Obesity prepU review
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." Explanation: The only statement that aids in avoiding gastric ulcers is the statement instructing the client to avoid taking non-steroidal anti-inflammatory (NSAID) drugs. Sitting in a semi-recumbent of low Fowler's position aids in digestion but does not aid in the prevention of gastric ulcers. Propping the head of the bed would be beneficial for a client report GERD or acid reflux. antacid drugs do not increase the risk of gastric ulcers.
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 has a history of sleep apnea. The client understands the disease process when he says:
"I should become involved in a weight loss program." Explanation: Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.
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." Explanation: Orlistat (Xenical) works to bind to gastric and pancreatic lipase to prevent the digestion of 30% of ingested fat, thereby decreasing caloric intake.
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 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." Explanation: In Roux-en-Y bariatric surgery, a horizontal row of staples across the fundus of the stomach creates a pouch with a capacity of 20 to 30 mL. The jejunum is divided distal to the ligament of Treitz, and the distal end is anastomosed to the new pouch. The proximal segment is anastomosed to the jejunum.
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." Explanation: Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, causes dry mouth. This is an expected and normal finding. Increasing fluid intake does not make this symptom go away. The other answer choices are incorrect.
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." Explanation: The client's BMI of > 35 kg/m2 and a more severe obesity-associated comorbid condition, makes the client a candidate for bariatric surgery.
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." Explanation: 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.
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 Explanation: Patients with a BMI of 23 would have the lowest risk for health problems. Those with a BMI of 18 might have the increased risk associated with poor nutritional status. Those with a BMI of 28 are considered overweight, and those with a BMI of 30 to 39 are considered obese. Both of these groups have an increased risk for health problems.
A greater risk for obesity is assessed by a waist circumference that is ______________ inches for women and ______________ inches for men.
35, 40
When discussing lifestyle modifications with a client who has obesity, what caloric deficit should the nurse recommend in order for the client to safely lose weight?
500-1,000 calories
A nurse plans care for a client who is post op bariatric surgery. Which nursing diagnosis will be the priority?
Acute pain related to surgical procedure Explanation: When determining the priority of nursing diagnoses, the nurse must recognize that airway, breathing, and circulation come first always. The client who is in acute pain will be unable to take deep breaths and is at increased risk for pulmonary complications. Acute pain is the priority nursing diagnosis. The other nursing diagnoses are appropriate for this client; however, they are not the priority.
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 Explanation: The 2019 ACC/AHA Guideline on the Primary Prevention of Coronary Vascular Disease (CVD) indicates a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests that decreasing obesity and body fat stores via exercise, dietary modification, or developing drugs that target proinflammatory proteins may reduce risk factors for heart disease. The risk for CVD accelerates for clients after menopause due to withdrawal of endogenous estradiol levels, which can worsen many traditional CVD risk factors, including body fat distribution. Avoiding the use of caffeine, using a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to atherosclerosis.
The nurse cares for a client with obesity and discusses the increased risk of certain cancers related to obesity. Which cancers will the nurse include in the teaching? Select all that apply Brain Cervical Colorectal Skin Breast
Breast Colorectal Cervical
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 Explanation: A client with obesity is at increased risk for developing thromboembolism due to compromised blood flow and resulting venous stasis. Although the client with obesity is at risk for high cholesterol levels, increased fat in the blood does not directly impact the risk for developing thromboembolism. Increased blood viscosity and impaired clotting do not typically occur in obesity and are not the reason a client with obesity would be at greater risk for developing thromboembolism.
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 Explanation: Assessment should precede intervention. In this case, the nurse should determine whether the client is following the nutrition plan before providing education or referrals. There is no evidence of an emergency, so immediate reporting is not warranted. Fiber intake should generally be increased postoperatively, not decreased. Frequent small meals will not normally affect bowel function.
A health care provider recommends behavior interventions for a client with obesity. What does the nurse understand is most effective behavioral intervention for clients with obesity?
High intensity Explanation: The most effective behavior intervention are those considered high intensity; meaning, consisting of 12 to 26 sessions annually, which may include individual counseling sessions, group nutrition education classes, or physical education classes. These may be motivation-focused or education-focused but the most effective is high intensity.
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 change the drain How to empty the drain Recording drainage amount When to contact the health care provider How to measure the drainage amount
How to empty the drain Recording drainage amount How to measure the drainage amount When to contact the health care provider Explanation: A client who is discharged with a Jackson-Pratt drain must be taught on methods to measure, record, and empty the drain. Additionally, the nurse should instruct the client on when to contact the health care provider. The client will not change the drain, this is reserved for the health care provider only.
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
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 Explanation: Positioning the client in low Fowler's position best promotes comfort in the client who is post op bariatric surgery. In addition to decreasing incisional pain, this position also promotes gastric emptying.
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 Explanation: Both mechanical compression (intermittent pneumatic compression devices) and prophylactic anticoagulation with low molecular weight heparin agents are prescribed in the client who is postoperative bariatric surgery. Early ambulation is encouraged; however, it is not the only intervention.
A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has?
Osteoarthritis Explanation: Osteoarthritis is an obesity-related musculoskeletal condition. Rheumatoid arthritis, inflammatory arthritis, and necrotizing arthritis are not obesity-related conditions.
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 Explanation: It is contraindicated to insert a nasogastric (NG) tube in patients that have had bariatric surgery, even if they have a gastric outlet obstruction. The nurse should question the order for this reason, not because decreased motility is expected.
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 Explanation: Rapid gastric dumping may lead to steatorrhea, excessive fat in the feces. The primary cause of this finding is rapid gastric dumping. Excessive fat intake can make the problem worse; however, this is not the primary cause of the symptoms. Steatorrhea results from increased motility, not decreased and the size of the stomach does not contribute to this finding.
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 Explanation: Clients with a history of renal sufficiency or liver disease should use caution while taking this medication as it has been linked to increase rates of cholelithiasis and liver failure. The other conditions do not pose an increase risk with this medication.
A nurse working with clients undergoing bariatric surgery understands that there are various types of bariatric procedures. Which statements represent the types of bariatric procedures? Select all that apply. Restrictive Malabsorptive Both restrictive and malabsorptive Obstructive Unobstructive
Restrictive Malabsorptive Both restrictive and malabsorptive
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 Explanation: Early oral hydration stimulates GI peristalsis. The nurse would not give a client oral hydration to assess for intact swallowing as this may lead to aspiration. There is no reason to assume a client would have gastric perforation and this would not be appropriate. Digestive hormones are stimulated once peristalsis begins; however, this is not the primary purpose of early oral hydration.
After bowel sounds have returned and oral intake is resumed following bariatric surgery, six small feedings consisting of a total of 600 to 800 calories per day should be consumed.
TRUE
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. Explanation: Certain signs and symptoms that suggest possible nutritional deficiency, such as muscle wasting, poor skin integrity, loss of subcutaneous tissue, and obesity, are easy to note because they are specific; these symptoms should be studied further. Food records, 24-hour diet recall, and dietary education directed at weight loss do not account for the client's medical condition as a factor in the client's weight or nutritional status, although each method helps estimate whether food intake is adequate and appropriate.
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. Explanation: The primary purpose of offering a sugar-free beverage is that they are less likely to cause dumping syndrome in the client who is post op from bariatric surgery. Sugar-free beverages are less likely than sugary beverages to raise the blood sugar; however, this is not the primary purpose of offering the sugar-free beverage. Sugar-free beverages do not necessarily ease nausea or gastric distention.
A nurse examines the socioeconomic impact of obesity among Americans. Which statements does the nurse understand is true? Select all that apply. Those with less education are impacted at a greater prevalence of disease. Education is not related to the prevalence of disease. Those with less income are impacted at a greater prevalence of disease. Income is not related to the prevalence of disease. Those who own their own homes have a decreased prevalence of disease.
Those with less education are impacted at a greater prevalence of disease. Those with less income are impacted at a greater prevalence of disease.
A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply. Blood pressure Total cholesterol Weight BMI Waist circumference
Weight, BMI, and wait circumference Weight, BMI, and wait circumference are used to measure obesity. Blood pressure and cholesterol may be used in the client with obesity; however, these do not diagnose obesity.
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 Explanation: The learning contract is recorded in writing. It is to be clear and describe what is to be achieved. A well-balanced diet is too vague. The nurse provides frequent and positive reinforcement as the client moves from one goal to the next. It is easier for the client to achieve a smaller, obtainable goal, such as 1-2 pound weight loss in one week, versus 30 pounds in 6 months.
