Ch 40 and 41 Nutrition and obesity

The nurse determines that an obese patient has obesity hypoventilation syndrome. Which body condition creates a high risk for this condition? 1 Gynoid body shape 2 Android body shape 3 Primary obesity 4 Secondary obesity

2

As a result of refeeding syndrome, a patient experiences hypophosphatemia. The nurse should monitor the patient for what complications associated with the condition? Select all that apply. 1 Lanugo 2 Paresthesias 3 Respiratory arrest 4 Cardiac dysrhythmias 5 Broken blood vessels in the eyes

2 3 4

The nurse is caring for an underweight patient and should recommend which food items? Select all that apply. 1 Salads 2 Yogurt 3 Croissants 4 Casseroles 5 Skim milk

2 3 4

Which body mass index (BMI) indicates that a patient is overweight? 1 A BMI of 32.0 kg/m2 2 A BMI of 28.7 kg/m2 3 A BMI of 24.9 kg/m2 4 A BMI of 23.7 kg/m2

2 The BMI is a measure of relative weight based on a patient's mass and height. If the patient's BMI is between 25.0 and 29.9 kg/m2, it indicates that the patient is overweight. If the BMI is greater than 30 kg/m2, the patient is obese. If the BMI is between 18.5 and 24.9 kg/m2, the patient is considered to be normal weight. Text Reference - p. 894

The nurse should instruct a student nurse that a syringe will be needed for what type of enteral feeding? 1 Cyclic feedings 2 Intermittent bolus 3 Continuous infusion 4 Intermittent infusion

2 The nurse or student nurse will deliver an intermittent bolus delivery using a syringe. Cyclic feedings and continuous infusions utilize pumps for delivery. An intermittent infusion uses gravity for delivery. Text Reference - p. 897

A patient who has dysphagia as a consequence of a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). What intervention should the nurse integrate into this patient's care? 1 Flush the tube with 30 mL of normal saline every four hours 2 Flush the tube before and after feedings if the patient's feedings are intermittent 3 Flush the PEG with 100 mL of sterile water before and after medication administration 4 To prevent fluid overload, avoid flushing when the patient is receiving continuous feeding

2 The nurse should flush feeding tubes with 30 mL of water (not normal saline) every four hours and before and after medication administration during continuous feeding or before and after intermittent feeding. Flushes of 100 mL are excessive and may cause fluid overload in the patient. Text Reference - p. 899

A patient who receives parenteral nutrition reports feeling tired and a burning and itching sensation. The nurse notes shallow respirations and a pulse rate of 40 beats/minute. What condition does the nurse suspect to have caused the patient's symptoms? 1 Distention of the abdomen 2 Displacement of a catheter 3 Presence of refeeding syndrome 4 Reduction in serum levels of fat-soluble vitamins

3

An overweight patient admitted to the hospital for heart failure weighs 192 pounds. The nurse instructs the patient that an acceptable portion size of animal protein is approximately how many ounces? 1 1 ounce 2 3 ounces 3 5 ounces 4 7 ounces

3 An appropriate serving size of animal protein is 3 ounces, about the size of one's fist. 1 ounce is one third of the normal serving size; 5 and 7 ounces are greater than one serving size. Text Reference - p. 914

The nurse is providing care for a 23-year-old woman who is a strict vegetarian. To prevent the consequences of iron deficiency, what should the nurse recommend? 1 Brown rice and kidney beans 2 Cauliflower and egg substitutes 3 Soybeans and hot breakfast cereal 4 Whole-grain bread and citrus fruits

3 Vegetarians are at a particular risk for iron deficiency, a problem that can be prevented by regularly consuming high-iron foods such as hot cereals and soybeans. Brown rice, kidney beans, cauliflower, egg substitutes, whole grain bread, and citrus fruits are sources of iron, but do not contain as much iron as soybeans and hot cereal. Text Reference - p. 889

The nurse recalls that the recommended dietary allowance of dietary cholesterol is what? Record your answer using a whole number. ___mg/day

300

The nurse is providing postoperative care for a bariatric surgery patient who has difficulty breathing and has abdominal pressure. Which priority nursing intervention would be beneficial in this situation? 1 Performing jaw-thrust maneuver 2 Assisting the patient to walk a short distance 3 Administering a low dose of heparin to the patient 4 Placing the patient's head at a 35 to 40 degree angle

4

Why does the nurse, who is preparing a diet regimen for an obese patient, advise the patient to lose around 1 to 2 lbs each week? 1 To ensure better cosmetic results 2 To reduce number of plateau periods 3 To reduce risk of venous complications 4 To provide a motivation for weight loss

1

he nurse is teaching a class about the health risks associated with obesity. Which of these are considered to be health risks for obesity? Select all that apply. 1 Sleep apnea 2 Breast cancer 3 Insulin resistance 4 Hyperthyroidism 5 Gastroesophageal reflux disease

1 2 3 5

A severely obese patient has undergone Roux-en-Y gastric bypass (RYGB) surgery. The nurse will monitor for dumping syndrome, which is characterized by which of these symptoms? Select all that apply. 1 Diarrhea 2 Sweating 3 Faintness 4 Constipation 5 Nausea and vomiting

1 2 3 5 A complication of RYGB is dumping syndrome, in which gastric contents empty too rapidly into the small intestine, overwhelming its ability to digest nutrients. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea. Patients are discouraged from eating sugary foods after surgery to avoid dumping syndrome. Constipation is not a symptom of dumping syndrome. Text Reference - p. 917

A severely obese patient has undergone Roux-en-Y gastric bypass (RYGB) surgery. The nurse will monitor for dumping syndrome, which is characterized by which of these symptoms? Select all that apply. 1 Diarrhea 2 Sweating 3 Faintness 4 Constipation 5 Nausea and vomiting

1 2 3 5 A complication of RYGB is dumping syndrome, in which gastric contents empty too rapidly into the small intestine, overwhelming its ability to digest nutrients. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea. Patients are discouraged from eating sugary foods after surgery to avoid dumping syndrome. Constipation is not a symptom of dumping syndrome. Text Reference - p. 917

An obese patient is diagnosed with liver failure. When reviewing the patient's medical records, the nurse finds that the patient is on weight loss therapy. Which medication is likely responsible for the patient's liver failure? 1 Orlistat 2 Diethylpropion 3 Benzphetamine 4 Phendimetrazine

1 Orlistat is a nutrient absorption-blocking drug, which blocks the breakdown of fats. The increased fat content in the liver may result in liver injury. Benzphetamine, diethylpropion, and phendimetrazines are nonamphetamines, which help to reduce obesity by suppressing appetite; they are not associated with liver failure. Text Reference - p. 916

A nurse is caring for a patient who is suspected to be malnourished. What anthropometric measurements should the nurse perform to assess malnutrition? Select all that apply. 1 Hip-to-waist ratio 2 Mid-arm muscle circumference 3 Skin fold thickness 4 Height 5 Waist circumference 6 Chest circumference

1 2 3 5 Anthropometric measurements are gross measures of fat and muscle contents. They consist of measures of skin fold thickness at various sites, which are indicators of subcutaneous fat stores, and mid-arm muscle circumference, which is an indicator of protein stores. Hip-to-waist ratio and waist circumference are also anthropometric measurements. Such measurements are compared with the standards for healthy persons of the same age and gender. A person's height alone cannot indicate the malnutrition status. Chest circumference does not directly indicate malnutrition. Text Reference - p. 893

The nurse is caring for a patient who is suspected to be malnourished. Which components should the nurse assess while performing a nutritional screening of this patient? Select all that apply. 1 Handgrip strength 2 Diet history 3 Depression 4 Serum albumin level 5 Rate of weight change 6 White blood cell (WBC) count

1 2 3 5 Handgrip strength is a measure of muscle strength that is used to assess the functional status, an important outcome of nutritional status. A diet history reflects food and nutrient intake and therefore helps to assess the nutritional status. Depression can affect intake of food and can lead to malnutrition. A consistent decrease in weight can lead to malnutrition; therefore, rate of weight change is an essential component of nutritional assessment. Serum albumin has a half-life of approximately 20 to 22 days. In the absence of marked fluid loss, such as from hemorrhage or burns, the serum albumin value lags behind the actual protein changes by more than two weeks. Therefore, albumin is not a good indicator of acute changes in nutritional status. WBC count does not directly indicate malnutrition. Text Reference - p. 894

A nurse provides care for patients on a medical-surgical unit and identifies patients with which conditions that put them at increased risk for malnutrition? Select all that apply. 1 Trauma 2 Dementia 3 Depression 4 Hypertension 5 Chronic alcoholism

1 2 3 5 Malnutrition is a deficit, excess, or imbalance of essential nutrients. Trauma leads to hypermetabolism, increasing the risk of malnutrition if the increased nutritional demands are not met. Dementia and depression affect the intake of food by affecting judgment. Chronic alcoholism depresses appetite and leads to malnutrition. Hypertension causes increases in blood pressure level; it is not a cause of malnutrition. Text Reference - p. 890

A nurse reviews a patient's history and recognizes that which conditions increase the risk of malnutrition? Select all that apply. 1 Certain medications 2 Excessive dieting 3 Swallowing disorders 4 Fracture of a bone 5 Chronic alcoholism

1 2 3 5 Medications may cause dry mouth, alter the taste of food, or decrease appetite, leading to a decrease in food intake and causing malnutrition. Excessive dieting for weight management results in the loss of nutrients from the body. A swallowing disorder can impair the ability to lubricate, masticate, and swallow food. Chronic alcoholism depresses appetite and leads to malnutrition. A fracture of a bone does not affect food intake and is not related to malnutrition. Text Reference - p. 890

What are manifestations of potassium deficiency in a patient with anorexia nervosa? Select all that apply. 1 Leukopenia 2 Renal failure 3 Muscle weakness 4 Metabolic alkalosis 5 Cardiac dysrhythmias 6 Swollen salivary glands

1 2 3 5 Potassium deficiency occurs in patients with anorexia nervosa due to a lack of potassium in the diet and loss of potassium in the urine. Manifestations of potassium deficiency include renal failure, muscle weakness, and cardiac dysrhythmias. Leukopenia, hypoglycemia, hyponatremia, hypomagnesemia, and hypophosphatemia may also be present. Metabolic alkalosis and swollen salivary glands are observed in patients with bulimia nervosa. Text Reference - p. 903

Which conditions can cause bulimia nervosa? Select all that apply. 1 Anxiety 2 Substance abuse 3 Affective disorder 4 Chronic alcoholism 5 Endocrine dysfunction

1 2 3 Anxiety, substance abuse, and affective disorder can cause bulimia nervosa. Chronic alcoholism may cause malnutrition and also increases the risk of refeeding syndrome. Anorexia nervosa is characterized by endocrine dysfunction. Text Reference - p. 903

A nurse assesses a patient who is diagnosed with malnutrition. Which assessment findings support the diagnosis? Select all that apply. 1 Anemia 2 Infection 3 Hyperglycemia 4 Delayed wound healing 5 Wasted and flabby muscle

1 2 4 5 Malnutrition leads to a decrease in iron and folic acid level, resulting in anemia. The patient is more susceptible to infection because humoral and cell-mediated immunity are deficient in malnutrition. Also, wound healing may be delayed due to decreased protein levels. Because protein intake is severely reduced, the muscles are wasted and flabby, leading to weakness and fatigability. Hyperglycemia commonly occurs in diabetic patients and is often associated with an increase in glucose levels. Text Reference - p. 892

The nurse reviews the laboratory reports of an adult female patient and concludes that the patient is experiencing metabolic syndrome. Which findings support the nurse's conclusion? Select all that apply. 1 Triglyceride level of 170 mg/dL 2 Waist circumference of 38 inches 3 Blood pressure of 125/80 mm of Hg 4 Fasting blood glucose level of 120 mg/dL 5 High-density lipoprotein (HDL) of 55 mg/dL

1 2 4 A normal triglyceride level is less than 150 mg/dL. Because the patient's triglyceride level is 170 mg/dL, it indicates that the patient is at risk for metabolic syndrome. A female patient that has a waist circumference of 38 inches has a risk of metabolic syndrome; a female patient with a waist circumference of less than 35 inches is normal. A normal fasting blood glucose level is 70 to 100 mg/dL. If the patient's fasting blood glucose is 120 mg/dL, it indicates that the patient is at an increased risk for metabolic syndrome. A blood pressure reading of 120/80 mm of Hg indicates that the patient has normal blood pressure. HDL is sometimes referred to as "good" cholesterol. HDL cholesterol levels greater than 40 to 60 mg/dL are desired. An HDL level of 55 does not indicate a risk of metabolic syndrome. Text Reference - p. 921

The nurse should encourage which dietary habits for a healthy lifestyle? Select all that apply. 1 A well-balanced diet 2 Adequate intake of water 3 Consumption of whole milk 4 Intake of whole grains 5 Consumption of preserved foods

1 2 4 A well-balanced diet contains a sufficient number of calories to maintain a healthy weight. It acts as a first step in the process of a healthy lifestyle. Depending on changes in health status and daily activity level, calorie intake should be adjusted. Consumption of sugar-added beverages results in the increase of calorific value of the recommended dietary allowance. The beverages can be replaced by adequate intake of water to reduce the risk of excess calorie intake. Grains provide essential carbohydrates and polysaccharides. Whole milk contains more saturated fats, which affect calorie intake. Whole milk can be replaced by fat-free or low-fat (1%) milk. Preserved foods contain high levels of salts, resulting in the intake of sodium and altering caloric intake. Text Reference - p. 887

Which nursing intervention would be beneficial for an obese patient who is at risk for deep venous thrombosis after surgery? Select all that apply. 1 Providing antiembolic stockings 2 Administering low-dose heparin 3 Administering aspirin medication 4 Encouraging range-of-motion exercises 5 Instructing in cough and deep breathing techniques

1 2 4 Antiembolic stockings help to prevent the formation of blood clots. Heparin is an anticoagulant, which helps reduce the risk of blood clots. Range-of-motion exercise will help reduce the risk of blood clots. Aspirin increases the risk of bleeding, so the nurse should not administer aspirin. Cough and deep breathing techniques help reduce pulmonary complications associated with bariatric surgery. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 919

What instructions does the nurse give to a patient who has undergone Roux-en-Y gastric bypass surgery? Select all that apply. 1 "You should increase the calcium in your diet." 2 "You should take iron supplements." 3 "You should eat foods high in sugar." 4 "You should take intranasal cobalamin." 5 "You should avoid folic acid supplements."

1 2 4 The patient who underwent Roux-en-Y gastric bypass surgery will have a calcium deficiency, so the nurse instructs the patient to take calcium-rich food and calcium supplements. The patient who has undergone Roux-en-Y gastric bypass surgery will have anemia, which can be helped with iron supplements, and cobalamin deficiency, which can be resolved with intranasal cobalamin. The nurse instructs the patient to avoid sugar-containing foods and to take folic acid supplements. Text Reference - p. 917

The nurse recognizes that total parenteral nutrition (TPN) may be the only feasible option for patients with what conditions? Select all that apply. Nonfunctioning GI tract 2 Bowel obstruction 3 Head cancer 4 Facial swelling 5 Short bowel syndrome due to surgery

1 2 5 TPN may be the only feasible option for patients who do not have a functioning GI tract or who have disorders requiring complete bowel rest, such as some stages of ulcerative colitis, bowel obstruction, certain pediatric GI disorders (such as congenital GI anomalies, prolonged diarrhea regardless of its cause), and short bowel syndrome due to surgery. Head cancer is not an indication for TPN. Facial swelling may or may not prevent a patient from consuming food through the oral route. Text Reference - p. 901

The nurse provides care for a patient with suspected malnutrition. Which assessment data is used for diagnosing malnutrition? Select all that apply. 1 Vital signs 2 Diet history 3 X-ray studies 4 Capnography 5 Body mass index

1 2 5 The vital signs can be recorded along with measurement of height and weight. The previous diet history of the patient is assessed for management and recovery of the condition. The body mass index is calculated to assess whether the patient is underweight. X-ray studies and capnography are not required for the diagnosis of malnutrition. X-ray studies are used to assess tube position in enteral feedings. Capnography is used in monitoring of breath-to- breath carbon dioxide level to detect entry of tube into the trachea during insertion. Text Reference - p. 892

A nurse is helping a patient select food for a healthy lifestyle. What instructions should the nurse give to this patient? Select all that apply. 1 Eat more whole grains. 2 Avoid oversized portions. 3 Drink more fruit juices. 4 Sodium intake should come from foods such as cured meats rather than from table salt. 5 Add fruits to meals as part of main or side dishes

1 2 5 Whole grains are better sources of fiber and other important nutrients, such as selenium, potassium, and magnesium, and therefore should be substituted for refined products. Oversized portions mean significant excess calorie intake, especially when eating high-calorie foods. Thus, foods should be portioned out before eating. Adding fruits as a part of the meal replaces unhealthy choices, and it adds much-needed nutrients and fiber. Sugary drinks, including many fruit juices, are high in calories and should be avoided. Pickled foods and cured meats contain high sodium levels and are not better sources of sodium than is table salt. Sodium attracts water, and a high-sodium diet draws water into the bloodstream, which increases the volume of blood and over time can increase the blood pressure. Therefore lower-sodium versions of foods such as soups and breads should be chosen. Text Reference - p. 887

The nurse assesses a patient who is obese. What psychosocial health risks are associated with obesity? Select all that apply. 1 Depression 2 Discrimination 3 Impaired flexibility 4 Stress incontinence 5 Exercise intolerance

1 2 Depression and discrimination are the psychosocial health risks associated with obesity. Impaired flexibility is a musculoskeletal health risk associated with obesity. Stress incontinence is a genitourinary health risk associated with obesity. Exercise intolerance is a respiratory health risk associated with obesity. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. Text Reference - p. 911

A patient has undergone a jejunostomy. The patient is receiving feedings through an orogastric tube. The nurse recognizes that the patient is at risk for what conditions? Select all that apply. 1 Skin irritation 2 Dislodgment of the tube 3 Fluid retention and electrolyte imbalances 4 Dry and scaly skin, brittle nails, rashes, and hair loss 5 Impaired absorption of nutrients from the gastrointestinal (GI) tract

1 2 The patient receiving feeding through an orogastric tube is at risk of skin irritation and dislodgment of the tube. Skin irritation occurs because the digestive juice irritates the skin. If the skin is irritated, other types of drain or tube pouches are used. The tubes can become dislodged by vomiting or coughing and can also become knotted or kinked. Fluid retention and electrolyte imbalances are symptoms of refeeding syndrome. Dry, scaly skin, brittle nails, rashes, and hair loss are symptoms of malnutrition. Impaired absorption of nutrients from the GI tract is a sign of malabsorption syndrome. Text Reference - p. 900

When assessing a patient with obesity, what questions are appropriate for the nurse to ask the patient? Select all that apply. 1 What kind of food do you prefer? 2 Where do you go for a vacation? 3 Are other family members overweight? 4 What is your motivation to lose weight? 5 What is your educational background?

1 3 4 Asking about food preferences helps to evaluate the patient's food habits, inquiring about the weight of family members will reveal any family history of weight issues, and asking about motivation to lose weight will clarify the patient's reasons for trying to lose weight. These all help in detailing the history and planning the required lifestyle modifications. Information about where the patient goes for vacation and about educational background are not relevant. Text Reference - p. 913

The nurse is caring for a patient who has undergone bariatric surgery. Which nursing interventions will be beneficial to this patient? Select all that apply. 1 Administering IV fluids 2 Administering carbohydrate-rich foods 3 Maintaining the patient in the semi-Fowler's position 4 Being prepared to perform a head-tilt maneuver 5 Maintaining the patient on excess liquid intake

1 3 4 The patient may experience electrolyte imbalances after bariatric surgery. Therefore, administering intravenous (IV) fluids will be beneficial. The nurse should place the patient's head at a 35- to 40-degree angle while assisting the patient into the semi-Fowler's position. This intervention promotes maximum chest expansion and prevents breathlessness by relaxing the patient's abdominal muscles and stabilizing the patient's airways. Anesthetics administered during surgery are stored in adipose tissues. The adipocytes release anesthetics into the blood stream after surgery, increasing the risk of resedation. Therefore, the nurse should be prepared to perform a head-tilt maneuver to prevent respiration depression that may be caused by resedation. Foods rich in carbohydrates increase the risk of diarrhea. Excess liquid intake promotes anastomosis leaks and increases the patient's pain. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 920

The nurse is teaching a patient about developing strategies to plan a weight loss program. What nursing actions are appropriate? Select all that apply. 1 Suggest lifestyle changes. 2 Advise diet therapy alone. 3 Advise focusing on reasons to lose weight. 4 Advise medication and surgery. 5 Modify diet, exercise, and behavior.

1 3 5 For successful weight loss, lifestyle changes such as healthy eating habits and adequate physical activity should be stressed. It is also important to focus on reasons to lose weight. A multifaceted approach needs to be used and will include nutritional therapy, exercise, and behavior modification. Advising diet therapy or medication and surgical intervention for all patients is not recommended. Text Reference - p. 913

The nurse is caring for a patient with an energy utilization and storage disorder called metabolic syndrome. Which treatment strategies will be helpful for this patient? Select all that apply. 1 Administering metformin 2 Administering tranexamic acid 3 Providing information on nutritious dietary intake 4 Advising the patient to consume palm kernel oil 5 Providing information on positive lifestyle changes

1 3 5 Metabolic syndrome is an energy utilization and storage disorder associated with an increase in fasting plasma glucose levels. Administering metformin enhances the patient's insulin sensitivity and decreases blood glucose levels. A healthy diet promotes weight loss and prevents obesity. A diet rich in unsaturated fatty acids decreases the patient's risk of weight gain. Therefore, the nurse should provide information about a nutritious diet to the patient. Sedentary lifestyles lead to metabolic syndrome. The nurse should provide the patient with information on positive lifestyle changes. Administering tranexamic acid increases blood clotting. A diet rich in saturated fat develops abnormal levels of blood cholesterol in the patient. Palm kernel oil is a rich source of saturated fat, so a patient with metabolic syndrome avoid it. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 921

The nurse is caring for a patient who has undergone Roux-en-Y gastric bypass surgery. Which nursing interventions will be beneficial to this patient? Select all that apply. 1 Encouraging the patient to take calcium supplements 2 Encouraging the patient to consume dairy products 3 Encouraging the patient to eat fiber-rich food 4 Encouraging the patient to eat simple carbohydrates 5 Encouraging the patient to drink carbonated beverages

1 3 Roux-en-Y gastric bypass surgery results in the rapid emptying of stomach contents and causes dumping syndrome, decreasing the patient's absorption of calcium and iron. Therefore, the nurse recommends that the patient take calcium supplements. Foods rich in soluble fiber slow gastric emptying and prevent reabsorption of sugar at a faster rate. Therefore, the patient is encouraged to eat fiber-rich food. A patient who has undergone Roux-en-Y gastric bypass surgery does not tolerate milk or milk products. Simple carbohydrates can pass quickly through the patient's stomach and cause diarrhea and cramping. Carbonated beverages can lead to bloating and pain. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer Text Reference - p. 971

Which tube feeding reduces the risk of aspiration in patients with chronic reflux? 1 Gastrostomy 2 Jejunostomy 3 Orogastric tubing 4 Nasogastric tubing

2 Jejunostomy tube feeding prevents recurrent aspiration pneumonia. Gastrostomy feeding is advised for patients who require enteral nutrition over a prolonged period of time. Orogastric and nasogastric tubes present a high risk for aspiration and mucosal damage. Text Reference - p. 898

A patient is on orlistat therapy. Which vitamin supplements will be prescribed? Select all that apply. 1 Vitamin A 2 Vitamin B1 3 Vitamin C 4 Vitamin D 5 Vitamin E 6 Vitamin K

1 4 5 6 Orlistat (Xenical) blocks fat metabolism and subsequent absorption in the intestine. Orlistat can decrease some fat-soluble vitamin levels in the body, such as A, D, E, and K. Orlistat (Xenical) is not known to decrease the water soluble vitamins, such as vitamin C and B complex, in the body. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 916

A community health nurse is conducting an initial assessment of a new patient. Which assessments should the nurse include when screening the patient for metabolic syndrome? Select all that apply. 1 Blood pressure 2 Resting heart rate 3 Physical endurance 4 Waist circumference 5 Fasting blood glucose

1 4 5 The diagnostic criteria for metabolic syndrome include elevated blood pressure, fasting blood glucose, waist circumference, triglycerides, and high-density lipoprotein (HDL) cholesterol. Resting heart rate and physical endurance are not part of the diagnostic criteria. Text Reference - p. 913

A community health nurse is conducting an initial assessment of a new patient. Which assessments should the nurse include when screening the patient for metabolic syndrome? Select all that apply. 1 Blood pressure 2 Resting heart rate 3 Physical endurance 4 Waist circumference 5 Fasting blood glucose

1 4 5 The diagnostic criteria for metabolic syndrome include elevated blood pressure, fasting blood glucose, waist circumference, triglycerides, and high-density lipoprotein (HDL) cholesterol. Resting heart rate and physical endurance are not part of the diagnostic criteria. Text Reference - p. 913

The nurse understands that which socioeconomic factors are responsible for malnutrition? Select all that apply. 1 Elderly on a fixed income 2 Alcoholism 3 Hospitalization 4 Food insecurity 5 Food-drug interactions

1 4 Elderly people tend to eat less nutritious food due to functional disability and limited access to resources. Assistance of a registered dietician can guide older adults to meet their nutritional requirements with available resources. Food insecurity arises in families with low income levels. They opt for filling foods with high calorific value and less nutritional value. Alcoholism is not a direct cause of malnutrition. Hospitalization due to surgery, illness, or trauma can result in a reduced metabolic rate and diet restrictions but is not a direct cause of malnutrition. Food-drug interactions can result in decreased appetite and loss in effectiveness of the drug but are not direct causes of malnutrition. Text Reference - p. 890

The nurse has completed initial weight-loss instruction with a patient. The nurse determines that additional teaching is needed when the patient states: 1 "I plan to lose six pounds a week until I have reached my weight loss goals." 2 "I should exercise most days of the week for best results." 3 "I will keep a diary of weekly weights to illustrate my weight loss." 4 "I will reduce my caloric intake to 1800 calories per day."

1 A healthy weight loss goal is one to two pounds per week. Exercising, keeping a diary of weekly weights, and reducing caloric intake to 1800 calories per day would show that the patient understands healthy weight loss. Text Reference - p. 913

In developing a weight reduction program with a 45-year-old female patient who weighs 197 lb, the nurse encourages the patient to set a weight loss goal of how many pounds weekly? 1 1-2 2 3-5 3 4-8 4 5-10

1 A realistic weight loss goal for patients is 1 to 2 lb/wk, which prevents the patient from becoming frustrated at not meeting weight loss goals. Three to 5 lbs per week, 4 to 8 lbs per week, and 5 to10 lbs per week is too much weight to lose in one week. Text Reference - p. 913

During patient teaching, the nurse emphasizes that a healthy weight loss averages how many pounds per week? 1 Two pounds 2 Four pounds 3 Six pounds 4 Eight pounds

1 A realistic weight loss goal is one to two pounds per week, which prevents the patient from becoming frustrated at not meeting weight loss goals. Also, it is not so rapid that the patient's skin and underlying tissue lose elasticity and become flabby. Text Reference - p. 913

The nurse inserts a nasogastric tube. What method should be used to confirm that the tube is correctly placed in the patient's gastrointestinal tract? 1 X-ray 2 Endoscopy 3 Capnography 4 Bronchoscopy

1 An x-ray confirmation helps determine whether a blindly placed nasogastric or orogastric tube is properly positioned in the gastrointestinal tract. An endoscopy is used to insert a gastrostomy tube. A capnography is used to detect an inadvertent entry of a tube into the trachea during insertion. A bronchoscopy helps diagnose the cause of pneumonic infiltrates. Text Reference - p. 899

A patient experiences abnormal weight loss, hair loss, sensitivity to cold, irregular menstruation, dry and yellowish skin, and constipation. The patient reports being extremely conscious about weight and appearance. The nurse recognizes that the assessment findings are indicative of which disorder? 1 Anorexia nervosa 2 Hypophosphatemia 3 Refeeding syndrome 4 Megaloblastic anemia

1 Anorexia nervosa is a serious mental illness. It shows symptoms like weight loss, hair loss, sensitivity to cold, irregular menstruation, dry and yellowish skin, and constipation. It occurs more frequently in women. Hypophosphatemia is commonly associated with refeeding syndrome. Refeeding syndrome is characterized by fluid retention and electrolyte imbalances. Megaloblastic anemia is associated with deficiency of cobalamin. Text Reference - p. 903

The nurse is caring for a patient who is 5'6" tall and weighs 186 lb. The nurse has discussed reasonable weight loss goals and a low-calorie diet with the patient. Which statement made by the patient indicates a need for further teaching? 1 "I will limit intake to 500 calories a day." 2 "I will try to eat very slowly during mealtimes." 3 "I'll try to pick foods from all of the basic food groups." 4 "It's important for me to begin a regular exercise program."

1 Limiting intake to 500 calories per day is not indicated for this patient and the severe calorie energy restriction would place this patient at risk for multiple nutrient deficiencies. Decreasing caloric intake of at least 500 to 1000 calories a day is recommended for weight loss of one to two pounds per week. The statements about eating slowly, picking food from basic food groups, and adhering to an exercise program indicate that the patient understands methods to aid in weight loss. Text Reference - p. 913

While performing the nutritional assessment of a patient, the nurse finds that the patient's height is 1.71 m and weight is 68 kg. What does the nurse interpret based on the patient's body mass index (BMI)? 1 The BMI indicates the weight is normal. 2 The BMI indicates a higher risk for disease. 3 The BMI indicates the weight is above normal. 4 The BMI indicates the weight is below normal

1 BMI is a measure of relative weight based on a patient's mass and height. It is calculated by using the following formula: actual body weight in kilograms/(height in meters)2. For this patient, multiply 1.71 m by 1.71 m. This equals 2.9241. Next, divide 68 kg (the patient's weight) by 2.9241. This equals 23.25 kg/m2. The patient's BMI of 23.25 falls in between 18.5 kg/m2 and 24.9 kg/m2, it indicates normal weight. If the patient's BMI is greater than 30 kg/m2, it indicates a higher risk of disease. If the patient's BMI falls in between 25.0 to 29.9 kg/m2, it indicates that the patient is above normal. If the patient's BMI is less than 18.5 kg/m2, it indicates that the patient is underweight. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 906

Which type of bariatric surgery decreases the amount of small intestine available for nutrient absorption and also removes part of the patient's stomach? 1 Biliopancreatic diversion 2 Adjustable gastric banding 3 Vertical sleeve gastrectomy 4 Roux-en-Y gastric bypass surgery

1 Biliopancreatic diversion is a malabsorptive surgery that involves removing 70% of the stomach. This surgery decreases the amount of small intestine available for nutrient absorption. Adjustable gastric banding is a restrictive surgery in which the band encircles the stomach, creating a stoma and a gastric pouch with about 30 mL capacity. Vertical sleeve gastrectomy is a restrictive surgery in which 85% of the stomach is removed, leaving a sleeve-shaped stomach with 60 to 150 mL capacity. Roux-en-Y gastric bypass surgery is a combination of restrictive and malabsorptive surgery in which a small pouch is created on the stomach by restrictive surgery. The small gastric pouch is connected to the jejunum and the remaining stomach and first segment of the small intestine are bypassed in this type of surgery. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 917

The nurse is caring for an obese patient who is being considered for bariatric surgery. What category of body mass index (BMI) would the patient fall within to be considered for bariatric surgery? 1 BMI of 40 2 BMI of 25 3 BMI of 30 with no other complications 4 BMI of 30 with one or more obesity-related medical complications

1 Criteria guidelines for bariatric surgery include having a BMI of 40 or a BMI of 35 with one or more severe obesity-related medical complications such as hypertension, type 2 diabetes mellitus, heart failure, or sleep apnea. A BMI greater than 25 is considered overweight, and a BMI greater than 30 is considered obese. Text Reference - p. 916

In developing a weight-reduction plan for an overweight patient it is important for the nurse to first assess the presence of which factor? 1 The patient's readiness to make lifestyle changes 2 The patient's current body mass index (BMI) 3 The patient's waist-to-hip circumference ratio 4 The patient's current employment status

1 Eating patterns are established early in life, and eating has many meanings for people. To establish a weight-reduction plan that will be successful for the patient, the nurse should first explore the social, emotional, and behavioral influences on the patient's eating patterns. Current BMI, waist-to-hip circumference, and employment status are not correlated with success of weight loss or the development of a weight loss plan. Text Reference - p. 913

A nurse inserts an orogastric tube in a patient for administration of enteral feeding. Which nursing action is a priority immediately after inserting the tube? 1 Checking the tube position 2 Placing the patient in upright position 3 Checking the residual volume 4 Elevating the head of bed

1 Following the placement of a tube, it is important to determine its position. Placing the patient in a semi-Fowler's position is important to prevent aspiration but is not a priority intervention immediately after tube insertion. Checking the residual volume is important to determine whether the patient is tolerating the feedings. However, it is not a priority. Elevating the head of the bed prevents aspiration but is not a priority. Text Reference - p. 899

The nurse recalls that levels of which hormone increase after starvation and lower in response to food in the stomach? 1 Ghrelin 2 Peptide YY 3 Neuropeptide Y 4 Cholecystokinin

1 Ghrelin is a peptide hormone, which increases appetite. The hormone levels of ghrelin increase after starvation and lower when the stomach is full. Peptide YY is a hormone that inhibits appetite by reducing gastrointestinal motility. Neuropeptide Y helps stimulate appetite by activating the hunger center. Cholecystokinin is the hormone secreted by the duodenum and jejunum that inhibits gastric signals. Peptide YY, neuropeptide Y, and cholecystokinin do not increase in response to starvation. Text Reference - p. 909

A patient who is malnourished is being administered an intravenous fat emulsion (IVFE). The nurse's assessment findings include an elevated body temperature, increased triglyceride levels, and a decreased respiratory rate. Which action should the nurse take? 1 Discontinue the IVFE. 2 Slow the rate of the IVFE administration. 3 Change the infusion to total parenteral nutrition. 4 Document the findings and continue the infusion.

1 Intravenous fat emulsions (IVFE) are not recommended for patients suffering from fever, hyperlipidemia, clotting problems, and respiratory disease; the nurse should discontinue IVFE to prevent complications. Slowing the rate of an IVFE administration will put the patient's safety at risk. The nurse cannot change the route of administration without consulting the patient's primary health care provider. Documenting the findings and continuing the infusion will put the patient's safety at risk. Text Reference - p. 901

The nurse recalls that which hormone increases an obese patient's risk of cancer due to cell proliferation? 1 Leptin 2 Insulin 3 Ghrelin 4 Peptide YY

1 Leptin is a hormone produced by adipocytes, that inhibits the appetite and increases cell proliferation. Therefore, the patient will have a higher risk of cancer. Insulin is a hormone produced by the pancreas that suppresses appetite and is a cell growth factor. Ghrelin is a hormone that helps to regulate appetite, but it does not cause cell proliferation. Peptide YY, produced by the colon, inhibits the appetite; however, it does not cause cell proliferation. Text Reference - p. 909

A 50-year-old African-American woman has a body mass index (BMI) of 35 kg/m2, type 2 diabetes mellitus, hypercholesterolemia, and irritable bowel syndrome (IBS). She is seeking assistance in losing weight, because, "I have trouble stopping eating when I should, but I do not want to have bariatric surgery." Which drug therapy should the nurse question if it is prescribed for this patient? 1 Orlistat 2 Locaserin 3 Phentermine 4 Phentermine and topiramate

1 Orlistat, which blocks fat breakdown and absorption in the intestine, produces some unpleasant gastrointestinal side effects. This drug would not be appropriate for someone with IBS. Locaserin suppresses the appetite and creates a sense of satiety that may be helpful for this patient. Phentermine needs to be used for a limited period of time (three months or less). Qsymia is a combination of two drugs, phentermine and topiramate. Phentermine is a sympathomimetic agent that suppresses appetite and topiramate induces a sense of satiety. Text Reference - p. 916

A patient is prescribed phentermine and topiramate for obesity. The nurse should monitor the patient for what serious side effect? 1 Hyperthyroidism 2 Migraine attacks 3 Seizure disorders 4 Respiratory distress

1 Phentermine is an anorectic, and topiramate is an anticonvulsant. These medications are commonly combined in a single drug and prescribed to overweight patients to reduce obesity by decreasing the appetite and promoting a satiated feeling. However, patients with hyperthyroidism should not use combined phentermine and topiramate, because it may cause severe complications. Phentermine is an anorectic drug, which controls the severity of migraines. Topiramate is an anticonvulsant, so it helps to reduce seizures. Anticonvulsants such as topiramate will help reduce respiratory distress. Therefore, severe complications are not anticipated for patients with migraines, seizures, or respiratory distress. Text Reference - p. 916

The nurse is reviewing diagnostic study results for a patient with suspected malnutrition. Which diagnostic test is considered to be a good indicator of current nutritional status? 1 Prealbumin 2 Transferrin 3 Serum albumin 4 Hemoglobin and hematocrit

1 Prealbumin, a protein synthesized by the liver, has a half-life of two days and is a good indicator of recent or current nutritional status. Serum transferrin level is another indicator of protein status. Transferrin, a protein synthesized by the liver and used to transport iron, decreases when protein is deficient. Serum albumin has a half-life of approximately 20 to 22 days. In the absence of marked fluid loss, such as from hemorrhage or burns, the serum albumin value lags behind actual protein changes by more than two weeks. Therefore albumin is not a good indicator of acute changes in nutritional status. Hemoglobin and hematocrit are not the best indicators of current nutritional status. Text Reference - p. 892

While providing postoperative care for a patient who underwent bariatric surgery, the nurse finds that the patient is unconscious and has not fully recovered from anesthesia. What action should the nurse take? 1 Perform a jaw-thrust maneuver. 2 Assist the patient with antiembolic stockings. 3 Administer intravenous fluids and electrolytes. 4 Open nasal airways by closing the patient's mouth.

1 The adipose tissue in the body stores anesthetics that are administered to induce sedation. Obese patients have excessive adipose tissue that releases the anesthetics into the bloodstream; therefore, these patients are at an increased risk for re-sedation after the surgery. This resedation can cause respiratory depression and subsequent fatal effects in the patient. Therefore, to prevent this risk, the nurse performs a jaw-thrust maneuver or head-tilt to ensure respiration. Antiembolic stockings reduce only the signs of deep vein thrombosis, not the signs of resedation; therefore, they should not be used in this situation. Intravenous fluids and electrolytes do not reverse the signs of resedation in the patient; therefore, they are not administered to the patient. Closing the patient's mouth and opening only the nasal airways may not provide adequate respiration; therefore, the nurse should open the patient's oral and nasal airways to ensure safety. Text Reference - p. 919

While assisting an obese patient in weight loss, the nurse says, "If you lose 5 pounds, I will get you a relaxing aromatherapy." Which behavioral technique is the nurse using for the patient? 1 Reward 2 Motivation 3 Self-monitoring 4 Stimulus control

1 The nurse is setting a target and establishing a reward if the target is achieved. This indicates that the nurse is setting a benchmark to earn rewards. While providing motivation to a patient, the nurse teaches the patient about advantages of weight loss and weight control. A patient who performs self-monitoring will keep a record of the time and type of food that he or she is consuming. A patient who separates him- or herself from activities that stimulate hunger is exhibiting stimulus control. Text Reference - p. 915

A patient with an orofacial fracture receives enteral nutrition through a nasogastric (NG) tube. By flushing the tube, what complication does the nurse try to prevent after medication administration through the tube? 1 Tube clogging 2 Tube dislodgement 3 Irritation of the lining of the stomach 4 Administration of less than the prescribed amount of medication

1 When a nasogastric tube is not flushed before and after a medication administration, tube clogging can result. Tube dislodgement occurs when a patient who has a nasogastric tube vomits or coughs. The lining of the stomach will not be affected by the small amount of flush that is used. The full amount of medication should be given through the tube prior to the flush. Text Reference - p. 898

A patient with severe burn injuries is prescribed a protein supplement. The body weight of the patient is 75 kg. How much protein should the nurse administer to the patient each day? (Record the answer using a whole number.)

150 g The recommended protein intake is 1 to 1.5 g/kg per day. Burn patients, who are often on parental nutrition, enteral nutrition, and oral food, may require 2 g/kg protein. Because the body weight of the patient is 75 kg, the formula would be 2 × 75 = 150 g. Thus, the nurse should administer 150 g of protein to the patient per day. Text Reference - p. 901

An obese patient tells the nurse, "I am unable to sleep properly, and I feel hungry all the time." What does the nurse suspect as being the reason for the patient's symptoms? 1 Increased levels of insulin hormone 2 Decreased levels of leptin hormone 3 Decreased levels of ghrelin hormone 4 Increased levels of peptide YY hormone

2

A patient with anorexia nervosa with refeeding syndrome also has hypophosphatemia. The nurse will monitor closely for which possible outcome? Select all that apply. 1 Diarrhea 2 Paresthesias 3 Respiratory arrest 4 Nausea and vomiting 5 Cardiac dysrhythmias

2 3 5 Hypophosphatemia is the hallmark of refeeding syndrome and is associated with serious outcomes, including cardiac dysrhythmias, respiratory arrest, and neurologic disturbances (e.g., paresthesias). Diarrhea, nausea, and vomiting are not commonly found in refeeding syndrome. Text Reference - p. 900

The patient has parenteral nutrition infusing with amino acids and dextrose. In report, the oncoming nurse is told that the tubing, the bag, and the dressing were changed 22 hours ago. What care should the nurse coming on be prepared to do? Select all that apply. 1 Give the patient insulin 2 Check amount of feeding left in the bag 3 Check that the next bag has been prescribed 4 Check the insertion site and change the tubing 5 Check the label to ensure ingredients and solution are as prescribed

2 3 5 The nurse should check the amount of feeding left in the bag, and that the next bag has been prescribed to be sure the solution will not run out before the next bag is available. Parenteral nutrition solutions are only good for 24 hours and usually take some time for the pharmacy to mix for each patient. The label on the bag should be checked to ensure that the ingredients and solution are what was prescribed. The patient would only receive insulin if the patient is experiencing hyperglycemia and was receiving sliding scale insulin or had diabetes mellitus. The insertion site should be checked, but the tubing is only changed every 72 hours unless lipids are being used. Text Reference - p. 901

When teaching a patient about reducing weight by using a calorie-restricted diet, what instructions should the nurse include? Select all that apply. 1 Skip meals if not hungry. 2 Exercise regularly. 3 Avoid concentrated sweets. 4 Select fried and greasy foods. 5 Select steamed and baked foods.

2 3 5 To follow a calorie-restricted diet to reduce weight, the patient should exercise regularly; avoid concentrated sweets such as sugar, candy, honey, pies, cakes, cookies, and regular sodas; and eat steamed and baked foods. It is not advisable to skip meals or to consume fried and greasy foods. Text Reference - p. 914

When taking the health history of a female patient presenting with obesity, the nurse makes note of the existing genetic and endocrine factors. What conditions should the nurse include in the assessment? Select all that apply. 1 Hyperacidity 2 Hypothyroidism 3 Cushing's syndrome 4 Chronic sinusitis 5 Polycystic ovarian disease

2 3 5 When obtaining the history, exploring genetic and endocrine factors such as hypothyroidism, Cushing's syndrome, and polycystic ovary syndrome in women is important. Chronic sinusitis and hyperacidity are not related to genetic and endocrine factors. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process. Text Reference - p. 912

Which diagnostic finding in the laboratory reports supports the nurse's suspicion that a patient with burn injuries is experiencing malnutrition? Select all that apply. 1 Increased creatinine 2 Decreased transferrin 3 Increased liver enzymes 4 Increased serum albumin 5 Decreased blood urea nitrogen

2 35 Transferrin is a globulin that transports iron in the plasma. Transferrin levels decrease due to severe injuries and cause malnutrition. Liver enzymes are increased as an adverse effect of inadequate protein. Blood urea nitrogen (BUN) is an indicator of the amount of nitrogen in the blood, which comes from waste-product urea; therefore, BUN is lowered in malnutrition. Creatinine levels will be decreased due to reduced muscle mass in patients with malnutrition. Malnutrition occurs when there is a loss of protein, which will be reflected in a low serum albumin level. Text Reference - p. 893

While caring for a patient after bariatric surgery, the nurse identifies that the patient is at risk for deep vein thrombosis (DVT). Which treatment strategy should be included in the patient's care plan to prevent this complication? Select all that apply. 1 Antifibrinolytic drugs 2 Antiembolic stockings 3 Vitamin K supplements 4 Low-dose heparin 5 Active and passive range-of-motion exercises

2 4 5

The nurse is reviewing the assessment of a 45-year-old female patient who may have metabolic syndrome. Which of these assessment findings from this patient are criteria for metabolic syndrome? Refer to chart. Select all that apply. 1 BMI 2 HDL results 3 Blood pressure 4 Waist circumference 5 Triglyceride level results 6 Fasting blood glucose results

2 4 5 6

Which changes in laboratory parameters occur in a patient with bulimia nervosa? Select all that apply. 1 Leukopenia 2 Hypokalemia 3 Hypoglycemia 4 Metabolic alkalosis 5 Elevated serum amylase

2 4 5 Abnormal laboratory parameters, including hypokalemia, metabolic alkalosis, and elevated serum amylase may occur with frequent vomiting. Leukopenia and hypoglycemia are manifestations of potassium deficiency in patients with anorexia nervosa. Text Reference - p. 903

While performing a physical assessment, the nurse observes that the patient has fat deposition in the abdominal area, arms, neck, and shoulders. Based on the assessment findings, the nurse determines that the patient has which health risks? Select all that apply. 1 Osteoporosis 2 Hypertension 3 Varicose veins 4 Diabetes mellitus 5 Endometrial cancer

2 4 5 Fat deposition in the abdominal area and upper body like arms, neck, and shoulders are the characteristics of an apple-shaped body, which indicates that the patient has android obesity. Body shape is one of the methods of identifying patients who are at greater risk for health problems. Health risks associated with android obesity are hypertension, diabetes mellitus, and endometrial cancer. This occurs due to the presence of more active visceral fat. Osteoporosis and varicose veins are the health risks associated with gynoid obesity in patients with a pear-shaped body. Test-Taking Tip: Be alert for details about what you are being asked to consider. In this question type, you are asked to select all options that apply to a given situation or patient. Text Reference - p. 908

While performing a physical assessment, the nurse observes that the patient has fat deposition in the abdominal area, arms, neck, and shoulders. Based on the assessment findings, the nurse determines that the patient has which health risks? Select all that apply. 1 Osteoporosis 2 Hypertension 3 Varicose veins 4 Diabetes mellitus 5 Endometrial cancer

2 4 5 Fat deposition in the abdominal area and upper body like arms, neck, and shoulders are the characteristics of an apple-shaped body, which indicates that the patient has android obesity. Body shape is one of the methods of identifying patients who are at greater risk for health problems. Health risks associated with android obesity are hypertension, diabetes mellitus, and endometrial cancer. This occurs due to the presence of more active visceral fat. Osteoporosis and varicose veins are the health risks associated with gynoid obesity in patients with a pear-shaped body. Text Reference - p. 908

A 58-year-old man with chronic low back pain realizes he needs to reduce his weight to lessen the back pain and strain. He is 6 feet tall and weighs 218 pounds. The nurse interprets that the patient currently is classified as overweight, which correlates to which body mass index (BMI) range? 1 18 to 24 2 25 to 29 3 30 to 34 4 35 to 40

2 A normal BMI is 18.5 to 24.9 kg/m2, and a BMI of 25 to 29.9 is considered overweight. A BMI of 30 to 34 indicates obesity, and more than 35 indicates morbid obesity. Text Reference - p. 907

The nurse identifies that an obese patient is at an increased risk of diabetes due to what abnormality? 1 Low leptin levels 2 Low adiponectin levels 3 High neuropeptide Y levels 4 High cholecystokinin levels

2 Adiponectin is a peptide, which has increased sensitivity to insulin. However, an obese patient will have reduced adiponectin levels. Leptin suppresses hunger, but it does not affect insulin regulation. Neuropeptide Y is a hormone produced by the hypothalamus; it stimulates the appetite, but it does not affect insulin sensitivity. Cholecystokinin reduces the appetite by inhibiting gastric emptying. However, it does not affect insulin sensitivity. Text Reference - p. 911

Which disorder is characterized by self-imposed weight loss? 1 Bulimia nervosa 2 Anorexia nervosa 3 Binge-eating disorder 4 Malabsorption syndrome

2 Anorexia nervosa is characterized by self-imposed weight loss. Hair loss, constipation, yellow skin, and sensitivity to cold are the signs of anorexia nervosa. A patient with bulimia nervosa has loss of control related to eating and has a persistent concern with body image. Binge-eating disorder is less severe than bulimia nervosa. A patient with binge-eating disorder is generally overweight or obese. Malabsorption syndrome refers to impaired absorption of nutrients from the gastrointestinal tract. It is associated with frequent episodes of disease in the patient. Text Reference - p. 903

The nurse recalls that, according to the rule of thumb estimation, what should the total calorie intake be to maintain weight? 1 20 to 25 cal/kg body weight 2 25 to 30 cal/kg body weight 3 30 to 35 cal/kg body weight 4 35 to 40 cal/kg body weight

2 Kilocalorie is the unit for estimating the total intake and expenditure of calories. The average intake of calories of an adult for weight management is 25 to 30 cal/kg body weight. An intake of 20 to 25 cal/kg body weight is necessary for weight loss in adults. Intake of more than 30 to 35 cal/kg body weight favors weight gain in adults. Text Reference - p. 888

The nurse performs a physical assessment on a patient with glaucoma and determines that the patient is overweight. The nurse expects that which medication will be prescribed to suppress the patient's appetite? 1 Orlistat 2 Lorcaserin 3 Topiramate 4 Phentermine and topiramate

2 Being overweight may result in various health risks. Certain medications are used to reduce weight to prevent the risk of diseases. Lorcaserin is a selective serotonin (5-HT) agonist that works by activating the serotonin receptor in the brain. This medication suppresses the appetite and creates a sense of satiety by activating the serotonin receptor that makes the patient eat less and feel full after eating smaller amounts of food. Orlistat blocks fat breakdown and absorption in the intestineby inhibiting the action of intestinal lipases. This may result in the excretion of undigested fat. Topiramate is an antiepileptic drug that induces a sense of satiety, but does not suppress the patient's appetite. Phentermine and topiramate suppresses appetite and induces a sense of satiety but is contraindicated in patients with glaucoma. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 916

The nurse recalls that which anatomical change is observed after biliopancreatic diversion surgery? 1 The stomach is sleeve-shaped with a 60- to 150-mL capacity. 2 The stomach is cut vertically like a tube with a duodenal switch. 3 A band encircles the stomach, creating a stoma and a gastric pouch. 4 A gastric pouch is connected to the jejunum, and the remaining stomach is bypassed.

2 Biliopancreatic diversion surgery is a malabsorptive surgery where the patient will undergo a 70 percent stomach removal with a duodenal switch. The stomach appears like a tube. A vertical sleeve gastrectomy is a surgical procedure where 85 percent of the stomach is removed, leaving a sleeve-shaped stomach with a 60- to 150-mL capacity. A vertical banded gastroplasty is a restrictive surgery in which the patient will have a band encircling the stomach creating a stoma and a gastric pouch. A Roux-en-Y gastric bypass is a combined malabsorptive and restrictive surgery in which the patient will have a gastric pouch connected to the jejunum and the remaining stomach will be bypassed. Text Reference - p. 917

A patient has a height of 180 cm and weighs 70 kg. Which weight category should the patient be placed in? 1 Underweight 2 Normal weight 3 Overweight 4 Obese

2 Body mass index (BMI) is a measure of weight for height. It can be calculated with the formula BMI = weight in kilograms / (height in meters)2. A BMI of less than 18.5 kg/m2 is considered underweight, normal weight is a BMI between 18.5 kg/m2 and 24.9 kg/m2, and overweight is a BMI between 25 and 29.9 kg/m2. A BMI of 30 kg/m2 or greater is obese. The BMI of the patient is 21.6 kg/m2, and hence the weight is normal. Text Reference - p. 894

The nurse provides education to a patient about reducing the risk of obesity. Which statement made by the patient indicates the need for further teaching? 1 "I should eat two ounces of baked chicken for dinner." 2 "I should incorporate canned fruits into my everyday diet." 3 "I should eat vegetables and salad at lunch and dinner." 4 "I should include a cup of low-fat milk at breakfast."

2 Canned fruits contain excess sugars, so the patient will have a higher risk of obesity. Therefore, the patient should avoid canned fruits. Two ounces of baked chicken should be included with dinner, because baked foods have a lower fat content. Vegetables and salads should be included in the diet, because vegetables contain protein and vitamins for effective growth. Low-fat milk does not contain excess fat and provides adequate calcium for development, so it should be included in the diet. Text Reference - p. 910

A patient who has suffered severe burns in a motor vehicle accident soon will be started on parenteral nutrition (PN). Which principle should guide the nurse's administration of the patient's nutrition? 1 Administration of PN requires clean technique 2 Central PN requires rapid dilution in a large volume of blood 3 Peripheral PN delivery is preferred over the use of a central line 4 Only water-soluble medications may be added to the PN by the nurse

2 Central PN is hypertonic and requires rapid dilution in a large volume of blood. Because PN is an excellent medium for microbial growth, aseptic technique is necessary during administration. Administration through a central line is preferred over the use of peripheral PN, and the nurse may not add any medications to PN. Text Reference - p. 902

Two weeks after a subtotal gastrectomy, a patient reports the sudden onset of clammy skin, weakness, and diaphoresis after a meal. What diagnosis does the nurse suspect? 1 Acute pancreatitis 2 Dumping syndrome 3 Acute myocardial infarction 4 Mesenteric artery embolism

2 Dumping syndrome is the most likely cause of these symptoms about two weeks after surgery. Dumping syndrome is believed to be caused by food directly entering the jejunum without first being processed in the stomach. Acute pancreatitis would present with acute abdominal pain, nausea, vomiting, and tachycardia. In addition to complaints of feeling clammy, weak, and diaphoretic, an acute myocardial infarction would likely manifest with chest pain and pressure. Mesenteric artery embolism would also manifest as nausea, vomiting, and abdominal pain. The nurse should further question the patient to determine the cause of the episode, including other associated symptoms and what types and quantities of foods were eaten at the meal. Text Reference - p. 917

The nurse is teaching a female patient with type 1 diabetes mellitus about nutrition before discharge. She had surgery to revise a lower leg stump with a skin graft. What food should the nurse teach the patient to eat to best facilitate healing? 1 Non-fat milk 2 Chicken breast 3 Fortified oatmeal 4 Olive oil and nuts

2 High quality protein such as chicken breasts is important for tissue repair. Although the non-fat milk, nuts, and fortified oatmeal have some protein, they do not have as much as the chicken breast. Text Reference - p. 888

A patient who is scheduled for gastric bypass surgery asks for information about dumping syndrome. How should the nurse explain dumping syndrome? 1 The inability to digest high-fat foods 2 When the passage of food into the jejunum occurs too rapidly 3 A decrease in the secretion of insulin caused by carbohydrates 4 An increase in the secretion of both bile and pancreatic enzymes

2 It is believed that the cause of dumping syndrome is the passage of undiluted food into the jejunum. This causes a surge of insulin to be released, resulting in the symptoms of profuse sweating, nausea, dizziness, and weakness. Dumping syndrome is frequently seen in patients who have undergone subtotal gastrectomy or gastric bypass surgery. Dumping syndrome is not caused by an inability to digest high-fat foods, a decrease in the secretion of insulin, or an increase in the secretion of bile and pancreatic enzymes. Text Reference - p. 917

The nurse includes lean meat, fish, and eggs in the diet of a patient with obesity. Which component of nutrition is most adequately provided through this diet? 1 Fiber 2 Protein 3 Vitamin C 4 Carbohydrates

2 Lean meat, fish, and eggs are rich in proteins and vitamin B complex and should be included in the diet plan of an obese patient. Fiber is adequately available in bulk foods such as whole-grain wheat bread. Vitamin C is adequately available in citrus fruits and green vegetables. Carbohydrates are present in lean meat, fish, and eggs; however, it is in comparatively less amounts than are proteins. Text Reference - p. 913

The nurse recognizes that which surgical procedure is most effective in enhancing facial appearance after weight loss? 1 Lipectomy 2 Liposuction 3 Restrictive surgery 4 Malabsorptive surgery

2 Liposuction is a cosmetic surgery that helps improve facial appearance around the chin, jaw, and nasal folds after weight loss. Lipectomy is a cosmetic surgery that improves body image. It is effective for the breasts, abdomen, and lumbar and femoral areas, but not the facial areas. Restrictive and malabsorptive surgeries are bariatric surgeries, which reduce the size of the stomach but do not affect the facial appearance. Text Reference - p. 917

Which finding supports the nurse's conclusion that a patient with dry skin, mouth ulcers, and irritability is experiencing primary protein-calorie malnutrition? 1 Obesity 2 Anorexia nervosa 3 Closed head injury 4 Rheumatoid arthritis

2 Primary protein-calorie malnutrition is also called starvation-related malnutrition. It is a condition in which there is chronic starvation without inflammation. Anorexia nervosa is caused by severely restricting caloric intake due to a fear of weight gain. Obesity is associated with secondary protein-calorie malnutrition. Closed head injury is associated with acute-disease or injury-related malnutrition. Rheumatoid arthritis may cause secondary protein-calorie malnutrition. Text Reference - p. 890

Which patient with nutritional disorders does the nurse suspect to have primary protein-calorie malnutrition? 1 The patient with bulimia nervosa 2 The patient with anorexia nervosa 3 The patient with refeeding syndrome 4 The patient with binge-eating disorder

2 Primary protein-calorie malnutrition is starvation-related malnutrition that occurs when nutritional needs are not met due to low intake of food. There is chronic starvation with no inflammation. Anorexia nervosa is associated with primary protein-calorie malnutrition. In bulimia nervosa and binge-eating disorder, the patient exhibits no control over eating and consumes large quantities of food in a short time. These conditions are not associated with starvation-related malnutrition. Refeeding syndrome is observed in enteral feedings. Text Reference - p. 890

In which manner should the nurse instruct the unlicensed assistive personnel (UAP) to position the patient who is receiving an enteral feeding through a small-bore nasogastric tube? 1 Supine in bed 2 Head of bed elevated 45 degrees 3 Head of bed elevated 90 degrees 4 Lying on the left side, head of bed elevated 15 degrees

2 Proper positioning is important for a patient with a small-bore nasogastric tube feeding to decrease the risk of aspiration. Elevate the head of bed to a minimum of 30 degrees, but preferably 45 degrees, to prevent aspiration. Lying on the left side with the head of bed elevated 15 degrees or lying supine places the patient at risk for aspiration. It is not necessary to elevate the head of bed to 90 degrees, and may cause discomfort for the patient. Text Reference - p. 899

A nurse is educating a group of caregivers about tube feedings, including safety during administration of enteral feedings. Which instruction should be included? 1 Lower the head of the bed during the tube feeding. 2 Obtain radiographic confirmation of newly inserted tubes. 3 Check gastric residual volumes hourly. 4 After surgical placement of a gastrostomy tube, wait for flatus or a bowel movement before feeding.

2 Radiographic confirmation should be obtained to determine if the blindly placed tube is properly positioned. Proper patient positioning decreases the risk of aspiration. Hence, the head of the bed should be elevated to a minimum of 30° to prevent aspiration. Gastric residual volumes should be checked every four hours during the first 48 hours for gastrically fed patients. Enteral feedings can be started within 24 to 48 hours after surgical placement of a gastrostomy tube, without waiting for flatus or a bowel movement. Text Reference - p. 898

The nurse is reviewing the caloric needs of a patient who states that he or she wants to lose weight. Which of these statements about calorie intake and weight loss are true? To lose weight, the patients will need to consume: 1 15 to 20 calories per kilogram 2 20 to 25 calories per kilogram 3 25 to 30 calories per kilogram 4 30 to 35 calories per kilogram

2 Rule-of-thumb estimations are that an individual should consume 20 to 25 cal/kg body weight to lose weight, 25 to 30 cal/kg to maintain body weight, and 30 to 35 cal/kg to gain weight. Text Reference - p. 887

Which fluid and electrolyte change occurs with malnutrition? 1 Shift of potassium to vascular space 2 Movement of sodium within the cell 3 Shift of potassium to the interstitial space 4 Movement of fluids to extracellular space

2 Sodium is an extracellular ion. In malnutrition, as the fluid shifts to interstitial space, sodium also moves with the fluid, resulting in increased amounts of sodium within the cells. There is a fluid shift, rather than a potassium shift, to interstitial spaces. Potassium, which is a predominant intracellular ion, is shifted to the extracellular space. Fluids move to the interstitial space rather than extracellular space. Text Reference - p. 892

This irreversible bariatric surgical procedure involves creating a small gastric pouch and attaching it directly to the small intestine, using a piece of the small bowel. The nurse recognizes that this is which surgical procedure? 1 Biliopancreatic diversion 2 Roux-en-Y gastric bypass (RYGB) 3 Adjustable gastric banding 4 Vertical sleeve gastrectomy

2 The RYGB procedure is a combination of restrictive and malabsorptive surgery. This surgical procedure is the most common bariatric procedure performed in the United States. This procedure, which is irreversible, involves creating a small gastric pouch and attaching it directly to the small intestine using a Y-shaped limb of the small bowel. After the procedure, food bypasses 90% of the stomach, the duodenum, and a small segment of jejunum. A biliopancreatic diversion removes 70% of the stomach horizontally and anastomosis between the stomach and intestine. Adjustable gastric banding is reversible (the band can be adjusted to be tighter or looser). Vertical sleeve gastrectomy removes 85% of the stomach, leaving a sleeve-shaped stomach with 60 to 150 mL capacity. Text Reference - p. 917

A patient is receiving parenteral nutrition. The nurse should monitor the patient for what metabolic complications? Select all that apply. 1 Phlebitis 2 Dislodgment 3 Hypoglycemia 4 Hyperglycemia 5 Hyperlipidemia

3 4 5

An obese patient is scheduled for cosmetic surgery for body image enhancement. The nurse provides education about reducing the risk of obesity recurrence. Which statement made by the patient indicates the need for further teaching? 1 "I can include baked food in my diet." 2 "I can eat candy and honey as I wish." 3 "I need to exercise every day." 4 "I need to drink low-fat milk and eat salads."

2 The patient is undergoing a lipectomy, which is a cosmetic surgery to reduce body fat. However, there is still a risk of recurrence of obesity unless the patient maintains a proper diet. Candies and honey contain excess sugar, which increases the risk of obesity. Therefore, the patient should prefer fresh fruits to candies. Baked foods are lower in fat, so they can be included in the diet. Exercise is necessary to maintain proper body structure and reduce the risk of obesity. Low-fat milk and salads provide adequate nutrition and reduce the risk of obesity. Text Reference - p. 914

A patient will begin receiving peripheral parenteral nutrition (PPN). The nurse would question which part of the PPN prescription? The solution contains amino acids 2 The solution contains 25% dextrose 3 The solution is to infuse at 100 mL/hour 4 The solution contains 30 mEq of potassium chloride

2 The safe amount of dextrose in PPN is up to 20%. Percentages higher than 20% may cause irritation and thrombophlebitis. It is not necessary to question the prescriptions of 30 mEq of potassium chloride, amino acids, or an infusion rate of 100mL/hr. Text Reference - p. 901

Which assessment should the nurse prioritize in the care of a patient who recently has begun receiving parenteral nutrition (PN)? 1 Skin integrity and bowel sounds 2 Electrolyte levels and daily weights 3 Auscultation of the chest and tests of blood coagulability 4 Peripheral vascular assessment and level of consciousness (LOC)

2 The use of PN necessitates frequent and thorough assessments. Key focuses of these assessments include daily weights and close monitoring of electrolyte levels. Assessments of bowel sounds, integument, peripheral vascular system, LOC, chest sounds, and blood coagulation may be performed variously, but close monitoring of fluid and electrolyte balance supersedes these in importance. Text Reference - p. 902

The patient cannot afford to buy the food needed for the family, so the patient makes sure the children eat first, and then the patient eats. When the patient comes to the clinic, the patient reports bleeding gums, loose teeth, and dry, itchy skin. The nurse should know that this patient most likely is lacking which vitamin? 1 Folic acid 2 Vitamin C 3 Vitamin D 4 Vitamin K

2 This patient is lacking Vitamin C as evidenced by the bleeding gums, loose teeth, and dry, itchy skin. Clinical manifestations of folic acid deficiency include megaloblastic anemia, anorexia, fatigue, sore tongue, diarrhea, or forgetfulness. Clinical manifestations of Vitamin D deficiency include muscular weakness, excess sweating, diarrhea, bone pain, rickets, or osteomalacia. Clinical manifestations of Vitamin K deficiency include defective blood coagulation. Text Reference - p. 896

What should the nurse include in a postoperative plan of care for a patient who has undergone bariatric surgery? 1 Avoid ambulating the patient. 2 Give 30 mL of water every two hours. 3 Give solid foods along with liquids. 4 Avoid sugar-free liquids in the patient's diet.

2 While performing postoperative care for a patient who has undergone bariatric surgery, the nurse should give 30 mL of water every two hours to maintain the patient's fluid and electrolyte balance. Limiting ambulation can result in deep vein thrombosis (DVT). Therefore, the nurse should encourage the patient to perform early ambulation. The combination of solids and liquids in the patient's diet should be avoided, because it puts stress on the gastrointestinal system, causing the patient discomfort. Sugar-rich liquids can result in dumping syndrome, so the nurse should give sugar-free liquids to the patient. Text Reference - p. 919

A nurse is assessing the nutritional needs of a very active 50-year-old male patient. The patient's weight is 82 kg, and his height is 178 cm. What are the total daily calorie needs of the patient? Record your answer using a whole number and no punctuation. __ calories

2911 calories The Mifflin-St. Jeor Equation is used for determination of total daily calorie needs. The energy expenditure is calculated and then multiplied by the appropriate activity factor. The formula for men is: Energy expenditure = 5 + 10(wt in kg) + 6.25(ht in cm) - 5(age) × activity factor. The activity factor for a very active man is 1725. The total daily calorie need of the patient is 2911. Energy expenditure = 5 + 10(82) + 6.25(178) - 5(50) × 1.725 = 2911. Text Reference - p. 888

What are the contraindications of enteral nutrition? Select all that apply. 1 Burns 2 Hyperlipidemia 3 Prolonged ileus 4 Enterocutaneous fistula 5 Gastrointestinal obstruction

3 4 5 Enteral nutrition is provided for patients who have a functional gastrointestinal tract but cannot ingest food orally. The contraindications of enteral nutrition include gastrointestinal obstruction, prolonged ileus, and enterocutaneous fistula. Enteral nutrition is recommended for patients with burns. Parenteral nutrition is contraindicated in patients who have hyperlipidemia. Text Reference - p. 895

The nurse is caring for a patient with syndrome X. Which nursing intervention will be beneficial for the patient? Select all that apply. 1 Recommending a sodium-rich diet 2 Monitoring estrogen levels 3 Monitoring serum lipid levels 4 Monitoring blood glucose level 5 Recommending unsaturated fatty foods

3 4 5 Syndrome X is also known as metabolic syndrome. A patient with syndrome X is at risk for obesity and abnormal high lipid levels. Therefore, the nurse should monitor the patient's serum lipid levels. The nurse should monitor blood glucose levels, because a patient with syndrome X is at risk for diabetes. Unsaturated fatty foods reduce the risk of obesity. The nurse should not recommend a sodium-rich diet, because patients with syndrome X are at risk for hypertension. Syndrome X is not associated with a change in estrogen levels. Therefore, the nurse does not monitor the patient's estrogen levels. Text Reference - p. 921

The nurse is caring for a patient with syndrome X. Which nursing intervention will be beneficial for the patient? Select all that apply. 1 Recommending a sodium-rich diet 2 Monitoring estrogen levels 3 Monitoring serum lipid levels 4 Monitoring blood glucose level 5 Recommending unsaturated fatty foods

3 4 5 Syndrome X is also known as metabolic syndrome. A patient with syndrome X is at risk for obesity and abnormal high lipid levels. Therefore, the nurse should monitor the patient's serum lipid levels. The nurse should monitor blood glucose levels, because a patient with syndrome X is at risk for diabetes. Unsaturated fatty foods reduce the risk of obesity. The nurse should not recommend a sodium-rich diet, because patients with syndrome X are at risk for hypertension. Syndrome X is not associated with a change in estrogen levels. Therefore, the nurse does not monitor the patient's estrogen levels. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 921

An obese patient consults a nurse for weight loss advice. The patient reports frequent hunger as a barrier to weight loss. Which medications may be helpful in suppressing the patient's appetite? Select all that apply. 1 Orlistat 2 Metformin 3 Diethylpropion 4 Phendimetrazine 5 Phentermine and Topiramate

3 4 5 The sympathomimetic action of diethylpropion, phendimetrazine, and phentermine and topiramate are used to suppress the appetite in obese patients. Orlistat blocks fat breakdown and absorption in the intestine by inhibiting the action of intestinal lipases. Metformin is an oral antidiabetic drug used to prevent diabetes by lowering glucose levels. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. Text Reference - p. 915

The body mass index (BMI) of a patient is 26 kg/m2. What does the nurse anticipate from the patient's BMI? 1 The patient is obese. 2 The patient is normal. 3 The patient is overweight. 4 The patient is underweight

3 A body mass index (BMI) of 25 to 29.9 kg/m2 indicates that the patient is overweight. A BMI of 30 kg/m2 or greater indicates that the patient is obese. A BMI of 18.5 to 24.9 kg/m2 indicates that the patient is normal. A BMI of less than 18.5 kg/m2 indicates that the patient is underweight. Text Reference - p. 894

The nurse concludes that a patient has metabolic syndrome based on what abnormal laboratory result? 1 Platelet count 2 Creatinine levels 3 Cholesterol levels 4 White blood cell count

3 A patient with metabolic syndrome will have abnormal lipid or cholesterol levels, because the metabolism is affected. A patient with an abnormality in his or her bone marrow may show an abnormal platelet count. A patient with kidney impairment or cardiovascular disease will have abnormal creatinine levels, but not metabolic syndrome. A patient who has an infection will have an abnormal white blood cell count. Text Reference - p. 921

The nurse identifies that a patient who has visceral fat with truncal obesity is at risk for what disease? 1 Reproductive disease 2 Genitourinary disease 3 Cardiovascular disease 4 Gastrointestinal disease

3 A patient with truncal obesity will have excess fat in the chest. Therefore, the patient has a high risk of cardiovascular disease. A patient who is pear-shaped or has excess fat in the upper thighs will have a high risk of reproductive and genitourinary disease. A patient who has excess fat depositions in the abdomen will have a risk of gastrointestinal disease. Text Reference - p. 907

The nurse is reviewing cultural and ethnic factors related to obesity. Which statement does the nurse identify as being true? 1 Among men, Mexican Americans have the lowest prevalence of being overweight or obese. 2 Native Americans have a lower prevalence of being overweight than the general population. 3 Among women, African Americans have the highest prevalence of being overweight or obese. 4 Asian Americans have the same prevalence of being overweight and obese compared with the general population.

3 African Americans and Hispanics have a higher prevalence of obesity than whites. Among women, African Americans have the highest prevalence of being overweight or obese, and 15% are severely obese. Among men, Mexican Americans have the highest prevalence of being overweight or obese. Native Americans have a higher prevalence of being overweight than the general population. Asian Americans have the lowest prevalence of being overweight and obese compared with the general population. Text Reference - p. 908

After reviewing the laboratory reports of an obese patient, the nurse determines that the patient has nonalcoholic steatohepatitis. Which condition does the nurse associate with this finding? 1 Hyperkalemia 2 Hyperuricemia 3 Hyperglycemia 4 Hyperinsulinemia

3 Nonalcoholic steatohepatitis is the excess deposition of fat in the liver associated with obesity. Liver glucose levels increase due to excessive metabolism of fat in the liver, which indicates that the patient has hyperglycemia. Hyperkalemia is observed in patients with anorexia nervosa. Hyperuricemia is observed in patients with metabolic syndrome and obesity. A patient with colorectal cancer will have hyperinsulinemia. Text Reference - p. 911

The nurse reviews the laboratory reports of a patient with android obesity and determines that the patient is at an increased risk of cardiovascular problems. Which finding supports the nurse's conclusion? 1 Triglyceride level of 140 mg/dL 2 Blood pressure of 125/80 mm Hg 3 High-density lipoprotein level (HDL) of 30 mg/dL 4 Low-density lipoprotein level (LDL) of 100 mg/dL

3 Android obesity is characterized by increased fat deposition in the abdomen, neck, and chest area, leading to a high risk of cardiovascular disorders. The normal level of HDL is 40 to 60 mg/dL. However, the patient has a low level of HDL at 30 mg/dL, which indicates that the patient has a high risk of cardiovascular disease. Normal levels of triglycerides are lower than 150 mg/dL. A triglyceride level of 140 mg/dL indicates that the patient has a low risk of cardiovascular disorders. A blood pressure of 125/80 mm Hg is normal and indicates a low risk of cardiovascular disease. A patient with an LDL level of more than 190 mg/dL will have a high risk of cardiovascular disease. However, the patient has an LDL level of 100 mg/dL, which indicates a low risk of cardiovascular disease. Text Reference - p. 921

The nurse recognizes that the majority of patients' caloric needs should come from which source? 1 Fats 2 Proteins 3 Polysaccharides 4 Monosaccharides

3 Carbohydrates should constitute between 45% and 65% of caloric needs, compared with 20% to 35% from fats and 10% to 35% from proteins. Polysaccharides are the complex carbohydrates that are contained in breads and grains. Monosaccharides are simple sugars. Text Reference - p. 888

The nurse provides care for a patient who has third-degree burns and a paralytic ileus. What type of intervention is appropriate for long-term support of nutrition for the patient? 1 Oral nutrition 2 Enteral nutrition 3 Central parenteral nutrition 4 Peripheral parenteral nutrition

3 Central parenteral nutrition is administered when long-term support is required or when the patient has high protein and caloric requirements. Central parenteral nutrition is given through a central venous catheter that originates at the subclavian or jugular vein. Because the patient has paralytic ileus, oral and enteral nutrition are not possible. Peripheral parenteral nutrition is preferred for the short term and when protein and caloric requirements are not high. Text Reference - p. 902

A nurse collaborates with a patient to create a meal service plan. The patient reports being a strict follower of Muslim dietary traditions and beliefs. The nurse anticipates that the patient will make what type of dietary selections? 1 The patient will select only soul foods 2 The patient will select Kosher food 3 The patient will observe Ramadan and select foods accordingly 4 The patient will observe a meatless diet and select vegetables only

3 Each culture has its own beliefs and behaviors related to food. Meal service plans should be adjusted based on an individual's cultural background. Islam has specific laws regarding food, according to the Islamic Food and Nutrition Council of America. The meal plan should be based on Ramadan. Soul food is traditional food eaten by some African Americans. Kosher food is traditional food eaten by Jewish people. Vegans eat only vegetables. Text Reference - p. 889

In developing an effective weight reduction plan for an overweight patient who states a willingness to try to lose weight, it is most important for the nurse first to assess which factor? 1 The length of time the patient has been obese 2 The patient's current level of physical activity 3 The patient's social, emotional, and behavioral influences on obesity 4 Anthropometric measurements such as body mass index and skinfold thickness

3 Eating patterns are established early in life and eating has many meanings for people. To establish a weight reduction plan that will be successful for the patient, the nurse should first explore the social, emotional, and behavioral influences on the patient's eating patterns. The duration of obesity, current physical activity level, and current anthropometric measurements are not as important for the weight reduction plan. Text Reference - p. 913

Which statement made by the patient who underwent a bariatric surgery indicates the need for further teaching about steps to maintain proper weight? 1 "I should reduce carbohydrates in my diet." 2 "I should limit cheese and butter in my diet." 3 "I should drink plenty of fluids with my meals." 4 "I should increase the protein content in my diet."

3 Fluids should be restricted because they may cause dumping syndrome. Excessive carbohydrates increase the risk of diarrhea. Cheese and butter contain excess calories and intake should be limited. Protein is essential to build muscle mass and produce energy. Test-Taking Tip: The patients who underwent bariatric surgery will have risk of weight gain unless proper diet is followed. Consider the key words in the question before selecting the correct option. Text Reference - p. 920

The nurse measures the waist circumferences of four patients and identifies that which patient has an extremely high risk of obesity? 1 A 20-year-old male with a waist circumference of 32 inches 2 A 40-year-old male with a waist circumference of 40 inches 3 A 30-year-old female with a waist circumference of 38 inches 4 A 22-year-old female with a waist circumference of 30 inches

3 Males who have a waist circumference above 40 inches and females who have a waist circumference above 35 inches have a high risk of obesity. A waist circumference of 38 inches in a 30-year-old female indicates an increased risk of obesity. A 20-year-old male with a waist circumference of 32 inches has a normal waist circumference. A 40-year-old male with a waist circumference of 40 inches and a 22-year-old female with a waist circumference of 30 inches would not be identified as being extremely high risk. Text Reference - p. 907

A patient with a fever is experiencing nausea, vomiting, and loss of appetite. The nurse finds that the patient's basic metabolic rate (BMR) has increased. Which medication in the patient's medication history should the nurse suspect to be the cause of this condition? 1 Diuretics 2 Laxatives 3 Antibiotics 4 Antidepressants

3 Nausea, vomiting, and loss of appetite with an increase in the BMR indicate malabsorption syndrome. Several drugs have undesirable gastrointestinal side effects and alter normal digestive and absorptive processes. Antibiotics disturb the flora of the intestine, which decreases the ability of the body to synthesize biotin. Diuretics and laxatives are used in bulimia nervosa. Antidepressants do not cause malabsorption syndrome, but may be used to treat eating disorders. Text Reference - p. 891

The nurse identifies that a patient who is taking medication for weight loss is at high risk of drug abuse. This determination was made based on the patient's history of taking which medication? 1 Antidiabetic drugs 2 Serotonin agonists 3 Nonamphetamines 4 Nutrient absorption-blocking drugs

3 Nonamphetamines are sympathomimetic drugs that should only be used short-term because of the potential for drug abuse. Antidiabetic drugs, serotonin agonists, and nutrient absorption-blocking drugs help reduce weight effectively, and the patient is not at an increased risk of abuse. Text Reference - p. 915

The nurse is caring for a patient with burn injuries who is also malnourished. The nurse notes that the patient's intravenous fat emulsion was recently discontinued. The nurse suspects that the action was taken because the patient is experiencing what condition? 1 Pancreatitis 2 Liver failure 3 Hyperlipidemia 4 Respiratory disease

3 Patients with burn injuries may become malnourished because of their inability to digest a proper diet. As a result, nutrition is provided through the parenteral route. Fat emulsions are contraindicated in patients who have disturbances in fat metabolism, such as hyperlipidemia. These emulsions interfere with the metabolism of triglyceride hydrolysis, leading to aggravation of hyperlipidemia. Fat and lipid emulsions can be used cautiously in patients with pancreatitis, liver failure, and respiratory disease. Text Reference - p. 901

Following a Roux-en-Y gastric bypass, the patient experiences vomiting, nausea, sweating, faintness, and occasional episodes of diarrhea. The nurse takes a history of the patient's oral consumption after the surgery. The nurse informs the patient that the consumption of which item triggered the patient's symptoms? 1 Fish 2 Meat 3 Candy 4 Spinach

3 Signs and symptoms such as vomiting, nausea, sweating, faintness, and occasional diarrhea following a Roux-en-Y Gastric Bypass procedure indicate dumping syndrome in the patient. Sugar-rich foods, such as candies, pass through the stomach quickly and further increase the risk of dumping syndrome in the patient. Protein-rich foods, such as fish and meat, do not pass through the stomach quickly and usually do not result in dumping syndrome. Spinach, which is a high-fiber soluble food, prevents the quick transfer of sugars to the stomach and does not worsen dumping syndrome. Text Reference - p. 917

The nurse is caring for a patient admitted to the hospital for asthma who weighs 186 lb (84.5 kg). During dietary counseling, the patient asks the nurse how much protein should be ingested each day. How many grams of protein does the nurse recommend should be included in the diet based on the patient's current weight? 1 24 2 41 3 68 4 93

3 The daily intake of protein should be between 0.8 and 1 g/kg of body weight. Thus this patient should take in between 68 and 84 g of protein per day in the diet; 24 and 41 grams of protein are not enough and 93 grams of protein is slightly too much. Text Reference - p. 888

The nurse calculates a patient's body mass index (BMI) to be 27 kg/m2. This BMI would fall under which classification? 1 Underweight 2 Normal body weight 3 Overweight 4 Obese

3 The most common measure of obesity is the body mass index (BMI). BMI is calculated by dividing a person's weight (in kilograms) by the square of the height in meters. Individuals with a BMI less than 18.5 kg/m2 are considered underweight, whereas those with a BMI between 18.5 and 24.9 kg/m2 reflect a normal body weight. A BMI of 25 to 29.9 kg/m2 is classified as being overweight, and those with values at 30 kg/m2 or above are considered obese. The term severely (morbidly, extremely) obese is used for those with a BMI greater than 40 kg/m2. Text Reference - p. 906

The primary health care provider prescribes short-term weight-loss management for an obese patient with migraine headaches. The nurse recognizes that which medication will be most effective for the patient? 1 Orlistat 2 Lorcaserin 3 Topiramate 4 Phendimetrazine

3 Topiramate is an anticonvulsant that is taken in combination with a nonamphetamine like phentermine. It is effective in reducing migraines and treating obesity. Orlistat is a nutrition-absorption blocking dru that helps to reduce obesity by blocking fat breakdown and absorption in the intestine. However, it is not effective in treating migraine episodes. Lorcaserin is a serotonin agonist that reduces the risk of obesity by promoting a feeling of satiety. However, lorcaserin does not reduce the incidence of migraines. Phendimetrazine is a nonamphetamine that reduces the risk of obesity, because it secretes norepinephrine. However, it is not effective in reducing the incidence of migraines. Text Reference - p. 916

While reviewing the physical assessment reports of a female patient, the nurse identifies that the patient is at increased risk for cardiovascular disease and metabolic syndrome. The nurse determined that the patient is at risk based on which assessment finding? 1 Waist to hip ratio of 0.6 2 Body mass index (BMI) of 24 kg/m2 3 Waist circumference of 48 inches 4 Waist circumference of 32 inches

3 Waist circumference is used to assess and classify a patient's weight. A female with a waist circumference of 48 inches is at risk for cardiovascular disease and metabolic syndrome. The waist to hip ratio of 0.6, body mass index (BMI) of 24, and waist circumference of 32 are normal findings and are not indicative of increased health risks. Text Reference - p. 907

While performing a physical assessment, the nurse documents the patient's height as 165 cm and weight as 88 kg. What body mass index (BMI) value should the nurse enter in the patient's medical record? Record your answer using two decimal places. ________ kg/m2

32.32

An obese patient underwent biliopancreatic diversion with a duodenal switch. Which complications are least likely to be observed with this treatment? Select all that apply. 1 Diarrhea 2 Steatorrhea 3 Iron deficiency 4 Dumping syndrome 5 Protein-calorie malnutrition

4 5 Dumping syndrome and protein-calorie malnutrition are complications of biliopancreatic diversion, which is less common with a duodenal switch, because it creates a metabolic switch. Diarrhea, steatorrhea, and iron deficiency are complications associated with any bariatric surgery. Text Reference - p. 917

The nurse assesses a patient with Alzheimer's disease and determines that the patient's body mass index (BMI) is 28.8 kg/m2. What does the nurse interpret from these findings? 1 The patient has gynoid obesity. 2 The patient has primary obesity. 3 The patient has android obesity. 4 The patient has secondary obesity.

4 A BMI of 28.8 kg/m2 indicates that the patient is overweight. Alzheimer's disease is one of the types of central nervous system lesions. Patients with this disease may become obese due to cognitive loss and functional inabilities. Secondary obesity may result from central nervous system lesions or congenital anomalies. Therefore, the nurse infers that the patient has secondary obesity. If an obese patient has a greater amount of fat in the upper body, it indicates that the patient has gynoid obesity. If the calorie intake is more than the calorie expenditure for the body's metabolic demands, it is called primary obesity. If an obese patient has a greater proportion of fat deposited in the abdominal area, it indicates that the patient has android obesity. Text Reference - p. 908

When the nurse identifies an individual at risk for malnutrition with nutritional screening, what is the next step for the nurse to take? 1 Supply supplements between meals 2 Encourage eating meals with others 3 Have family bring in food from home 4 Complete a full nutritional assessment

4 A full nutritional assessment includes history and physical examination and laboratory data. The nutritional assessment will need to be done to provide the basis for nutrition intervention. Supplements may be given if prescribed; the family bringing food from home and socializing with meals may be an option after a full nutritional assessment is done. Text Reference - p. 904

The nurse is educating a student nurse about enteral feedings that are administered through a nasogastric (NG) tube. What is appropriate for the nurse to include in the teaching about the nasogastric (NG) tube? 1 It is surgically inserted into the stomach. 2 It is inserted through the nose into the jejunum. 3 It is surgically inserted directly into the jejunum. 4 It is inserted through the nose into the stomach.

4 A nasogastric tube is inserted through the nose and goes to the stomach via the throat. The tube does not go all the way to the jejunum. The insertion of a nasogastric tube is not a surgical intervention. Text Reference - p. 898

The nurse is caring for a patient with burn injuries who receives a prescription for the placement of a nasointestinal tube into the small intestine. What is the rationale behind this intervention? 1 To prevent tube clogging 2 To prevent tube obstruction 3 To decrease the risk of mucosal damage 4 To decrease the likelihood of regurgitation of contents

4 A nasointestinal tube placed in the small intestine will decrease the likelihood of the regurgitation of contents into the esophagus and reduces the risk for aspiration. Flushing the tube before and after administrating medication prevents tube clogging. Crushing medications thoroughly and dissolving them in water will help prevent tube obstruction. The use of polyurethane or silicone feeding tubes help decrease the risk of mucosal damage. Text Reference - p. 898

The nurse reviews the laboratory reports of an obese patient who is diagnosed with gout. Which finding does the nurse associate with the patient's condition? 1 Hypovolemia 2 Hyperkalemia 3 Hyponatremia 4 Hyperuricemia

4 A patient with gout will have crystallization of uric acid, which is deposited in joints and causes inflammation. This condition is associated with hyperuricemia. Obesity and gout are not associated with loss of blood or hypovolemia. Obesity and gout do not affect the potassium and sodium electrolyte balance. Therefore, hyperkalemia and hyponatremia are not observed in obese patients who are diagnosed with gout. Text Reference - p. 911

At the first visit to the clinic, the female patient with a body mass index (BMI) of 29 kg/m2 tells the nurse that she does not want to become obese. Which question used for assessing weight issues is the most important question for the nurse to ask? 1 "What factors contributed to your current body weight?" 2 "How is your overall health affected by your body weight?" 3 "What is your history of gaining weight and losing weight?" 4 "In what ways are you interested in managing your weight differently?"

4 Asking the patient about her desire to manage her weight in a different manner helps the nurse determine the patient's readiness for learning, degree of motivation, and willingness to change lifestyle habits. The nurse can help the patient set realistic goals. This question also will lead to discussing the patient's history of gaining and losing weight and factors that have contributed to the patient's current weight. The patient may be unaware of the overall health effects of her body weight, so this question is not helpful at this time. Text Reference - p. 913

During the physical examination of a patient, the nurse records the patient's height as 1.72 m and weight as 108 kg. What does the patient's body mass index (BMI) indicate? 1 The patient is underweight. 2 The patient is at a normal weight. 3 The patient falls into Class I obesity. 4 The patient falls into Class II obesity.

4 BMI is a measure of relative weight based on a patient's mass and height. It is calculated using the following formula: weight in kilograms/(height in meters)2. For this patient, multiply 1.72 by 1.72. This equals 29,584. Then divide 108 (the patient's weight) by 2.9584. This equals 36.51 kg/m2. If the patient's weight falls between 35.0 kg/m2 and 39.9 kg/m2, the patient falls into Class II obesity. If the patient's weight is less than 18.5 kg/m2, it indicates that the patient is underweight. If the patient's weight falls between 18.5 kg/m2and 24.9 kg/m2, it indicates normal weight. If the patient's weight falls between 30.0 kg/m2and 34.9 kg/m2, the patient falls into Class 1 obesity. Text Reference - p. 907

A nurse is caring for a patient who is malnourished. For what manifestation should the nurse look when assessing the patient with malnutrition? 1 Increased serum vitamin levels 2 Decreased liver enzymes 3 Increased hemoglobin levels 4 Increased sensitivity to cold

4 Because of loss of body mass there is increased sensitivity to cold in patients with malnutrition. Also because of depletion of proteins in malnutrition, wound healing is delayed. Because of increased enzyme protein synthesis, liver enzymes increase in malnutrition, and because of decreased intake of nutrients, serum vitamin levels decrease in malnutrition. Hemoglobin levels are also low, owing to decreased protein synthesis and to iron deficiency. Text Reference - p. 892

A patient has a body mass index (BMI) of 27. The nurse has discussed weight-loss goals with the patient. Which statement made by the patient indicates proper understanding of the teaching? 1 "I will exercise for 15 minutes every day of the week." 2 "I will limit intake to 500 calories per day." 3 "I will increase my intake of sugar-free foods and beverages." 4 "I will begin to steam and broil my foods for most meals.

4 Broiling and steaming foods is a healthier way to prepare meals. Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie-energy restriction would place the patient at risk for multiple nutrient deficiencies. Low-calorie diets are defined as those having 800 to 1200 calories per day. Exercise should be at least 30 minutes per day.

A patient has a body mass index (BMI) of 27. The nurse has discussed weight-loss goals with the patient. Which statement made by the patient indicates proper understanding of the teaching? 1 "I will exercise for 15 minutes every day of the week." 2 "I will limit intake to 500 calories per day." 3 "I will increase my intake of sugar-free foods and beverages." 4 "I will begin to steam and broil my foods for most meals."

4 Broiling and steaming foods is a healthier way to prepare meals. Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie-energy restriction would place the patient at risk for multiple nutrient deficiencies. Low-calorie diets are defined as those having 800 to 1200 calories per day. Exercise should be at least 30 minutes per day. Text Reference - p. 913

A patient has undergone a gastrectomy. What should the nurse suggest for the patient to include in the dietary selections? 1 Foods that are rich in vitamin E 2 Foods that are rich in vitamin A 3 Foods that are rich in vitamin K 4 Foods that are rich in cobalamin

4 Cobalamin requires an intrinsic factor to bind with to facilitate absorption in the ileum. Following a gastrectomy, cobolamin may not get absorbed due to deficiency of intrinsic factors; therefore, cobalamin needs to be supplemented. Vitamin E, Vitamin A, and Vitamin K may not need supplementation after a gastrectomy. These are absorbed in the terminal ileum. Text Reference - p. 891

A patient's blood pressure is 139/110 mm Hg, fasting blood sugar is 150 mg/dL, and serum triglyceride level is 260 mg/dL. What does the nurse infer from these findings? 1 The patient has truncal obesity. 2 The patient has gynoid obesity. 3 The patient has android obesity. 4 The patient has metabolic syndrome

4 Elevated blood pressure, increased fasting plasma glucose, elevated triglycerides, increased waist circumference, and low high-density lipoprotein (HDL) cholesterol are the biomarkers of metabolic syndrome. If an obese patient has any three of these five biomarkers, it indicates metabolic syndrome. As the patient has an elevated blood pressure of 139/110 mm Hg (normal blood pressure being 130/90 mm Hg), increased fasting blood glucose levels of 150 mg/dL (normal levels being 110 mg/dL), and elevated serum triglyceride levels of 260 mg/dL (normal levels being 230 mg/dL) the nurse infers that the patient has metabolic syndrome. These biomarkers do not indicate the presence of truncal, android, or gynoid obesity. If an obese patient has a lot of fat stored mostly around the trunk of the body, it indicates truncal obesity. If an obese patient has a greater amount of fat in the upper body, it indicates that the patient has gynoid obesity. If an obese patient has a greater proportion of fat deposited in the abdominal area, it indicates that the patient has android obesity. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. Text Reference - p. 921

The registered nurse teaches a student nurse about enteral nutrition. Which statement made by the student nurse indicates the need for further teaching? 1 "A nasogastric tube is used when there is a risk for aspiration with oral consumption." 2 "A nasogastric tube is used when a patient needs short-term feeding." 3 "A fluoroscopic procedure is used for the placement of a nasointestinal tube." 4 "Enteral nutrition is given to patients with nonfunctional gastrointestinal tracts."

4 Enteral nutrition is ordered for patients who have a functional gastrointestinal tract but who are unable to consume food orally. Nasogastric tubes are used in pathophysiologic conditions in which there is a risk for aspiration and they are used for short-term feeding. If the feedings are extended, then a fluoroscopic procedure is used for the placement of a nasointestinal tube. Text Reference - p. 897

What is the hallmark of refeeding syndrome? 1 Hypokalemia 2 Hyponatremia 3 Hypomagnesemia 4 Hypophosphatemia

4 Hypophosphatemia is the hallmark of refeeding syndrome, which is associated with serious outcomes. Hypokalemia is also present in refeeding syndrome, but is not considered the hallmark of refeeding syndrome. Hyponatremia is associated with anorexia nervosa. Hypomagnesemia is also present in refeeding syndrome, but it also is not considered a hallmark of refeeding syndrome. Text Reference - p. 902

The nurse finds that a patient receiving tube feedings has developed diarrhea. What nursing action is appropriate to manage diarrhea in this patient? 1 Increase the rate of the feedings. 2 Change to a formula with less fiber. 3 Maintain unused formula at room temperature. 4 Properly secure the tube before beginning feeding.

4 If a patient who is on tube feedings develops diarrhea, the nurse should properly secure the tube before beginning feeding. Diarrhea can be caused if the tube is pushed too distally. Increased rate of feedings, low-fiber formula, and contaminated formula (caused by not refrigerating unused formula) are other causes of diarrhea that should be taken care of. Text Reference - p. 899

The nurse is prescribing a diet to promote weight loss to an obese patient. Which advice is the most appropriate? 1 Use whole milk, which has more vitamin D. 2 Avoid steamed foods, which removes much of the nutrients. 3 Reduce fiber intake, which can cause digestion complications. 4 Include fruits and vegetables in each meal.

4 Including adequate fruits and vegetables will the help the patient to maintain a lower calorie intake as well as providing essential nutrients. Whole milk is not advisable for losing weight and should be replaced with low-fat or skim milk as required. Steaming foods can help to reduce fat intake and aid in weight loss. Reducing fiber intake will not help with weight loss; instead, consumption of fiber and bulk-forming foods is recommended. Text Reference - p. 913

The nurse is evaluating the suitability of a patient for liposuction. Which characteristics indicate that the patient is suitable for liposuction? 1 The patient is aged and obese. 2 The patient is aged and underweight. 3 The patient is obese and desires weight reduction. 4 The patient has reduced weight but more fat around the chin.

4 Liposuction is a surgical procedure used for cosmetic purposes, and a patient with reduced weight but more fat around the chin is the most suitable for liposuction. Liposuction is not recommended for the aged, because the skin is less elastic and will not accommodate the new underlying shape. The patient who is obese and aims at weight reduction is not suitable, because liposuction is not for weight reduction. Text Reference - p. 917

The nurse recalls that lorcaserin reduces the risk of obesity through what mechanism? 1 It activates insulin receptors. 2 It blocks the breakdown of fat cells. 3 It increases the availability of norepinephrine. 4 It activates serotonin receptors to suppress the appetite.

4 Lorcaserin is a serotonin agonist that helps to reduce the risk of obesity by activating serotonin receptors, which in turn suppress the appetite and create a feeling of satiety. Lorcaserin is not an insulin agonist; therefore insulin receptors are not activated by this medication. Orlistat is a nutrient absorption-blocking drug that helps to reduce the risk of obesity by blocking fat breakdown. Nonamphetamines stimulate the central nervous system, which increases norepinephrine. An increase in norepinephrine helps to reduce weight. Text Reference - p. 916

An overweight patient tells the nurse, "I had a friend who lost lots of weight on a low-carb diet. I want to try that!" The nurse will answer the patient with what factor in mind? 1 Low-carbohydrate diets are safe and easy to follow. 2 Low-carbohydrate diets produce long-lasting weight loss. 3 Low-fat diets provide more chance of success than low-carbohydrate diets. 4 People on low-carbohydrate diets may not get adequate amounts of fiber, vitamins, and minerals.

4 Low-carbohydrate diets do produce a rapid weight loss, but reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals. These restrictive diets are difficult to maintain for long-term weight loss. It is best to recommend a dietary approach in which calorie restriction includes all food groups. Low-carbohydrate diets are generally not safe nor are they easy to follow. They produce short-term, not long-term, weight loss. Low-fat diets are not necessarily more successful than low-carbohydrate diets. Text Reference - p. 913

While assessing an obese patient, the nurse finds that the patient consumes a high-fat diet daily. Which class of medication should be included in the patient's prescription to provide effective treatment? 1 Serotonin agonists 2 Sympathomimetics 3 Appetite-suppressing drugs 4 Nutrient absorption-blocking drugs

4 Nutrient absorption-blocking drugs inhibit fat breakdown and absorption in the intestine. These drugs inhibit intestinal lipases and promote fecal elimination of undigested fat in obese patients. Serotonin agonists activate serotonin receptors and suppress the appetite. These medications do not decrease the absorption of fat. Sympathomimetics suppress the appetite and reduce feelings of hunger. Appetite-suppressing drugs increase norepinephrine levels in the brain and reduce the appetite. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 916

A patient presents with a body mass index (BMI) of 20. What should the nurse document about the patient's weight classification? 1 Obese 2 Overweight 3 Underweight 4 Normal weight

4 Patients with a BMI between 18.5 and 24.9 are considered to have a normal body weight. Patients with a BMI less than 18.5 are considered underweight, those with a BMI of 25 to 29.9 are overweight, and those with a BMI of 30 or above are considered obese. Text Reference - p. 906

The nurse is providing postoperative care for a bariatric surgery patient who has difficulty breathing and has abdominal pressure. Which priority nursing intervention would be beneficial in this situation? 1 Performing jaw-thrust maneuver 2 Assisting the patient to walk a short distance 3 Administering a low dose of heparin to the patient 4 Placing the patient's head at a 35 to 40 degree angle

4 Placing the patient's head at a 35 to 40 degree angle will reduce pressure on the abdomen and help in lung expansion, improving breathing. The jaw-thrust maneuver is performed to reduce the risk of pulmonary aspiration and to promote airway opening in a sedated patient. After a bariatric surgery, the patient is encouraged to walk for short distances three to four times a day to prevent complications such as deep venous thrombosis. A low dose of an anticoagulant, such as heparin, will help prevent deep venous thrombosis. Text Reference - p. 919

A patient is receiving enteral nutrition through a nasogastric tube. What measure should the nurse take to reduce the risk of aspiration? 1 Using a high-fiber formula 2 X-ray confirmation 3 Marking the exit site of the feeding tube 4 Elevating the head of bed to 45 degrees

4 Proper position of the patient reduces the risk of aspiration. The head of the bed should be elevated to a minimum of 45 degrees to prevent aspiration. Using a high-fiber formula helps to prevent constipation but does not protect from aspiration. X-ray confirmation is used to determine the position of the orogastric tube in the gastrointestinal (GI) tract. Marking the exit site of the feeding tube is for observing a change in the external tube length during feedings. Text Reference - p. 899

The nurse is planning to administer enteral feedings to a patient with an orofacial fracture. How should the nurse position the patient after delivering a bolus feeding through the patient's nasogastric (NG) tube? 1 Allow the patient to choose the position that provides the most comfort. 2 Place the patient in the Trendelenburg position to reduce facial edema. 3 Raise the head of the bed to 20 to 30 degrees for two hours after the feeding. 4 Place the patient in the semi-Fowler's position for 30 to 60 minutes after the feeding.

4 Raise the head of the bed to at least 30 to 45 degrees (semi-Fowler's position) to prevent aspiration. The head should remain elevated for 30 to 60 minutes after feeding. A position of comfort may not be the position that will prevent aspiration. The Trendelenburg position is used to elevate the foot of the bed; it will increase the risk of the patient aspirating. Raising the head of the bed to 20 to 30 degrees is not sufficient to prevent aspiration. Text Reference - p. 899

The nurse is reviewing the surgical notes of a patient who underwent bariatric surgery and notes that the first segment of the small intestine is bypassed with a small gastric pouch connected to the jejunum. Which surgical technique was performed? 1 Adjustable gastric banding 2 Vertical sleeve gastrectomy 3 Vertical banded gastroplasty 4 Roux-en-Y gastric bypass surgery

4 Roux-en-Y gastric bypass surgery is a combination of restrictive and malabsorptive surgical techniques. During Roux-en-Y, a small gastric pouch is connected to the jejunum. The remaining stomach and first segment of the small intestine is bypassed. Adjustable gastric banding involves placing a band around the stomach, reducing its capacity to approximately 30 mL. The vertical sleeve gastrectomy involves the removal of 85% of the stomach, reducing its capacity to approximately 60 to 150 mL. Vertical banding involves placing a band around the stomach and using a stapling technique above the band to create a small gastric pouch. Text Reference - p. 916

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? 1 "This surgery will preserve the function of my stomach." 2 "This surgery will remove the fat cells from my abdomen." 3 "This surgery can be modified whenever I need it to be changed." 4 "This surgery decreases how much I can eat and how many calories I can absorb."

4 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. The vertical sleeve gastrectomy removes 85% of the stomach, but preserves the function of the stomach. Lipectomy and liposuction remove fat tissue from the abdomen or other areas. Adjustable gastric banding can be modified or reversed at a later date. Text Reference - p. 917

While performing a nutritional assessment on a 25-year-old patient, the nurse finds that the patient's height is 1.71 m and weight is 68 kg. What should the nurse interpret from these findings based on patient's body mass to height index? 1 The patient is obese. 2 The patient is overweight. 3 The patient is underweight. 4 The patient has a normal weight.

4 The body mass index (BMI) is a measure of relative weight based on a patient's mass and height. It is calculated by the formula: Actual body weight (kilograms)/(height in meters)2. Calculating 68/(1.71 × 1.71) = 23.25 kg/m2. Because the patient's BMI falls between 18.5 and 24.9 kg/m2, it indicates a normal weight. If the patient's BMI is greater than 30 kg/m2, it indicates that the patient is obese. If the patient's BMI falls between 25.0 and 29.9 kg/m2, it indicates that the patient is overweight. If the patient's BMI is less than 18.5 kg/m2, it indicates that the patient is underweight. Text Reference - p. 894

Why does the nurse instruct a patient who has undergone bariatric surgery to restrict the oral intake of food for a few days? 1 To reduce the risk of hernia 2 To reduce the risk of venous stasis 3 To reduce the risk of dumping syndrome 4 To reduce the risk of abdominal distention

4 The patient has undergone bariatric surgery. Therefore, oral intake of food should be restricted to reduce the risk of abdominal distention, which occurs due to the inability to digested food. The presence of sutures after surgery will increase the risk of hernia. Venous stasis is the condition of slow blood flow in the veins that may arise due to bed rest and an increase in body fat. The nurse instructs the patient to avoid drinking water with meals to prevent dumping syndrome. Text Reference - p. 919

Which patient has the highest morbidity risk? 1 Male 6'1" tall, body mass index (BMI) 29 kg/m2 2 Female 5'6". tall, weight 150 lb. 3 Male with waist circumference 46 in. 4 Female 5'10" tall, obesity Class III

4 The patient in Class III obesity has the highest risk for disease because Class III denotes severe obesity or a BMI greater than 40 kg/m2. The female who is 5'6" tall has a normal weight for her height. The male patient who is over 6 feet tall is overweight, which increases his risk of disease, but a more precise determination cannot be made without the waist circumference. The patient with a waist circumference of 46 inches has a high risk for disease, but without the BMI or obesity class, a more precise determination cannot be made. Text Reference - p. 906

A nurse is interacting with a dieting obese patient and interprets that the patient is exhibiting the behavioral technique of stimulus control. Which statement made by the patient helps the nurse to reach this conclusion? 1 "I maintain a diary about my diet and timings of diet every day." 2 "I decided that I will pamper myself with a massage after I lose 5 lbs." 3 "I will treat myself with my favorite food after losing 10 lbs of weight." 4 "I avoided going near the food court because the smell is very tempting."

4 The patient likes the smell of fast food and avoids a location where fast food is sold, indicating that the patient is controlling stimuli. Maintaining a diary about the type of diet and timings indicates that the patient is employing self-monitoring behavior. The patient deciding that he or she will get a massage after losing weight is an appropriate reward. The patient eating a favorite food after losing 10 lbs of weight indicates improper behavior, because he or she should not use food as a reward. Text Reference - p. 915

What diet should the nurse provide to the patient immediately after bariatric surgery? 1 20 mL of whole milk 2 Porridge with water 3 Protein-rich milk shake 4 30 mL water and sugar-free liquid

4 The patient who has undergone a bariatric surgery should be given a liquid diet that is easily digestible; 30 mL of water and sugar-free liquid are adequate to provide energy to the patient. Twenty mL of whole milk contain a high amount of fat and calories, and should be avoided. The patient will not be able to digest solid food such as porridge immediately after surgery. Providing water with solid food will result in dumping syndrome. A protein milkshake would be appropriate for the patient, because it provides adequate energy, but is not recommended during postoperative care. Text Reference - p. 919

The patient being admitted has been diagnosed with anorexia nervosa. What clinical manifestations should the nurse expect to see on admission assessment? 1 Tan skin, blonde hair, and diarrhea 2 Sensitivity to heat, fatigue, and polycythemia 3 Dysmenorrhea, gastric ulcer pain, and hunger 4 Hair loss, dry, yellowish skin, and constipation

4 The patient with anorexia nervosa, along with abnormal weight loss, is likely to have hair loss, dry, yellow skin, constipation, sensitivity to cold, and absent or irregular menstruation. Other signs of malnutrition also are noted during physical examination. The anorexic patient will not have tan skin, may have hair color other than blonde, and will not have diarrhea. Text Reference - p. 903

The nurse recognizes that which finding indicates that a patient has gynoid obesity? 1 Apple-shaped body 2 Waist-to-hip ratio of 0.7 3 Waist circumference of 32 inches 4 Deposition of fat in the upper legs

4 The presence of a pear-shaped body with distribution of fat in the upper legs indicates that the patient has gynoid obesity. An apple-shaped body occurs when fat is deposited in the abdominal area, which indicates android obesity. A normal waist-to-hip ratio should be less than 0.8. A waist-to-hip ratio of 0.7 indicates that the patient has a normal waist. The normal waist circumference for females is less than 35 inches and less than 40 inches for males. The patient has waist circumference of 32 inches, which indicates that the patient has a normal waist circumference. Text Reference - p. 907

A patient who is a strict vegan avoids taking any vitamin and mineral supplements. The nurse recognizes that the patient is predisposed to which condition? 1 Sepsis 2 Dementia 3 Depression 4 Megaloblastic anemia

4 The primary deficiency of a strict vegan is lack of cobalamin. This vitamin is obtained from animal protein, special supplements, or foods that have been fortified with the vitamin. The patient who avoids eating any vitamin and mineral supplements is susceptible to the development of megaloblastic anemia, which is due to deficiency of cobolamin. Sepsis, dementia, and depression are not associated with cobalamin deficiency. These are conditions that increase the risk of malnutrition. Text Reference - p. 889

A patient who underwent restrictive bariatric surgery has a sleeved-shaped stomach with a 60 mL capacity and has no risk of malabsorption. The nurse recognizes that the patient had what type of surgery? 1 Biliopancreatic diversion 2 Roux-en-Y gastric bypass 3 Adjustable gastric banding 4 Vertical sleeve gastrectomy

4 Vertical sleeve gastrectomy is a restrictive surgery in which about 85 percent of the stomach is removed, leaving a sleeve-shaped stomach with a 60 to 150 mL capacity. The patient undergoing vertical sleeve gastrectomy will have no risk of malabsorption, because it avoids all complications of obstruction, anemia, and vitamin deficiencies. Biliopancreatic surgery is a malabsorptive surgery, and the patient will have the risk of malabsorption of fat-soluble vitamins after the surgery. Roux-en-Y gastric bypass is a restrictive surgery and malabsorptive surgery, which reduces the incidence of malnutrition. However, the patient will still be at risk of anemia and folic acid deficiency. Adjustable gastric banding is a restrictive bariatric surgery in which the patient will have a gastric pouch with a 30 mL capacity after the surgery. Text Reference - p. 917

Which figure depicts a malabsorptive surgery that helps in rapid and long-term weight loss?

Biliopancreatic surgery, depicted in option 4, is a malabsorptive surgery in which 70 percent of the stomach is removed horizontally. Patients undergoing this surgery will experience rapid weight loss and greater long-term weight loss. Adjustable gastric banding bariatric surgery, depicted in option 1, is a restrictive surgery that helps in weight loss. Ventral banded gastroplasty, depicted in option 2, is a restrictive surgery. Vertical sleeve gastrectomy, depicted in option 2, is also a restrictive surgery. Text Reference - p. 917

The nurse is caring for an obese patient who takes orlistat. The nurse should monitor the patient for which adverse effect? 1 Insomnia 2 Dizziness Correct3 Fecal incontinence 4 Abnormal heart rate

Orlistat is a nutrient absorption-blocking drug, which blocks fat breakdown and absorption. This action of the drug may result in fecal incontinence. Insomnia and dizziness are the side effects associated with appetite-suppressing drugs like nonamphetamines. Phentermine and topiramate are anticonvulsant drugs, which may cause an abnormal heart rate. Text Reference - p. 916

An obese patient receives a prescription for orlistat for weight loss. What should the nurse include in the patient's medication teaching? 1 "Take a stool softener." 2 "Consume a high-calorie diet." Correct3 "Take vitamin supplements." 4 "Take folic acid supplements."

Orlistat is a nutrition absorption-blocking drug that acts by blocking fat breakdown and absorption in the intestine. Fat-soluble vitamins may also decrease in patients taking this medication. Therefore, the nurse instructs the patient to take vitamin supplements. Orlistat may cause diarrhea; therefore, the nurse should not instruct the patient to take a stool softener, because it would aggravate diarrhea. The patient is obese, so a high-calorie diet should not be recommended. The patient who is on orlistat will not experience a folic acid deficiency or anemia.

The nurse recalls that which type of bariatric surgery may result in calcium and folic acid deficiency 1 Biliopancreatic diversion Correct2 Roux-en-Y gastric bypass 3 Vertical sleeve gastrectomy 4 Vertical banded gastroplasty

The Roux-en-Y gastric bypass is a restrictive and malabsorptive surgery in which the patient may have a small gastric pouch connected to the jejunum. The patient who undergoes a roux-en-Y gastric bypass may have complications like folic acid deficiency and calcium deficiency. Biliopancreatic diversion is a malabsorptive bariatric surgery in which 70 percent of the stomach is removed horizontally. A patient who undergoes biliopancreatic diversion may experience protein-calorie malnutrition and iron deficiency. Vertical sleeve gastrectomy is a restrictive surgery in which 85 percent of the stomach is removed. The patient undergoing a vertical sleeve gastrectomy may have limited weight loss. Vertical banded gastroplasty is a restrictive surgery in which a band is placed on the patient's stomach vertically and may cause dumping syndrome. Calcium and folic acid deficiency is not associated with biliopancreatic diversion, vertical sleeve gastrectomy, and vertical banded gastroplasty. Text Reference - p. 917

Which bariatric surgical technique does not usually result in patients experiencing problems with dumping syndrome and malabsorption?

The adjustable gastric banding type of bariatric surgery does not cause dumping syndrome and malabsorption. Image 1 indicates the adjustable gastric banding type of bariatric surgery; therefore, this surgery does not result in dumping syndrome and malabsorption in the patient. Patients undergoing surgical techniques illustrated in images 2 (vertical banded gastroplasty), 3 (biliopancreatic diversion), and 4 (Roux-en-Y gastric bypass) are at higher risk for developing dumping syndrome and malabsorption problems. Text Reference - p. 917