards regarding weight D. Provide objective data and feedback regarding the client’s weight and attractiveness

7. Nurse Harry is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? A. Restrict visits with the family until the client begins to eat B. Provide privacy during meals C. Set up a strict eating plan for the client D. Encourage the client to exercise, which will reduce her anxiety 8. A female client with anorexia nervosa describes herself as “a whale.” However, the nurse’s assessment reveals that the client is 5′ 8 ″ (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client’s unrealistic body image, which intervention should nurse Angel be included in the plan of care? A. Asking the client to compare her figure with magazine photographs of women her age B. Assigning the client to group therapy in which participants provide realistic feedback about her weight C. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift D. Telling the client of the nurse’s concern for her health and desire to help her make decisions to keep her healthy 9. A 14-year-old client was brought to the clinic by her mother. Her mother expresses concern about her daughter’s weight loss and constant dieting. Nurse Kris conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? A. “I like the way I look. I just need to keep my weight down because I’m a cheerleader.” B. “I don’t like the food my mother cooks. I eat plenty of fast food when I’m out with my friends.” C. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to other girls.” D. “I do diet around my periods; otherwise, I just get so bloated.”

10. Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client? A. Providing one-on-one supervision during meals and for one (1) hour afterward B. Letting the client eat with other clients to create a normal mealtime atmosphere C. Trying to persuade the client to eat and thus restore nutritional balance D. Giving the client as much time to eat as desired

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Answers'&'Rationale' ' 1. Answer C. Identify anxiety-causing situations Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety.

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Option A: Controlling shopping for large amounts of food isn’t a goal early in treatment.

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Option B: Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues.

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Option D: Eating three meals per day isn’t a realistic goal early in treatment.

2. Answer D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.” This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives.

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Option A: Because their therapeutic relationships with caregivers are less important than their need to purge, they don’t fear betraying the nurse’s trust by engaging in the activity. They commonly plot to purge and rarely share their secrets about it.

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Options B and C: An authoritarian or challenging response may trigger a power struggle between the nurse and client.

3. Answer A. The client will establish adequate daily nutritional intake According to Maslow’s hierarchy of needs, all humans need to meet basic physiological needs first. Because a client with anorexia nervosa eats little or nothing, the nurse must first plan to help the client meet this basic, immediate physiological need.

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Options B, C, and D: The nurse may give lesser priority to goals that address long-term plans, self-perception, and potential complications.

4. Answer A. They tend to overprotect their children Clients with anorexia nervosa typically come from a family with parents who are controlling and overprotective. These clients use eating to gain control of an aspect of their lives.

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The characteristics described in options B, C, and D isn’t typical of parents of children with anorexia.

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Option C: Telling the husband to leave would probably be ineffective because of his agitated and irrational state.

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Option D: Exploring his anger doesn’t take precedence over safeguarding the client and staff.

5. Answer C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal Allowing the client to select her own food from the menu will help her feel some sense of control.

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Option A: She must then eat 100% of what she selected.

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Option B: Remaining with the client for at least 1 hour after eating will prevent purging.

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Option D: Bulimic clients should only be allowed to eat food provided by the dietary department.

6. Answer D. Provide objective data and feedback regarding the client’s weight and attractiveness By focusing on reality, this strategy may help the client develop a more realistic body image and gain self-esteem.

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Option A is inappropriate because discussing the client’s perceptions and feeling wouldn’t help her to identify, accept, and work through them.

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Option B: Focusing discussions on food and weight would give the client attention for not eating.

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Option C is inappropriate because recognizing unrealistic cultural standards wouldn’t help the client establish more realistic weight goals.

7. Answer C. Set up a strict eating plan for the client Establishing a consistent eating plan and monitoring the client’s weight are important for this disorder.

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Option A: The family should be included in the client’s care.

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Option B: The client should be monitored during meals — not given privacy.

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Option D: Exercise must be limited and supervised.

8. Answer D. Telling the client of the nurse’s concern for her health and desire to help her make decisions to keep her healthy A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about health.

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Instead of protecting the client’s health, options A, B, and C may serve to make the client defensive and more entrenched in her unrealistic body image.

9. Answer C. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to other girls.” Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a “desirable weight” is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem.

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Option A: Most clients with anorexia nervosa don’t like the way they look, and their self-perception may be distorted. A girl with cachexia may perceive herself to be overweight when she looks in the mirror.

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Option B: Preferring fast food over healthy food is common in this agegroup.

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Option D: Because of the absence of body fat necessary for proper hormone production, amenorrhea is common for a client with anorexia nervosa.

10. Answer A. Providing one-on-one supervision during meals and for one (1) hour afterward Because the client with anorexia nervosa may discard food or induce vomiting in the bathroom, the nurse should provide one-on-one supervision during meals and for 1 hour afterward.

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Option B wouldn’t be therapeutic because other clients may urge the client to eat and give attention for not eating.

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Option C would reinforce control issues, which are central to this client’s underlying psychological problem.

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Instead of giving the client unlimited time to eat, the nurse should set limits and let the client know what is expected.

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