CLINICAL SKILLS 3554 MODULE #5
EXAM TEST BANK QUESTIONS AND
ANSWERS
A patient with a diagnosis of somatic symptom disorder is being assessed. What
assessment questions are appropriate and therapeutic in nature? (Select all that
apply.)
A. "Would you consider yourself to be mentally ill?"
B. "Do you have periods of depression or extreme sadness?"
C. "Have you ever been told that your symptoms are not real?"
D. "Are you able to care for yourself and meet your own basic needs?"
E. "How do the members of your immediate family react to your illness?" - Answer-B.
"Do you have periods of depression or extreme sadness?"
D. "Are you able to care for yourself and meet your own basic needs?"
E. "How do the members of your immediate family react to your illness?"
The assessment should address possible comorbid conditions like depression, the
patient's ability to meet their basic needs independently, and the dynamics of the
family regarding the existence of the sick role and secondary benefits. The remaining
options are likely to increase the patient's stress and foster anger, either of which are
therapeutic.
Over the past year, a woman has cooked gourmet meals for her family but eats only
tiny servings. She wears layered, loose clothing and now has amenorrhea. Her
current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most
likely?
A. Binge-eating disorder
B. Anorexia nervosa
C. Bulimia nervosa
D. Pica - Answer-B. Anorexia nervosa
Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation
with food, and wearing several layers of loose clothing to appear larger are part of
the clinical picture of an individual with anorexia nervosa. The individual with bulimia
usually is near normal weight. The binge eater is often overweight. Pica refers to
eating nonfood items.
Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating
disorder. Which outcome indicator is most appropriate to monitor?
A. Weight, muscle, and fat are congruent with height, frame, age, and sex.
B. Calorie intake is within the required parameters of the treatment plan.
C. Weight reaches the established normal range for the patient.
D. The patient expresses satisfaction with body appearance. - Answer-D. The patient
expresses satisfaction with body appearance.
Body image disturbances are considered improved or resolved when the patient is
consistently satisfied with his or her own appearance and body function. This
,consideration is subjective. The other indicators are more objective but less related
to the nursing diagnosis.
A patient who was referred to the eating disorders clinic has lost 35 pounds in the
past 3 months. To assess the patient's oral intake, the nurse should ask which
assessment question?
A. "Do you often feel fat?"
B. "Who plans the family meals?"
C. "What do you eat in a typical day?"
D. "What do you think about your present weight?" - Answer-C. "What do you eat in
a typical day?"
Although all the questions might be appropriate to ask, only "What do you eat in a
typical day?" focuses on the eating patterns. Asking if the patient often feels fat
focuses on distortions in body image. Questions about family meal planning are
unrelated to eating patterns. Asking for the patient's thoughts on present weight
explores the patient's feelings about weight.
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago
and has lost 25% of body weight. A nurse asks, "Describe what you think about your
present weight and how you look." Which response by the patient is most consistent
with the diagnosis?
A. "I am fat and ugly."
B. "What I think about myself is my business."
C. "I am grossly underweight, but that's what I want."
D. "I am a few pounds overweight, but I can live with it." - Answer-A. "I am fat and
ugly."
Patients diagnosed with anorexia nervosa do not recognize their thinness. They
perceive themselves to be overweight and unattractive. The patient with anorexia will
usually disclose perceptions about self to others. The patient with anorexia will
persist in trying to lose more weight.
A patient was diagnosed with anorexia nervosa. The history shows the patient
virtually stopped eating 5 months ago and has lost 25% of body weight. The patient's
current serum potassium is 2.7 mg/dL. Which nursing diagnosis is most applicable?
A. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte
imbalances and weight loss
B. Disturbed energy field, related to physical exertion in excess of energy produced
through caloric intake as evidenced by weight loss and hyperkalemia
C. Ineffective health maintenance, related to self-induced vomiting as evidenced by
swollen parotid glands and hyperkalemia
D. Imbalanced nutrition: less than body requirements, related to malnutrition as
evidenced by loss of 25% of body weight and hypokalemia - Answer-D. Imbalanced
nutrition: less than body requirements, related to malnutrition as evidenced by loss of
25% of body weight and hypokalemia
The patient's history and laboratory results support the correct nursing diagnosis.
Available data do not confirm that the patient uses laxatives, induces vomiting, or
,exercises excessively. The patient has hypokalemia rather than hyperkalemia. There
is no evidence of failure to thrive at this time.
Outpatient treatment is planned for a patient diagnosed with anorexia nervosa.
Select the most important outcome related to the nursing diagnosis: imbalanced
nutrition: less than body requirements. Within 1 week, the expectation is that the
patient will demonstrate what?
A. Weigh self accurately using balanced scales.
B. Limit exercise to less than 2 hours daily.
C. Select clothing that fits properly.
D. Gain ½ to ¾ pound. - Answer-D. Gain ½ to ¾ pound.
Only the outcome of a gain of ½ to ¾ pound can be accomplished within 1 week
when the patient is an outpatient. The focus of an outcome is not on the patient
weighing self. Limiting exercise and selecting proper clothing are important, but
weight gain takes priority.
Which nursing intervention has priority as a patient diagnosed with anorexia nervosa
begins to gain weight?
A. Assess for depression and anxiety.
B. Observe for adverse effects of refeeding.
C. Communicate empathy for the patient's feelings.
D. Help the patient balance energy expenditure and caloric intake. - Answer-B.
Observe for adverse effects of refeeding.
The nursing intervention of observing for adverse effects of refeeding most directly
relates to weight gain and is a priority. Assessing for depression and anxiety and
communicating empathy relate to coping. Helping the patient balance energy
expenditure and caloric intake is an inappropriate intervention.
A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the
rationale for establishing a contract with the patient to participate in measures
designed to produce a specified weekly weight gain?
A. Because severe anxiety concerning eating is expected, objective and subjective
data must be routinely collected.
B. Patient involvement in decision making increases a sense of control and promotes
compliance with the treatment.
C. A team approach to planning the diet ensures that physical and emotional needs
of the patient are met.
D. Because of increased risk for physical problems with refeeding, obtaining patient
permission is required. - Answer-B. Patient involvement in decision making
increases a sense of control and promotes compliance with the treatment.
A sense of control for the patient is vital to the success of therapy. A diet that
controls weight gain can allay patient fears of a too-rapid weight gain. Data collection
is not the reason for contracting. A team approach is wise but is not a guarantee that
the patient's needs will be met. Permission for treatment is a separate issue. The
contract for weight gain is an additional aspect of treatment.
, The nursing care plan for a patient diagnosed with anorexia nervosa includes the
intervention "Monitor for complications of refeeding." Which body system should a
nurse closely monitor for dysfunction?
A. Renal
B. Endocrine
C. Central nervous
D. Cardiovascular - Answer-D. Cardiovascular
Refeeding resulting in a too-rapid weight gain can overwhelm the heart, resulting in
cardiovascular collapse. Associated complications of this shift can include heart
failure, arrhythmias, respiratory failure, muscle breakdown, and death. Focused
assessment becomes a necessity to ensure patient physiological integrity. The other
body systems are not initially involved in the refeeding syndrome.
A psychiatric clinical nurse specialist uses cognitive therapy techniques with a
patient diagnosed with anorexia nervosa. Which statement by the staff nurse
supports this type of therapy?
A. "What are your feelings about not eating the food that you prepare?"
B. "You seem to feel much better about yourself when you eat something."
C. "It must be difficult to talk about private matters to someone you just met."
D. "Being thin does not seem to solve your problems. You are thin now but still
unhappy." - Answer-D. "Being thin does not seem to solve your problems. You are
thin now but still unhappy."
Cognitive behavioral therapy is used to diminish distortions in the patient's thinking
that result in problematic attitudes and eating-disordered behaviors. The correct
response is the only strategy that attempts to question the patient's distorted
thinking.
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges,
and purges is to teach the patient what intervention?
A. Eat a small meal after purging.
B. Avoid skipping meals or restricting food.
C. Concentrate oral intake after 4 pm daily.
D. Understand the value of reading journal entries aloud to others. - Answer-B. Avoid
skipping meals or restricting food.
One goal of health teaching is the normalization of eating habits. Food restriction and
skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal
after purging will probably perpetuate the need to induce vomiting. Teaching the
patient to concentrate intake after 4 pm will lead to late-day bingeing. Journal entries
are private.
What behavior by a nurse caring for a patient diagnosed with an eating disorder
indicates the nurse needs supervision?
A. The nurse's comments are compassionate and nonjudgmental.
B. The nurse uses an authoritarian manner when interacting with the patient.
C. The nurse teaches the patient to recognize signs of increasing anxiety and ways
to intervene.
EXAM TEST BANK QUESTIONS AND
ANSWERS
A patient with a diagnosis of somatic symptom disorder is being assessed. What
assessment questions are appropriate and therapeutic in nature? (Select all that
apply.)
A. "Would you consider yourself to be mentally ill?"
B. "Do you have periods of depression or extreme sadness?"
C. "Have you ever been told that your symptoms are not real?"
D. "Are you able to care for yourself and meet your own basic needs?"
E. "How do the members of your immediate family react to your illness?" - Answer-B.
"Do you have periods of depression or extreme sadness?"
D. "Are you able to care for yourself and meet your own basic needs?"
E. "How do the members of your immediate family react to your illness?"
The assessment should address possible comorbid conditions like depression, the
patient's ability to meet their basic needs independently, and the dynamics of the
family regarding the existence of the sick role and secondary benefits. The remaining
options are likely to increase the patient's stress and foster anger, either of which are
therapeutic.
Over the past year, a woman has cooked gourmet meals for her family but eats only
tiny servings. She wears layered, loose clothing and now has amenorrhea. Her
current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most
likely?
A. Binge-eating disorder
B. Anorexia nervosa
C. Bulimia nervosa
D. Pica - Answer-B. Anorexia nervosa
Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation
with food, and wearing several layers of loose clothing to appear larger are part of
the clinical picture of an individual with anorexia nervosa. The individual with bulimia
usually is near normal weight. The binge eater is often overweight. Pica refers to
eating nonfood items.
Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating
disorder. Which outcome indicator is most appropriate to monitor?
A. Weight, muscle, and fat are congruent with height, frame, age, and sex.
B. Calorie intake is within the required parameters of the treatment plan.
C. Weight reaches the established normal range for the patient.
D. The patient expresses satisfaction with body appearance. - Answer-D. The patient
expresses satisfaction with body appearance.
Body image disturbances are considered improved or resolved when the patient is
consistently satisfied with his or her own appearance and body function. This
,consideration is subjective. The other indicators are more objective but less related
to the nursing diagnosis.
A patient who was referred to the eating disorders clinic has lost 35 pounds in the
past 3 months. To assess the patient's oral intake, the nurse should ask which
assessment question?
A. "Do you often feel fat?"
B. "Who plans the family meals?"
C. "What do you eat in a typical day?"
D. "What do you think about your present weight?" - Answer-C. "What do you eat in
a typical day?"
Although all the questions might be appropriate to ask, only "What do you eat in a
typical day?" focuses on the eating patterns. Asking if the patient often feels fat
focuses on distortions in body image. Questions about family meal planning are
unrelated to eating patterns. Asking for the patient's thoughts on present weight
explores the patient's feelings about weight.
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago
and has lost 25% of body weight. A nurse asks, "Describe what you think about your
present weight and how you look." Which response by the patient is most consistent
with the diagnosis?
A. "I am fat and ugly."
B. "What I think about myself is my business."
C. "I am grossly underweight, but that's what I want."
D. "I am a few pounds overweight, but I can live with it." - Answer-A. "I am fat and
ugly."
Patients diagnosed with anorexia nervosa do not recognize their thinness. They
perceive themselves to be overweight and unattractive. The patient with anorexia will
usually disclose perceptions about self to others. The patient with anorexia will
persist in trying to lose more weight.
A patient was diagnosed with anorexia nervosa. The history shows the patient
virtually stopped eating 5 months ago and has lost 25% of body weight. The patient's
current serum potassium is 2.7 mg/dL. Which nursing diagnosis is most applicable?
A. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte
imbalances and weight loss
B. Disturbed energy field, related to physical exertion in excess of energy produced
through caloric intake as evidenced by weight loss and hyperkalemia
C. Ineffective health maintenance, related to self-induced vomiting as evidenced by
swollen parotid glands and hyperkalemia
D. Imbalanced nutrition: less than body requirements, related to malnutrition as
evidenced by loss of 25% of body weight and hypokalemia - Answer-D. Imbalanced
nutrition: less than body requirements, related to malnutrition as evidenced by loss of
25% of body weight and hypokalemia
The patient's history and laboratory results support the correct nursing diagnosis.
Available data do not confirm that the patient uses laxatives, induces vomiting, or
,exercises excessively. The patient has hypokalemia rather than hyperkalemia. There
is no evidence of failure to thrive at this time.
Outpatient treatment is planned for a patient diagnosed with anorexia nervosa.
Select the most important outcome related to the nursing diagnosis: imbalanced
nutrition: less than body requirements. Within 1 week, the expectation is that the
patient will demonstrate what?
A. Weigh self accurately using balanced scales.
B. Limit exercise to less than 2 hours daily.
C. Select clothing that fits properly.
D. Gain ½ to ¾ pound. - Answer-D. Gain ½ to ¾ pound.
Only the outcome of a gain of ½ to ¾ pound can be accomplished within 1 week
when the patient is an outpatient. The focus of an outcome is not on the patient
weighing self. Limiting exercise and selecting proper clothing are important, but
weight gain takes priority.
Which nursing intervention has priority as a patient diagnosed with anorexia nervosa
begins to gain weight?
A. Assess for depression and anxiety.
B. Observe for adverse effects of refeeding.
C. Communicate empathy for the patient's feelings.
D. Help the patient balance energy expenditure and caloric intake. - Answer-B.
Observe for adverse effects of refeeding.
The nursing intervention of observing for adverse effects of refeeding most directly
relates to weight gain and is a priority. Assessing for depression and anxiety and
communicating empathy relate to coping. Helping the patient balance energy
expenditure and caloric intake is an inappropriate intervention.
A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the
rationale for establishing a contract with the patient to participate in measures
designed to produce a specified weekly weight gain?
A. Because severe anxiety concerning eating is expected, objective and subjective
data must be routinely collected.
B. Patient involvement in decision making increases a sense of control and promotes
compliance with the treatment.
C. A team approach to planning the diet ensures that physical and emotional needs
of the patient are met.
D. Because of increased risk for physical problems with refeeding, obtaining patient
permission is required. - Answer-B. Patient involvement in decision making
increases a sense of control and promotes compliance with the treatment.
A sense of control for the patient is vital to the success of therapy. A diet that
controls weight gain can allay patient fears of a too-rapid weight gain. Data collection
is not the reason for contracting. A team approach is wise but is not a guarantee that
the patient's needs will be met. Permission for treatment is a separate issue. The
contract for weight gain is an additional aspect of treatment.
, The nursing care plan for a patient diagnosed with anorexia nervosa includes the
intervention "Monitor for complications of refeeding." Which body system should a
nurse closely monitor for dysfunction?
A. Renal
B. Endocrine
C. Central nervous
D. Cardiovascular - Answer-D. Cardiovascular
Refeeding resulting in a too-rapid weight gain can overwhelm the heart, resulting in
cardiovascular collapse. Associated complications of this shift can include heart
failure, arrhythmias, respiratory failure, muscle breakdown, and death. Focused
assessment becomes a necessity to ensure patient physiological integrity. The other
body systems are not initially involved in the refeeding syndrome.
A psychiatric clinical nurse specialist uses cognitive therapy techniques with a
patient diagnosed with anorexia nervosa. Which statement by the staff nurse
supports this type of therapy?
A. "What are your feelings about not eating the food that you prepare?"
B. "You seem to feel much better about yourself when you eat something."
C. "It must be difficult to talk about private matters to someone you just met."
D. "Being thin does not seem to solve your problems. You are thin now but still
unhappy." - Answer-D. "Being thin does not seem to solve your problems. You are
thin now but still unhappy."
Cognitive behavioral therapy is used to diminish distortions in the patient's thinking
that result in problematic attitudes and eating-disordered behaviors. The correct
response is the only strategy that attempts to question the patient's distorted
thinking.
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges,
and purges is to teach the patient what intervention?
A. Eat a small meal after purging.
B. Avoid skipping meals or restricting food.
C. Concentrate oral intake after 4 pm daily.
D. Understand the value of reading journal entries aloud to others. - Answer-B. Avoid
skipping meals or restricting food.
One goal of health teaching is the normalization of eating habits. Food restriction and
skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal
after purging will probably perpetuate the need to induce vomiting. Teaching the
patient to concentrate intake after 4 pm will lead to late-day bingeing. Journal entries
are private.
What behavior by a nurse caring for a patient diagnosed with an eating disorder
indicates the nurse needs supervision?
A. The nurse's comments are compassionate and nonjudgmental.
B. The nurse uses an authoritarian manner when interacting with the patient.
C. The nurse teaches the patient to recognize signs of increasing anxiety and ways
to intervene.
