Question 1

A primary care NP has prescribed phentermine for a patient who is obese.The patient loses 10 lb in the first month but reports that the drug does not seem to be suppressing appetite as much as before.The NP should:

A) discontinue the phentermine.
B) increase the dose of phentermine.
C) continue the phentermine at the same dose.
D) change to a combination of phentermine and topiramate.

discontinue the phentermine.

Accepted Answer

Tolerance to the effects of phentermine usually develops within a few weeks of starting therapy.When this occurs,the drug should be discontinued,not increased.Phentermine use is not recommended longer than a few weeks.

Question 2

A man with a BMI of 38 and a waist size of 48 inches is seen in the clinic for an annual well check-up.The primary care NP orders laboratory tests and notes a fasting plasma glucose of 110 mg/dL,triglyceride level of 220 mg/dL,and high-density lipoprotein level of 40 mg/dL.The man's blood pressure is 160/110 mm Hg.The man has a history of cardiovascular disease and tells the NP he has tried to lose weight numerous times.The NP should consider:

A) orlistat (Xenical).
B) phentermine (Adipex-P).
C) an oral antidiabetic agent.
D) a strict low-fat, low-sodium diet.

orlistat (Xenical).

Accepted Answer

This man's BMI and waist circumference indicate that he is obese,and he has more than three indicators of metabolic syndrome.Because of his history of cardiovascular disease,his past failed attempts to lose weight,and his elevated blood pressure,treatment is indicated.Phentermine would be a good initial choice but carries significant risks in patients with cardiovascular disease and high blood pressure.Orlistat is a safer choice for pharmacologic therapy.An oral antidiabetic agent would be used if insulin resistance were present,but his fasting plasma glucose is normal.A strict change in diet is warranted but in this case should be combined with pharmacologic treatment.

Question 3

A patient has a BMI of 35,a fasting plasma glucose of 120 mg/dL,elevated triglycerides,and a history of myocardial infarction.The primary care NP plans to initiate dietary and lifestyle counseling and should consider prescribing:

A) ephedra.
B) orlistat (Xenical).
C) phentermine (Adipex-P).
D) phentermine and topiramate (Onexa).

Accepted Answer

Patients who take Onexa have shown improvement in blood glucose levels and triglyceride levels,so this combination is a good choice for this patient.

Question 4

A patient comes to the clinic to discuss weight loss.The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors.The NP should recommend:&#10;A) orlistat (Xenical).&#10;B) surgical intervention.&#10;C) changes in diet and exercise.&#10;D) changes in diet and exercise along with short-term phentermine.

Accepted Answer

This patient is grade 2 overweight (obese),so a short-term course of phentermine is useful,especially as there are no cardiovascular risk factors.Orlistat is a second-line drug.Surgical intervention is indicated when other therapies fail.Changes in diet and physical activity alone do not bring immediate results,and patients often get discouraged.

Question 5

A patient who has hypothyroidism and is obese begins therapy with orlistat.The primary care NP teaches the patient about this drug and then asks the patient to describe its use.Which statement by the patient indicates understanding of the teaching?

A) "I may eat a high-fat diet while taking orlistat."
B) "I can expect the most benefit in the first few months."
C) "I should take fat-soluble vitamins each time I take orlistat."
D) "I should take an increased dose of levothyroxine while I am taking orlistat."

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Accepted Answer

In long-term studies on the use of orlistat,most of the weight loss occurred during the first months.Patients should not be counseled to eat a high-fat diet; the maximum amount of fat excretion is around 25% to 30%.Patients should take fat-soluble vitamins,but the vitamins should be taken at different times and not with orlistat.Orlistat interferes with levothyroxine absorption,so the two drugs should be taken at different times,and thyroid levels should be monitored with an increase in levothyroxine dose only when indicated by thyroid levels.

Question 6

A woman comes to the clinic to talk about weight reduction.The primary care nurse practitioner (NP)calculates a body mass index (BMI)of 28.The woman's waist measures 34 inches.The woman tells the NP that she would like to lose 20 lb for her daughter's wedding in 6 months.The NP should:

A) suggest she try over-the-counter (OTC) orlistat.
B) consider prescribing phentermine short-term.
C) discuss her short-term and long-term weight loss goals.
D) give her information about physical activity and diet modification.

Accepted Answer

This woman's BMI is in the moderate range for overweight,and her waist circumference is 34,which is not diagnostic for metabolic syndrome.Because her apparent motivation for losing weight is based on an upcoming event,the NP first should determine what her short-term and long-term weight loss goals are before initiating therapy.Orlistat is used long-term and would not be appropriate in this case.Phentermine should be used short-term and,because of serious risks,should be used only as adjunct therapy to lifestyle modifications.The initial intervention for weight loss is physical activity and diet modification.

Question 7

A patient who weighs 170 lb wishes to lose weight,with a target weight goal of 125 lb.To initiate a program that will result in a loss of 1 lb per week,the primary care NP should recommend a dietary intake of _____ kcal.

A) 1000
B) 1200
C) 1700
D) 2000

Accepted Answer

To lose weight,a patient must decrease intake to below the level needed to maintain weight.The patient must decrease daily calorie consumption by 500 kcal for each pound he or she wishes to lose weekly.Because it takes approximately 10 kcal per pound to maintain weight,the NP can assume that the patient currently takes in 1700 kcal/day and should recommend a diet of 1200 kcal/day for weight loss.

Deck 71: Weight Management