obesity

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en- gastric bypass? b. Instructing the patient on coughing and breathing techniques

B Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia.

Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet? b. "You are likely to notice changes in how you feel after a few weeks of diet and exercise."

B Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 22-yr-old patient is unlikely to be motivated by future health problems.

The nurse is caring for a patient on the first postoperative day after a Roux-en- gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? c. Emesis of bile-colored fluid past the nasogastric (NG) tube

C Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures.

Wich of the following criteria must be met for a diagnosis of metabolic syndrome (select all that apply)? a. Hypertension b. Elevated triglycerides c. Elevated plasma glucose d. Increased waist circumference

Correct answers: a, b, c, d Rationale: Three of the following five criteria must be met for a diagnosis of metabolic syndrome: • Waist circumference of 40 inches or more in men and 35 inches or more in women • Triglyceride levels higher than 150 mg/dL, or need for drug treatment for elevated triglyceride levels • High-density lipoprotein (HDL) cholesterol levels lower than 40 mg/dL in men and lower than 50 mg/dL in women, or need for drug treatment for reduced HDL cholesterol levels • Blood pressure: 130 mm Hg or higher systolic or 85 mm Hg or higher diastolic, or need for drug treatment for hypertension • Fasting blood glucose level of 110 mg/dL or higher, or need for drug treatment for elevated glucose levels Which

What is a postoperative nursing intervention for the obese patient who has undergone bariatric surgery?

d. Providing adequate support to the incision during coughing, deep breathing, and turning

The nurse is caring for a patient after bariatric surgery. What should be included in the plan of care (select all that apply.)? a. Teach the patient to increase carbohydrate intake. b. Assess for incisional pain versus anastomosis leak. c. Maintain elevation of the head of bed at 35-45 degrees. d.Monitor for vomiting that is a common complication. e. Instruct the patient to consume liquids frequently during meals. f. Assist with early independent ambulation during hospitalization.

Correct Answer: b,c,d,f After bariatric surgery, the nurse needs to assess for incisional pain versus anastomosis leak. Because vomiting is a common postoperative complication, maintain elevation of the head of bed to reduce the risk of vomiting and aspiration. Dietary recommendations include six small meals that are high in protein and low in carbohydrates and fat. Fluids should be avoided during meals to prevent dumping syndrome. Early ambulation with assistance is recommended.

The nurse instructs an obese 22-year-old man with a sedentary job about the health benefits of an exercise program. The nurse evaluates that teaching is effective when the patient makes which statement? a. "The goal is to walk at least 10,000 steps every day of the week."

Correct answer: a Rationale: A realistic activity goal is to walk 10,000 steps a day. Increased activity does not promote an increase in appetite or lead to weight gain. Exercise should be done daily, preferably 30 minutes to an hour a day. Exercise increases metabolic rate.

Priority Decision: Before selecting a weight reduction plan with an obese patient, what is most important for the nurse to first assess? a. The patient's motivation to lose weight

Correct answer: a Rationale: Motivation is essential. Focus on the reasons for wanting to lose weight.

During the initial postoperative period following bariatric surgery, the nurse recognizes the importance of monitoring obese patients for respiratory insufficiency based on what knowledge? a. The body stores anesthetics in adipose tissue

Correct answer: a Rationale: The body stores anesthetics in adipose tissue, placing patients with excess adipose tissue at risk for re-sedation.

A 40-year-old severely obese female patient with type 2 diabetes wants to lose weight. After learning about the surgical procedures, she thinks a combination of restrictive and malabsorptive surgery would be best. Which procedure should the nurse teach her about? b. Roux-en-Y gastric bypass

Correct answer: b Rationale: The Roux-en-Y gastric bypass is a common combination of restrictive (limiting the size of the stomach) and malabsorptive (less food is absorbed) surgery.

Which female patient is most likely to have metabolic syndrome? b. BP 142/90 mm Hg, high-density lipoproteins 45 mg/dL, fasting blood glucose 130 mg/dL

Correct answer: b Rationale: Three of the following five measures are needed for a woman to be diagnosed with metabolic syndrome: waist circumference >35 in, triglycerides >150 mg/dL, high-density lipoproteins <50 mg/dL, BP >130 mm Hg systolic or >85 mm Hg diastolic, fasting blood glucose >110 mg/dL.

Priority Decision: During care of the severely obese patient, what is most important for the nurse to do? c. Plan for necessary modifications in equipment and nursing techniques before initiating care.

Correct answer: c Rationale: Special considerations are needed for the care of the severely obese patient because most hospital units are not prepared with beds, chairs, BP cuffs, and other equipment that will need to be used with the very obese patient.

Which explanation about weight reduction should be included when teaching the obese patient and her obese husband? c. Fat is not burned until the glycogen-water pool is depleted.

Correct answer: c Rationale: With reducing diets that severely restrict carbohydrates, the body's glycogen stores become depleted within a few days. The glycogen normally binds to water in fat cells and it is this water loss that causes weight loss in the first few days. Fat is not burned until the glycogen-water pool is depleted.

Which patient is at highest risk for developing metabolic syndrome?

Correct answer: d Rationale: African Americans, Hispanics, Native Americans, and Asians are at an increased risk for development of metabolic syndrome. Other risk factors include individuals who have diabetes that cannot maintain a normal glucose level, have hypertension, and secrete a large amount of insulin, or who have survived a heart attack and have hyperinsulinemia.

A severely obese patient has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient d. may have only liquids orally, and in very limited amounts, during the postoperative period.

Correct answer: d Rationale: During the immediate postoperative period, water and sugar-free clear liquids are given (30 mL every 2 hours while the patient is awake).

The best nutritional therapy plan for a person who is obese is d. foods from the basic food groups.

Correct answer: d Rationale: Restricted food intake is a cornerstone for any weight loss or maintenance program. A good weight loss plan should include foods from the basic food groups.

The severely obese patient has elected to have the Roux-en-Y gastric bypass (RYGB) procedure. The nurse will know the patient understands the preoperative teaching when the patient makes which statement? d. "This surgery decreases how much I can eat and how many calories I can absorb."

Correct answer: d Rationale: The RYGB decreases the size of the stomach to a gastric pouch and attaches it directly to the small intestine so food bypasses 90% of the stomach, the duodenum, and a small segment of the jejunum

Which teaching points are important when providing information to a patient with metabolic syndrome (select all that apply)? a. Stop smoking. b. Monitor weight daily. c. Increase level of activity. d. Decrease saturated fat intake. e. Reduce weight and maintain lower weight. f. Check blood glucose each morning prior to eating.

Correct answers: a, c, d, e Rationale: Patients with metabolic syndrome need to lower their risk factors by reducing and maintaining weight, increasing physical activity, establishing healthy diet habits, and smoking cessation. Some patients with metabolic syndrome are diabetic and would need to monitor glucose levels frequently. When monitoring weight reduction, it is recommended to check weight weekly, not daily.