Question 1

Which topic would be of importance for the nurse to include when teaching a patient about testing for possible metabolic syndrome?

Accepted Answer

A fasting blood glucose test >100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome, although they may be used to check for cardiovascular complications of the disorder.

Question 2

A patient who has been 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

Accepted Answer

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

Question 3

A patient returns to the surgical nursing unit following a vertical banded gastroplasty with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia ( PCA ) machine for pain control. Which nursing action should be included in the postoperative plan of care?

Accepted Answer

The incision should be protected from strain to decrease the risk for wound dehiscence. The patient should be encouraged to use the PCA since pain control will improve cough effort and patient mobility. NG irrigation may damage the suture line or overfill the stomach pouch. Sugar-free clear liquids are offered during the immediate postoperative time to decrease the risk for dumping syndrome.

Question 4

When developing a weight reduction plan for an obese patient who wants to lose weight, which question should the nurse ask first?

Accepted Answer

The nurse should obtain information about the patient's perceptions of the reasons for the obesity to develop a plan individualized to the patient. The other information also will be obtained from the patient, but the patient is more likely to make changes when the patient's beliefs are considered in planning.

Question 5

After the nurse has completed teaching a patient about the recommended amounts of foods from animal and plant sources, which of these menu selections indicates that the initial instructions about diet have been understood?

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 6

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

Accepted Answer

Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle also will be discussed, but avoidance of respiratory complications is the priority goal after surgery.

Question 7

Which information will the nurse plan to include in discharge teaching for a patient after gastric bypass surgery?

Accepted Answer

Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin.

Question 8

What specific information will the nurse include in patient teaching for an overweight patient who is starting a weight loss plan?

Accepted Answer

The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorie-restricted diets are not necessary for patients in the overweight category of obesity and need to be closely supervised. Patients should weigh weekly rather than daily.

Question 9

Which nursing action included in the plan of care for a patient who is being admitted for bariatric surgery can the nurse delegate to nursing assistive personnel (NAP)?

Accepted Answer

NAP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require RN level education and scope of practice.

Question 10

A 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?

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

Which patient behavior indicates that an overweight patient has understood the nurse's teaching about the best exercise plan for weight loss?

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 12

The nurse is developing a weight loss plan for a 21-year-old patient who is morbidly obese. Which statement by the nurse is most likely to help the patient in losing weight on the planned 1000-calorie diet?

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 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 13

A few months after bariatric surgery, a 62-year-old patient tells the nurse, "My skin is hanging in folds. I think I need cosmetic surgery." Which response by the nurse is most appropriate?

Accepted Answer

Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. Skinfolds 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 available.

Question 14

When the health care provider in the outpatient clinic is considering prescribing sibutramine ( Meridia ) for a patient, which patient information is most important for the nurse to discuss with the provider?

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 15

Which assessment will the nurse do to help determine if an obese patient seen in the clinic has metabolic syndrome?

Accepted Answer

Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information also may be obtained by the nurse, but it will not assist with the diagnosis of metabolic syndrome.

Question 16

When working with an obese patient who is enrolled in a behavior modification program, which nursing action is appropriate?

Accepted Answer

Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as calorie counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior modification.

Question 17

The nurse obtains these assessment data for a patient who has been taking orlistat (Xenical) for several months as part of a weight loss program. Which finding is most important to report to the health care provider?

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. Weight loss plateaus are normal during weight reduction.

Question 18

Which of these patients in the clinic will the nurse plan to teach about risks associated with obesity?

Accepted Answer

The waist-to-hip ratio for this patient is 0.88, which exceeds the recommended level of <0.80. A BMI of 24 kg/m² is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm). A patient with a BMI of 18 kg/m² is considered underweight.

Question 19

On the first postoperative day the nurse is caring for a patient who has had a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon?

Accepted Answer

Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected.

Quiz 41: Nursing Management: Obesity