Prep-U ch. 48 Assessment and Management of Patients with Obesity

A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers? "Avoid taking non-steroidal anti-inflammatory drugs." "Keep the head of your bed propped on blocks at night." "Avoid taking antacid drugs." "Sit in a semi-recumbent position while eating."

"Avoid taking non-steroidal anti-inflammatory drugs." Explanation: The only statement that aids in avoiding gastric ulcers is the statement instructing the client to avoid taking non-steroidal anti-inflammatory (NSAID) drugs. Sitting in a semi-recumbent of low Fowler's position aids in digestion but does not aid in the prevention of gastric ulcers. Propping the head of the bed would be beneficial for a client report GERD or acid reflux. antacid drugs do not increase the risk of gastric ulcers.

A nurse cares for an obese client taking phentermine for weight loss. What client teaching will the nurse include when discussing precautions about the medication? "Do not drive while taking this medication." "Do not drink alcohol while taking this medication." "Take the medication with a full glass of water." "Take the medication at night before bedtime."

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

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? "I should pick cereals with less than 2 g of fiber per serving." "I need to chew my food slowly and thoroughly." "I need to drink 8 oz of water before eating." "A total serving should amount to be less than 1 cup."

"I need to drink 8 oz of water before eating." Explanation: After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withhold fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly; keeping total serving sizes to less than 1 cup; and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: "I should eat a high-protein diet." "I should become involved in a weight loss program." "I should sleep on my side all night long." "I need to keep my inhaler at the bedside."

"I should become involved in a weight loss program"

A nurse is caring for a client who will undergo bariatric surgery. Which nutritional recommendation will the nurse include in the client teaching? "Increase your intake of fluids at meals." "Increase your intake of complex carbohydrates." "Increase your intake of plant-based proteins." "Increase your intake of monounsaturated fats."

"Increase your intake of plant-based proteins." Explanation: The client should be advised to increase protein intake, particularly plant-based protein because animal-based protein may not be tolerated well. The client should be advised to decrease fat intake, regardless of the source. Additionally, the client should be advised to decrease fluid intake at meals, not increase intake.

A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include? "It decreases your appetite." "It binds with enzymes to decrease carbohydrate absorption." "It works to make you feel full." "It binds with enzymes to help prevent digestion of fat."

"It binds with enzymes to help prevent digestion of fat." Explanation: Orlistat (Xenical) works to bind to gastric and pancreatic lipase to prevent the digestion of 30% of ingested fat, thereby decreasing caloric intake.

A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response? "The fat is absorbed in your intestines." "The fat is excreted in your urine." "The fat is passed in your stools." "The fat remains undigested in your stomach."

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

A nurse cares for a client with a BMI of 36 kg/m2 and nonalcoholic fatty liver disease. The client asks the nurse if he is a candidate for bariatric surgery. How should the nurse respond to the client? "No, you do not have any qualifying criteria for bariatric surgery." "No, you have one qualifying condition but not the other; this excludes you from bariatric surgery." "Yes, your chronic condition meets the criteria for bariatric surgery but not your BMI." "Yes, your BMI and chronic condition meets the criteria for bariatric surgery."

"Yes, your BMI and chronic condition meets the criteria for bariatric surgery." Explanation: The client's BMI of > 35 kg/m2 and a more severe obesity-associated comorbid condition, makes the client a candidate for bariatric surgery.

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

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

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

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

A nurse caring for adults with obesity recognizes that obesity is classified based on BMI. Which BMI does the nurse recognize as Class II obesity? 40 kg/m2 34 kg/m2 29 kg/m2 35 kg/m2

35 kg/m2 Explanation: Class I obesity is defined as 30-34.9 kg/m2. Class II obesity is defined as a BMI of 35-39.9 kg/m2. A BMI of 40 kg/m2 or greater defines Class III obesity.

A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI? Overweight Class II obesity Normal weight Class I obesity

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

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Nearly two-thirds of clients with diabetes mellitus are older than age 60. Approximately one-half of the clients diagnosed with type 2 diabetes are obese. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus.

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

A client is diagnosed with dumping syndrome after bariatric surgery. Which findings on the nursing assessment correlate with this diagnosis? Select all that apply. Dizziness Sweating Hypertension Tachycardia Fever

Dizziness Sweating Tachycardia Explanation: Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that is common among clients who have had bariatric surgery. Symptoms of dumping syndrome include (but are not limited to): sweating, tachycardia, nausea, vomiting, dizziness, and diarrhea. Fever and hypertension are not symptoms of dumping syndrome.

A nurse cares for a client with obesity who is taking phentermine/topiramate ER and reports tingling around the mouth and fingertips. What is the priority nursing action? Obtain the client's vital signs. Review the client's laboratory results. Document the finding. Immediately notify the health care provider.

Document the finding. Explanation: A common side effect of phentermine/topiramate ER is tingling around the mouth and fingertips. This is not a life threatening side effect and does not need to be immediately reported to the health care provider and the client's vital signs and laboratory results do not need to obtained right away.

A nurse cares for a client with obesity. Which medication that the client takes may be contributing to the client's obesity? Metformin Bupropion Gabapentin Topiramate

Gabapentin Explanation: Gabapentin (Neurontin) is an anticonvulsant medication which promotes weight gain. The other answer choices are medications which promote weight loss, not gain.

A client who is postoperative open RYGB bariatric surgery is scheduled for discharge and will have a Jackson-Pratt drain to care for while at home. Which teaching will the nurse include specific to this? Select all that apply. How to empty the drain Recording drainage amount How to measure the drainage amount How to change the drain When to contact the health care provider

How to empty the drain Recording drainage amount When to contact the health care provider How to measure the drainage amount Explanation: A client who is discharged with a Jackson-Pratt drain must be taught on methods to measure, record, and empty the drain. Additionally, the nurse should instruct the client on when to contact the health care provider. The client will not change the drain, this is reserved for the health care provider only.

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply. Tobacco use Hyperlipidemia Obesity Gender Race

Hyperlipidemia Obesity Tobacco use Explanation: Modifiable risk factors for coronary artery disease include hyperlipidemia, tobacco use, hypertension, diabetes mellitus, metabolic syndrome, obesity, and physical inactivity. Nonmodifiable risk factors include family history, advanced age, gender, and race.

A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply. Hypertension Heart murmur Coronary artery disease Myocardial infarction Heart failure

Hypertension Coronary artery disease Heart failure Myocardial infarction Explanation: Various cardiac diseases and conditions may be associated with obesity. These include: hypertension, heart failure, myocardial infarction, and coronary artery disease. Heart murmur is not directly associated with obesity.

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply. History of gestational diabetes Family history Age greater of 45 years or older Obesity Hypertension

Hypertension Obesity Family history Age greater of 45 years or older History of gestational diabetes Explanation: Risk factors for the development of diabetes mellitus include hypertension, obesity, family history, age of 45 years or older, and a history of gestational diabetes.

What pathophysiological concept is related to the increase in the hormone leptin, as it relates to satiety and hunger? Increased adipose stores Increased caloric intake Alterations in metabolism Decreased carbohydrate intake

Increased adipose stores Explanation: Increased fat stores increases the level of leptin in the bloodstream.

Place the pathophysiological steps in order of how a client with obesity is at greater risk for venous thromboembolism in comparison to the general population. Formation of a thrombus Impairment of peripheral blood flow Blood stasis increased adipose tissue

Increased adipose tissue Impairment of peripheral blood flow Blood stasis Formation of a thrombus Explanation: In obesity, an increase in adipose tissue impairs the peripheral blood flow, leading to blood stasis and the formation of a thrombus.

A nurse cares for a client who is post op bariatric surgery. Which position will the nurse place the client in order to best promote comfort? Low Fowler's High Fowler's Upright Lateral

Low Fowler's Explanation: Positioning the client in low Fowler's position best promotes comfort in the client who is post op bariatric surgery. In addition to decreasing incisional pain, this position also promotes gastric emptying.

A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate? Mechanical compression only Mechanical compression and prophylactic anticoagulation Early ambulation only Prophylactic anticoagulation only

Mechanical compression and prophylactic anticoagulation Explanation: Both mechanical compression (intermittent pneumatic compression devices) and prophylactic anticoagulation with low molecular weight heparin agents are prescribed in the client who is postoperative bariatric surgery. Early ambulation is encouraged; however, it is not the only intervention.

A nurse admits a wealthy client who is 8 weeks postpartum after her third child and overweight. The client reports severe right upper quadrant pain that radiates to the back after eating Thanksgiving dinner with turkey and gravy earlier in the evening. What factors lead the nurse to suspect gallbladder disease? Select all that apply. Female gender Multiparous Wealthy Eating a high fat diet Obese

Multiparous Obese Eating a high fat diet Female gender Explanation: Cholelithiasis affects approximately 50% of women by the age of 70 years. Two to three times more women than men develop cholesterol stones and gallbladder disease, particularly those who are multiparous, eat a high fat diet, and obese. Wealth is not associated with cholelithiasis.

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

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

A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity? Multiple mutations of genes over time have lead to the epidemic. Over time, we have become efficient in food storage and deposition of fat stores. A single gene mutation is responsible for the epidemic. Over time, we have become less efficient in hunting and gathering of food.

Over time, we have become efficient in food storage and deposition of fat stores. Explanation: According to the "thrifty gene" theory, hunting for scarce food sources during prehistoric times consumed a lot of energy, and food sources were not abundant. Storing fat to provide energy sources during times of food scarcity was a physiologic adaptive response to these environmental challenges and over time, we became more efficient in food storage and fat deposition.

A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding? Decreased gastric size Decreased motility Rapid gastric dumping Excessive fat intake

Rapid gastric dumping Explanation: Rapid gastric dumping may lead to steatorrhea, excessive fat in the feces. The primary cause of this finding is rapid gastric dumping. Excessive fat intake can make the problem worse; however, this is not the primary cause of the symptoms. Steatorrhea results from increased motility, not decreased and the size of the stomach does not contribute to this finding.

A client with obesity is interested in trying orlistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication? Anemia Renal insufficiency Chronic obstructive pulmonary disease Diabetes mellitus

Renal insufficiency Explanation: Clients with a history of renal sufficiency or liver disease should use caution while taking this medication as it has been linked to increase rates of cholelithiasis and liver failure. The other conditions do not pose an increase risk with this medication.

A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose? Assess for gastric perforation Stimulate GI peristalsis Assess for intact swallowing Stimulate digestive hormones

Stimulate GI peristalsis Explanation: Early oral hydration stimulates GI peristalsis. The nurse would not give a client oral hydration to assess for intact swallowing as this may lead to aspiration. There is no reason to assume a client would have gastric perforation and this would not be appropriate. Digestive hormones are stimulated once peristalsis begins; however, this is not the primary purpose of early oral hydration.

A nurse epidemiologist examines the overall decrease in life expectancy related to obesity. What finding is true? There is a 25-30 year decrease in overall life expectancy for those with obesity. There is a 6-20 year decrease in overall life expectancy for those with obesity. There is a 21-28 year decrease in overall life expectancy for those with obesity. There is a 2-4 year decrease in overall life expectancy for those with obesity.

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

A client weighs 215 lbs and is 5' 8" tall. The nurse calculate this client's body mass index (BMI) as what? 32.7 19.5 44.9 24.8

Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703. The result would be 32.7.

A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply. Total cholesterol Blood pressure Waist circumference Weight BMI

Weight BMI Waist circumference Explanation: Weight, BMI, and wait circumference are used to measure obesity. Blood pressure and cholesterol may be used in the client with obesity; however, these do not diagnose obesity.

The nurse establishes a learning contract with an overweight client. The contract is best if it includes an incremental goal of 1-2 pound weight loss this week has an overall goal of 30-pound weight loss in six months contains an agreement to ingest a well-balanced diet is an oral contract between the nurse and the client

includes an incremental goal of 1-2 pound weight loss this week Explanation: The learning contract is recorded in writing. It is to be clear and describe what is to be achieved. A well-balanced diet is too vague. The nurse provides frequent and positive reinforcement as the client moves from one goal to the next. It is easier for the client to achieve a smaller, obtainable goal, such as 1-2 pound weight loss in one week, versus 30 pounds in 6 months.

Understanding the definition of eating disorders is important in communicating facts while managing these conditions. Which is not an eating disorder? anorexia nervosa binge eating bulimia nervosa obesity

obesity Explanation: Anorexia nervosa, bulimia nervosa, binge eating, and compulsive overeating are eating disorders. Obesity is a consequence of overeating.

A nurse geneticist is researching the gut microbiome and its relationship to disease. What is true regarding the microbiome? It has over 10 times more genes than the human genome. It has over 100 times more genes than the human genome. Its function has yet to be discovered. It is less diverse than human genome.

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

A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has? Rheumatoid arthritis Inflammatory arthritis Osteoarthritis Necrotizing arthritis

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

A nurse examines the socioeconomic impact of obesity among Americans. Which statements does the nurse understand is true? Select all that apply. Those with less education are impacted at a greater prevalence of disease. Education is not related to the prevalence of disease. Income is not related to the prevalence of disease. Those with less income are impacted at a greater prevalence of disease. Those who own their own homes have a decreased prevalence of disease.

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

A nurse is caring for a client with a BMI of 35 kg/m2 who is wanting to lose weight. What is the initial recommendation the nurse will expect from the client's health care provider? Nonsurgical interventions Lifestyle modification Surgical interventions Pharmacological management

Lifestyle modification Explanation: All answer choices represents the various treatment for obesity; however, lifestyle modification is the initial recommendation for weight loss.

The nurse is teaching a group of clients with obesity about the risks of disease associated with obesity. Which respiratory conditions or diseases will the nurse include in the teaching, which are associated with obesity? Select all that apply. Infection Obstructive sleep apnea Emphysema Central sleep apnea Asthma

Asthma Infection Obstructive sleep apnea Explanation: Respiratory conditions associated with obesity include asthma, obstructive sleep apnea, and respiratory infections. Central sleep apnea and emphysema are not obesity-related conditions.

A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face? Both low metabolism and high metabolism Both undernutrition and sedentary lifestyles Both undernutrition and obesity Both obesity and scare food sources

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

The nurse cares for a client with obesity and discusses the increased risk of certain cancers related to obesity. Which cancers will the nurse include in the teaching? Select all that apply. Colorectal Breast Skin Brain Cervical

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

A nurse caring for a client with obesity recognizes the client is at risk for renal complications related to obesity. Which disease or condition is associated with obesity? Renal cancer Glomerulonephritis Nephrolithiasis Rhabdomyolysis

Renal cancer Explanation: Renal cancer is associated with obesity. Rhabdomyolysis, glomerulonephritis, and nephrolithiasis are all renal conditions; however, these are not directly associated with obesity.

A client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response? "This is an expected finding with this medication." "Taking this medication with meals decreases this symptom." "How much water are drinking?" "Your dose may need to be adjusted."

"This is an expected finding with this medication. explanations: "Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, causes dry mouth. This is an expected and normal finding. Increasing fluid intake does not make this symptom go away. The other answer choices are incorrect.

A nurse works in a bariatric clinic and cares for client with obesity who will or have undergone bariatric surgery. What is the nurse's understanding of how the procedure works? Impairs gastric motility. Restricts the client's ability to digest fat. Impairs caloric absorption. Restricts the client's ability to eat.

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

A nurse cares for a client with obesity who is also diagnosed with depression. Which medication does the nurse expect the health care provider will prescribe, which also aids in weight loss? Nortriptyline Bupropion Doxepin Amitriptyline

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

A nurse researches the cost and financial impact of obesity in America. What is the annual health care cost tied to obesity? $118 billion $1 trillion $147 billion $3 trillion

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

A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population? "You should avoid pregnancy for at least 9 months after surgery" "After surgery, your ability to conceive is decreased considerably." "You should avoid pregnancy for at least 18 months after surgery." "After surgery, contraceptives have much less efficacy."

"You should avoid pregnancy for at least 18 months after surgery." Explanation: When teaching a female of childbearing age regarding precautions after bariatric surgery, the nurse should instruct the client to avoid pregnancy for at least 18 months after surgery. The ability to conceive after weight loss surgery may improve more often than worsen. Contraceptives are no less effective after surgery than before.

A client is scheduled for a Roux-en-Y bariatric surgery. When teaching the client about the surgical procedure, which statement will the nurse use? "85% of the stomach is removed surgically, leaving a much smaller tube-like structure." "The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." "A prosthetic device binds the stomach and creates a very small pouch and restricts oral intake." "The stomach is stapled to a very small pouch and the entire small intestine is rerouted.

"The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." Explanation: In Roux-en-Y bariatric surgery, a horizontal row of staples across the fundus of the stomach creates a pouch with a capacity of 20 to 30 mL. The jejunum is divided distal to the ligament of Treitz, and the distal end is anastomosed to the new pouch. The proximal segment is anastomosed to the jejunum.

A nurse cares for a client who wants to know more information about bariatric surgery. The client asks the nurse, "What weight loss can I expect?" What is the nurse's best response? "Expect to lose 45-50% of total body weight 2 to 3 years postoperatively." "Expect to lose 10-35% of total body weight 2 to 3 years postoperatively." "Expect to lose 50 pounds in the first month after surgery." "Expect to lose 10-35 pounds in the first month after surgery."

"Expect to lose 10-35% of total body weight 2 to 3 years postoperatively." Explanation: When discussing weight loss expectations with the client, the nurse should let the client know to expect to lose 10-35% of total body weight 2 to 3 years postoperatively. The client may lose a large amount of weight the first month after surgery; however, this is not generally quantified with exact numbers or ranges.

A client who is 6 months postoperative bariatric surgery tells the nurse, "I hate what my body looks like now. All these skin folds really bother me." What is the nurse's best response? "Why would you say that? You look great!" "You can change how you look." "You are not alone in having these feelings." "Why are you dissatisfied?"

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

The nurse plans care for a client with obesity. What does the nurse recognize is the primary pathophysiological reason clients with obesity are at greater risk for developing thromboembolism? Increased blood viscosity Increased fat accumulation in the blood Impaired clotting Compromised peripheral blood flow

Compromised peripheral blood flow Explanation: A client with obesity is at increased risk for developing thromboembolism due to compromised blood flow and resulting venous stasis. Although the client with obesity is at risk for high cholesterol levels, increased fat in the blood does not directly impact the risk for developing thromboembolism. Increased blood viscosity and impaired clotting do not typically occur in obesity and are not the reason a client with obesity would be at greater risk for developing thromboembolism.

A nurse cares for a client with obesity who reports taking "a medication of weight loss" but cannot remember the name of it. The client also reports nervousness and feeling "jittery". Which medication is the client most likely taking? Phentermine Lorcaserin Naltrexone/bupropion Orlistat

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

A nurse cares for a client with obesity who is scheduled to undergo vagal blocking therapy. When teaching the client about the procedure or device, which statements will the nurse include? Select all that apply. "It is a pacemaker-type device that is implanted under your skin." "Recharge the device two times per week." "A pre-programed pulsating signal is delivered." "It is a stent-like device that is inserted into your vein." "A liquid medication is slowly delivered."

"It is a pacemaker-type device that is implanted under your skin." "A pre-programed pulsating signal is delivered." "Recharge the device two times per week." Explanation: Vagal blocking therapy involves placement of a pacemaker-like device into the subcutaneous tissue in the lateral thoracic cavity with two leads that are laparoscopically implanted at the point where the vagus nerve truncates, at the gastroesophageal junction. A pre-programed pulsating signal is delivered, "blocking" the vagus nerve. This leads to decreased gastric contraction and emptying, limited ghrelin secretion, and diminished pancreatic enzyme secretion; these cause increased satiety, decreased cravings, and diminished absorption of calories, all of which lead to weight loss.

A nurse reviews with the client the various types of medications used to treat diabetes. Which statement will the nurse use when teaching the client about liraglutide's mechanism of action? "It causes delayed gastric emptying." "It diminishes intestinal absorption and metabolism of fats." "It stimulates central 5-HT2C receptors." "It stimulates central noradrenergic receptors."

"It causes delayed gastric emptying." Explanation: Liraglutide (Saxenda), a GLP-1 receptor agonist, delays gastric emptying, curbing appetite. Gastrointestinal lipase inhibitors (orlistat/Xenical), diminishes intestinal absorption and metabolism of fats. The selective serotonergic 5-HT2C receptor agonist stimulates central 5-HT2C receptors, causing appetite suppression. Sympathomimetic amines stimulate central noradrenergic receptors, causing appetite suppression.

The nurse provides care to a menopausal client, who states, "I read a news article that says I am at risk for coronary vascular disease due to inflammation." Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis? Taking a daily multivitamin Addressing obesity Drinking at least 2 liters of water a day Avoiding use of caffeine

Addressing Obesity Explanation: The 2019 ACC/AHA Guideline on the Primary Prevention of Coronary Vascular Disease (CVD) indicates a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests that decreasing obesity and body fat stores via exercise, dietary modification, or developing drugs that target proinflammatory proteins may reduce risk factors for heart disease. The risk for CVD accelerates for clients after menopause due to withdrawal of endogenous estradiol levels, which can worsen many traditional CVD risk factors, including body fat distribution. Avoiding the use of caffeine, using a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to atherosclerosis.

A nurse cares for a client who is post op bariatric surgery and the nurse offers the client a sugar-free beverage. What is the primary purpose of offering a sugar-free beverage? These ease gastric distention. These are less likely to cause dumping syndrome. These are less likely to raise the blood sugar. These ease nausea.

These are less likely to cause dumping syndrome. Explanation: The primary purpose of offering a sugar-free beverage is that they are less likely to cause dumping syndrome in the client who is post op from bariatric surgery. Sugar-free beverages are less likely than sugary beverages to raise the blood sugar; however, this is not the primary purpose of offering the sugar-free beverage. Sugar-free beverages do not necessarily ease nausea or gastric

A client who is obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states "You need to work harder to achieve your goal." "You have succeeded in making positive progress." "You are not achieving satisfactory weight loss." "We will have to re-evaluate your goal."

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

A nurse is reviewing the medical records of several patients and their risk for health problems. The nurse determines that the patient with which body mass index (BMI) would have the lowest risk? 23 28 31 18

23 Explanation: Patients with a BMI of 23 would have the lowest risk for health problems. Those with a BMI of 18 might have the increased risk associated with poor nutritional status. Those with a BMI of 28 are considered overweight, and those with a BMI of 30 to 39 are considered obese. Both of these groups have an increased risk for health problems.

The nurse observes that a client's medical report indicates that the client has Cushing syndrome. During inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. Which of the following must the nurse keep in mind while planning the client's care? The nurse knows that a waist circumference of 40 places the client at risk. The nurse instructs the client to remember all food consumed over the next 24-hour period. The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment. Knowing that the client is obese, the nurse plans to provide dietary education to reduce the daily caloric intake using the U.S. Department of Agriculture's MyPlate pyramid. A BMI of 31 indicates obesity, and the nurse instructs the patient to keep a record of food actually consumed over the next 3 to 7 days.

The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment.

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

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

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is: pancreatitis hepatitis A acute cholecystitis hepatitis B

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