303 Hinkle PrepU Chapter 48: Assessment and Management of Patients with Obesity

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 prevent the digestion of fat" 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 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 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 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 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 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.

The nurse cares for a client who is post op bariatric surgery and reports dysphagia. Which procedures are most likely to cause these symptoms? Select all that apply.

RYGB Gastric band Modified RYGB The RYGB, modified RYGB, and gastric band are all most likely to cause dysphagia after bariatric surgery. The sleeve gastrectomy and biliopancreatic diversion may also cause postoperative dysphagia; however, these are less likely to cause this.

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 Bupropion (Wellbutrin) is an antidepressant medication which promotes weight loss. The other medications are antidepressants; however, these promote weight gain, not weight loss.

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 be come involved in a weight loss program" 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 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" 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 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" 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 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 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.

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 In obesity, an increase in adipose tissue impairs the peripheral blood flow, leading to blood stasis and the formation of a thrombus.

A nurse cares for an older adult client with obesity who also has glaucoma. Which obesity medication is contraindicated in this client?

Phentermine Sympathomimetic amines, such as phentermine, are contraindicated in clients with glaucoma. The other answer choices represent obesity medications; however, these are not contraindicated in clients with glaucoma.

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. Those with less income are impacted at a greater prevalence of disease The socioeconomic disparities of obesity among Americans is great. In general, those who are less educated and earn less income are more likely to have obesity. Home ownership does not decrease the prevalence of 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.

Usually occurs after disruption of the pylorus. Symptoms are usually relieved after pharmacological treatment Bile reflux may occur with procedures that manipulate or remove the pylorus, which acts as a barrier to the reflux of duodenal contents. Reflux of bile can cause inflammation of the stomach (i.e., gastritis) or esophagus (i.e., esophagitis). Burning epigastric pain and vomiting of bilious material manifest this condition. Eating or vomiting does not relieve the symptoms. Bile reflux may be managed with proton pump inhibitors.

A client with obesity reports taking orlistat in order to aid in weight loss. Which medication order for the client will the nurse question?

cyclosporine Clients taking orlistat (Xenical) should not take cyclosporine. The other answer choices do not represent interactions if taking concurrently with orlistat.

At its most fundamental level, what does obesity result from?

metabolic imbalance At it's most fundamental level, obesity results from a metabolic imbalance characterized by an excess of caloric consumption relative to caloric expenditures.

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 bases 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 client with obesity is suspected of having nonalcoholic fatty liver disease. Which diagnostic labs does the nurse anticipate the client needing? Select all that apply.

Aspartate aminotransferase Alanine aminotransferase Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are two liver function tests that will be used in diagnosing nonalcoholic fatty liver disease, a complication of obesity. Triglycerides, glycosylated hemoglobin (HbgA1C), and fasting glucose are diagnostic tests; however, these are not generally required in diagnosing nonalcoholic fatty liver disease.

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

Diabetes is more common in Hispanics and Blacks than Whites Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese.

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 Under normal circumstances, increased fat stores, increases leptin, which increases satiety and feeling full. This then inhibits food intake. In obesity, alterations in leptin are thought to play a role in the development of the disease.

A nurse provides medication teaching for a client with obesity who is prescribed Lorcaserin. Which statement will the nurse include in the teaching?

avoid driving heavy equipment Lorcaserin (Belviq) may cause drowsiness and the client should be told not to operate heavy equipment. The other answer choices do not pertain to this medication and will not be used when teaching the client about the medication.

A nurse cares for a client who is post op from bariatric surgery. What risk factors does the nurse recognize increases the client's risk for developing venous thromboembolism (VTE)? Select all that apply.

higher BMI age history of VTE Increased age, higher BMI, and history of previous VTE all increase the risk for developing a VTE after bariatric surgery. Gender and ethnicity do not increase the risk.

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.

breast colorectal cervical Obesity increases the risk of developing certain cancers, including: breast, cervical, colorectal, endometrial, esophageal, gallbladder, liver, ovarian, non-Hodgkin lymphoma, pancreatic, prostate, kidney, and thyroid. Obesity is not associated with the increased risk of developing skin or brain cancer.

A client who is postoperative bariatric surgery is diagnosed with bile reflux. Which conditions are associated with bile reflux? Select all that apply.

gastritis esophagitis Bile reflux may cause gastritis or esophagitis. Pharyngitis, laryngitis, and tonsillitis are associated with pulmonary conditions and not associated with bile reflux.

` 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 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.

Calculate the BMI of a client who is 6 feet 1 inch tall and weighs 200 pounds. Round to one decimal.

26.4 To calculate BMI, multiply weight in pounds by 703 and then divide that by height in inches squared

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?

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

it has more than 100 times more genes than the human genome The collective genome of the microbiota, or the gut microbiome, has more than 100 times more genes than in the human genome. Its function and relationship to disease has long been studied.

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

collaborates with the client to establish an agreed upon goal When establishing a goal, the nurse should collaborate with the client. The nurse does not dictate to the client what the goal will be. Goals must be consistent with the abilities and motivation of the client. The long-term and short-term goals may not be realistic for this client.

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

has a weight gain of 5 pounds Obesity is a risk factor for osteoarthritis. Excess weight is a stressor on the weight-bearing joints. Weight reduction is often a part of the therapeutic regimen.

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." 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 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 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.

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

$147 billion The estimated annual health care costs in America tied to obesity is $147 billion.

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

nausea Liraglutide (Saxenda), a GLP-1 receptor agonist, has the following common side effects: nausea, diarrhea or constipation, headache, and tachycardia. The other answer choices do not reflect the symptoms of the medication.

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 Metformin (Glucophage) is a diabetes medication that also promotes weight loss. The other medications are diabetes medications; however, these promote weight gain, not weight loss.

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 intestine is rerouted" 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 white female client is admitted to an acute care facility with a diagnosis of stroke. Her history reveals bronchial asthma, exogenous obesity, and iron-deficiency anemia. Which history finding is a risk factor for stroke?

being obese Obesity is a risk factor for stroke. Other risk factors include a history of ischemic episodes, cardiovascular disease, diabetes mellitus, atherosclerosis of the cranial vessels, hypertension, polycythemia, smoking, hypercholesterolemia, hormonal contraceptive use, emotional stress, family history of stroke, and advancing age. The client's race, gender, and bronchial asthma aren't risk factors for stroke.

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" In the evaluation stage of the nursing process, the nurse validates even small increments toward goal achievement, as reflected in statement b. This is important for enhancement of client self-esteem and reinforcing client behavior. Change is a slow process, and success may be defined as making some progress. The nurse and client will then need to re-evaluate the goal, as in statement d, and either continue with the current goal, change the goal, or discontinue the goal. Statements a and c are negative criticisms and would diminish client self-esteem.

Calculate the BMI of a client who weighs 160 lbs and is 5 feet 6 inches tall. Round to one decimal.

25.8 To calculate BMI, multiply weight in pounds by 703 and then divide that by height in inches squared. BMI = ( Weight (pounds)/ [Height (inches)]2 ) × 703; The weight of 160 is multiplied by 703, which equals 112,480. The height is 66 inches—when squared, it equals 4356. Divide 112,480 by 4356, which equals a BMI of 25.8, which identifies this client as overweight.

A client with obesity taking lorcaserin reports feeling agitated lately and has had diarrhea for several days. What is the nurse's priority response?

notify the healthcare provider The client may be developing serotonin syndrome, a potentially life-threatening condition which the health care provider needs to know about right away.

A nurse cares for a client with a BMI of 40 kg/m2. Which gastrointestinal condition or disease does the nurse recognize is associated with the client's BMI?

colorectal cancer Colorectal cancer is associated with obesity, which the client has. The other answer choices represent GI diseases or conditions; however, these are not directly associated with obesity.

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

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

young dehiscence Risk factors for wound dehiscence include advanced age over 65 years, chronic disease such as diabetes, hypertension, obesity, history of radiation or chemotherapy, malnutrition, particularly insufficient protein and vitamin C, and hypoalbuminemia. This client is not at increased risk for hypotension, contractures, or phlebitis.or?

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 nonsteroidal anti-inflammatory drugs" 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 evaluates the effectiveness of discharge teaching for a client who is postoperative from bariatric surgery. Which statement made by the client indicates to the nurse that additional teaching is necessary?"

"For minor pain I should take prescribed ibuprophen The client who is postoperative from bariatric surgery should avoid non-steroidal anti-inflammatory medications due to the risk of gastric ulcers. The other answer choices are all true statements and indicate the client has understood the nurse's teaching.

A nurse is caring for a client who is considering vagal blocking therapy for the treatment of obesity. The client asks the nurse, "How does this therapy make me lose weight?" What is the nurse's best response? Select all that apply.

"It decreases stomach emptying." "It decreases pancreatic enzyme secretion." "It decreases stomach contractions." "It decreases absorption of calories." Vagal blocking therapy results in diminished gastric contraction and emptying, limited ghrelin secretion, and diminished pancreatic enzyme secretion; these cause increased satiety, decreased cravings, and diminished absorption of calories, all of which lead to weight loss.

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." Older adults have a slightly higher prevalence of obesity when compared to the general population.

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

32.7 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.

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. 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 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 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 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?

restrict the client's ability to eat Bariatric surgical procedures work by restricting a patient's ability to eat (restrictive procedure), interfering with ingested nutrient absorption (malabsorptive procedures), or both. Bariatric procedures do not impair caloric absorption; rather, nutrients are impaired by malabsorption.

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 fowlers 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 male client in a wheelchair comes in for his yearly physical examination. He is unable to stand. The nurse retrieves the wheelchair scale to obtain an accurate weight. The nurse understands the importance of this assessment with this client. What is the nurse's reasoning for obtaining an accurate weight?

people with disabilities have in increased incidence of obesity Many clients with disabilities report that they have not been weighed for years because they cannot stand during weighing. Alternative methods such as use of a wheelchair scale is important, because there is an increased incidence of obesity in clients with disabilities.

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 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.

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 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.

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

Cushing's disease Cushing's disease, results from excess cortisol in the blood. This increases the risk of obesity. The other diseases or conditions listed most likely causes weight loss, not weight gain.

The nurse is admitting a client with traumatic injuries who also has class III obesity. When planning this client's care, the nurse should address the client's heightened risk of what nursing diagnoses related to obesity? Select all that apply.

impaired gas exchange impaired skin integrity Obesity creates risks for ineffective respiration and consequent impaired gas exchange due to changes in the structure and function of the respiratory system. As well, obesity is associated with risks to skin integrity due to the possibility of pressure injuries. There is no accompanying risk of bowel incontinence or fluid volume deficit that is accounted for by obesity. If neglect exists, it is likely to be bilateral, not unilateral.

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 client who is postoperative from bariatric surgery may share that they are dissatisfied with their appearance, often due to loose skin folds from excessive weight loss. It is the nurse's role to validate the client's feelings and to make sure the client understands that these feelings are normal. Asking the client why he or she is dissatisfied put the client in a defensive space and is not therapeutic. The client needs validation for his or her feelings; not being told that he or she can change. This may worsen the client's body image.

The nurse cares for a client who is post op bariatric surgery whose bowel sounds have returned and is tolerating oral intake. What teaching will the nurse provide the client about the nutrition required at this time? Select all that apply.

"You need to drink plenty of water in between meals." "Eat slowly." "You will have six small meals per day." Once the client's bowel sounds have returned and the client is tolerating oral intake, the nurse will advise the client to drink plenty of water between meals, eat slowly, and eat six meals that total 600-800 calories for the day (at the advisement of the health care provider).

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 on this medication" The nurse should tell the client to avoid drinking alcohol while taking this medication. The other answer choices are not as important as avoiding the drug/alcohol interaction associated with this medication.

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

osteoarthritis Osteoarthritis is an obesity-related musculoskeletal condition. Rheumatoid arthritis, inflammatory arthritis, and necrotizing arthritis are not obesity-related conditions.

A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response?

"the fat is passed in your stools" Orlistat (Xenical) prevents the absorption of 30% of fat, decreasing caloric intake. Undigested fat is passed in the stools. The undigested fat is not excreted in the urine, absorbed in the intestines, or left undigested in the stomach.

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 Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders. The patient profile and symptoms are suggestive of acute cholecystitis.

The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis?

addressing obesity Published information by Balistreri et al. (2010) indicated a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests decreasing obesity and body fat stores may help to reduce the risk. Avoiding the use of caffeine, encouraging the use of 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.

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 The WHO mentions that many developing nations now face a double-burden of both undernutrition and obesity. Both of these issues occur simultaneously and create a public health burden to developing nations.

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 To calculate BMI, multiply weight in pounds by 703 and then divide that by height in inches squared. The client's BMI is 31.4 kg/m2. This falls under the Class I obesity category. Normal weight BMI is 18.5-25 kg/m2. Overweight BMI is 25-30 kg/m2. Class II obesity is a BMI 35-40 kg/m2.

A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history:

coronary artery disease Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.

A nurse cares for a client who is postoperative bariatric surgery and has experienced frequent episodes of dumping syndrome. The client now reports anorexia. What is the primary reason for the client's report of anorexia?

fear of eating Dumping syndrome is an unpleasant set of GI and vasomotor symptoms that commonly occur in clients who have had bariatric surgery. The symptoms are so unpleasant that the client may develop a fear of eating, leading to anorexia.

A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns?

obesity along with conditions associated with it has become a major health concern In recent years, obesity has become a major health concern and the multiple comorbidities that accompany it add significantly to its associated mortality. Although many infectious diseases have been controlled or eradicated, some such as tuberculosis, acquired immunodeficiency syndrome and sexually transmitted infections are on the rise. The prevalence of chronic illnesses and disability is increasing because of the lengthened lifespan in the United States and the advances in care and treatment. People with chronic illnesses constitute the largest group of health care consumers in the United States.

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

overtime, 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 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 Phentermine is a sympathomimetic amine that stimulates central noradrenergic receptors, causing appetite suppression. Feeling jittery and nervousness is associated with this type of medication. The other answer choices represent treatment options for obesity; however, these do not cause the client's symptoms.

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 Phentermine, a sympathomimetic amine, stimulates the noradrenergic receptors, causing appetite suppression. The other answer choices represent medications used to treat obesity; however, these do not stimulate noradrenergic receptors.

A client who is post op bariatric surgery reports diarrhea. What is the most likely cause of the client's symptoms?

poor dietary choices Postoperative diarrhea in a client who has had bariatric surgery is most likely caused by poor dietary choices. Immobility would most likely cause constipation, not diarrhea. Medication side effects may increase the risk for diarrhea; however, this is not the primary reason for diarrhea. Decreased intrinsic factor does not lead to an increase in diarrhea.

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

weight BMI waist 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.