Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 137

1. Assessment of a client reveals a 30% loss of preillness weight, lanugo, and cessation of menses for 3 months. Her vital signs are BP 90/50, P 96 bpm, respirations 30, and temperature 97 F. She admits to the nurse that she has induced vomiting 3 times this morning, but she had to continue exercising to lose'just 5 more lb.' Her symptoms are consistent with:

A) Pregnancy
B) Bulimia
C) Gastritis
D) Anorexia nervosa

2. Blood work reveals the following lab values for a client who has been diagnosed with anorexia nervosa: hemoglobin 9.6 g/dL, hemocrit 27%, potassium 2.7 mEq/L, sodium 126 mEq/L. The greatest danger to her at this time is:

A) Hypoglycemia from low-carbohydrate intake
B) Possible cardiac dysrhythmias secondary to hypokalemia
C) Dehydration from vomiting
D) Anoxia secondary to anemia

3. A client suspected of having anorexia nervosa is placed on bed rest with an IV infusion and a high-carbohydrate liquid diet. Within 72 hours, the results of her lab work show a return to normal limits. She is transferred to the psychiatric service for further treatment. A behavior modification plan is initiated. Three days after her transfer, the client tells the nurse, 'I haven - t exercised in 6 days. I won - t be eating lunch today.' This statement by her most likely reflects:

A) Her lack of internal awareness about the outcome of the behavior
B) Increased knowledge about personal exercise plans
C) A manipulative technique to trick the nurse into allowing her to miss a meal
D) A true desire to stay fit while in the hospital

4. A client who has been diagnosed with anorexia nervosa refuses to eat lunch. The most therapeutic response by the nurse to her refusal is:

A) 'Okay, missing one meal won - t hurt.'
B) 'You - ll have to eat lunch, or we - ll force-feed you.'
C) 'It - s not appropriate for you to try to manipulate the staff into granting your wishes.'
D) 'We will not allow you to starve yourself. You may choose to eat voluntarily or be fed.'

5. A client who has been diagnosed with anorexia nervosa reluctantly agrees to eat all prescribed meals. The most important intervention in monitoring her dietary compliance would be to:

A) Allow her privacy at mealtimes
B) Praise her for eating everything
C) Observe behavior for 1 - 2 hours after meals to prevent vomiting
D) Encourage her to eat in moderation, choose foods that she likes, and avoid foods that she dislikes

1. Right Answer: D
Explanation: (A) Presenting behaviors collectively are inconsistent with depression. (B) A preillness weight loss of 30%, lanugo, and cessation of menses are inconsistent with bulimia. (C) Symptoms and vital signs do not indicate the presence of infection. (D) All symptoms and vital signs are consistent with anorexia nervosa.

2. Right Answer: B
Explanation: (A) There is no lab data to support hypoglycemia. (B) Hypokalemia, caused by vomiting and decreased dietary intake of potassium, can result in life-threatening dysrhythmias. (C) Evidence of dehydration is not life threatening at this time, although fluid volume deficit does need to be addressed. (D) The clients hemoglobin does not reflect a life threatening value sufficient to render the client anoxic.

3. Right Answer: A
Explanation: (A) Indirect self-destructive behavior such as that seen in anorexia nervosa is characterized by the clients lack of insight and the awareness that the outcome of the dieting, exercising, and weight loss will ultimately result in death if uninterrupted. (B) Although the client is knowledgeable about exercise, knowledge about the balance between nutrition, exercise, and rest is absent. (C) The clients level of denial and lack of awareness disallow this behavior as a manipulative trick. (D)The clients illness-maintaining behaviors are inconsistent with fitness.

4. Right Answer: D
Explanation: (A) This response reinforces the clients maladaptive behavior, thereby contributing to the clients risk. (B) Ultimatums are not therapeutic. (C) This comment invites an argument because it puts the client on the defensive and stabs at her self-esteem, which is already compromised. (D) Setting limits assures the client that staff has genuine concern for her safety and well-being. Giving her an actual choice will give the client an increased sense of control over her life and avoid an argument or power struggle.

5. Right Answer: C
Explanation: (A) Eating alone is not recommended for anorexic clients because they tend to hoard food instead of eating it. (B) The client should be praised for whatever she eats, which is usually a small portion or percentage of what is served. Praise should not be withheld until she eats everything. (C) The client should be observed eyeto- eye for at least 1 hour following meals to prevent discarding food stashed in her clothing at mealtime or engaging in selfinduced vomiting. (D) If offered these choices, the client would choose low-caloric foods, not a nutritious diet.

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