Chapter 42

A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI?

Class I obesity

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true?

Diabetes mellitus is more common in Hispanics and Blacks than in Whites.

A client with obesity is prescribed liraglutide for weight loss. Which common side effect will the nurse include in the client teaching?

Nausea

The nurse is providing care for a client who had a biliopancreatic diversion with duodenal switch 2 days ago. How should the nurse best address the client's risk for postoperative venous thromboembolism?

Assist the client with ambulating as early and often as possible

A nurse epidemiologist examines the overall decrease in life expectancy related to obesity. What finding is true?

There is a 6-20 year decrease in overall life expectancy for those with obesity.

A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers?

"Avoid taking non-steroidal anti-inflammatory drugs."

A nurse cares for an obese client taking phentermine for weight loss. What client teaching will the nurse include when discussing precautions about the medication?

"Do not drink alcohol while taking this medication."

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:

"I should become involved in a weight loss program."

A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include?

"It binds with enzymes to help prevent digestion of fat."

A nurse cares for a client with obesity who is scheduled to undergo vagal blocking therapy. When teaching the client about the procedure or device, which statements will the nurse include? Select all that apply.

"It is a pacemaker-type device that is implanted under your skin." "A pre-programed pulsating signal is delivered." "Recharge the device two times per week."

A client is scheduled for a Roux-en-Y bariatric surgery. When teaching the client about the surgical procedure, which statement will the nurse use?

"The stomach is stapled to create a very small pouch and part of the small intestine is rerouted."

A client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response?

"This is an expected finding with this medication."

A nurse cares for a client with a BMI of 36 kg/m2 and nonalcoholic fatty liver disease. The client asks the nurse if he is a candidate for bariatric surgery. How should the nurse respond to the client?

"Yes, your BMI and chronic condition meets the criteria for bariatric surgery."

A client who is 6 months postoperative bariatric surgery tells the nurse, "I hate what my body looks like now. All these skin folds really bother me." What is the nurse's best response?

"You are not alone in having these feelings."

A nurse researches the cost and financial impact of obesity in America. What is the annual health care cost tied to obesity?

$147 billion

A nurse caring for adults with obesity recognizes that obesity is classified based on BMI. Which BMI does the nurse recognize as Class II obesity?

29 kg/m2

Calculate the BMI of a client who is 180 pounds and is 5 feet 2 inches tall. Round to one decimal point.

32.9

A client weighs 215 lbs and is 5' 8" tall. The nurse calculate this client's body mass index (BMI) as what? BMI = (weight in pounds x 703) / (height in inches x height in inches).

37.2

A nurse is educating a client who will undergo bariatric surgery on methods to prevent dysphagia. What teaching will the nurse include? Select all that apply.

"Eat slowly." "Chew your food thoroughly." "Avoid eating tough foods." "Avoid eating overcooked meats."

A nurse cares for a client who wants to know more information about bariatric surgery. The client asks the nurse, "What weight loss can I expect?" What is the nurse's best response?

"Expect to lose 10-35% of total body weight 2 to 3 years postoperatively."

A nurse is caring for a client who will undergo bariatric surgery. Which nutritional recommendation will the nurse include in the client teaching?

"Increase your intake of plant-based proteins."

A nurse prepares community teaching on healthy lifestyle modifications to a group of older adults. When discussing obesity rates of older adults in comparison with the rest of the population, what will the nurse include?

"Older adults have a slightly higher prevalence of obesity in comparison to the general population."

A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population?

"You should avoid pregnancy for at least 18 months after surgery."

A nurse is reviewing the medical records of several patients and their risk for health problems. The nurse determines that the patient with which body mass index (BMI) would have the lowest risk?

23

A nurse caring for adults with obesity recognizes that obesity is classified based on BMI. Which BMI does the nurse recognize as Class II obesity?

35 kg/m2

The nurse provides care to a menopausal client, who states, "I read a news article that says I am at risk for coronary vascular disease due to inflammation." Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis?

Addressing obesity

An older client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which factors in the client's history may have increased the risk of breast cancer?

Being female Being older than 50 years of age Having a family history of breast cancer Obesity No children after 30 years of age

A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face?

Both undernutrition and obesity

A nurse cares for a client with obesity who is also diagnosed with depression. Which medication does the nurse expect the health care provider will prescribe, which also aids in weight loss?

Bupropion

The nurse is working with a client who has difficulty controlling blood sugar. The client is classified as overweight. The client does not adhere to a low-calorie diet and forgets to take medications and check blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, what action will the take first?

Collaborates with the client to establish an agreed-upon goal

A nurse cares for a client who has secondary obesity. Which condition is the most likely to result in secondary obesity?

Cushing's disease

A client underwent bariatric surgery 2 weeks ago and has been meeting goals for recovery. However, during the nurse's most recent assessment the client reports bowel movements every 2 to 3 days and a sensation of constipation. What is the nurse's best action?

Educate the client about the need to temporarily limit dietary fiber intake

A client has recovered well from bariatric surgery 3 weeks ago, but during the nurse's most recent assessment, the client states, "I'm having some trouble swallowing my food, and that was never an issue before." What is the nurse's best initial action?

Encourage the client to eat slowly and chew food thoroughly

A nurse teaches a client homecare nutrition expectations who will undergo bariatric surgery. Which foods will the nurse suggest the client keep on hand at home after surgery? Select all that apply.

Gelatin Pudding Fat-free milk

The nurse is providing discharge education to a 30-year-old woman who has undergone a biliopancreatic diversion with duodenal switch. What guidelines should the nurse provide to the client? Select all that apply.

Prioritize foods that are dense in nutrients Eat several small meals daily rather than three large meals Use contraceptives for at least the next year and a half

A nurse works in a bariatric clinic and cares for client with obesity who will or have undergone bariatric surgery. What is the nurse's understanding of how the procedure works?

Restricts the client's ability to eat.

A nurse working in a bariatric clinic assesses various clients with obesity. Which clients will the nurse recognize as meeting the selection criteria for bariatric surgery? Select all that apply.

48-year-old female with BMI 36 k/m2 and uncontrolled type 2 diabetes. 34-year-old male with BMI 30 k/m2 and metabolic syndrome with hypertension.

A client who is recovering from bariatric surgery has not had a bowel movement for 48 hours and bowel sounds are absent on auscultation. The nurse has informed the on-call health care provider who has prescribed insertion of a nasogastric tube to low suction. What is the nurse's best action?

Question the order due to the client's recent bariatric surgery

A client who is postoperative open RYGB bariatric surgery is scheduled for discharge and will have a Jackson-Pratt drain to care for while at home. Which teaching will the nurse include specific to this? Select all that apply.

How to empty the drain Recording drainage amount When to contact the health care provider How to measure the drainage amount

A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply.

Hypertension Coronary artery disease Heart failure Myocardial infarction

A nurse geneticist is researching the gut microbiome and its relationship to disease. What is true regarding the microbiome?

It has over 100 times more genes than the human genome.

A nurse cares for a client who is post op bariatric surgery. Which position will the nurse place the client in order to best promote comfort?

Low Fowler's

A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate?

Mechanical compression and prophylactic anticoagulation

A client with obesity is diagnosed with type 2 diabetes. In order to promote weight loss in the client and aid in glucose management, which medication will the nurse anticipate the health care provider ordering?

Metformin

A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has?

Osteoarthritis

Which of the following factors may contribute to rapid and shallow respirations in a postoperative client? Select all that apply.

Pain Constricting dressings Abdominal distention Obesity

A nurse cares for a client with obesity who reports taking "a medication of weight loss" but cannot remember the name of it. The client also reports nervousness and feeling "jittery". Which medication is the client most likely taking?

Phentermine

A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding?

Rapid gastric dumping

A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose?

Stimulate GI peristalsis

A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply.

Weight BMI Waist circumference

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan?

Weight reduction through diet and exercise

A nurse is caring for a client with obesity and diabetes after abdominal surgery. What is the client at increased risk for?

Wound dehiscence

A nurse cares for a client who is post op bariatric surgery and the nurse offers the client a sugar-free beverage. What is the primary purpose of offering a sugar-free beverage?

These are less likely to cause dumping syndrome.

The nurse establishes a learning contract with an overweight client. The contract is best if it

includes an incremental goal of 1-2 pound weight loss this week

A client with obesity will undergo intragastric balloon therapy for weight loss. What teaching will the nurse include when educating the client about this procedure? Select all that apply.

"The balloon will remain in place for 3 to 6 months." "Nausea and vomiting are the most commonly reported side effects."

The nurse observes that a client's medical report indicates that the client has Cushing syndrome. During inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. Which of the following must the nurse keep in mind while planning the client's care?

The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment.

The nurse plans care for a client with obesity. What does the nurse recognize is the primary pathophysiological reason clients with obesity are at greater risk for developing thromboembolism?

Compromised peripheral blood flow

Place the pathophysiological steps in order of how a client with obesity is at greater risk for venous thromboembolism in comparison to the general population.

Increased adipose tissue Impairment of peripheral blood flow Blood stasis Formation of a thrombus

Place the pathophysiological steps in order for the normal role of leptin as it relates to hunger and satiety.

Increased fat stores Increased leptin Increased satiety Inhibition of food intake

A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity?

Over time, we have become efficient in food storage and deposition of fat stores.