Ch. 48 Assessment & mgmt of pts w/ obesity
A public health nurse plans teaching on the neurological morbid diseases and conditions associated with obesity. Which diseases or conditions will the nurse identify in the teaching? Select all that apply.
Alzheimer disease Anxiety Depression Stroke Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1359.
A nurse prepares nutrition education for a client who will undergo bariatric surgery. What nutrition suggestion best indicates a beneficial effect on the number and quality of bowel movements the client may have after surgery?
Avoid high-fat foods Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1371.
A nurse cares for a client with a BMI of 40 kg/m2. Which gastrointestinal condition or disease does the nurse recognize is associated with the client's BMI?
Colorectal cancer
The nurse plans care for a client with obesity. What does the nurse recognize is the primary pathophysiological reason clients with obesity are at greater risk for developing thromboembolism?
Compromised peripheral blood flow
A nurse cares for a client with obesity. Which medication that the client takes may be contributing to the client's obesity?
Gabapentin
After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching?
"I need to drink 8 oz of water before eating."
A nurse working with clients with obesity understands that the hypothalamus plays an important role in hunger and satiety. Which statement best describes the role of the hypothalamus in hunger and satiety?
It signals higher neural pathways that lead to eating behaviors. Chapter 48: Assessment and Management of Patients with Obesity - Page 1360 The hypothalamus signals higher neural pathways that lead to eating behaviors. The hypothalamus does not signal the release of ghrelin or neuropeptide y, nor does it signal the GI system to slow gastric motility.
Which of the following factors may contribute to rapid and shallow respirations in a postoperative client? Select all that apply.
Pain Constricting dressings Abdominal distention Obesity Hinkle, J. L., Cheever, K. H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 19: Postoperative Nursing Management, p. 464.
A nurse cares for older adults with obesity and understands that this particular population is impacted differently than the general population. What does the nurse understand is true regarding older adults with obesity? Select all that apply.
They are at greater risk for falls. They are admitted to nursing homes more than other older adults. They have lower SpO2 levels.
A client who is post op from bariatric surgery tells the nurse, "I love cereal for breakfast. Do you have recommendations for which kind I should eat?" How should the nurse respond?
"Choose a cereal with less than 2 grams of fiber per serving."
A nurse cares for an obese client taking phentermine for weight loss. What client teaching will the nurse include when discussing precautions about the medication?
"Do not drink alcohol while taking this medication."
A nurse provides nutritional teaching to a client who is scheduled to have bariatric surgery. Which statements will the nurse include on fluid intake after the procedure? Select all that apply.
"Drink plenty of water." "Avoid drinking liquid calories." "Drink frequent, small amounts of liquids." "Drink liquids 30-60 minutes after eating." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1372.
A nurse is educating a client who will undergo bariatric surgery on methods to prevent dysphagia. What teaching will the nurse include? Select all that apply.
"Eat slowly." "Chew your food thoroughly." "Avoid eating tough foods." "Avoid eating overcooked meats."
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:
"I should become involved in a weight loss program."
A nurse is caring for a client who will undergo bariatric surgery. Which nutritional recommendation will the nurse include in the client teaching?
"Increase your intake of plant-based proteins."
A nurse is teaching a group of adults on the risks of obesity on neurological health. What statement will the nurse include in the teaching regarding obesity and the risk for developing Alzheimer disease?
"Individuals with obesity are twice as likely to develop Alzheimer disease than those who do not have obesity."
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." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
A client with obesity will undergo intragastric balloon therapy for weight loss. What teaching will the nurse include when educating the client about this procedure? Select all that apply.
"The balloon will remain in place for 3 to 6 months." "Nausea and vomiting are the most commonly reported side effects." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1366.
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 nurse researches the cost and financial impact of obesity in America. What is the annual health care cost tied to obesity?
$147 billion
A client who is obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states
"You have succeeded in making positive progress." Hinkle, J. L., Cheever, K. H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 9: Chronic Illness and Disability, p. 148.
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." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1373.
A nurse caring for adults with obesity recognizes that obesity is classified based on BMI. Which BMI does the nurse recognize as Class II obesity?
35 kg/m2
A nurse working in a bariatric clinic assesses various clients with obesity. Which clients will the nurse recognize as meeting the selection criteria for bariatric surgery? Select all that apply.
48-year-old female with BMI 36 k/m2 and uncontrolled type 2 diabetes. 34-year-old male with BMI 30 k/m2 and metabolic syndrome with hypertension. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1369.
A nurse plans care for a client who is post op bariatric surgery. Which nursing diagnosis will be the priority?
Acute pain related to surgical procedure Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1371.
The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis?
Addressing obesity Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Risk Factors, p. 851.
The nurse cares for clients with obesity and understands that causes are multifactorial. What factors contribute to the development of obesity? Select all that apply.
Behavior Environment Physiology Genetics
A white female client is admitted to an acute care facility with a diagnosis of stroke. Her history reveals bronchial asthma, exogenous obesity, and iron-deficiency anemia. Which history finding is a risk factor for stroke?
Being obese Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Chart 67-2, p. 2014.
A nurse cares for clients who undergo bariatric surgery due to obesity. When teaching the client on the most successful surgery in clients with very high BMI's, which procedure will the nurse mention?
Biliopancreatic diversion with duodenal switch
The nurse cares for a client with obesity and discusses the increased risk of certain cancers related to obesity. Which cancers will the nurse include in the teaching? Select all that apply.
Breast Colorectal Cervical
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 Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?
Degenerative joint disease
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. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Figure 48-1, p. 1359.
A nurse cares for a client with sepsis who had bariatric surgery two weeks ago. What is the most likely source of the sepsis?
Disruption at the site of anastomosis. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1371.
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 Tachycardia
A client who is postoperative bariatric surgery is diagnosed with bile reflux. Which conditions are associated with bile reflux? Select all that apply.
Gastritis Esophagitis
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 Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1363.
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.
Multiparous Obese Eating a high fat diet Female gender Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Pathophysiology, p. 1431.
A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns?`
Obesity along with conditions associated with it has become a major health concern.
A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns?
Obesity along with conditions associated with it has become a major health concern. Hinkle, J. L., Cheever, K. H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing , 14th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 1: Health Care Delivery and Evidence-Based Nursing Practice, p. 6.
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 male client in a wheelchair comes in for his yearly physical examination. He is unable to stand. The nurse retrieves the wheelchair scale to obtain an accurate weight. The nurse understands the importance of this assessment with this client. What is the nurse's reasoning for obtaining an accurate weight?
People with disabilities have an increased incidence of obesity.
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 Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1372.
Which hormones released throughout the gastrointestinal tract promote satiety? Select all that apply.
Somatostatin Cholecystokinin Insulin Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1360.
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
A client who is postoperative from bariatric surgery is diagnosed with bile reflux after reports of severe epigastric pain and vomiting of bilious material. What statements are true regarding this condition? Select all that apply.
Usually occurs after disruption of the pylorus. Symptoms are usually relieved after pharmacological treatment. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1373.
Understanding the definition of eating disorders is important in communicating facts while managing these conditions. Which is not an eating disorder?
obesity
A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client?
Age Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Chart 31-1, p. 887.
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 Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1369.
A community health nurse prepares teaching regarding gut health and the impact on obesity. What will the nurse include on how the "Western diet" impacts gut health? Select all that apply.
"This diet decreases the diversity of gut microbes." "This diet decreases the gut microbes that lead to a leaner body." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1361.
An obese client describes symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm the suspected diagnosis. What diagnostic procedure would the nurse expect to be prescribed?
transesophageal echocardiography Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 25: Assessment of Cardiovascular Function, p. 702.
A nurse reviews a client's medication list and notes the client takes orlistat for the treatment of obesity and to promote weight loss. Which client teaching will the nurse include that best promotes health in the client taking this medication?
"Make sure and take a daily multivitamin." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Pharmacologic Therapy, p. 1364.
A nurse cares for a client with obesity who takes anticonvulsant medication for the treatment of epilepsy. Which anticonvulsant medications may be contributing to the client's obesity? Select all that apply.
Carbamazepine Gabapentin
A nurse is caring for a client who is post operative bariatric surgery. The client's pain has not been well controlled. Which nursing diagnosis is the nurse's priority?
Risk for impaired gas exchange Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1371.
A nurse researcher evaluates the epidemiology of obesity among gender and ethnicity of adults in the United States. Which findings correlate with data the nurse researcher finds? Select all that apply.
Among women, the highest prevalence of obesity is among non-Hispanic blacks. Among men, the highest prevalence of obesity is among Hispanics. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1359.
A nurse researcher investigates why clients with obesity who have lost weight often regain the weight. The nurse looks at the relationship of leptin and its role in weight gain. What does the nurse determine is true regarding leptin and weight gain? Select all that apply.
Drops in leptin level increases hunger. Leptin signals satiety in the hypothalamus. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1360.
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.
Asthma Infection Obstructive sleep apnea Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1359.
A nurse cares for a client who is 36 hours postoperative from bariatric surgery and is suspected of having a hemorrhage related to the procedure. What is the nurse's understanding of the most likely cause of the hemorrhage?
Disruption of a staple Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1372.
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. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1361.
A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response?
"The fat is passed in your stools."
A client with obesity is suspected of having nonalcoholic fatty liver disease. Which diagnostic labs does the nurse anticipate the client needing? Select all that apply.
Aspartate aminotransferase Alanine aminotransferase Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1362.
Place the physiological processes in order that are involved in feelings of satiety and hunger.
Fasting Release of ghrelin and neuropeptide y Stimulation of appetite through the CNS Eating behaviors signaled Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1360.
A nurse caring for clients with obesity understands these clients are at increased risk for developing pressure ulcers. What does the nurse recognize increases the client's risk for developing pressure ulcers? Select all that apply.
Increased adipose tissue decreases the supply of blood, oxygen, and nutrients to peripheral tissue. Skin folds are associated with more moisture and friction.
Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome?
Rimonabant (Acomplia) Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018.
A health care provider recommends behavior interventions for a client with obesity. What does the nurse understand is most effective behavioral intervention for clients with obesity?
High intensity Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1362.
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.
Hyperlipidemia Obesity Tobacco use Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Chart 27-1, p. 752.
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
Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply.
Hypertension Obesity Family history Age greater of 45 years or older History of gestational diabetes Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Chart 51-1, p. 1457.
Place the pathophysiological steps in correct order for the development of dumping syndrome.
Hypertonic food bolus from the stomach to the small intestine Release of metabolic peptides Tachycardia, dizziness, sweating, nausea, vomiting, bloating, abdominal cramping, and diarrhea Rapid rise of glucose, release of insulin, reactive hypoglycemia Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1373.
A client who is post op from bariatric surgery experiences dumping syndrome. What is the nurse's understanding of the cause of this condition?
Hypertonic food releases metabolic peptides. Chapter 48: Assessment and Management of Patients with Obesity - Page 1373 The previous theory behind dumping syndrome was that the hypertonic food bolus drew extracellular fluid from the blood into the small intestines, causing symptoms. This theory has since been challenged and the newest theory suggests the rapid release of metabolic peptides that release from the hypertonic food bolus causes dumping syndrome symptoms.
What pathophysiological concept is related to the increase in the hormone leptin, as it relates to satiety and hunger?
Increased adipose stores
Place the pathophysiology of obesity in the correct order.
Increased body fat Adiposopathy Release of biochemical mediators Chronic inflammation Disease Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1360.
The nurse working with clients who have obesity understand that gut microbes perform numerous digestive, metabolic, and immunologic functions. What is the nurse's understanding of how these microbes contribute to obesity? Select all that apply.
Individuals with obesity have less diverse gut microbes than those of normal weight. Specific gut microbes have been linked to a leaner body shape. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1361.
A client who is post op from bariatric surgery reports constipation. What is the most likely cause of the client's symptoms?
Insufficient water intake
A nurse works in a community clinic that treats clients with obesity. The nurse understands that obesity is considered a disease based on what characteristics? Select all that apply.
It impairs normal body function It has characteristic signs and symptoms It causes morbidity
A nurse cares for older adult clients with obesity and understands that older adults have greater risk for developing obesity than the general population. What pathophysiological concepts contribute to this? Select all that apply.
Lean skeletal mass decreases as an individual ages. Adipose tissue increases as an individual ages. Metabolism decreases as an individual ages. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1366.
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?
Lifestyle modification
A nurse cares for a client with obesity who has type 2 diabetes. Which medication does the nurse recognize may assist in weight loss and is also approved to treat type 2 diabetes?
Liraglutide
A client has just received a diagnosis of hypertension after the completion of diagnostics. What can the client do to decrease the consequences of hypertension? Select all that apply.
Lose weight. Manage stress effectively
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
A nurse is reviewing the health history of a client who has been diagnosed with endometrial cancer. Which of the following would the nurse identify as a factor increasing this client's risk? Select all that apply.
Obesity Nulliparity Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Chart 57-9, p. 1709.
A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has?
Osteoarthritis
A nurse researcher analyzes data trends of obesity in both the United States and globally. What statistics does the nurse determine is true regarding the epidemiology of obesity? Select all that apply.
Over 600 million adults have obesity worldwide The prevalence of obesity has more than doubled since 1975 The prevalence of obesity in the United States is the highest in the world Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1358.
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
A client who is post op bariatric surgery reports diarrhea. What is the most likely cause of the client's symptoms?
Poor dietary choices Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1371.
A nurse cares for an obese client taking phentermine/topiramate-ER. Which laboratory findings will the nurse recognize as most concerning and will report to the health care provider? Select all that apply.
Potassium 3.3 mEq/L Bicarbonate 19 mEq/L Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
The nurse cares for a client who is post op bariatric surgery and reports dysphagia. Which procedures are most likely to cause these symptoms? Select all that apply.
RYGB Gastric band Modified RYGB
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 Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1359.
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. Causes of obesity are complex and multifactorial. Obesity increases the risk of mortality. Obesity decreases the overall life expectancy. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1359.
A client with obesity has been taking lorcaserin for several months and presents to the health care provider's office reporting fever and diarrhea. Which life-threatening condition does the nurse suspect?
Serotonin syndrome
A nurse cares for a client who is post op bariatric surgery and the nurse offers the client a sugar-free beverage. What is the primary purpose of offering a sugar-free beverage?
These are less likely to cause dumping syndrome.
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 Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
Which group of clients is at high risk of developing breast cancer?
Women who are obese Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Table 58-3, p. 1359, 1731.
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:
acute cholecystitis Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1430.
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
A nurse teaches a client who will undergo bariatric surgery the importance of avoiding problematic foods post surgery. Which foods will the nurse suggest the client avoid? Select all that apply.
Doughy breads Overcooked meats Pasta Rice Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1371.
The nurse is admitting a client with traumatic injuries who also has class III obesity. When planning this client's care, the nurse should address the client's heightened risk of what nursing diagnoses related to obesity? Select all that apply.
Impaired skin integrity Impaired gas exchange Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Nursing Management, p. 1367.
Which clients will the nurse recognize as being at high risk for complication if taking Lorcaserin for obesity? Select all that apply.
Client with type 2 diabetes Client taking medication for migraines Client taking medication for depression Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
Place the pathophysiological steps in order for the normal role of leptin as it relates to hunger and satiety.
Increased fat stores Increased leptin Increased satiety Inhibition of food intake Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1360.
A nurse cares for clients with obesity and recognizes that clients with larger waist-to-hip ratios are at greater risk for obesity-related morbidity in comparison to others with smaller waist-to-hip ratios. What findings related to this does the nurse recognize as true? Select all that apply.
Individuals with larger waist-to-hip ratios have android obesity. Individuals with larger waist-to-hip ratios are also referred to as apple-shaped. Individuals with larger waist-to-hip ratios have larger visceral fat stores. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1362.
A nurse cares for clients with obesity who undergo bariatric surgery. Which clients will the nurse identify as having increased risk of infection after surgery? Select all that apply.
Older adults Adults with greater body mass Males Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1372.
A nurse cares for a client who has secondary obesity. Which condition is the most likely to result in secondary obesity?
Cushing's disease
A nurse provides medication teaching for a client with obesity who is prescribed Lorcaserin. Which statement will the nurse include in the teaching?
"Avoid driving heavy equipment."
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."
A nurse cares for a client who wants to know more information about bariatric surgery. The client asks the nurse, "What weight loss can I expect?" What is the nurse's best response?
"Expect to lose 10-35% of total body weight 2 to 3 years postoperatively."
A nurse evaluates the effectiveness of discharge teaching for a client who is postoperative from bariatric surgery. Which statement made by the client indicates to the nurse that additional teaching is necessary?"
"For minor pain, I should take prescribed ibuprofen."
A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include?
"It binds with enzymes to help prevent digestion of fat." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
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." "A pre-programed pulsating signal is delivered." "Recharge the device two times per week."
A nurse prepares community teaching on healthy lifestyle modifications to a group of older adults. When discussing obesity rates of older adults in comparison with the rest of the population, what will the nurse include?
"Older adults have a slightly higher prevalence of obesity in comparison to the general population." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1366.
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." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
A client who is 6 months postoperative bariatric surgery tells the nurse, "I hate what my body looks like now. All these skin folds really bother me." What is the nurse's best response?
"You are not alone in having these feelings." Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1372.
The nurse cares for a client who is post op bariatric surgery whose bowel sounds have returned and is tolerating oral intake. What teaching will the nurse provide the client about the nutrition required at this time? Select all that apply.
"You need to drink plenty of water in between meals." "Eat slowly." "You will have six small meals per day."
The nurse is providing medication administration teaching for a client with obesity who is prescribed liraglutide for weight loss. What will the nurse include in the teaching?
"You will be injecting the medication on a daily basis."
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
Calculate the BMI of a client who weighs 160 lbs and is 5 feet 6 inches tall. Round to one decimal.
25.8
What is the body mass index (BMI) of a client who weighs 195 lbs and is 6 feet tall? Round to the nearest whole number, and enter the correct number ONLY.
26
Calculate the BMI of a client who is 6 feet 1 inch tall and weighs 200 pounds. Round to one decimal.
26.4
A client weighs 215 lbs and is 5' 8" tall. The nurse calculate this client's body mass index (BMI) as what?
32.7
Calculate the BMI of a client who is 180 pounds and is 5 feet 2 inches tall. Round to one decimal point.
32.9
When discussing lifestyle modifications with a client who has obesity, what caloric deficit should the nurse recommend in order for the client to safely lose weight?
500-1,000 calories Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1363.
What statement best describes a client with severe or extreme obesity?
A BMI >40 kg/m2
A nurse cares for a client with obesity who is also diagnosed with depression. Which medication does the nurse expect the health care provider will prescribe, which also aids in weight loss?
Bupropion
A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI?
Class I obesity
The nurse is working with a client who has difficulty controlling her blood sugar. The overweight client does not adhere to a low-calorie diet and forgets to take medications and check her blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, the nurse first
Collaborates with the client to establish an agreed-upon goal Hinkle, J. L., Cheever, K. H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 9: Chronic Illness and Disability, p. 147.
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?
Document the finding. Chapter 48: Assessment and Management of Patients with Obesity - Page 1365 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 who is postoperative bariatric surgery and has experienced frequent episodes of dumping syndrome. The client now reports anorexia. What is the primary reason for the client's report of anorexia?
Fear of eating
A nurse teaches a client homecare nutrition expectations who will undergo bariatric surgery. Which foods will the nurse suggest the client keep on hand at home after surgery? Select all that apply.
Gelatin Pudding Fat-free milk
The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?
Has a weight gain of 5 pounds
Place the pathophysiological steps in order of how a client with obesity is at greater risk for venous thromboembolism in comparison to the general population.
Increased adipose tissue Impairment of peripheral blood flow Blood stasis Formation of a thrombus Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1367.
A client with obesity taking lorcaserin reports feeling agitated lately and has had diarrhea for several days. What is the nurse's priority response?
Notify the health care provider.
A nurse cares for an older adult client with obesity who also has glaucoma. Which obesity medication is contraindicated in this client?
Phentermine
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?
Restricts the client's ability to eat. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1368.
The nurse observes that a client's medical report indicates that the client has Cushing syndrome. During inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. Which of the following must the nurse keep in mind while planning the client's care?
The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment.
The nurse is teaching injection techniques for a client prescribed liraglutide for the treatment of obesity. Which areas of the body will the nurse suggest for injection sites? Select all that apply.
Upper thigh Abdomen Upper arm Lower thigh
A middle-aged female client is overweight and sedentary, has slightly elevated blood pressure, and is seeking ways to begin exercise. The client wishes to lose weight and improve her blood pressure. The nurse plans an exercise program in which the client
Walks for 30 minutes three times this week and is re-evaluated
A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply.
Weight BMI Waist circumference
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan?
Weight reduction through diet and exercise Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Lifestyle Modification, p. 1364.
A nurse is caring for a client with obesity and diabetes after abdominal surgery. What is the client at increased risk for?
Wound dehiscence
A client with obesity is interested in trying orlistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication?
Renal insufficiency
A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate?
Mechanical compression and prophylactic anticoagulation
A client with obesity is prescribed liraglutide for weight loss. Which common side effect will the nurse include in the client teaching?
Nausea
Which of the following dietary guidelines should be followed following bariatric surgery? Select all that apply.
Include two protein snacks per day. Eat slowly. Eat three meals per day. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018.
At its most fundamental level, what does obesity result from?
A metabolic imbalance Chapter 48: Assessment and Management of Patients with Obesity - Page 1360 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 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 Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1358.
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. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1359.
A nurse cares for a client with a BMI of 36 kg/m2 and nonalcoholic fatty liver disease. The client asks the nurse if he is a candidate for bariatric surgery. How should the nurse respond to the client?
"Yes, your BMI and chronic condition meets the criteria for bariatric surgery."
A nurse is planning care for a client who will undergo bariatric surgery in a week. What goals are acceptable during this point in the client's care? Select all that apply.
Client will become knowledgeable about the procedure. Client will understand preoperative and postoperative dietary restrictions. Client will have decreased anxiety about the procedure.
A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history:
Coronary artery disease Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Management of Patients With Gastric and Duodenal Disorders, Pharmacologic Therapy, p. 1364.
A nurse caring for a client who is post op bariatric surgery notes that the client has no bowel sounds and suspects the client may have a bowel obstruction. What treatment or therapy does the nurse expect the client will require?
Endoscopy Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1373.
A client who is postoperative open RYGB bariatric surgery is scheduled for discharge and will have a Jackson-Pratt drain to care for while at home. Which teaching will the nurse include specific to this? Select all that apply.
How to empty the drain Recording drainage amount When to contact the health care provider How to measure the drainage amount
Which of the following is a leading health indicator to be used to measure the health of the nation?
Overweight and obesity Hinkle, J. L., Cheever, K. H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing , 14th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 4: Health Education and Health Promotion, p. 57.
A nurse teaches a client with obesity about the various medication options for the treatment of obesity. Which medication will the nurse include when teaching the client about the class of medications that stimulate noradrenergic receptors?
Phentermine Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, p. 1365.
A nurse examines the socioeconomic impact of obesity among Americans. Which statements does the nurse understand is true? Select all that apply.
Those with less education are impacted at a greater prevalence of disease. Those with less income are impacted at a greater prevalence of disease.
