CH 40 EAQ Management of Obesity

The nurse provides dietary recommendations to an obese patient who is planning to lose weight. What should the nurse include? a. "Bake, broil, or steam your foods." b. "Eliminate carbohydrates from your diet." c. "Two thirds of your diet should be animal-source foods." d. "Eating small pieces of candy between meals is recommended to suppress your appetite."

ANS: A Broiling, baking, or steaming foods reduces fat intake. Low-carbohydrate diets reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals. Two thirds of the diet should be plant-source foods. Candy contains excess sugar, which increases the risk of weight gain.

When assessing a patient with obesity, what questions are appropriate for the nurse to ask the patient? Select all that apply. a. What kind of food do you prefer? b. Where do you go for a vacation? c. Are other family members obese? d. What is your motivation to lose weight? e. What is your educational background?

ANS: A C D Asking about food preferences helps to evaluate the patient's food habits, inquiring about the weight of family members will reveal any family history of weight issues, and asking about motivation to lose weight will clarify the patient's reasons for trying to lose weight. These all help in detailing the history and planning the required lifestyle modifications. Information about where the patient goes for vacation and about educational background is not relevant.

A community health nurse is conducting an assessment of a new patient. Which assessments should the nurse include when screening the patient for metabolic syndrome? Select all that apply. a. Blood pressure b. Resting heart rate c. Physical endurance d. Waist circumference e. Fasting blood glucose

ANS: A D E The diagnostic criteria for metabolic syndrome include elevated blood pressure, fasting blood glucose, waist circumference, triglycerides, and high-density lipoprotein (HDL) cholesterol. Resting heart rate and physical endurance are not part of the diagnostic criteria.

The nurse provides dietary information to an overweight patient related to portion sizes. The nurse should include that the recommended portion size of animal protein is how many ounces? a. 1 ounce b. 3 ounces c. 5 ounces d. 7 ounces

ANS: B An appropriate serving size of animal protein is 3 ounces, about the size of one's fist. 1 ounce is one third of the normal serving size; 5 and 7 ounces are greater than one serving size.

When teaching a patient about reducing weight by using a calorie-restricted diet, what instructions should the nurse include? Select all that apply. a. Skip meals if not hungry. b. Exercise regularly. c. Avoid concentrated sweets. d. Select fried foods. e. Select steamed and baked foods.

ANS: B C E To follow a calorie-restricted diet to reduce weight, the patient should exercise regularly; avoid concentrated sweets such as sugar, candy, honey, pies, cakes, cookies, and regular sodas; and eat steamed and baked foods. It is not advisable to skip meals or to consume fried and greasy foods.

The nurse is creating a plan of care for an obese patient who is at risk for cardiovascular disease. How many minutes of daily exercise should the plan include? a. 10 b. 20 c. 30 d. 90

ANS: C Most experts recommend 30-60 minutes of daily exercise to reduce the risk of cardiovascular disease. Exercising for 10 or 20 minutes is not long enough, and 90 minutes is more than necessary to prevent heart disease.

While caring for a patient after bariatric surgery, the nurse identifies that the patient is at risk for deep vein thrombosis (DVT). Which treatment strategy should be included in the patient's care plan to prevent this complication? Select all that apply. a. Antifibrinolytic drugs b. Compression stockings c. Vitamin K supplements d. Low-dose heparin e. Active and passive range-of-motion exercises

ANS: C D E DVT is characterized by the presence of a blood clot in a vein deep in the body. Venous stasis and venous distension in the patient stimulates the formation of blood clots in the body. Compression stockings prevent venous stasis, thereby reducing the signs of DVT. Low-dose heparin prevents the formation of new blood clots and prevents the enlargement of blood clots in the body. Therefore, low-dose heparin is prescribed to the patient. Active and passive range-of-motion exercises increase venous return, thereby reducing blood clots in the veins. Antifibrinolytic drugs and vitamin K supplements have blood clotting ability and further increase the risk in the patient.

A patient with a BMI of 26.1 kg/m² is scheduled for a laparoscopic hernia repair at an outpatient surgical facility. Which nursing action is appropriate prior to the surgery? a. Orlistat b. Locaserin c. Liraglutide d. Phentermine/topiramate

ANS: A Phentermine/topiramate can increase heart rate; it should not be used in patients with uncontrolled hypertension or heart disease. Orlistat blocks fat breakdown and absorption in the intestine; there are no contraindications for use with this patient. Based on the BMI, the patient is classified as "overweight." This status is not a contraindication for laparoscopic surgery.

The nurse collaborates with an obese patient to create a plan that contains specific daily weight loss goals. Which statement made by the patient indicates an appropriate goal to include in the plan? a. "I plan to eat fewer carbohydrates at every meal." b. "I plan to eat at least 3 cups of vegetables daily." c. "I will participate in a community walk for cancer." d. "I will seek medical advice for a weight loss program."

ANS: B A specific, measurable action plan to modify behavior is the best weight loss goal. The goal of eating at least 3 cups of vegetables daily is specific and measurable. Eating fewer carbohydrates is not a measurable goal, and participating in a community walk for cancer is not a daily activity. Seeking medical advice for a weight loss program is not directly associated with a specific weight loss goal.

The nurse includes lean meat, fish, and eggs in the diet of a patient with obesity. Which component of nutrition is most adequately provided through this diet? a. Fiber b. Protein c. Vitamin C d. Carbohydrates

ANS: B Lean meat, fish, and eggs are rich in proteins and vitamin B complex and should be included in the diet plan of an obese patient. Fiber is adequately available in bulk foods such as whole-grain wheat bread. Vitamin C is adequately available in citrus fruits and green vegetables. Carbohydrates are present in lean meat, fish, and eggs; however, they are in comparatively lesser amounts than are proteins.

The nurse identifies that orlistat has been prescribed to an obese patient for what reason? a. To reduce swelling b. To block fat breakdown and absorption in the intestine c. To suppress appetite d. To decrease the risk of sleep apnea

ANS: B Orlistat blocks fat breakdown and absorption in the intestine. It also inhibits the action of intestinal lipases, resulting in undigested fat excreted in feces. Diuretics reduce the circulating blood volume in an obese patient. Lorcaserin suppresses appetite. During sleep, the throat and tongue muscles relax, which may cause airway blockage in an obese patient. Administering sleep-inducing agents decreases the risk of sleep apnea in an obese patient.

The nurse is providing postoperative care for a bariatric surgery patient who experiences difficulty breathing and abdominal pressure. What action should the nurse take? a. Perform the jaw-thrust maneuver b. Assist the patient to walk a short distance c. Administer a low dose of heparin to the patient d. Place the patient's head at a 35- to 40-degree angle

ANS: D Placing the patient's head at a 35- to 40-degree angle will reduce pressure on the abdomen and help in lung expansion, improving breathing. The jaw-thrust maneuver is performed to reduce the risk of pulmonary aspiration and to promote airway opening in a sedated patient. After a bariatric surgery, the patient is encouraged to walk for short distances 3 to 4 times a day to prevent complications such as deep venous thrombosis. A low dose of an anticoagulant, such as heparin, will help prevent deep venous thrombosis.

The nurse provides initial weight-loss instructions to a patient. Which statement made by the patient indicates that additional teaching is needed? a. "I plan to lose 6 pounds a week until I have reached my weight loss goals." b. "I should exercise most days of the week for best results." c. "I will keep a diary of weekly weights to illustrate my weight loss." d. "I will reduce my caloric intake to 1800 calories per day."

ANS: A A healthy weight-loss goal is 1 to 2 pounds per week. Exercising, keeping a diary of weekly weights, and reducing caloric intake to 1800 calories per day would show that the patient understands healthy weight loss.

The nurse is caring for an obese patient who is being considered for bariatric surgery. What do the criteria guidelines for bariatric surgery include? a. BMI of 40 kg/m 2 or more b. BMI of 28 kg/m 2 or more c. BMI of 30 kg/m 2 or more d. BMI of 32 kg/m 2 or more with other significant co-morbidities

ANS: A Criteria guidelines for bariatric surgery include having a BMI of 40 kg/m 2 or a BMI of 35 kg/m 2 with one or more severe obesity-related medical complications such as hypertension, type II diabetes mellitus, heart failure, or sleep apnea. A BMI greater than 25 kg/m 2 is considered overweight, and a BMI greater than 30 kg/m 2 is considered obese.

Which nursing intervention would be beneficial for an obese patient who is at risk for deep venous thrombosis after surgery? Select all that apply. a. Providing compression stockings b. Administering low-dose heparin c. Administering aspirin medication d. Encouraging range-of-motion exercises e. Instructing in cough and deep-breathing techniques

ANS: A B D Compression stockings help to prevent the formation of blood clots. Heparin is an anticoagulant, which helps reduce the risk of blood clots. Range-of-motion exercise will help reduce the risk of blood clots. Aspirin increases the risk of bleeding, so the nurse should not administer aspirin. Cough and deep-breathing techniques help reduce pulmonary complications associated with bariatric surgery.

Which statement made by a patient who underwent a bariatric surgery indicates the need for further teaching about steps to maintain proper weight? a. "I should reduce carbohydrates in my diet." b. "I should limit cheese and butter in my diet." c. "I should drink plenty of fluids with my meals." d. "I should increase the protein content in my diet."

ANS: C Fluids should be restricted because they may cause dumping syndrome. Excessive carbohydrates increase the risk of diarrhea. Cheese and butter contain excess calories and intake should be limited. Protein is essential to build muscle mass and produce energy.

An obese patient reports consuming a high-fat diet daily. The nurse recognizes that which medication that is used to treat obesity blocks fat breakdown? a. A serotonin agonist b. A sympathomimetic c. Lorcaserin d. Orlistat

ANS: D Nutrient absorption-blocking drugs, such as orlistat, inhibit fat breakdown and absorption in the intestine. These drugs inhibit intestinal lipases and promote fecal elimination of undigested fat in obese patients. Serotonin agonists activate serotonin receptors and suppress the appetite. These medications do not decrease the absorption of fat. Sympathomimetics suppress the appetite and reduce feelings of hunger. Appetite-suppressing drugs, such as lorcaserin, increase norepinephrine levels in the brain and reduce the appetite.

Why does the nurse, who is preparing a diet regimen for an obese patient, advise the patient to lose approximately 1 to 2 pounds each week? a. To ensure better cosmetic results b. To reduce number of plateau periods c. To reduce risk of venous complications d. To provide a motivation for weight loss

ANS: A Steady, reasonable weight loss ensures that the patient does not have loss of skin elasticity and skin tone, providing better cosmetic results. Slow weight loss will not reduce plateau periods. The nurse instructs the patient to ambulate frequently to reduce the risk of venous complications. To provide motivation, the nurse teaches about advantages of weight loss and weight control but does not set a goal for weight loss.

When developing a weight-reduction plan for an overweight patient, it is important for the nurse to first assess the presence of which factor? a. The patient's readiness to make lifestyle changes b. The patient's current body mass index (BMI) c. The patient's waist-to-hip circumference ratio d. The patient's current employment status

ANS: A Eating patterns are established early in life, and eating has many meanings for people. To establish a weight-reduction plan that will be successful for the patient, the nurse should first explore the social, emotional, and behavioral influences on the patient's eating patterns. Current BMI, waist-to-hip circumference, and employment status are not correlated with success of weight loss or the development of a weight-loss plan.

An obese patient tells the nurse, "As part of my weight loss program, I have begun exercising daily for an hour in the morning and an hour in the evening. I also have a goal of 10,000 steps a day, but I started by walking one-third of the recommended steps. I have been swimming and cycling." The patient reports feeling fatigued at the end of the day. What recommendation should the nurse make? a. Exercise for an hour each day. b. Continue swimming but do not cycle. c. Change the goal to 5,000 steps a day. d. Start by walking 2,000 steps, with incremental increases.

ANS: A Exercise is an essential part of a weight loss program. Patients should exercise daily, preferably 30 minutes to an hour. Encourage individuals to wear a pedometer to track their activity with a goal of 10,000 steps a day. However, success may be walking one-third of the recommended steps with incremental increases over time. Patients can walk, swim, and cycle, all of which have long-term benefits.

The nurse provides weight-loss education to a patient with a body mass index (BMI) of 30 kg/m 2. Which statement made by the patient indicates the need for further teaching? a. "I will limit intake to 500 calories a day." b. "Engaging in weekend exercise only is not recommended." c. "Two thirds or more of my diet should be plant-source foods." d. "I should track my activity with a goal of 10,000 steps a day."

ANS: A Limiting intake to 500 calories per day is not indicated for this patient,and the severe calorie energy restriction would place this patient at risk for multiple nutrient deficiencies. A diet plan that limits calories to a total of 800 or less per day is not sustainable on a long-term basis. The nurse should stress to patients that engaging in weekend exercise only is not advantageous and can actually be dangerous. Two thirds or more of an individual's diet should be plant-source foods. Patients should track activity with a goal of 10,000 steps a day.

While providing postoperative care for a patient who underwent bariatric surgery, the nurse finds that the patient is unconscious and has not fully recovered from anesthesia. What action should the nurse take? a. Perform a jaw-thrust maneuver. b. Assist the patient with compression stockings. c. Administer intravenous fluids and electrolytes. d. Open nasal airways by closing the patient's mouth.

ANS: A The adipose tissue in the body stores anesthetics that are administered to induce sedation. Obese patients have excessive adipose tissue that releases the anesthetics into the bloodstream; therefore, these patients are at an increased risk for resedation after the surgery. This resedation can cause respiratory depression and subsequent fatal effects in the patient. Therefore, to prevent this risk, the nurse performs a jaw-thrust maneuver or head-tilt to ensure respiration. Compression stockings reduce only the signs of deep vein thrombosis, not the signs of resedation; therefore, they should not be used in this situation. Intravenous fluids and electrolytes do not reverse the signs of resedation in the patient; therefore, they are not administered to the patient. Closing the patient's mouth and opening only the nasal airways may not provide adequate respiration; therefore, the nurse should open the patient's oral and nasal airways to ensure safety.

A patient with a body mass index (BMI) of 22 kg/m 2 asks the nurse for weight-reducing medications. How should the nurse respond? a. Suggest a healthy diet to the patient. b. Suggest a low-dose form of orlistat. c. Report the BMI to the primary health care provider. d. Instruct the patient to avoid carbohydrates in the diet.

ANS: A Weight-reducing drugs are reserved for adults with a BMI of 30 kg/m 2 or greater or adults with a BMI of 27 kg/m 2 with at least one weight-related condition, such as hypertension, type II diabetes, or dyslipidemia. The BMI of 22 kg/m 2 in an adult patient indicates normal levels, so the nurse should suggest that the patient maintain a healthy diet. The nurse may suggest over-the-counter medications to an obese patient but not to a patient with a BMI of 22 kg/m 2. Because the patient has a normal BMI, there is no need to report the information to the primary health care provider or tell the patient to avoid a carbohydrate-rich diet, unless the patient has any co-morbid condition.

An obese patient underwent biliopancreatic diversion with a duodenal switch. The nurse should monitor the patient for which complications? Select all that apply. a. Malabsorption of fat-soluble vitamins b. Steatorrhea c. Iron deficiency d. Dumping syndrome e. Calcium deficiency

ANS: A B C D Malabsorption of fat-soluble vitamins and dumping syndrome are complications of biliopancreatic diversion, which is less common with a duodenal switch, because it creates a metabolic switch. Steatorrhea and iron deficiency are common with most bariatric surgeries. Calcium deficiency is associated with the Roux-en Y gastric bypass (RYBG) surgery.

The nurse is caring for a patient who has undergone Roux-en-Y gastric bypass surgery. The nurse should monitor the patient for signs of which deficiencies? Select all that apply. a. Calcium b. Iron c. Cobalamin d. Folic acid e. Protein

ANS: A B C D Roux-en-Y gastric bypass surgery results in the rapid emptying of stomach contents and causes dumping syndrome, decreasing the patient's absorption of calcium and iron. Therefore, the patient is at risk for calcium and iron deficiencies, in addition to cobalamin and folic acid deficiencies. Protein deficiency is not associated with this type of surgery.

A patient receives a prescription for a nonamphetamine drug for weight loss. What information should the nurse include in the patient's medication education? Select all that apply. a. Dose of the drug b. Action of the drug c. Side effects of the drug d. Encouraging the use of additional over-the-counter diet aids e. Informing the patient that the drugs will be enough to cure obesity f. Telling the patient to consult with the health care provider before modification of dosage

ANS: A B C F Patient education for all medications should include the dose prescribed, drug action, and side effects. The patient should consult with the health care provider before modifying the dosage. The patient should be discouraged from purchasing over-the-counter diet aids. The patient should be informed that drugs will not cure obesity on their own; a healthy diet and exercise are also important.

What discharge instructions should the nurse provide to a patient who has undergone Roux-en-Y gastric bypass surgery? Select all that apply. a. "You will need to take a calcium supplement." b. "You should take an iron supplement." c. "You will likely experience belching and heartburn." d. "Report vomiting, weakness, or faintness, which may indicate dumping syndrome." e. "You should experience a decrease in total cholesterol."

ANS: A B D E The patient who underwent Roux-en-Y gastric bypass surgery will have a calcium deficiency, so the nurse instructs the patient to take a calcium supplement. The patient who has undergone Roux-en-Y gastric bypass surgery will have anemia, which can be helped with iron supplements. An associated complication is dumping syndrome, which include symptoms of vomiting, weakness, and faintness. An outcome of the surgery is decreased total cholesterol. Heartburn and belching are associated with the surgery in which a gastric stimulation device is implanted.

The nurse is caring for a patient who has undergone bariatric surgery. Which nursing interventions will be beneficial to this patient? Select all that apply. a. Assisting the patient to walk in the evening after the surgery b. Administering carbohydrate-rich foods c. Maintaining the patient in the semi-Fowler's position d. Being prepared to perform a head-tilt maneuver e. Maintaining the patient on large quantities of liquid intake

ANS: A C D To prevent complications, the patient is typically assisted to walk the evening after the surgery. The nurse should place the patient's head at a 35- to 40-degree angle while assisting the patient into the semi-Fowler's position. This intervention promotes maximum chest expansion and prevents breathlessness by relaxing the patient's abdominal muscles and stabilizing the patient's airways. Anesthetics administered during surgery are stored in adipose tissues. The adipocytes release anesthetics into the blood stream after surgery, increasing the risk of resedation. Therefore, the nurse should be prepared to perform a head-tilt maneuver to prevent respiration depression that may be caused by resedation. Foods rich in carbohydrates increase the risk of diarrhea. Excess liquid intake promotes anastomosis leaks and increases the patient's pain.

The nurse is caring for a patient with an energy utilization and storage disorder called metabolic syndrome. Which treatment strategies will be helpful for this patient? Select all that apply. a. Administering metformin b. Administering tranexamic acid c. Providing information on nutritious dietary intake d. Advising the patient to consume palm kernel oil e. Providing information on positive lifestyle changes

ANS: A C E Metabolic syndrome is an energy utilization and storage disorder associated with an increase in fasting plasma glucose levels. Administering metformin enhances the patient's insulin sensitivity and decreases blood glucose levels. A healthy diet promotes weight loss and prevents obesity. A diet rich in unsaturated fatty acids decreases the patient's risk of weight gain. Therefore, the nurse should provide information about a nutritious diet to the patient. Sedentary lifestyles lead to metabolic syndrome. The nurse should provide the patient with information on positive lifestyle changes. Administering tranexamic acid increases blood clotting. A diet rich in saturated fat develops abnormal levels of blood cholesterol in the patient. Palm kernel oil is a rich source of saturated fat, so a patient with metabolic syndrome should avoid it.

The nurse is teaching a patient about developing strategies for a weight-loss program. What should the nurse include in the education? Select all that apply. a. Providing information about stimulus control and self-monitoring b. Stating that diet therapy alone is often effective c. Advising to stay focused on reasons to lose weight. d. Recommending that weight loss medication is part of the initial plan e. Including a reduced-calorie diet, exercise, and behavior modification in the plan

ANS: A C E Various behavioral techniques for patients engaged in a weight-loss program include self-monitoring and stimulus control. It is important to focus on reasons to lose weight. A multifaceted approach needs to be used and will include nutritional therapy, exercise, and behavior modification. Drugs are reserved for patients that meet specific criteria. Advising diet therapy or medication and surgical intervention for all patients is not recommended.

The nurse performs a physical assessment on a patient with glaucoma and determines that the patient is overweight. The nurse expects that which medication will be prescribed to suppress the patient's appetite? a. Orlistat b. Lorcaserin c. Topiramate d. Phentermine and topiramate

ANS: B Being overweight may result in various health risks. Certain medications are used to reduce weight to prevent the risk of diseases. Lorcaserin is a selective serotonin (5-HT) agonist that works by activating the serotonin receptor in the brain. This medication suppresses the appetite and creates a sense of satiety by activating the serotonin receptor that makes the patient eat less and feel full after eating smaller amounts of food. Orlistat blocks fat breakdown and absorption in the intestine by inhibiting the action of intestinal lipases. This may result in the excretion of undigested fat. Topiramate is an antiepileptic drug that induces a sense of satiety but does not suppress the patient's appetite. Phentermine and topiramate suppresses appetite and induces a sense of satiety but is contraindicated in patients with glaucoma.

A patient who is scheduled for gastric bypass surgery asks for information about dumping syndrome. How should the nurse explain dumping syndrome? a. The inability to digest high-fat foods b. When the passage of food into the small intestine occurs too rapidly c. A decrease in the secretion of insulin caused by carbohydrates d. An increase in the secretion of both bile and pancreatic enzymes

ANS: B It is believed that the cause of dumping syndrome is the passage of undiluted food into the jejunum. This causes a surge of insulin to be released, resulting in the symptoms of profuse sweating, nausea, dizziness, and weakness. Dumping syndrome is frequently seen in patients who have undergone subtotal gastrectomy or gastric bypass surgery. Dumping syndrome is not caused by an inability to digest high-fat foods, a decrease in the secretion of insulin, or an increase in the secretion of bile and pancreatic enzymes.

The nurse is administering postoperative care to a patient that underwent bariatric surgery. What is a priority intervention? a. Ambulating the patient b. Administering analgesics c. Providing solid foods to the patient d. Providing a low-protein diet to the patient

ANS: B The nurse administers analgesic medication immediately to relieve the severe pain associated with bariatric surgery. Ambulating the patient will reduce complications of surgery, but not before the patient has had an analgesic. The patient will not properly digest solid foods immediately after bariatric surgery, so only liquid foods are provided for the patient. The patient who has undergone bariatric surgery will require a high-protein diet.

The nurse has completed initial instruction with a patient regarding a weight-loss program. The nurse determines that the teaching has been effective when the patient makes which statement? a. "I plan to lose 4 pounds a week until I have met my 60-pound weight loss goal." b. "I will keep a diary of weekly weights to track my weight loss." c. "I will restrict my carbohydrate intake to less than 30 g/day to maximize weight loss." d. "I should not exercise more than my program requires because increased activity increases the appetite."

ANS: B The patient should monitor and record weight once per week. This prevents frustration at the normal variations in daily weights and may help the patient to maintain motivation to stay on the prescribed diet. Weight loss should occur at a rate of 1 to 2 lb/week. The diet should be well balanced rather than lacking in specific components that may cause an initial weight loss; this weight loss is not usually sustainable. Exercise is a necessary component of any successful weight loss program.

What should the nurse include in a postoperative plan of care for a patient who has undergone bariatric surgery? a. Avoid ambulating the patient. b. Give 30 mL of water every 2 hours. c. Give solid foods along with liquids. d. Avoid sugar-free liquids in the patient's diet.

ANS: B While performing postoperative care for a patient who has undergone bariatric surgery, the nurse should give 30 mL of water every 2 hours to maintain the patient's fluid and electrolyte balance. Limiting ambulation can result in deep vein thrombosis (DVT). Therefore, the nurse should encourage the patient to perform early ambulation. The combination of solids and liquids in the patient's diet should be avoided because it puts stress on the gastrointestinal system, causing the patient discomfort. Sugar-rich liquids can result in dumping syndrome, so the nurse should give sugar-free liquids to the patient.

A patient is taking lorcaserin. The nurse should monitor for what adverse effects associated with the medication? Select all that apply. a. Diarrhea b. Dizziness c. Dry mouth d. Constipation e. Abdominal bloating

ANS: B C D Lorcaserin is a selective serotonin (5-HT) agonist that acts on the brain to suppress the appetite and create a sense of satiety. Adverse effects of this drug include dizziness, dry mouth, and constipation related to the drug's action. Diarrhea and abdominal bloating are not common adverse effects of this drug.

The nurse develops a weight-reduction plan with a patient. The nurse should encourage the patient to set a weight-loss goal of how many pounds in a 4-week time period? a. A goal of 1 to 2 pounds b. A goal of 3 to 5 pounds c. A goal of 4 to 8 pounds d. A goal of 5 to 10 pounds

ANS: C A realistic weight loss goal for patients is 1 to 2 lb/wk, which prevents the patient from becoming frustrated at not meeting weight loss goals. If a patient loses 1 to 2 pounds per week, the weight loss in a 4-week time period would be 4 to 8 pounds.

An overweight patient states a willingness to lose weight. When developing an effective weight reduction plan, what factors should the nurse assess first? a. The length of time the patient has been obese b. The patient's current level of physical activity c. The patient's psychosocial and environmental influences on obesity d. Anthropometric measurements, such as body mass index (BMI) and skinfold thickness

ANS: C Eating patterns are established early in life and eating has many meanings for people. To establish a weight reduction plan that will be successful for the patient, the nurse should first explore the psychosocial and environmental influences on the patient's eating patterns. The duration of obesity, current physical activity level, and current anthropometric measurements are not as important for the weight reduction plan.

The nurse provides discharge education to a patient who has undergone bariatric surgery. Why does the nurse instruct the patient to restrict foods that are high in carbohydrates? a. To reduce the risk of hernia b. To reduce the risk of venous stasis c. To reduce the risk of dumping syndrome d. To reduce the risk of small bowel obstruction

ANS: C Fluids and food high in carbohydrate tend to promote diarrhea and the symptoms of dumping syndrome. A hernia is not related to restricting foods high in carbohydrates. Venous stasis is the condition of slow blood flow in the veins that may arise due to bed rest and an increase in body fat. Bowel obstruction may be seen late in the recovery and rehabilitation stage.

What concern related to bariatric surgery can be addressed through use of cosmetic surgery? a. Dehiscence b. Dumping syndrome c. Altered body image d. Deep venous thrombosis

ANS: C Massive weight loss often leaves the patient with large quantities of flabby skin, which can result in problems related to altered body image. Cosmetic surgery may alleviate this situation. Wound infection, dehiscence, and delayed healing are potential complications that are addressed by careful skin assessments. The nurse instructs the patient to restrict fluid with meals to prevent dumping syndrome. The patient with deep venous thrombosis will have effective treatment with low-dose heparin.

The nurse reviews the medical records of four female patients and identifies that which patient is at increased risk for metabolic syndrome? a. A patient with a waist-to-hip ratio of 0.6 b. A patient with a body mass index (BMI) of 24 kg/m 2 c. A patient with a waist circumference of 37 inches d. A patient with a family history of obesity

ANS: C Obesity is one of the health problems associated with metabolic syndrome. Waist circumference is used to assess and classify a patient's weight. Health risks increase if the waist circumference is greater than 35 inches in women. A female with a waist circumference of 37 inches is at risk for metabolic syndrome. The waist-to-hip ratio of 0.6 and BMI of 24 kg/m 2 are normal. A family history of obesity is not a problem associated with metabolic syndrome..

Following a Roux-en-Y gastric bypass, the patient experiences vomiting, nausea, sweating, faintness, and occasional episodes of diarrhea. The nurse reviews the patient's oral consumption after the surgery and suspects that what triggered the patient's symptoms? a. Fish b. Meat c. Candy d. Spinach

ANS: C Signs and symptoms such as vomiting, nausea, sweating, faintness, and occasional diarrhea following a Roux-en-Y Gastric Bypass procedure indicate dumping syndrome in the patient. Sugar-rich foods, such as candies, pass through the stomach quickly and further increase the risk of dumping syndrome in the patient. Protein-rich foods, such as fish and meat, do not pass through the stomach quickly and usually do not result in dumping syndrome. Spinach, which is a high-fiber soluble food, prevents the quick transfer of sugars to the stomach and does not worsen dumping syndrome.

The nurse is caring for a patient with metabolic syndrome. Which nursing intervention will be beneficial for the patient? Select all that apply. a. Recommending a sodium-rich diet b. Monitoring estrogen levels c. Monitoring serum lipid levels d. Monitoring blood glucose level e. Recommending foods low in saturated fats

ANS: C D E A patient with metabolic syndrome is at risk for obesity and abnormal high lipid levels. Therefore, the nurse should monitor the patient's serum lipid levels. The nurse should monitor blood glucose levels because a patient with metabolic syndrome is at risk for diabetes. Unsaturated fatty foods reduce the risk of obesity. The nurse should not recommend a sodium-rich diet because patients with metabolic syndrome are at risk for hypertension. Metabolic syndrome is not associated with a change in estrogen levels. Therefore, the nurse does not monitor the patient's estrogen levels.

An obese patient consults a nurse for weight-loss advice. The patient states, "I never feel full, so I keep eating." Which medications may be helpful to this patient? Select all that apply. a. Orlistat b. Metformin c. Lorcaserin d. Liraglutide e. Phentermine/topiramate

ANS: C D E Lorcaserin, liraglutide, and phentermine/topiramate induce satiety. Orlistat blocks fat breakdown and absorption in the intestine by inhibiting the action of intestinal lipases. Metformin is an oral antidiabetic drug used to prevent diabetes by lowering glucose levels.

At the first visit to the clinic, a patient with a body mass index (BMI) of 29 kg/m 2 tells the nurse, "I do not want to become obese." Which question used for assessing weight issues is the most important for the nurse to ask? a. "What is your waist circumference?" b. "How is your overall health affected by your body weight?" c. "What is your history of gaining weight and losing weight?" d. "In what ways are you interested in managing your weight differently?"

ANS: D Asking the patient about the desire to manage weight in a different manner helps the nurse determine the patient's readiness for learning, degree of motivation, and willingness to change lifestyle habits. The nurse can help the patient set realistic goals. This question also will lead to discussing the patient's history of gaining and losing weight and factors that have contributed to the patient's current weight. The patient may be unaware of the overall health effects of her body weight, so this question is not helpful at this time. The patient's waist circumference measurement is not needed during this part of the assessment.

A patient has a body mass index (BMI) of 27 kg/m 2. The nurse has discussed weight-loss goals with the patient. Which statement made by the patient indicates understanding of the teaching? a. "I will exercise for 15 minutes every day of the week." b. "I will limit my intake to 500 calories per day." c. "I will increase my intake of sugar-free foods and beverages." d. "I will begin to steam and broil my foods for most meals."

ANS: D Broiling and steaming foods is a healthier way to prepare meals. Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie-energy restriction would place the patient at risk for multiple nutrient deficiencies. Low-calorie diets are defined as those having 800 to 1200 calories per day. Exercise should be at least 30 minutes per day.

The nurse is prescribing a diet to promote weight loss to an obese patient. Which information should be included? a. Use whole milk, which has more vitamin D. b. Avoid steamed foods, which removes much of the nutrients. c. Reduce fiber intake, which can cause digestion complications. d. Include fruits and vegetables in each meal.

ANS: D Including adequate fruits and vegetables will help the patient to maintain a lower calorie intake as well as provide essential nutrients. Whole milk is not advisable for losing weight and should be replaced with low-fat or skim milk as required. Steaming foods can help to reduce fat intake and aid in weight loss. Reducing fiber intake will not help with weight loss; instead, consumption of fiber and bulk-forming foods is recommended.

An overweight patient tells the nurse, "I had a friend who lost a lot of weight on a low-carbohydrate diet. I would like to try that." The nurse should respond to the patient with what factor in mind? a. Low-carbohydrate diets are safe and easy to follow. b. Low-carbohydrate diets produce long-lasting weight loss. c. Low-fat diets provide more chance of success than low-carbohydrate diets. d. Low-carbohydrate diets reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals.

ANS: D Low-carbohydrate diets do produce a rapid weight loss but reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals. These restrictive diets are difficult to maintain for long-term weight loss. It is best to recommend a dietary approach in which calorie restriction includes all food groups. Low-carbohydrate diets are generally not safe nor are they easy to follow. They produce short-term, not long-term, weight loss. Low-fat diets are not necessarily more successful than low-carbohydrate diets.

A patient tells the nurse, "I often feel fatigued. I think it's related to my obesity." What action should the nurse take? a. Identify a medical professional who specializes in treating fatigue. b. Help the patient obtain reimbursement for a weight management program. c. Explain that a loss of 3-5% of weight will produce multiple health benefits. d. Use motivational interviewing principles to explore the patient's desires.

ANS: D Motivational interviewing will help the patient explore desires for improved health and gain confidence in achieving weight loss. For the goal of reducing weight, seeing a medical professional who specializes in treating fatigue will not be helpful to this patient. Reimbursement for weight loss programs is not always easy to obtain and does not directly help the patient understand his or her motivation for better health. A loss of 3-5% of body weight will produce multiple health benefits, but this may is not be enough of a motivating factor for weight loss.

The nurse is reviewing the surgical notes of a patient who underwent bariatric surgery and notes that a small gastric pouch was created and attached directly to the small intestine. The remaining stomach and first segment of the small intestine are bypassed. Which surgical technique was performed? a. Adjustable gastric banding b. Sleeve gastrectomy c. Vertical banded gastroplasty d. Roux-en-Y gastric bypass surgery

ANS: D Roux-en-Y gastric bypass surgery is a combination of restrictive and malabsorptive surgical techniques. During Roux-en-Y, a small gastric pouch is connected to the jejunum. The remaining stomach and first segment of the small intestine is bypassed. Adjustable gastric banding involves placing a band around the stomach, reducing its capacity to approximately 30 mL. The sleeve gastrectomy involves the removal of 85% of the stomach, reducing its capacity to approximately 60 to 150 mL. Vertical banded gastroplasty involves placing a band around the stomach and using a stapling technique above the band to create a small gastric pouch.

The nurse is interacting with a dieting obese patient. Which statement made by the patient indicates that the patient is practicing stimulus control? a. "I maintain a diary about my diet and eating times every day." b. "I decided that I will pamper myself with a massage after I lose 5 lbs." c. "I will treat myself with my favorite food after losing 10 pounds of weight." d. "I avoided going near the food court because the smell is very tempting."

ANS: D The patient likes the smell of fast food and avoids a location where fast food is sold, indicating that the patient is controlling stimuli. Maintaining a diary about the type of diet and eating times indicates that the patient is employing self-monitoring behavior. The patient deciding that he or she will get a massage after losing weight is an appropriate reward. The patient eating a favorite food after losing 10 lbs of weight indicates improper behavior because he or she should not use food as a reward.

The nurse is educating a patient about preparing for bariatric surgery. Which adherence goal is important for the patient to meet prior to surgical intervention? a. Walking 1 mile daily b. Weight reduction of 20% c. Consistent intake of carbohydrates d. Eating according to prescribed reducing diet

ANS: D The patient preparing to undergo bariatric surgery must demonstrate adherence to the prescribed reducing diet. After surgery, the patient's adherence to reduced intake is necessary because of the concern for abdominal distension, cramping abdominal pain, and possible diarrhea. Walking 1 mile a day is a good exercise regimen, but it is not mandatory prior to bariatric surgery. The percent of body weight reduction depends on the patient's baseline weight and physical condition. Consistent intake of carbohydrates will not help the patient to reduce food intake as a preparation for surgery.

What diet should the nurse provide to a patient during the immediate postoperative period after bariatric surgery? a. 20 mL of whole milk b. Porridge with water c. Protein-rich milk shake d. 30 mL water and sugar-free liquid

ANS: D The patient who has undergone a bariatric surgery should be given a liquid diet that is easily digestible; 30 mL of water and sugar-free liquid are adequate to provide energy to the patient. Twenty mL of whole milk contain a high amount of fat and calories and should be avoided. The patient will not be able to digest solid food such as porridge immediately after surgery. Providing water with solid food will result in dumping syndrome. A protein milkshake would be appropriate for the patient because it provides adequate energy but is not recommended during postoperative care.

The nurse assists the patient who has undergone bariatric surgery in making dietary selections. Which types of food items should be recommended? a. High-protein b. High-carbohydrate c. High-fat d. High-roughage

ANS: A Following bariatric surgery, a patient is usually prescribed a diet high in protein and low in carbohydrates, fats, and roughage. Fluids and foods high in carbohydrates tend to promote diarrhea and symptoms of dumping syndrome.

While performing a physical assessment, the nurse documents a patient's height as 66 inches and the patient's weight as 160 pounds. What body mass index (BMI) value should the nurse enter in the patient's medical record? Record the answer using two decimal places.

ANS: 25.82 lb/in2 BMI can be calculated using the following formula: Actual body weight in pounds multiplied by 703, then divided by height in inches squared. The patient's weight is given as 160 pounds and height as 66 inches. (1) Multiply 160 (the weight) by 703 = 112480. (2) Square the height. For this patient, 66 inches x 66 inches = 4356. (3) Divide the weight number (112480) by the height number (4356) = 25.82.

What should the nurse include in the discharge education provided to a female patient who underwent bariatric surgery? a. "Postpone pregnancy for 12 to 18 months." b. "Irregular menstruation for 12 months is likely." c. "A result of the surgery is loss of fertility." d. "You will need hormone replacement therapy."

ANS: A A female patient should be encouraged to avoid pregnancy for 12 to 18 months after bariatric surgery; pregnancy complications can result from anemia and nutritional deficiencies. The surgery does not affect menstruation. Often one result of bariatric surgery is the return of fertility in women. Hormone replacement therapy is not needed.

The nurse is reviewing the assessment findings and body mass index (BMI) of four patients. Which patient is an appropriate candidate for bariatric surgery? Patient A: RR 10 BMI 35 Patient B: BP 120/80 BMI 25 Patient C: Glucose 100 BMI 35 Patient D: HR 80 BMI 23

ANS: A Criteria for patients to undergo bariatric surgery include: BMI 40 kg/m 2 or BMI 35 kg/m 2, complicated by one or more of the following: hypertension, type II diabetes mellitus, heart failure, or sleep apnea. Patient A, with a respiratory rate of 10 breaths/min during sleep and a BMI of 35 kg/m 2, is eligible for bariatric surgery. Patients B and D are not eligible because the findings are within normal parameters. Although obese, Patient C does not have accompanying hyperglycemia.

A patient takes orlistat for weight loss. The nurse anticipates that which supplement will be prescribed? a. Fat-soluble vitamin supplements b. Water-soluble vitamin supplements c. Iron supplement d. Folic acid supplement

ANS: A Orlistat (Xenical) blocks fat metabolism and subsequent absorption in the intestine. Orlistat can decrease some fat-soluble vitamin levels in the body, such as A, D, E, and K. Orlistat (Xenical) is not known to decrease the water soluble vitamins, such as vitamin C and B complex, in the body. Iron and folic acid supplements are not necessary.

A patient that is participating in a weight-loss program tells the nurse, "When I lose 5 pounds, I plan to have a spa treatment." Which behavioral technique is the patient using? a. Reward b. Motivation c. Self-monitoring d. Stimulus control

ANS: A The patient is setting a target and establishing a reward if the target is achieved. This indicates that the patient is setting a benchmark to earn rewards. While providing motivation to a patient, the nurse teaches the patient about advantages of weight loss and weight control. A patient who performs self-monitoring will keep a record of the time and type of food that he or she is consuming. A patient who separates him- or herself from activities that stimulate hunger is exhibiting stimulus control.

The nurse is caring for an obese patient and anticipates that what diagnostic studies will be performed? Select all that apply. a. Serum glucose b. Liver function tests c. Chest x-ray d. Magnetic resonance imaging (MRI) e. Electrocardiogram (ECG)

ANS: A B C E Patients with obesity may experience elevated serum glucose and abnormal liver function tests. A chest x-ray may demonstrate an enlarged heart. An ECG may show dysrhythmia. An MRI is not necessary as part of an initial assessment.

When teaching the patient about the use of weight-reducing drug therapy, what instructions should the nurse include? Select all that apply. a. Become familiar with the side effects of drug therapy. b. Utilize any of the available over-the-counter weight-loss drugs. c. Weight loss caused by weight-reducing drugs is permanent. d. Avoid modification of the drug dosage without medical advice. e. Recognize that a weight-loss program includes other components, rather than relying only on drugs.

ANS: A D E The patient should be taught about proper administration and side effects of the drug, to avoid modification of dosage without medical advice, and that drugs are never to be used alone. A comprehensive weight-loss program includes diet, exercise regimens, and behavior modifications. The patient should consult with the health care provider before using an over-the-counter weight-loss drug. The nurse should explain that the weight loss caused by weight-reducing drugs may not be permanent.

When providing teaching to an obese patient, the nurse should emphasize that a healthy weight loss average is how many pounds per week? a. 2 pounds b. 3 pounds c. 6 pounds d. 8 pounds

ANS: A A realistic weight loss goal is 1 to 2 pounds per week, which prevents the patient from becoming frustrated at not meeting weight-loss goals. Also, it is not so rapid that the patient's skin and underlying tissue lose elasticity and become flabby.