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

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?

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?

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?

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

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?

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?

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

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, "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 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?

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

Accepted Answer

Drugs can assist with weight loss, but should be just one part of a program that includes diet and exercise changes, or weight gain will occur when the drugs are stopped. Orlistat can decrease the absorption of fat-soluble vitamins, but vitamin supplements can be used to prevent deficiency. A reply indicating that the patient is lacking in willpower is judgmental and nontherapeutic. Orlistat may be used for weight maintenance as well as for weight loss and does not cause serious side effects.

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?

Accepted Answer

Motivation is essential for a successful outcome and will predict the chance for success more than the patient's initial BMI, previous history of weight loss, and activity level.

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?

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 will also be obtained from the patient, but the patient is more likely to make changes when the patient's beliefs are considered in planning.

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

Accepted Answer

Wound dehiscence is a more common problem in obese patients postoperatively and the patient should cough and deep breathe every 2 hours. 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 and should only be done by the health care provider. The patient's head should be elevated to allow better respiratory effort.

Question 15

The nurse is assessing patients at the outpatient clinic. Which of these patients is at risk for health complications related to weight?

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. A patient 6 ft tall and weighing 150 lb would have a BMI of 20 kg/m², well within the normal range. A 5 ft 4 in patient weighing 120 lb would have a BMI of 21 kg/m²; additionally, carrying most of the weight in the hips and thighs would place the patient at lower risk.

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

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 17

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 18

The nurse provides discharge instructions to a patient following gastric bypass surgery for treatment of obesity. The nurse teaches the patient to

Accepted Answer

Fluids and high carbohydrate foods tend to cause dumping syndrome and diarrhea. The patient transitions to pureed foods at about 2 to 4 weeks and by 4 to 6 weeks is eating solid foods. The diet after bariatric surgery should be high in protein and low in carbohydrates and roughage. Exercise and massage will not prevent the development of flabby skin.

Quiz 41: Nursing Management: Obesity