Chapter 48: Assessment and Management of Patients with Obesity

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? "Take the medication at night before bedtime." "Take the medication with a full glass of water." "Do not drink alcohol while taking this medication." "Do not drive while taking this medication."

"Do not drink alcohol while taking this medication." The nurse should tell the client to avoid drinking alcohol while taking this medication. The other answer choices do not pertain to education specific to this medication.

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

"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. 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 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 stimulates central noradrenergic receptors." "It diminishes intestinal absorption and metabolism of fats." "It stimulates central 5-HT2C receptors." "It causes delayed gastric emptying."

"It causes delayed gastric emptying." 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.

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 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." "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 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 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." "Your dose may need to be adjusted." "How much water are drinking?" "Taking this medication with meals decreases this symptom."

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

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

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

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

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

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

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

Calculate the BMI of a client who is 180 pounds and is 5 feet 2 inches tall. Round to one decimal point.

32.9 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 29 kg/m2 34 kg/m2 35 kg/m2

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

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. The other diseases or conditions listed most likely causes weight loss, not weight gain.

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

Dizziness Tachycardia Sweating 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. Which medication that the client takes may be contributing to the client's obesity? Metformin Topiramate Gabapentin Bupropion

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

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

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 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? Lorcaserin Orlistat Benzphetamine Liraglutide

Liraglutide Liraglutide (Saxenda), a GLP-1 receptor agonist, is used for both the treatment of obesity and type 2 diabetes. The other medications are used for the treatment of obesity only.

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? Glyburide Metformin Glipizide Pioglitazone

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

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

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

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

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. "Chew your food thoroughly." "Avoid eating tough foods." "Eat slowly." "Eat bland foods such as doughy bread." "Avoid eating overcooked meats."

"Eat slowly." "Chew your food thoroughly." "Avoid eating tough foods." "Avoid eating overcooked meats." Dysphagia means "difficulty swallowing." This complication may occur after restrictive bariatric surgery and tends to be most severe 4 to 6 weeks after surgery and persists for up to 6 months. The nurse should instruct the client to chew thoroughly and eat slowly. Advise the client to avoid eating tough foods, doughy breads, and overcooked meats.

A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help the 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 decrease carbohydrate absorption." "It decreases your appetite." "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." Orlistat (Xenical) works to bind to gastric and pancreatic lipase to prevent the digestion of 30% of ingested fat, thereby decreasing caloric intake.

A nurse examines the socioeconomic impact of obesity among Americans. Which statements does the nurse understand is true? Select all that apply. Income is not related to the prevalence of disease. Education is not related to the prevalence of disease. Those with less education are impacted at a greater 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 education are impacted at a greater prevalence of disease. Those with less income are impacted at a greater prevalence of disease. The socioeconomic disparities of obesity among Americans is great. In general, those who are less educated and earn less income are more likely to have obesity. Home ownership does not decrease the prevalence of obesity.

A client with obesity is suspected of having nonalcoholic fatty liver disease. Which diagnostic labs does the nurse anticipate the client needing? Select all that apply. Triglycerides Glycosylated hemoglobin Aspartate aminotransferase Alanine aminotransferase Fasting glucose

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

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

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

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. Heart failure Hypertension Heart murmur Coronary artery disease Myocardial infarction

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

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 Class II obesity Overweight Normal weight

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

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

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

A nurse 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 Pharmacological management Nonsurgical interventions Surgical interventions

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

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

A 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? "After surgery, your ability to conceive is decreased considerably." "After surgery, contraceptives have much less efficacy." "You should avoid pregnancy for at least 18 months after surgery." "You should avoid pregnancy for at least 9 months after surgery"

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

A 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. Recording drainage amount How to change the drain When to contact the health care provider How to empty the drain How to measure the drainage amount

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

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. Impairment of peripheral blood flow Blood stasis Formation of a thrombus Increased adipose tissue

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

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

Low Fowler's 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 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 Chronic obstructive pulmonary disease Anemia Diabetes mellitus

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

A nurse 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 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 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 obesity and scare food sources Both undernutrition and sedentary lifestyles Both undernutrition and obesity Both low metabolism and high metabolism

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

A nurse cares for a client who is 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? Absorption of food Fear of eating Size of the stomach Taste of food

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

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

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

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 remains undigested in your stomach." "The fat is passed in your stools."

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

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 Compromised peripheral blood flow Increased fat accumulation in the blood Impaired clotting

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

The nurse 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. Unilateral neglect Impaired skin integrity Deficient fluid volume Impaired gas exchange Bowel incontinence

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

A 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 the release of neuropeptide y, which leads to feelings of satiety. It signals the release of ghrelin, which increases feelings of hunger. It signals the GI system to slow gastric motility. It signals higher neural pathways that lead to eating behaviors.

It signals higher neural pathways that lead to eating behaviors. 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.

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 Prophylactic anticoagulation only Mechanical compression only Early ambulation only

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

A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity? A single gene mutation is responsible for the epidemic. Over time, we have become efficient in food storage and deposition of fat stores. 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? Excessive fat intake Rapid gastric dumping Decreased motility Decreased gastric size

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

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." "Avoid taking antacid drugs." "Keep the head of your bed propped on blocks at night." "Avoid taking non-steroidal anti-inflammatory drugs."

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

A nurse 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 Orlistat Naltrexone/bupropion

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

A nurse 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? Glomerulonephritis Rhabdomyolysis Nephrolithiasis Renal cancer

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

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 ease nausea. These are less likely to raise the blood sugar.

These are less likely to cause dumping syndrome. 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 distention.

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 digest fat. Restricts the client's ability to eat. Impairs gastric motility. Impairs caloric absorption.

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