NU 272: Metabolism
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? 80 to 110 mg/dL 150 to 240 mg/dL 250 to 300 mg/dL 300 to 350 mg/dL
80 to 110 mg/dL Although the surgical risk in the client with controlled diabetes is no greater than in the client without diabetes, strict glycemic control (80 to 110 mg/dL) leads to better outcomes. Frequent monitoring of blood glucose levels is important before, during, and after surgery.
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." "Expect to lose 45-50% of total body weight 2 to 3 years postoperatively." "Expect to lose 50 pounds in the first month after surgery." "Expect to lose 10-35 pounds in the first month after surgery."
"Expect to lose 10-35% of total body weight 2 to 3 years postoperatively." When discussing weight loss expectations with the client, the nurse should let the client know to expect to lose 10-35% of total body weight 2 to 3 years postoperatively. The client may lose a large amount of weight the first month after surgery; however, this is not generally quantified with exact numbers or ranges.
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 complex carbohydrates." "Increase your intake of monounsaturated fats." "Increase your intake of plant-based proteins." "Increase your intake of fluids at meals."
"Increase your intake of plant-based proteins." The client should be advised to increase protein intake, particularly plant-based protein because animal-based protein may not be tolerated well. The client should be advised to decrease fat intake, regardless of the source. Additionally, the client should be advised to decrease fluid intake at meals, not increase intake.
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." "Yes, your chronic condition meets the criteria for bariatric surgery but not your BMI." "No, you do not have any qualifying criteria for bariatric surgery." "No, you have one qualifying condition but not the other; this excludes you from bariatric surgery."
"Yes, your BMI and chronic condition meets the criteria for bariatric surgery." The client's BMI of > 35 kg/m2 and a more severe obesity-associated comorbid condition, makes the client a candidate for bariatric surgery. To qualify you need to either have a BMI > 40 or a BMI > 35 PLUS a obesity-associated comorbid condition
The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? B12 C A Folate
B12 The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12.
A nurse cares for clients who undergo bariatric surgery due to obesity. When teaching the client on the most successful surgery in clients with very high BMI's, which procedure will the nurse mention? Roux-en-Y Gastric banding Sleeve gastrectomy Biliopancreatic diversion with duodenal switch
Biliopancreatic diversion with duodenal switch The biliopancreatic diversion with duodenal switch is the most successful bariatric surgery for clients with the highest BMI's. The other answer choices represent additional bariatric surgeries; however, these are not the most successful in clients with the highest BMI's.
A nurse cares for a client who is 36 hours postoperative from bariatric surgery and is suspected of having a hemorrhage related to the procedure. What is the nurse's understanding of the most likely cause of the hemorrhage? Disruption of a staple Formation of a gastric ulcer Formation of a duodenal ulcer Dehiscence of the surgical site
Disruption of a staple Bleeding within the first 72 hours postoperatively is most likely cause by the disruption of a staple or suture. Bleeding 72 hours to 30 days postoperatively is most likely from formation of a gastric or duodenal ulcer.
A client is diagnosed with dumping syndrome after bariatric surgery. Which findings on the nursing assessment correlate with this diagnosis? Select all that apply. Dizziness Sweating Fever Hypertension Tachycardia
Dizziness Sweating Tachycardia Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that is common among clients who have had bariatric surgery. Symptoms of dumping syndrome include (but are not limited to): sweating, tachycardia, nausea, vomiting, dizziness, and diarrhea. Fever and hypertension are not symptoms of dumping syndrome.
A nursing instructor is preparing a class about age-related changes in the cardiovascular system that occur in the older adult. Which of the following would the instructor most likely include? Thinning of the heart valves Increased blood pressure Atophy of the heart muscle Decreased arterial resistance
Increased blood pressure Age-related changes in the cardiovascular system include thickening of the heart valves, increased blood pressure, hypertrophy of the heart muscle, and increased arterial resistance.
A child is born with dwarfism to normal-sized parents. The physician is explaining how growth hormone (GH) plays a central role in the increase in stature that characterizes childhood and adolescence. What is the first step in the growth hormone chain of events? The liver is stimulated. The hypothalamus secretes GHRH. GH is released and circulates unbound in the plasma. Epiphyseal growth plates of long bones are influenced.
The hypothalamus secretes GHRH. Like other pituitary functions, hypothalamic stimulation precedes hormone release. In the case of GH, stimulation is the result of GHRH by the hypothalamus. GH is then released by the pituitary gland, stimulating the liver to release IGFs, which ultimately causes the epiphyseal plates of long bones to grow.
The health care provider reviews the waist-hip ratio of a male client. The ratio is 1.0. What interpretation is most accurate for this result? Upper body obesity Gluteal-femoral obesity Lower body obesity Peripheral obesity
Upper body obesity A waist-hip ratio greater than 1.0 in men and 0.8 in women indicates upper body obesity. Research suggests that fat distribution may be a more important factor for morbidity and mortality than overweight or obesity. The other options are lower body obesity types.
A nurse prepares nutrition education for a client who will undergo bariatric surgery. What nutrition suggestion best indicates a beneficial effect on the number and quality of bowel movements the client may have after surgery? Increase fluid intake Avoid high-fat foods Eat a wide variety of foods Increase protein intake
Avoid high-fat foods Reducing the amount of fat will have a direct beneficial effect on the number and quality of bowel movements a client may have. Increasing fluid intake will help, but it is not the most beneficial. The client should not be encouraged to eat a wide variety of foods; rather, instruction on foods that will be best tolerated will be encouraged. Protein intake does not have a direct correlation to the client's quality of bowel movements post-bariatric surgery.
A nurse teaches a client who will undergo bariatric surgery the importance of avoiding problematic foods post surgery. Which foods will the nurse suggest the client avoid? Select all that apply. Doughy breads Overcooked meats Pasta Rice Mashed potatoes
Doughy breads Overcooked meats Pasta Rice Problematic foods the post-bariatric client should avoid include: doughy breads, overcooked or fibrous meats, pasta, rice, nuts, seeds, skins and seeds of fruits and vegetables, and popcorn. Mashed potatoes are acceptable after bariatric surgery.
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 Heart murmur
Hypertension Coronary artery disease Heart failure Myocardial infarction Various cardiac diseases and conditions may be associated with obesity. These include: hypertension, heart failure, myocardial infarction, and coronary artery disease. Heart murmur is not directly associated with obesity.
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 single gene mutation is responsible for the epidemic. Over time, we have become less efficient in hunting and gathering of food. Multiple mutations of genes over time have lead to the epidemic.
Over time, we have become efficient in food storage and deposition of fat stores. According to the "thrifty gene" theory, hunting for scarce food sources during prehistoric times consumed a lot of energy, and food sources were not abundant. Storing fat to provide energy sources during times of food scarcity was a physiologic adaptive response to these environmental challenges and over time, we became more efficient in food storage and fat deposition.
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. There is a 2-4 year decrease in overall life expectancy for those with obesity. There is a 25-30 year decrease in overall life expectancy for those with obesity. There is a 21-28 year decrease in overall life expectancy for those with obesity.
There is a 6-20 year decrease in overall life expectancy for those with obesity. Overall, there is a 6-20 year decrease in overall life expectancy for those with obesity.
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." "After surgery, your ability to conceive is decreased considerably." "You should avoid pregnancy for at least 9 months after surgery" "After surgery, contraceptives have much less efficacy."
"You should avoid pregnancy for at least 18 months after surgery." When teaching a female of childbearing age regarding precautions after bariatric surgery, the nurse should instruct the client to avoid pregnancy for at least 18 months after surgery. The ability to conceive after weight loss surgery may improve more often than worsen. Contraceptives are no less effective after surgery than before.
The client who is newly diagnosed with diabetes mellitus type 2 is concerned about eating products with sugar in them. What information does the nurse explain to the client regarding the use of sugar? Excess sugar increases demand on the pancreas. Healthy amounts of sugar are usually consumed. Sugar increases natural bacterial flora in the GI tract. Sugar assists with cellular absorption of nutrients.
Excess sugar increases demand on the pancreas. Excess sugar increases demand on the pancreas; therefore, less sugar should be consumed. The client who has diabetes mellitus type 2 may have a compromised pancreas. Further stress to the pancreas can cause further injury to the organ.
A client with type 1 diabetes asks what causes several brown spots on the skin. What would be the best response by the nurse? "The brown spots reflect the accumulation of blood fats in the skin; they should disappear." "Those spots indicate a high glucose content in the skin that may get infected if left untreated." "They are the result of diseased small vessels in the shins and may spread if not treated soon." "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot."
"Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot" is an accurate explanation for the client's concern; brown spots are caused by the deposit of hemosiderin in the tissue. Brown spots reflecting the accumulation of blood fats in the skin and disappearing is the definition of a xanthoma. A high glucose content in the skin that has become infected is not the cause of brown spots on the skin; increased glucose in the skin is not observable by inspection. Brown spots result from the deposition of hemosiderin. Blood vessels may become diseased with diabetes, but this does not cause brown spots.
A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating "The test must be repeated following a 12-hour fast." "It looks like you aren't following the ordered diabetic diet." "It tells us about your sugar control for the last 3 months." "Your insulin regimen must be altered significantly."
"It tells us about your sugar control for the last 3 months." The nurse is providing accurate information to the client when they state that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.