Psychiatric Mental Health Nursing 8th Edition Mohr – Test Bank

Complete Test Bank With Answers

 

 

Sample Questions Posted Below

 

 

 

 

Import Settings:

Base Settings: Brownstone Default

Information Field: Chapter

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

Information Field: Page and Header

Highest Answer Letter: D

Multiple Keywords in Same Paragraph: No

 

 

 

 

 

Chapter: Chapter 05: Legal and Ethical Aspects

 

 

 

 

Multiple Choice

 

 

 

 

1. A psychiatric–mental health nurse has been consistently aware of the need to adhere to standards of practice during interactions with clients and their families. What is a standard of nursing practice?
2. A) The body of text in the state nurse practice act
3. B) A document outlining minimum expectations for safe nursing practice
4. C) Unwritten but traditional practices that constitute safe nursing care
5. D) Part of the federal nurse practice act

 

Ans:  B

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  06

Page and Header:  76, Nurse Practice Acts and the Expanding Role of Nursing

Feedback:  Standards of nursing practice are written documents that outline minimum expectations for safe nursing care. They are used to guide and evaluate nursing care, and courts look to them for guidance when malpractice cases are deliberated.

 

 

 

 

2. Nursing students are reviewing the nurse practice act in the state where they reside. A state’s nurse practice act has which of the following functions?
3. A) Makes recommendations for how nurses should practice
4. B) Defines the scope and limit of nursing practice
5. C) Defines specific situations that constitute malpractice
6. D) Follows federal laws about nursing practice

 

Ans:  B

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  02

Page and Header:  76, Nurse Practice Acts and the Expanding Role of Nursing

Feedback:  The nurse practice act in each state defines nursing, describes its scope, and identifies its limits within that state.

 

 

 

 

3. A psychiatric–mental health nurse has been named in a malpractice suit in which certain criteria have to be demonstrated by the client’s legal team. Which of the following lists includes the correct criteria?
4. A) Duty of care, professional performance, injury related to the nurse’s action, action foreseeably could have caused the injury, and proven injury
5. B) Duty of care, professional performance, injury related to the nurse’s action, failure to document injury, and proven injury
6. C) Professional performance, injury related to the nurse’s action, action foreseeably could have caused the injury, and proven injury
7. D) Duty of care, professional performance, injury related to the nurse’s action, and action foreseeably could have caused the injury

 

Ans:  A

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  03

Page and Header:  77, Malpractice

Feedback:  Malpractice includes the following elements of nursing negligence: The nurse professional had a duty of due care toward the plaintiff; the nurse professional’s performance fell below the standard of care and was, therefore, a breach of that duty; as a result of the failure to meet the standard of care, the plaintiff consumer was injured, and the nurse’s action was the proximate cause of the injury; and the plaintiff consumer must prove his or her injuries.

 

 

 

 

4. A class of nursing students are learning how to protect themselves from liability for malpractice. How can the students best do this once they begin providing care for clients?
5. A) Know and follow the statutory and professional standards.
6. B) Avoid documenting incriminating information.
7. C) Carry individual malpractice insurance.
8. D) Request legal consultation from their employers.

 

Ans:  A

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  03

Page and Header:  77, Malpractice

Feedback:  To decrease their chances of liability for malpractice, psychiatric nurses must ensure that their professional practice is within the bounds of statutory and professional standards. Documentation should be thorough and malpractice insurance does not necessarily prevent liability.

 

 

 

 

5. A physician would like to include a client with schizophrenia in a research study testing a new medication. What is the nurse’s primary obligation in this situation?
6. A) Ensure the client knows what he or she is agreeing to when providing consent.
7. B) Help the client with revoking consent once the study has started.
8. C) Obtain informed consent when the primary provider cannot be present.
9. D) Persuade the client to consent, because the new drug has shown promising results.

 

Ans:  A

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Documentation

Objective:  03

Page and Header:  78, Informed Consent

Feedback:  The nurse serves as the client’s advocate, the team’s colleague, and the facility’s excellent employee by continually evaluating the client’s ability to give informed consent and his or her willingness to participate and continue with a treatment modality. Unless serving as the primary provider, the nurse is not responsible for obtaining informed consent: that is the role of the primary provider or researcher.

 

 

 

 

6. An adolescent client has refused to wash or change his clothes for several days. He smells and looks filthy. Three male staff members approach him to escort him to the shower. The client resists and becomes combative when staff members insist. They place the client in seclusion and restraints and tell him that they will release him when he is calm and willing to shower. The client’s rights have been which of the following?
7. A) Not been violated, because a degree of cleanliness is important
8. B) Been violated, primarily because he should not be forced to shower
9. C) Been violated, primarily because of the inappropriate use of restraints
10. D) Not been violated, because his combative behavior warranted seclusion and restraint to protect others

 

Ans:  C

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  83, Right to Treatment in the Least Restrictive Environment

Feedback:  Clients have the right to treatment in the least restrictive environment. No staff member can confine a person with mental illness who is not a threat to self or others. Nurses must assess a client’s condition and status constantly so that health care professionals can initiate more or less restrictive treatment alternatives based on the client’s evolving needs.

 

 

 

 

7. A client was admitted to a psychiatric facility because he was found walking around the street naked and talking incoherently. He has no known next of kin and has been adjudicated incompetent for the first time following a thorough assessment. He refuses any antipsychotic medications but has not been harmful to himself or others. What action should the facility take?
8. A) Initiate court proceedings to have a guardian named
9. B) Convince the client of his need for care
10. C) Continue custodial care
11. D) Contact social services to find outpatient housing

 

Ans:  A

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Communication and Documentation

Objective:  05

Page and Header:  81, Substituted Consent

Feedback:  When a client cannot give informed consent due to mental illness, health care providers must obtain substituted consent for necessary treatments or procedures. Substituted consent is authorization that another person gives on behalf of a client who needs a procedure or treatment but cannot provide such consent independently. Substituted consent can come from a court-appointed guardian or, in some instances, from the client’s next of kin. If the client has not previously been adjudicated incompetent and if the law so permits and no next of kin are available to give substituted consent, the health care agency may initiate a court proceeding to appoint a guardian so that treatment professionals can carry out the procedure or treatment. The care team may or may not be able to convince the client that he needs care.

 

 

 

 

8. A client with a diagnosis of depression has been admitted to the health care facility. From a legal standpoint, clients hospitalized as voluntary admissions differ from other types of admissions in which of the following ways?
9. A) They can dictate their own plan of care independently.
10. B) They are considered legally competent.
11. C) They are considered a danger to themselves or others.
12. D) They cannot refuse treatment.

 

Ans:  B

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  05

Page and Header:  84, Voluntary Admission

Feedback:  Voluntary clients have certain rights that differ from those of other hospitalized clients. Specifically, they are considered competent (unless otherwise adjudicated) and therefore have the absolute right to refuse treatment, including psychotropic medications, unless they are dangerous to themselves or others, as in a violent destructive episode within the treatment unit. Though client preferences are always considered, these clients cannot dictate their plan of care without input from the care team.

 

 

 

 

9. A 25-year-old man is seen standing on a rooftop. His employer calls the police and tells them the man had been behaving strangely. When the police arrive, the man states that he has special healing powers and no harm will come to him. The man believes the police have been provided to him as a courtesy, and he willingly accompanies them to a psychiatric facility. His admission is considered what?
10. A) Involuntary admission
11. B) Legal admission
12. C) Coerced admission
13. D) Emergency admission

 

Ans:  D

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Evaluation

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  05

Page and Header:  85, Emergency Admission

Feedback:  Clients are considered to have emergency admission status when they act in a way that indicates that they are mentally ill and, due to the illness, likely to harm themselves or others.

 

 

 

 

10. A client with persistent depression is considering electroconvulsive therapy (ECT). The nurse has seen ECT be effective in other cases. When the client expresses fear and doubt about undergoing ECT, the nurse tries to talk him into taking it, truly believing it will help him. Which two ethical concepts are in conflict?
11. A) Beneficence and fidelity
12. B) Fidelity and paternalism
13. C) Paternalism and autonomy
14. D) Beneficence and autonomy

 

Ans:  C

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  11

Page and Header:  88, Beneficence and Paternalism

Feedback:  Paternalism and autonomy are in conflict. Paternalism is practicing with the intent to do good; however, professionals define how to do good, which may override the wishes and self-determination of the client. Autonomy is the patient’s right to make decisions for himself or herself. Beneficence is the principle of the nurse doing good, not harm. Fidelity is the nurse’s faithfulness to duties, obligations, and promises.

 

 

 

 

11. A client’s plan of care includes revoking privileges for inappropriate behavior, based on a contract between the client and the nurse who wrote the plan. Another nurse decides to ignore this, because the client promises that she will adhere to the contract in the future. The second nurse’s behavior may have violated which ethical principle?
12. A) Veracity
13. B) Beneficence
14. C) Autonomy
15. D) Fidelity

 

Ans:  D

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  09

Page and Header:  88, Veracity and Fidelity

Feedback:  Fidelity is the nurse’s faithfulness to duties, obligations, and promises. Autonomy is the patient’s right to make decisions for himself or herself. Veracity is a systematic behavior of honesty and truthfulness in speech. Beneficence is the principle of doing good, not harm.

 

 

 

 

12. A client asks if her medication has any possible negative side effects. The nurse considers the client highly suggestible, believes the medication will benefit the client, and, since the client has no history of cardiovascular disease, does not tell her of the potential for cardiac dysrhythmias. The nurse’s actions involve a conflict between which two ethical principles?
13. A) Veracity and justice
14. B) Veracity and paternalism
15. C) Veracity and beneficence
16. D) Veracity and fidelity

 

Ans:  B

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  09

Page and Header:  88, Beneficence and Paternalism

Feedback:  The conflict is between veracity and paternalism. Veracity is a systematic behavior of honesty and truthfulness in speech. Paternalism is practicing with the intent to do good; however, professionals define how to do good, which may override the wishes and self-determination of the client. Justice in health care is seen as the equitableness of benefits, including the right to access care. Beneficence is the principle of doing good, not harm. Fidelity is the nurse’s faithfulness to duties, obligations, and promises.

 

 

 

 

13. A group of psychiatric–mental health nurses have attended an inservice that addressed the topic of “everyday ethics.” This concept is best described as an approach to care that:
14. A) Emphasizes respect, caring, and unconditional positive regard
15. B) Focuses on maintaining the client’s autonomy
16. C) Emphasizes beneficence and fidelity in all nurse–client interactions
17. D) Ensures that health care is provided justly

 

Ans:  A

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  07

Page and Header:  86, Ethical Issues in Psychiatric–Mental Health Nursing

Feedback:  “Everyday ethics” act as the center of nursing practice and give meaning and purpose to nursing care. They focus on interpersonal relationships, demand the confirmation of positive regard, and respect the search for human dignity. They involve not only caring “for” but also caring “about” the client. The other given characteristics are congruent with everyday ethics but are not the central concepts.

 

 

 

 

14. During a client’s case conference, a nurse has made reference to the Code of Ethics for Nurses of the American Nurses Association (ANA). What is the main characteristic of the ANA Code of Ethics for Nurses?
15. A) It provides descriptions of case studies in which ethical dilemmas were resolved.
16. B) It provides standards of conduct for nurses regarding ethical care.
17. C) It outlines a decision-making framework for resolving ethical dilemmas.
18. D) It provides definitions of ethical principles and how they relate to nursing practice.

 

Ans:  B

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  08

Page and Header:  87, Nursing Spotlight 5.2

Feedback:  The ANA’s Code of Ethics for Nurses lists ethical standards of conduct for nurses. It does not outline a specific decision-making process, give explicit definitions of concepts, or provide case studies.

 

 

 

 

15. A nurse has been focusing on one particular client at work. She believes she sees a side of the client no one else on the treatment team can see. As a result, the nurse is in serious conflict with the other members of the care team. This demonstrates that the nurse may have:
16. A) Exceptional caring and concern for the client
17. B) Appropriate dedication to her job
18. C) A failure to maintain appropriate boundaries
19. D) An professional relationship with the client

 

Ans:  C

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  10

Page and Header:  89, Boundaries in Ethical Nursing Care

Feedback:  Interpersonal boundaries protect clients from emotional harm that would impede their recovery. Boundary violations are usually insidious in their development. In the beginning, a health care provider may be unaware that the relationship is drifting from therapeutic interactions into a friendship or social relationship. As this relationship changes, the judgment of the health care provider becomes clouded and the therapeutic needs of the client slip from focus. During treatment, providers must conduct interactions with clients within appropriate guidelines and focus on the client’s growth and movement toward wellness. Members of the health care team must recognize that stepping outside their professional boundaries can compromise a client’s movement toward recovery.

 

 

 

 

16. A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with which of the following?
17. A) Maleficence
18. B) Battery
19. C) Beneficence
20. D) Infidelity

 

Ans:  B

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  01

Page and Header:  78, Informed Consent

Feedback:  All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client’s informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove that they did not consent to the procedure, that providers did not give adequate information for a decision, or that the treatment exceeded the scope of the consent. This action does not constitute maleficence, beneficence, or infidelity.

 

 

 

 

17. While conducting an interview with a 14-year-old mental health client, he tells you that he has a plan to kill students at his school because they will not stop picking on him. He says, “I have everything I need all set up.” What would be your responsibility after hearing this statement?
18. A) To maintain the client’s confidentiality and not share the information with anyone
19. B) To maintain the client’s confidentiality, but try to convince him that it is the wrong thing to do
20. C) To break the client’s confidentiality because he has threatened the lives of other people
21. D) To break his confidentiality by documenting the client’s plan

 

Ans:  C

Chapter:  05

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  81, Health Insurance Portability and Accountability Act

Feedback:  Providers may use and disclose protected health information without consent, authorization, or both when they are conducting treatment, payment, and health care operations. They may disclose information without consent or authorization if so mandated by state or federal reporting requirements, such as those related to public health, abuse, neglect, and domestic violence. Providers may disclose protected information to law enforcement officials under specific circumstances. Documentation does not constitute a violation of confidentiality, though the nurse should certainly document the client’s statement.

 

 

 

 

18. A nurse has been accused by a client of breaking confidentiality. Breaching a client’s confidentiality is acceptable under which of the following circumstances?
19. A) The client’s situation is unique and unprecedented.
20. B) The client is a minor.
21. C) The client demonstrates an antisocial personality.
22. D) The client has made allegations of abuse.

 

Ans:  D

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  81, Health Insurance Portability and Accountability Act

Feedback:  Providers may use and disclose protected health information without consent, authorization, or both when they are conducting treatment, payment, and health care operations. They may disclose information without consent or authorization if so mandated by state or federal reporting requirements, such as those related to public health, abuse, neglect, and domestic violence. A unique case does not justify a breach in confidentiality. Similarly, the nurse cannot breach confidentiality solely because the client is a minor or has an antisocial personality.

 

 

 

 

19. During a care conference, a group of nurses have made reference to principles that serve as codes of conduct about right and wrong behaviors to guide actions. These principles are known as what?
20. A) Ethics
21. B) Laws
22. C) Mores
23. D) Fiduciary guidelines

 

Ans:  A

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  07

Page and Header:  86, Ethical Issues in Psychiatric-Mental Health Nursing

Feedback:  Ethics are principles that serve as codes of conduct about right and wrong behaviors to guide actions. They are not synonymous with laws, mores, or fiduciary guidelines.

 

 

 

 

20. A client who has bipolar disorder stops taking her medication because she says she likes how she feels in a manic state. What is the client’s right to make decisions for herself known as?
21. A) Paternalism
22. B) Autonomy
23. C) Justice
24. D) Veracity

 

Ans:  B

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  09

Page and Header:  88, Autonomy

Feedback:  Autonomy is the right to make decisions for oneself. Paternalism is similar to beneficence in that the intent is to do good. Veracity is a systematic behavior of honesty and truthfulness in speech. The ethical principle of justice in health care commonly is seen as the equitableness of benefits, including the right to access care.

 

 

 

 

21. Hospital managers have emphasized the need for care providers to adhere to the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Which of the following actions may violate HIPAA?
22. A) A nurse communicates a client’s medical history to another care provider electronically.
23. B) A nurse discusses a client’s treatment plan without first eliciting the client’s input.
24. C) A nurse discusses a client’s prognosis with a visitor without obtaining the client’s permission.
25. D) A nurse fails to make copies of a client’s medical record before transferring the client to a new care facility.

 

Ans:  C

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Evaluation

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  01

Page and Header:  81, Health Insurance Portability and Accountability Act

Feedback:  Discussing a client’s case with a non–care provider without obtaining permission is a violation of privacy and goes against the provisions of HIPAA. HIPAA allows for electronic communication and client input does not have to be obtained at every stage of care planning. A facility does not necessarily have to make copies of client records prior to transfer.

 

 

 

 

22. An adult male client has been admitted to the psychiatric care facility on an involuntary basis. In addition to being diagnosed as mentally ill, what is the main criterion for involuntary admission?
23. A) The client poses a danger to himself or others.
24. B) The client has a poor prognosis for recovery.
25. C) The client has not responded favorably to previous treatments.
26. D) The client lacks an adequate support system.

 

Ans:  A

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  85, Involuntary Admissions

Feedback:  To deprive a person of liberty by involuntary commitment is a serious matter, and the legal protections are strict. Before involuntary commitment, clear and convincing evidence must be used as the standard of proof in a civil hearing to determine if a person is mentally ill and dangerous to self or others.

 

 

 

 

23. A man with a longstanding history of schizophrenia has been implicated in arson that destroyed a large amount of property. The man’s competency to stand trial will be primarily determined on the basis of:
24. A) His willingness to adhere to prescribed treatment
25. B) His attorney’s experience in working with clients who have mental illness
26. C) His prognosis for recovery
27. D) His mental condition at the time of the trial

 

Ans:  D

Chapter:  05

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  01

Page and Header:  86, Competency to Stand Trial

Feedback:  Competency to stand trial refers to a defendant’s mental condition at the time of the trial. It is not based on the attorney’s experience, the client’s recovery prognosis, or the client’s adherence to treatment.

 

 

 

Import Settings:

Base Settings: Brownstone Default

Information Field: Chapter

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

Information Field: Page and Header

Highest Answer Letter: D

Multiple Keywords in Same Paragraph: No

 

 

 

 

 

Chapter: Chapter 26: Eating Disorders

 

 

 

 

Multiple Choice

 

 

 

 

1. A recent nursing graduate is surprised to learn how many people are directly affected by eating disorders in the United States. Which of the following percentages accurately reflects the incidence of anorexia and bulimia in the United States?
2. A) 1% to 4%
3. B) 4% to 6%
4. C) 6% to 9%
5. D) 10% to 12%

 

Ans:  A

Chapter:  26

Client Needs:  B

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Teaching/Learning

Objective:  01

Page and Header:  515, Incidence and Prevalence

Feedback:  Estimates of the prevalence of anorexia nervosa and bulimia nervosa range from 1% to 4% of the U.S. general population.

 

 

 

 

2. Eating disorders have a high incidence and prevalence in the United States but they are not distributed evenly across different demographic groups. Eating disorders primarily affect which of the following populations?
3. A) Young white females from upper socioeconomic groups
4. B) Young white females, with no distinction among socioeconomic or ethnic groups
5. C) Young to middle-aged white females from lower socioeconomic groups
6. D) Young females from lower socioeconomic groups, with no distinction among ethnic groups

 

Ans:  A

Chapter:  26

Client Needs:  B

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  01

Page and Header:  515, Incidence and Prevalence

Feedback:  Historically, anorexia and bulimia have been diagnosed most frequently in white, affluent, well-educated adolescent and young-adult females. Both disorders, however, are becoming more widely distributed among social classes and cultures (Anderson and Yager, 2005).

 

 

 

 

3. Which of the following statements best describes the biologic theories of the etiology of eating disorders?
4. A) Eating disorders involve dysregulation of multiple neurotransmitter systems and may be influenced by behavioral, cultural, and familial factors.
5. B) Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component.
6. C) Eating disorders result from family dysfunction involving a controlling mother; neurotransmitter dysfunction is a result, not a cause, of the eating disorder.
7. D) Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.

 

Ans:  D

Chapter:  26

Client Needs:  C

Cognitive Level:  Comprehension

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  02

Page and Header:  516, Biological Theories

Feedback:  Eating disorders can be best understood in terms of a multifactorial etiology. Most experts agree that anorexia and bulimia develop from a complex interaction of individual, family, and sociocultural factors. Research strongly suggests that eating disorders may originate in part from hypothalamic, hormonal, neurotransmitter, or biochemical disturbances. Whether the biologic abnormalities seen in clients with eating disorders contribute to the disorders or are secondary to the dysregulation in the eating behavior remains unclear.

 

 

 

 

4. The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks her to step on the scale. The student asks if she can go to the bathroom first to empty her bladder, stating, “That can make a big difference.” The student’s comment raises the nurse’s suspicion that the student may have:
5. A) Anorexia nervosa
6. B) Binge-eating disorder
7. C) Bulimia nervosa
8. D) Eating disorder not otherwise specified

 

Ans:  A

Chapter:  26

Client Needs:  B

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  03

Page and Header:  518, Anorexia Nervosa

Feedback:  Anorexia is characterized by a voluntary refusal to eat and typically a weight less than 85% of what is considered normal for height and age. Clients with anorexia have a distorted body image and, to the bewilderment of others, view their emaciated bodies as fat.

 

 

 

 

5. A client meets some of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the client’s weight is on the lower end of the normal range. What diagnosis would be given to this client according to the DSM-IV-TR?
6. A) Anorexia nervosa
7. B) Risk for anorexia nervosa
8. C) No diagnosis if weight is in normal range
9. D) Eating disorder not otherwise specified (NOS)

 

Ans:  D

Chapter:  26

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  03, 04

Page and Header:  518, Signs and Symptoms/Diagnostic Criteria

Feedback:  Eating disorders that do not meet the full criteria for anorexia or bulimia are classified as eating disorders NOS.

 

 

 

 

6. A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. She does not want to feel fat in her bathing suit on vacation. Her sodium level is 146 mEq/L; her potassium level is 3.1 mEq/L. She is 5 feet tall, weighs 100 lb, and has lost 15 lb in 3 weeks. Which of the following goals is a priority at this time?
7. A) Stabilize her electrolyte levels.
8. B) Assist her to begin gaining weight at the rate of 2 to 3 lb per week until she reaches 112 lb.
9. C) Help build her self-esteem.
10. D) Develop a contract with her to stop using laxatives and diuretics.

 

Ans:  A

Chapter:  26

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  534, Restoring Nutritional Balance

Feedback:  Restoring nutritional balance is a priority for clients with severe eating disorders. Clients who are clearly malnourished need to become physiologically stabilized until they are no longer at risk for severe medical complications related to starvation. Refeeding the very-low-weight client with anorexia means that nurses must carefully monitor cardiac function; another important intervention is to carefully monitor electrolytes. These clients are at risk for developing a “refeeding syndrome” with accompanying hypokalemia.

 

 

 

 

7. The mother and stepfather of a 15-year-old girl are distraught and confused about their daughter’s eating disorder, stating, “We did everything for her. I don’t understand why she chose this.” The nurse should be aware that family-based theories of causality propose that eating disorders develop how?
8. A) In response to pressure by the parents to have a thin, attractive daughter
9. B) As an attempt for the child to get attention from disinterested parents
10. C) Due to the socialization of girls to evaluate themselves against certain “idealized” standards of appearance
11. D) As a way for the child to feel a sense of control in response to controlling parents

 

Ans:  D

Chapter:  26

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  02

Page and Header:  518, Family-Based Theories

Feedback:  Studies provide some evidence to support that disturbed patterns of interaction exist in families of girls with anorexia. In such situations, from the viewpoint of family structure, the appropriate hierarchy of “parent in charge of child” is reversed in the area of food and eating. The child-adolescent is eating or not eating as she desires, and parents have very little influence over these behaviors. Feeling extremely helpless, parents often make extraordinary efforts to appease the child to get her to eat.

 

 

 

 

8. A client with a diagnosis of bulimia is being discharged from inpatient care. The nurse considers which of the following indicators to be most important when evaluating the effectiveness of the care plan?
9. A) The client has begun to talk about food positively.
10. B) The client admits that bulimia is unhealthy.
11. C) The client eats six small meals per day.
12. D) The client has moved into her own apartment.

 

Ans:  C

Chapter:  26

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  06

Page and Header:  537, Evaluation

Feedback:  The nurse evaluates the client’s physical and psychosocial responses to interventions. Desired physical outcomes include weight gain, normal laboratory values and vital signs, and return of secondary sexual characteristics and menstruation. Desired psychosocial outcomes include a realistic perception of body image, direct expression of feelings, improved self-esteem, a sense of control over self and environment, and constructive family process. The client’s adoption of healthy eating habits is paramount.

 

 

 

 

9. A 24-year-old woman is in treatment for anorexia nervosa. The therapist, using solution-focused brief therapy, should pose which of the following questions to the client as a basis for designing interventions?
10. A) “What do you think causes eating disorders?”
11. B) “When do you manage your eating behaviors successfully?”
12. C) “Do you know what ultimately happens to people who can’t manage their eating disorder?”
13. D) “What do you enjoy that is unrelated to your weight or body image?”

 

Ans:  B

Chapter:  26

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  06

Page and Header:  535, Encouraging Realistic Thinking Processes

Feedback:  People with eating disorders tend to have perfectionistic personalities and to think in all-or-nothing terms. The client defines rigid appropriate behaviors for herself in terms of “walking on a tightrope,” with the need for constant vigilance to keep from falling off. The client must learn balance and moderation in thinking and behavior. The nurse reassures the client that life is more like walking in a big meadow and that she can move safely in many directions.

 

 

 

 

10. The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old girl admitted with anorexia nervosa. The client’s weight is 40% below normal. She engages in many rituals related to eating, asks to be weighed several times per day, and complains that her access to the bathroom is limited. The nurse develops a contract with her. The purpose of the contract is to do which of the following?
11. A) Provide the client with a feeling of responsibility and control over her behavior
12. B) Provide the therapist with a strategy for client compliance
13. C) Allow the client a tool by which to negotiate behavior
14. D) Provide the nurse with a tool for evaluating the plan of care

 

Ans:  A

Chapter:  26

Client Needs:  C

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  534, Restoring Nutritional Balance

Feedback:  A contract may be useful in eliminating power struggles with the client. Even though clients may rebel against contract terms, it reassures them to know that consistent limits are being maintained and that they can trust the staff to help maintain control, and ultimately it enables the client to feel more in control.

 

 

 

 

11. During a therapy session, a client with anorexia tells the nurse, “I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I’m so fat.” Which of the following potential responses by the nurse is most therapeutic?
12. A) “I don’t think you are fat.”
13. B) “Has something occurred that caused you to measure your thighs?”
14. C) “You are exactly the right weight for your height.”
15. D) “You have always been very focused on your thighs. Is that the part of your body you like least?”

 

Ans:  B

Chapter:  26

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  06

Page and Header:  536, Improving Body Image

Feedback:  The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.

 

 

 

 

12. The nurse is interviewing Jessica, 18 years old, about her eating behaviors. Jessica’s parents have brought her to treatment because her mother suspects that Jessica has been binge eating and vomiting. The nurse asks Jessica if she ever feels that she cannot control her eating. Jessica is silent for a moment, and her mother states, “I know she can’t control it; she ate an entire cake last night!” Which of the following comments by the nurse is best?
13. A) “I see. Jessica, why did you feel like you have to eat so much?”
14. B) “Do you often have to answer for your daughter?”
15. C) “Jessica, is what your mother said true?”
16. D) “I see. Jessica, do you ever feel as though you cannot control your eating?”

 

Ans:  D

Chapter:  26

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  06

Page and Header:  537, Enmeshment and  Overprotectiveness

Feedback:  Parents in enmeshed families frequently try to protect their children by speaking for them, as in “She feels happy most of the time.” Members are not accustomed to identifying and expressing their own feelings and need frequent prompting from the nurse. The nurse encourages members to speak for themselves and not for one another.

 

 

 

 

13. The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old woman, is 5 feet 2 inches and weighs 82 lb. The nurse assesses her history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes characteristic physical findings such as dry skin, lanugo, and brittle hair and nails. Which of the following factors is a priority for the nurse to assess next?
14. A) Throat and esophagus
15. B) Condition of mouth and gums
16. C) Heart rate and rhythm
17. D) Patterns of activity and rest

 

Ans:  C

Chapter:  26

Client Needs:  D-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  06

Page and Header:  532, Physical Examination

Feedback:  Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.

 

 

 

 

14. A nurse is discussing the plan of care with a client who has anorexia nervosa. The client’s weight is 15% below ideal. The nurse and client agree on many issues and are now discussing the client’s activity level. The client would like to run 5 miles per day as she normally does. Which of the following responses by the nurse is best?
15. A) “That’s fine as long as you adhere to your eating program and do not use laxatives or purging.”
16. B) “No, exercise is not allowed until your weight is closer to normal.”
17. C) “Aerobic exercise is not the best choice now. Have you ever tried weightlifting?”
18. D) “Five miles per day is too much. How about 3 miles per day?”

 

Ans:  C

Chapter:  26

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  06

Page and Header:  534, Restoring Nutritional Balance

Feedback:  Rigorous aerobic exercise generally is contraindicated when weight gain is a goal. Allowing the client to engage in moderate resistance training (eg, weight lifting), however, would increase lean body mass as the client gains weight and minimize the gain in “fat weight,” which is a great fear of the client.

 

 

 

 

15. A 30-year-old woman is in therapy for bulimia, depression, and anxiety. She relates that she feels unable to cope with the demands of her life and that her boyfriend recently ended their long-term relationship. She states that she frequently binges when her stress levels are high. She denies feeling suicidal but states, “I’m a mess. I’m just not smart enough to figure out how to run my life!” Which of the following nursing diagnoses would best identify the client’s problems?
16. A) Social Isolation related to recent loss of significant relationship
17. B) Chronic Low Self-esteem related to unrealistic self-expectations
18. C) Fear related to life stressors
19. D) Risk for Delayed Growth and Development related to low self-esteem

 

Ans:  B

Chapter:  26

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  06

Page and Header:  533, Nursing Diagnosis

Feedback:  Clients with eating disorders generally have low self-esteem even though they achieve well at school, sports, and work. Most nursing diagnoses for clients with eating disorders center on psychosocial problems, such as Chronic Low Self-Esteem related to unrealistic expectations from self or others, lack of positive feedback, and striving to please others to gain acceptance.

 

 

 

 

16. Kim’s identical twin sister was just diagnosed with anorexia nervosa. Kim tells the nurse that she is concerned that she may also develop the disorder. Which of the following responses by the nurse is the most appropriate?
17. A) “Eating disorders have not been found to be genetic, so you do not have a risk for developing the disorder.”
18. B) “While eating disorders have shown a genetic link, environmental factors also play a role in the development of eating disorders.”
19. C) “Identical twins have about a 5% chance of both twins developing an eating disorder.”
20. D) “It is not genetics that increases the risk, it is environment. Since you both live in the same environment, you have an equal chance of developing the disorder.”

 

Ans:  B

Chapter:  26

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  02

Page and Header:  516, Biologic Theories

Feedback:  Studies of twins and the sisters and daughters of people with eating disorders suggest a genetic link. Monozygotic twins have a concordance rate of 50% to 80% for eating disorders (Anderson and Yager, 2005). Wade and colleagues (2000) attribute 58% of cases of anorexia nervosa to genes, with environmental factors also having a strong influence. The exact role of genetics in eating disorders, however, remains speculative.

 

 

 

 

17. While the nurse is talking to the mother of a 15-year-old girl, the mother expresses concern over her daughter’s eating and exercise habits. The mother says that as soon as her daughter comes home from school she exercises for 2 to 3 hours. She says her daughter eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. Her daughter was complaining of tooth pain, and when she took her to the dentist, her daughter had over 10 cavities. Which of the following disorders is her daughter most likely suffering from?
18. A) Anorexia nervosa
19. B) Binge-eating disorder
20. C) Bulimia nervosa
21. D) Eating disorder not otherwise specified

 

Ans:  C

Chapter:  26

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  03

Page and Header:  519, Bulimia Nervosa

Feedback:  Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental caries from the frequent contact of tooth enamel with food and acidic gastric fluids.

 

 

 

 

18. A client with an eating disorder is going through behavior family systems therapy (BFST). The client’s therapist is encouraging the parents to take charge of their daughter’s eating and is coaching her parents in developing an appropriate behavioral weight program. In what phase of BFST is this family?
19. A) Assessment
20. B) Control rationale
21. C) Weight gain
22. D) Weight maintenance

 

Ans:  B

Chapter:  26

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  523, Family Therapy

Feedback:  In the control rationale phase, the therapist encourages parents to “take charge” of the client’s eating and deals with their reactions. The therapist also coaches parents to develop an appropriate behavioral weight program. In the assessment phase, the multidisciplinary team, consisting of dietitian, physician, psychologist, nurse, and other professionals, comes together to coordinate care with the client and family. Team members engage the family in treatment and check the client’s weight weekly. They conduct history, behavioral analyses, and social and functional analyses. In the weight gain phase, the therapist begins to refine the weight-gain program and introduces non–food-related issues. He or she begins cognitive therapy interventions (eg, cognitive restructuring). Family psychotherapy and psychoeducation take place. The last phase is weight maintenance, where control over food gradually returns to the client. Team members teach healthy ways of maintaining weight. Family interactions increasingly become the focus of treatment. The therapist fosters client individuation.

 

 

 

 

19. Andrew is an overweight 32-year-old man who frequently eats vast amounts of food at one sitting. After these episodes, Andrew feels guilty and ashamed. Which of the following conditions is Andrew most likely suffering from?
20. A) Anorexia nervosa
21. B) Binge-eating disorder
22. C) Bulimia nervosa
23. D) Eating disorder not otherwise specified

 

Ans:  B

Chapter:  26

Client Needs:  B

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  03

Page and Header:  520, Other Eating Disorders

Feedback:  Binge-eating disorder (BED), an additional diagnostic category to the DSM-IV-TR, similarly affects males and females, many of whom are medically overweight or obese (Anderson and Yager, 2005). Characteristics of BED include recurrent eating binges; guilt, shame, and disquiet about binging; and marked psychological distress (Costin, 2002).

 

 

 

 

20. Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which of the following classes of medications has been used with some success in the treatment of eating disorders?
21. A) Antipsychotics
22. B) Stimulants
23. C) Mood stabilizers
24. D) Antidepressants

 

Ans:  D

Chapter:  26

Client Needs:  D-2

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  523, Psychopharmacology

Feedback:  Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms (APA, 2000b).

 

 

 

 

21. Following a precipitous weight loss over the previous 6 months, a 17-year-old female client has been brought to the adolescent psychiatry clinic by her mother and father. The psychiatric–mental health nurse should consider which of the following when planning the client’s care?
22. A) Denial and resistance to treatment are common among individuals with eating disorders.
23. B) An eating disorder is the outward manifestation of an underlying somatization disorder.
24. C) An individual cannot be treated for an eating disorder unless he or she provides informed consent.
25. D) Success rates for treatment of eating disorders in adolescents are close to zero.

 

Ans:  A

Chapter:  26

Client Needs:  A-1

Cognitive Level:  Evaluation

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  521, Interdisciplinary Goals and Treatment

Feedback:  These clients may resist treatment because denial is typically strong and resistance to treatment is common. In spite of these challenges, some clients respond favorably to treatment. Treatment may take place without consent if the individual is deemed a safety threat to himself or herself. Eating disorders are not necessarily related to somatization disorders.

 

 

 

 

22. A morbidly obese client is receiving care and the nurse suspects that his unhealthy body mass index is largely attributable to binge-eating disorder (BED). Which of the following statements would corroborate the nurse’s suspicion?
23. A) “I go through these alternating periods of starving myself and then eating way too much.”
24. B) “From time to time, I’ll eat nearly the entire fridge and then feel so guilty afterward.”
25. C) “When I think about it, I guess I usually eat five or six meals every day.”
26. D) “When I’m feeling anxious or depressed, I find that eating makes me feel a bit better.”

 

Ans:  B

Chapter:  26

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  03

Page and Header:  520, Other Eating Disorders

Feedback:  Characteristics of BED include recurrent eating binges; guilt, shame, and disquiet about binging; and marked psychological distress. Periodic starving, consistently frequent meals, and “solace eating” are not central characteristics of BED.

 

 

 

 

23. A psychiatric–mental health nurse is working with a female client in her early twenties who was diagnosed with anorexia nervosa 6 months ago. The nurse is aware of the prevalence of emotional reasoning among such clients. Which of the following statements is indicative of emotional reasoning?
24. A) “I try to explain the reasons why I don’t eat a lot to you all, but no one seems to get it.”
25. B) “When I’m sad or mad, a vigorous workout is the best thing for me.”
26. C) “I don’t really feel like talking about my eating because that’s my business, not yours.”
27. D) “No one else agrees, but I know that I’m fat because I always feel fat.”

 

Ans:  D

Chapter:  26

Client Needs:  D-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Communication and documentation

Objective:  06

Page and Header:  530, Psychosocial

Feedback:  Emotional reasoning means relying on emotions to determine reality. An example of emotional reasoning in clients with eating disorders is “I know I’m fat because I feel fat.” The other listed statements do not demonstrate this relationship between beliefs and emotions.