Chapter 42: Assessment and Management of Patients 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." "How much water are drinking?" "Taking this medication with meals decreases this symptom." "Your dose may need to be adjusted."

"This is an expected finding with this medication." Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, causes dry mouth.

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

"You should avoid pregnancy for at least 18 months after surgery."

At its most fundamental level, what does obesity result from? A metabolic imbalance A hormone imbalance A genetic alteration A lifestyle imbalance

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

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

Stimulate GI peristalsis

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

A client is scheduled for a Roux-en-Y bariatric surgery. When teaching the client about the surgical procedure, which statement will the nurse use? "The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." "A prosthetic device binds the stomach and creates a very small pouch and restricts oral intake." "85% of the stomach is removed surgically, leaving a much smaller tube-like structure." "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." 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 researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face? Both undernutrition and obesity Both low metabolism and high metabolism Both obesity and scare food sources Both undernutrition and sedentary lifestyles

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

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

Cyclosporine

A nurse teaches a client with obesity on the various types of bariatric surgical procedures. Which procedures will the nurse include when discussing restrictive procedures only? Select all that apply. Gastric banding Sleeve gastrectomy RYGB Biliopancreatic diversion with duodenal switch Total gastrectomy

Gastric banding Sleeve gastrectomy Gastric banding and sleeve gastrectomy are both bariatric surgical procedures that are considered restrictive procedures. RYGB and biliopancreatic diversion with duodenal switch are combined restrictive and malabsorptive procedures. Total gastrectomy is not a procedure used for bariatric surgery.

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

Hypertension Coronary artery disease Heart failure Myocardial infarction

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

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

A client with obesity is diagnosed with type 2 diabetes. In order to promote weight loss in the client and aid in glucose management, which medication will the nurse anticipate the health care provider ordering? Metformin Glipizide Glyburide Pioglitazone

Metformin Metformin (Glucophage) is a diabetes medication that also promotes weight loss.

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

Osteoarthritis is an obesity-related musculoskeletal condition.

A nurse researcher examines the risk factors of obesity. Which statements does the nurse find true? Select all that apply. Risk factors that identify the odds of being diagnosed with obesity are not clearly defined. Risk factors that identify the odds of being diagnosed with obesity are predictable and defined. Causes of obesity are complex and multifactorial. Obesity increases the risk of mortality. Obesity decreases the overall life expectancy.

Risk factors that identify the odds of being diagnosed with obesity are not clearly defined. Causes of obesity are complex and multifactorial. Obesity increases the risk of mortality. Obesity decreases the overall life expectancy.

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

A nurse cares for an obese client who wants more information about naltrexone/bupropion to help with weight loss. Which medical conditions does the nurse recognize as contraindications to this medication? Select all that apply. Uncontrolled hypertension History of alcohol abuse History of bulimia Epilepsy Asthma

Uncontrolled hypertension History of alcohol abuse History of bulimia Epilepsy Naltrexone/bupropion (Contrave) inhibits central opioid receptors and inhibits reuptake of dopamine and norepinephrine selectively, resulting in diminished appetite and cravings. This medication is contraindicated in clients with uncontrolled hypertension, history of alcohol abuse, history of eating disorders, or epilepsy.

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? "Sit in a semi-recumbent position while eating." "Keep the head of your bed propped on blocks at night." "Avoid taking non-steroidal anti-inflammatory drugs." "Avoid taking antacid drugs."

"Avoid taking non-steroidal anti-inflammatory drugs."

A nurse prepares community teaching on healthy lifestyle modifications to a group of older adults. When discussing obesity rates of older adults in comparison with the rest of the population, what will the nurse include? "Older adults have a greatly reduced prevalence of obesity in comparison to the general population." "Older adults have a slightly reduced prevalence of obesity in comparison to the general population." "Older adults have a slightly higher prevalence of obesity in comparison to the general population." "Older adults have the same prevalence of obesity in comparison to the general population."

"Older adults have a slightly higher prevalence of obesity in comparison to the general population."

A nurse prepares nutrition education for a client who will undergo bariatric surgery. What nutrition suggestion best indicates a beneficial effect on the number and quality of bowel movements the client may have after surgery? Increase fluid intake Avoid high-fat foods Eat a wide variety of foods Increase protein intake

Avoid high-fat foods Reducing the amount of fat will have a direct beneficial effect on the number and quality of bowel movements a client may have.

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 complex carbohydrates." "Increase your intake of monounsaturated fats." "Increase your intake of plant-based proteins." "Increase your intake of fluids at meals."

"Increase your intake of plant-based proteins." The client should be advised to increase protein intake, particularly plant-based protein because animal-based protein may not be tolerated well.

A nurse cares for a client who has secondary obesity. Which condition is the most likely to result in secondary obesity? Cushing's disease Addison's disease Grave's disease Crohn's disease

Cushing's disease Cushing's disease, results from excess cortisol in the blood. This increases the risk of obesity.

Place the pathophysiological steps in order for the normal role of leptin as it relates to hunger and satiety. Increased leptin Increased satiety Increased fat stores Inhibition of food intake

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

A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity? 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. 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. 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? Rapid gastric dumping Excessive fat intake Decreased motility Decreased gastric size

Rapid gastric dumping Rapid gastric dumping may lead to steatorrhea, excessive fat in the feces.