Question 1

In planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass as treatment for morbid obesity, the nurse places the highest priority on&#10;A) demonstrating passive range-of-motion exercises to the legs.&#10;B) teaching the patient about the postoperative presence of a NG tube connected to suction.&#10;C) teaching the patient proper coughing and deep-breathing techniques and methods of turning and positioning.&#10;D) discussing the necessary postoperative modifications in lifestyle.

Accepted Answer

Coughing, deep breathing, and turning can prevent major postoperative complications such as carbon monoxide retention, hypoxemia, and deep vein thrombosis. Passive range of motion is not as helpful in preventing deep vein thrombosis and other complications of immobility as active range of motion. The patient will be instructed about the NG tube, but this is not as important as pulmonary function. The focus during the preoperative teaching is the immediate recovery from the surgery, rather than the long-term lifestyle changes that are needed.

Question 2

A patient has a new prescription for sibutramine (Meridia). Which information about the patient indicates that the nurse should discuss the medication with the health care provider before administration?

A) The patient has a history of hypertension.
B) The patient has a permanent pacemaker to prevent bradycardia.
C) The patient's goal is to lose 90 lb (41 kg).
D) The patient used fenfluramine (Pondimin) in the past for weight loss.

Accepted Answer

Side effects of sibutramine (Meridia) include hypertension. A permanent pacemaker and a history of fenfluramine use are not contraindications for sibutramine. Sibutramine is prescribed for patients who have large weight-loss goals.

Question 3

The nurse in the clinic is assessing a new patient who has abdominal obesity and hypertension. What further assessment should the nurse do to assess for possible metabolic syndrome?&#10;A) Take the patient's apical pulse.&#10;B) Ask the patient about dietary intake.&#10;C) Measure the patient's waist size.&#10;D) Determine the patient's ethnic origin.

Accepted Answer

Waist size greater than 40 inches in men or 35 inches in women is one of the diagnostic criteria for metabolic syndrome. The other criteria are: increased triglycerides, low high-density lipoprotein (HDL), hypertension, and increased fasting glucose. Dietary intake and ethnicity are risk factors for metabolic syndrome but will not help determine whether the patient has this disorder. Cardiovascular disease may occur in patients with metabolic syndrome, but the pulse rate will not assist in the diagnosis of metabolic syndrome.

Question 4

A patient has been taking orlistat (Xenical) for several months as part of a weight loss program which also includes a low-fat diet. Which of these data obtained by the nurse indicate that a change in therapy may be needed?

A) The patient complains of abdominal bloating after meals.
B) The patient has lost 31 lb (14 kg) of the original 65 lb (30 kg) goal.
C) The patient frequently has liquid stools.
D) The patient is pale and has many bruises.

Accepted Answer

Because orlistat blocks the absorption of fat-soluble vitamins, the patient may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. The patient's weight loss indicates that the diet and medication are successful and should be continued.

Question 5

After discussing appropriate exercise activities with an overweight patient who is starting to exercise as part of a weight-loss program, the nurse will determine that the instructions have been understood when the patient reports

A) playing soccer for an hour on the weekend.
B) running for 10 to 15 minutes 3 times/week.
C) walking for 40 minutes 6 or 7 days a week.
D) lifting weights with friends three times a week.

Accepted Answer

Exercise should be done daily for 30 minutes to an hour. Exercising in highly aerobic activities for short bursts or only once a week is not helpful and may be dangerous in an individual who has not been exercising. Running may be appropriate, but a patient should start with an exercise that is less stressful and can be done for a longer period. Weight-lifting is not as helpful as aerobic exercise in weight loss.

Question 6

Which of these menu selections by a patient who is attempting to lose weight indicates that the initial instructions about diet have been understood?&#10;A) 3 oz of pork roast, a cup of corn, and a sliced tomato&#10;B) A chicken breast and a cup of tossed salad with nonfat dressing&#10;C) A 6 oz can of tuna mixed with nonfat mayonnaise and chopped celery&#10;D) 3 oz of roast beef, 2 oz of low-fat cheese, and a half-cup of carrot sticks

Accepted Answer

This selection is most consistent with the recommendation of the American Institute for Cancer Research that one third of the diet should be from animal sources and two thirds from plant source foods. The other choices all have higher ratios of animal origin foods to plant source foods than would be recommended.

Question 7

The nurse is developing a weight loss plan for a 21-year-old obese patient. Which statement by the nurse is most likely to help the patient in losing weight on the planned 800-calorie diet?&#10;A) &#34;You will decrease your risk for future health problems such as diabetes by losing weight now.&#34;&#10;B) &#34;You are likely to start to notice changes in how you feel with just a few weeks of diet and exercise.&#34;&#10;C) &#34;Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.&#34;&#10;D) &#34;It will be necessary to change lifestyle habits permanently to maintain weight loss.&#34;

Accepted Answer

Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 21-year-old patient is developmentally unlikely to be motivated by future health problems. Telling a patient that the initial weight loss is water will be discouraging, although this may be correct. Changing lifestyle habits is necessary, but this process occurs over time and discussing this is not likely to motivate the patient.

Question 8

A patient who has been consistently following a diet and exercise program and successfully losing 1 lb weekly for several months is weighed at the clinic and has not lost any weight for the last month. The nurse should first

A) review the diet and exercise guidelines with the patient.
B) instruct the patient to weigh weekly and record the weights.
C) discuss the possibility that the patient has reached a temporary weight loss plateau.
D) ask the patient whether there have been any changes in exercise or diet patterns.

Accepted Answer

The initial nursing action should be assessment of any reason for the failure to lose weight. The other actions may be needed, but further assessment is required before any interventions are planned or implemented.

Question 9

A few months after bariatric surgery, the patient tells the nurse, &#34;My skin is hanging in folds. I think I need cosmetic surgery.&#34; Which response by the nurse is most appropriate?&#10;A) &#34;The skin folds will gradually disappear once most of the weight is lost.&#34;&#10;B) &#34;The important thing is that your weight loss is improving your health.&#34;&#10;C) &#34;Perhaps you would like to talk to a counselor about your body image.&#34;&#10;D) &#34;Cosmetic surgery is certainly a possibility once your weight has stabilized.&#34;

Accepted Answer

Reconstructive surgery may be used to eliminate excess skin folds after at least a year has passed since the surgery. Skin folds may not disappear over time, especially in older patients. The response, "The important thing is that your weight loss is improving your health" ignores the patient's concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counselor, it is more likely to be helpful to know that cosmetic surgery is possible later.

Question 10

A moderately obese patient has been on a 1000-calorie diet with a daily exercise routine and a prescription for sibutramine (Meridia) for 10 weeks. Which information obtained by the nurse is important to report to the health care provider?

A) The patient has not lost any weight for the last 2 weeks.
B) The patient complains about having chronic constipation.
C) The patient tells the nurse about occasional palpitations.
D) The patient reports walking only 3 days during the last week.

Accepted Answer

The patient may be experiencing an increase in heart rate caused by the sibutramine (Meridia) that should be evaluated further by the health care provider. Plateaus during weight-loss programs are common. Chronic constipation may be a side effect of the sibutramine, and the nurse should instruct the patient in measures such as eating more high-fiber foods and increasing fluid intake. The nurse should reinforce the need to exercise more frequently, but no additional intervention by the health care provider is necessary regarding the patient's activity level.

Question 11

An obese patient asks the nurse about using orlistat (Xenical) for weight reduction. The nurse advises the patient that&#10;A) this drug can cause serious depletion of fat-soluble vitamins and should be used for only several weeks.&#10;B) weight-reduction drugs of any type are used for only those who do not have the willpower to reduce their intake of food.&#10;C) drugs may be helpful in weight loss, but weight gain is likely to recur unless changes in diet and exercise are maintained.&#10;D) the long-term effect of orlistat is not known, and the drug may cause serious side effects such as heart valve problems.

Accepted Answer

The answer of An obese patient asks the nurse about...

Question 12

When taking the health history from an obese patient, which information obtained by the nurse is most helpful in determining whether the patient will be successful in losing weight?&#10;A) The patient's body mass index is 39 kg/m2.&#10;B) The patient has a history of losing weight successfully in the past.&#10;C) The patient says, &#34;I am ready to make some changes in my lifestyle.&#34;&#10;D) The patient's rides a stationary bicycle.

Accepted Answer

The answer of When taking the health history from an...

Question 13

When developing a weight-reduction plan for an obese patient who is starting a weight-loss program, which question is most important for the nurse to ask?&#10;A) &#34;What kind of physical activities do you enjoy?&#34;&#10;B) &#34;How long have you been overweight?&#34;&#10;C) &#34;What factors do you think led to your obesity?&#34;&#10;D) &#34;Have you been on any previous diets?&#34;

Accepted Answer

The answer of When developing a weight-reduction plan for an...

Question 14

A patient returns to the surgical nursing unit following a vertical banded gastroplasty with a nasogastric tube to low, intermittent suction and a PCA machine for pain control. During the postoperative care of the patient, the nurse recognizes the need to

A) promote return of bowel sounds by discouraging excessive PCA use.
B) maintain patency of the NG tube with frequent normal saline irrigations.
C) support the surgical incision during coughing to prevent dehiscence of the wound.
D) position the patient flat in bed on the right side to promote normal stomach emptying.

Accepted Answer

The answer of A patient returns to the surgical nursing...

Question 15

The nurse is assessing patients at the outpatient clinic. Which of these patients is at risk for health complications related to weight?&#10;A) A 24-year-old with a waist measurement of 30 in (75 cm) and a hip measurement of 34 in (85 cm)&#10;B) A 33-year-old who has a body mass index (BMI) of 24 kg/m2&#10;C) A 56-year-old who is 6 ft (180 cm) tall and weighs 150 lb (68 kg)&#10;D) A 71-year-old who is 5 ft 4 in (160 cm), weighs 120 lb (55 kg), and carries most of the weight in the thighs

Accepted Answer

The answer of The nurse is assessing patients at the...

Question 16

A patient is being evaluated at the clinic for possible metabolic syndrome. The nurse will instruct the patient about the purpose of the&#10;A) resting electrocardiogram.&#10;B) fasting blood glucose test.&#10;C) postural blood pressures.&#10;D) cardiac enzyme tests.

Accepted Answer

The answer of A patient is being evaluated at the...

Question 17

When working with an obese patient who is enrolled in a behavior modification program, which nursing action is appropriate?&#10;A) Having the patient write down the caloric intake of each meal&#10;B) Asking the patient about situations that tend to increase appetite&#10;C) Suggesting that the patient have a reward, such as a piece of sugarless candy, after achieving a weight-loss goal&#10;D) Encouraging the patient to eat small amounts throughout the day rather than having scheduled meals

Accepted Answer

The answer of When working with an obese patient who...

Question 18

The nurse provides discharge instructions to a patient following gastric bypass surgery for treatment of obesity. The nurse teaches the patient to&#10;A) avoid foods high in carbohydrates and not to drink fluids with meals.&#10;B) maintain a liquid diet for about 6 weeks until gastric healing is complete.&#10;C) eat a high carbohydrate, high-roughage diet to promote bowel function when solid foods are allowed.&#10;D) exercise and massage to prevent the development of flabby skin resulting from massive weight loss.

Accepted Answer

The answer of The nurse provides discharge instructions to a...

Deck 41: Nursing Management: Obesity