Question 1

Which of the following assessments should the nurse do to help determine if an obese client 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 2

Which of the following topics is of most importance for the nurse to include when teaching a client about testing for possible metabolic syndrome?

Accepted Answer

A fasting blood glucose test from 4-6 mmol/L 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 3

The nurse has completed teaching a client about the recommended amounts of foods from different food groups. Which of the following menu selections indicates that the initial instructions about health eating have been understood?

Accepted Answer

This selection is most consistent with What is a Healthy Plate? The other choices are all missing at least one food group.

Question 4

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

Accepted Answer

Because orlistat blocks the absorption of fat-soluble vitamins, the client may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common adverse effects of orlistat and indicate that the nurse should remind the client that fat in the diet may increase these adverse effects. Weight loss plateaus are normal during weight reduction.

Question 5

Which of the following information should the nurse plan to include in discharge teaching for a client 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 fibre. Exercise does not prevent the development of flabby skin.

Question 6

Which of the following surgeries places the client at greatest risk of developing dumping syndrome postoperatively?

Accepted Answer

A possible complication of vertical banded gastroplasty is dumping syndrome. Dumping syndrome is not a possible complication in adjustable gastric banding, vertical sleeve gastrectomy, or Lap-Band.

Question 7

The nurse is collaborating with an obese client who is enrolled in a behaviour modification program. Which of the following nursing actions is best?

Accepted Answer

Behaviour 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. Clients are often taught to restrict eating to designated meals when using behaviour modification.

Question 8

The nurse is developing a weight reduction plan for an obese client who wants to lose weight. Which of the following questions should the nurse ask first?

Accepted Answer

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

Question 9

A client who has been successfully losing 0.5 kg weekly for several months is weighed at the clinic and has not lost any weight for the last month. Which of the following actions should the nurse do 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 10

Which of the following client behaviours indicate that an overweight client has understood the nurse's teaching about the best exercise plan for weight loss?

Accepted Answer

Exercise should be done daily for at least 15-30 minutes. 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 client 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 11

What of the following specific information should the nurse include in client teaching for an overweight client who is starting a weight loss plan?

Accepted Answer

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

Question 12

The nurse is caring for a client who has undergone bariatric surgery and has just arrived on the unit from the recovery room. Which of the following actions should the nurse implement to promote tidal flow and reduce abdominal pressure?

Accepted Answer

Maintain the head of the client at a 35- to 40-degree angle to reduce abdominal pressure and increase tidal flow. Passive range-of-motion exercises may be completed but will not affect abdominal pressure. Ambulation postoperatively is not expected in the first couple of hours. Heparin may be ordered but that will not promote tidal flow or reduce abdominal pressure.

Question 13

The nurse is caring for a client who 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 of the following nursing actions 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 client should be encouraged to use the PCA since pain control will improve cough effort and client 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 14

Afew months after bariatric surgery, an older-adult client tells the nurse, "My skin is hanging in folds. I think I need cosmetic surgery." Which of the following responses by the nurse is best?

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 clients. The response, "The important thing is that your weight loss is improving your health." ignores the client's concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the client to talk to a counsellor, it is more likely to be helpful to know that cosmetic surgery is available.

Question 15

On the first postoperative day the nurse is caring for a client who has had a Roux-en-Y gastric bypass procedure. Which of the following assessment findings 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 client 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.

Question 16

The nurse is providing nutritional teaching to a client who is to start on a very-low-calorie diet. Which of the following calorie amounts should the nurse tell the client that daily calories are not to exceed?

Accepted Answer

A very-low-calorie diet does not exceed 800 calories/day. A low-calorie diet is between 800 and 1 200 calories/day.

Question 17

The nurse is planning preoperative teaching for a client undergoing a Roux-en-Y gastric bypass as treatment for morbid obesity. Which of the following interventions is priority?

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 18

Which of the following clients in the clinic should the nurse plan to teach about risks associated with obesity?

Accepted Answer

The waist-to-hip ratio for this client 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 89 cm and men with a waist circumference larger than 102 cm. A client with a BMI of 18 kg/m2 is considered underweight.

Question 19

The nurse is developing a weight loss plan for a young adult client who is morbidly obese. Which of the following statements by the nurse is most likely to help the client in losing weight on the planned 1 000-calorie diet?

Accepted Answer

Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A young adult client is unlikely to be motivated by future health problems. Telling a client that the initial weight loss in 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 client.

Quiz 43: Nursing Management Obesity