Chapter 42: Assessment and Management of Patients with Obesity

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 obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states

"You have succeeded in making positive progress."

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

$147 billion

Place the pathophysiological steps in correct order for the development of dumping syndrome. Release of metabolic peptides Tachycardia, dizziness, sweating, nausea, vomiting, bloating, abdominal cramping, and diarrhea Hypertonic food bolus from the stomach to the small intestine Rapid rise of glucose, release of insulin, reactive hypoglycemia

1) Hypertonic food bolus from the stomach to the small intestine 2) Release of metabolic peptides 3) Tachycardia, dizziness, sweating, nausea, vomiting, bloating, abdominal cramping, and diarrhea 4) Rapid rise of glucose, release of insulin, reactive hypoglycemia

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

1) Increased adipose tissue 2) Impairment of peripheral blood flow 3) Blood stasis 4) Formation of a thrombus

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 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

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.

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 nurse teaches a client with obesity about the various medication options for the treatment of obesity. Which medication will the nurse include when teaching the client about the class of medications that stimulate noradrenergic receptors?

Phentermine

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 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 45-50% of total body weight 2 to 3 years postoperatively."

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 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 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 client weighs 215 lbs and is 5' 8" tall. The nurse calculate this client's body mass index (BMI) as what?

32.7 Explanation: Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703. The result would be 32.7.

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 Explanation: Class I obesity is defined as 30-34.9 kg/m2. Class II obesity is defined as a BMI of 35-39.9 kg/m2. A BMI of 40 kg/m2 or greater defines Class III obesity.

A nurse provides nutritional teaching to a client who is scheduled to have bariatric surgery. Which statements will the nurse include on fluid intake after the procedure? Select all that apply. A) "Drink plenty of water." B) "Drink water at meals." C) "Avoid drinking liquid calories." D) "Drink frequent, small amounts of liquids." E) "Drink liquids 30-60 minutes after eating."

A) "Drink plenty of water." C) "Avoid drinking liquid calories." D) "Drink frequent, small amounts of liquids." E) "Drink liquids 30-60 minutes after eating."

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? A) Age B) Obesity C) Inactivity D) Dyslipidemia

A) Age

A client is diagnosed with dumping syndrome after bariatric surgery. Which findings on the nursing assessment correlate with this diagnosis? Select all that apply. A) Dizziness B) Sweating C) Fever D) Hypertension E) Tachycardia

A) Dizziness B) Sweating E) Tachycardia

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. A) Hypertension B) Coronary artery disease C) Heart failure D) Myocardial infarction E) Heart murmur

A) Hypertension B) Coronary artery disease C) Heart failure D) Myocardial infarction

Which hormones released throughout the gastrointestinal tract promote satiety? Select all that apply. A) Somatostatin B) Cholecystokinin C) Insulin D) Ghrelin E) Neuropeptide y

A) Somatostatin B) Cholecystokinin C) Insulin

A nurse examines the socioeconomic impact of obesity among Americans. Which statements does the nurse understand is true? Select all that apply. A) Those with less education are impacted at a greater prevalence of disease. B) Education is not related to the prevalence of disease. C) Those with less income are impacted at a greater prevalence of disease. D) Income is not related to the prevalence of disease. E) Those who own their own homes have a decreased prevalence of disease.

A) Those with less education are impacted at a greater prevalence of disease. C) Those with less income are impacted at a greater prevalence of disease.

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? All options are correct. increased age obesity not giving birth

All options are correct.

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 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? A) 18 B) 23 C) 28 D) 31

B) 23

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. A) How to change the drain B) How to empty the drain C) Recording drainage amount D) When to contact the health care provider E) How to measure the drainage amount

B) How to empty the drain C) Recording drainage amount D) When to contact the health care provider E) How to measure the drainage amount

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. A) Sit fully upright during meals and for at least 30 minutes thereafter B) Prioritize foods that are dense in nutrients C) Drink at least 250 mL (8 oz) of unsweetened beverages during meals D) Eat several small meals daily rather than three large meals E) Use contraceptives for at least the next year and a half

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

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 client who is postoperative from bariatric surgery is diagnosed with bile reflux after reports of severe epigastric pain and vomiting of bilious material. What statements are true regarding this condition? Select all that apply. A) Symptoms are usually relieved after vomiting. B) Symptoms are usually relieved after eating. C) Usually occurs after disruption of the pylorus. D) Usually occurs after alteration of pancreatic enzymes. E) Symptoms are usually relieved after pharmacological treatment.

C) Usually occurs after disruption of the pylorus. E) Symptoms are usually relieved after pharmacological treatment.

A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply. A) Blood pressure B) Total cholesterol C) Weight D) BMI E) Waist circumference

C) Weight D) BMI E) Waist circumference

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

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

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

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 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 client with obesity is interested in trying orlistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication?

Renal insufficiency

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 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

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.

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 middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:

acute cholecystitis