*Obesity and Malnutrition Med-Surg 102 I Evolve

The nurse is teaching a middle-aged adult patient with a body mass index (BMI) of 27.5 and a height of 5'2" about what the BMI number means. Which patient statement indicates a need for further instruction? "My goal should be to get my BMI below 18.5." "I realize that this means that I have some increased health risks." "This means that I have an increased amount of total fat stored in my body." "If I could get my BMI below 25, my risk for malnutrition would decrease."

"My goal should be to get my BMI below 18.5." The least risk for malnutrition is actually seen in adult patients whose BMI is between 18.5 and 25. Older adults should have a BMI between 23 and 27. The patient with a BMI greater than 24.9 does have increased health risks that a patient with a lower number would not have. The patient's BMI of 27.5 does mean that an increased amount of fat is stored in the body in relation to the patient's height.

A postoperative bariatric patient comes in for a four week follow-up. The patient reports feeling depressed and somewhat anxious. What statement by the nurse is most appropriate? "Do you have any feelings of harming yourself or others? Suicidal feelings can sometimes be a complication of the surgery." "I'm really sorry you're feeling this way; would you like to talk about it?" "This is a normal experience for people going through bariatric surgery; we often call it the 'hibernation phase.'" "That may be an indication that seeing a psychologist is the best thing for you; would you like us to give you a referral?"

"This is a normal experience for people going through bariatric surgery; we often call it the 'hibernation phase.'" Feelings of depression and anxiety are normal for patients after bariatric surgery; it is often called the "hibernation phase." It is important to have the patient talk about his or her feelings; however, it is also important for the patient to know that this is a normal finding. The nurse should not refer the patient directly to a psychologist because it dismisses the patient's feelings. Rather, the nurse should get to the bottom of the feelings first and then possibly give a referral. Suicidal feelings are not a complication of this surgery.

The nurse is teaching a class of older adults in the community about engaging in "regular" exercise. What does the nurse advise them?

"Walking 30 minutes provides the same benefit as long periods of exercise." Although some people think that regular exercise has to include joining a fitness program or exercising for long periods of time, simple forms of exercise like walking 30 minutes provide the same type of benefit. Older adults can engage in this type of exercise; it does not cost anything (like joining a program) and provides health benefits such as strengthening joints and improving cardiovascular health. One to two hours of cardiovascular exercise every day is not required to achieve benefits of exercise. Joining a gym is not necessary; plus, many older adults have a fixed income and cannot afford memberships. A 20-minute walk can be accomplished with a group (such as "mall walking") or alone.

A patient weighs 150 lbs and is 5 feet, 5 inches tall. What is the body mass index for this patient? Record your answer using two decimal places.

24.96 BMI = Weight (lbs) / [Height (inches)] 2 x 703, so Weight = 150 lbs, Height = 5'5" (65 inches) results in the calculation: [150 ÷ (65) 2] x 703 = 24.96.

An RN receives the change-of-shift report about these four patients. Which patient does the nurse assess first? Multiple choice question 30-year-old admitted 2 hours ago with malnutrition associated with malabsorption syndrome 45-year-old who had gastric bypass surgery and is reporting severe incisional pain 50-year-old receiving total parenteral nutrition (TPN) with a blood glucose (BG) level of 300 mg/dL 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min

75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min Aspiration is a major complication in patients receiving tube feedings, especially in patients with an altered level of consciousness. The patient with dementia who has a respiratory rate of 38 breaths/min needs respiratory assessment and interventions immediately. The patient with malnutrition associated with malabsorption syndrome, the patient with incisional pain from gastric bypass surgery, and the patient receiving TPN with a BG of 300 mg/dL all need assessments and/or interventions by the RN, but maintaining respiratory function in the patient with tachypnea is the highest priority.

The nurse is caring for four patients. Which patient has the highest risk for infection? A female patient with a BMI of 31 taking corticosteroids A male patient with a BMI of 29 prescribed antihypertensive medication A male patient with a waist circumference of 35 taking nonsteroidal anti-inflammatory drugs A female patient with a waste circumference of 38 prescribed anti-epileptic medication

A female patient with a BMI of 31 taking corticosteroids A patient with a BMI of 31 is considered obese, and corticosteroids increase the risk of infection; obese patients are more susceptible to infections and infectious disease, as are patients taking corticosteroids. The male patient with a BMI of 29 has a normal BMI. The male patient with the waist circumference of 35 is not considered obese and has no increased risk for infection. The female patient with a waist circumference of 38 is within normal range and is not considered obese.

What patient has the greatest risk of coronary artery disease secondary to obesity? A male patient with a BMI of 30 A female patient with a BMI of 29 A male patient with a waist circumference of 38 inches A female patient with the waist circumference of 37 inches

A female patient with the waist circumference of 37 inches A female patient with a waist circumference of 37 inches is at high risk for coronary artery disease. A BMI of 30 is obese, but waist circumference is a greater indicator of cardiac disease than BMI. The BMI of 29 is considered overweight, not obese. The male patient with a waist circumference of 38 inches is within the normal range.

A patient's blood test report reveals a low hematocrit level. The patient is prescribed ferrous sulfate and multivitamin supplements. The nurse should monitor the patient for what complication? Constipation

A low hematocrit level is indicative of anemia. Iron preparations, such as ferrous sulfate and multivitamins, are generally prescribed to treat anemia; however, the prolonged use of iron preparations can lead to constipation. Vitamin D is needed for the absorption of calcium from food, and calcium helps to maintain bone health; therefore, vitamin D deficiency can result in bone pain, osteomalacia, and rickets. A deficiency in niacin causes nasolabial seborrhea. The chronic use of zinc supplements can cause nausea and vomiting.

The nurse is providing medication teaching to an adult patient who is prescribed an anorectic drug for weight loss. Which finding in the patient's medical record would cause the nurse to question this drug prescription? History of hypertension

A patient history of hypertension would require the nurse to question this drug prescription. Patients with hypertension should not take anorectic drugs because they may worsen their symptoms. A history of hyponatremia and hyperglycemia is not a contraindication for the use of anorectic drugs for weight loss. A history of hyperthyroidism, not hypothyroidism, is a contraindication for the use of anorectic drugs for weight loss.

Which patient has the highest chance of successful weight loss? A patient who is having gastric restriction surgery A patient who is having Roux-en-Y gastric bypass (RNYGB) A patient who is having laparoscopic sleeve gastrectomy (LSG) A patient who is having the laparoscopic adjustable gastric band (LAGB)

A patient who is having Roux-en-Y gastric bypass (RNYGB) The patient who is having Roux-en-Y gastric bypass (RNYGB) has a 60% to 70% chance of maintaining weight loss. Gastric restriction surgery, such as laparoscopic adjustable gastric band surgery and the laparoscopic sleeve gastrectomy, often result in eventual weight gain.

A patient reports a sensation of tingling, tickling, and prickling in the fingers and toes. What does the nurse suspect as the possible reason for this patient's condition? Deficiency of vitamin B 12

A sensation of tingling, tickling, prickling in the fingers and toes indicate paresthesia, which occurs due to the deficiency of vitamin B 12 . Deficiency of vitamin A causes xerosis of conjunctiva. Deficiency of vitamin D results in osteomalacia, bone pains, and rickets. Vitamin C deficiency results in swollen and bleeding gums

Which hormone is responsible for sensitizing insulin? Leptin Ghrelin Adiponectin < Cholecystokinin

Adiponectin Adiponectin is an anti-inflammatory and insulin-sensitizing hormone. Leptin is a hormone released by fat cells and possibly gastric cells; it acts on the hypothalamus to control appetite. Ghrelin is called the "hunger hormone;" it is secreted in the stomach. Ghrelin increases in a fasting state and decreases after a meal. Cholecystokinin is a hormone that stimulates digestive juices.

The nurse is caring for a patient after bariatric surgery. What intervention does the nurse perform for this patient?

Apply an abdominal binder. An abdominal binder should be applied to the patient to prevent wound dehiscence. The patient is first given clear liquids; pureed foods and juices are given 24 to 48 hours after clear liquids are tolerated. The patient is placed in a semi-Fowler's position to improve breathing. The urinary catheter is removed within 24 hours after surgery to prevent urinary tract infection.

A patient is being evaluated prior to starting an anorectic drug. The patient's vital signs are blood pressure 155/90, pulse 88, and oxygen 95% on room air. The patient's BMI is 41, and the fasting blood glucose level is 90. The patient is currently taking methimazole and metoprolol. What action by the nurse is priority?

Ask why the patient is taking the medications. It is important to ask why the patient is taking methimazole and metoprolol; these drugs treat hypertension and hypothyroidism, which would be contraindications for taking anorectic drugs. Contacting the primary health care provider would be important after identifying those diagnoses. Retaking the blood pressure is not indicated. Asking if the patient has ever been diagnosed with diabetes is not indicated.

The nurse is providing care to a patient who is 8 hours postoperative for bariatric surgery. Which is the priority safety intervention when providing care for this patient? Monitoring for flatus Repositioning for comfort Advancing to a clear liquid diet Assessing the nasogastric tube for patency

Assessing the nasogastric tube for patency The priority nursing action during the first 24 hours postoperative period following bariatric surgery is assessing the nasogastric (NG) tube for patency. In gastroplasty procedures, the NG tube drains both the proximal pouch and the distal stomach. Monitoring for flatus, repositioning for comfort, and advancing to a clear liquid diet may all be appropriate interventions for this patient; however, the safety priority is NG tube patency.

Which statement describing the administration of drugs through a feeding tube is accurate? Drugs must first be deemed compatible with the feeding solution.

Before any drug is administered via feeding tube, it must be established that the drug is compatible with the feeding solution. Drugs must not be mixed in with the feeding solution before administration. Liquid medications are preferable unless they cause diarrhea. Most tablets can be crushed finely and dissolved in warm water before administration. However, slow-release and slow-acting tablets must not be crushed.

What is the major side effect of phendimetrazine, a sympathomimetic that is often used to suppress appetite? Nausea Loose stools Abdominal Cramps Blurred Vision

Blurred Vision Blurred vision can be a side effect of phendimetrazine ( Bontril). Loose stools, abdominal cramps, and nausea are common side effects of orlistat, which is taken for long-term treatment of obesity.

A patient has a primary problem of inadequate nutrition caused by the effects of chemotherapy. The patient is receiving continuous enteral feedings through a nasogastric (NG) tube. What does the RN ask the LPN/LVN to do for this patient? Teach the patient about the purpose of enteral feedings. Check the residual volume of the NG tube every 4 hours. Assess nutritional parameters on the patient every 3 days. Monitor the patient for signs and symptoms of pneumonia.

Check the residual volume of the NG tube every 4 hours. Checking the residual volume of the patient's NG tube every 4 hours is within the scope of knowledge and practice for the LPN/LVN. Assessing nutritional parameters on the patient, monitoring the patient for signs and symptoms of pneumonia, and teaching the patient about the purpose of enteral feedings are complex and require broad knowledge about the physiology associated with malnutrition and possible complications of tube feedings. These activities should be performed by an RN.

While assessing the history of a patient diagnosed with obesity, what information should be collected? Waist-to-hip ratio Cultural background < Developmental level < Waist circumference Body mass index (BMI)

Cultural background and developmental level should be assessed when evaluating a patient's history. Waist-to-hip ratio, body mass index, and waist circumference are part of the physical assessment.

A patient is receiving nutritional supplements to restore nutritional status. What does the nurse do to assess the effectiveness of the supplements for the patient? Makes certain the patient is weighed daily at the same time

Daily weigh-ins will best show the effects of nutritional supplements by showing how much weight the patient is regaining. Although it is important to identify everything that the patient is taking in orally, monitor vital signs, and assess for any evidence of skin breakdown, these assessments do not help determine the effects of nutritional supplements on the patient.

A patient who reports nausea, vomiting, and diarrhea is ruled out for all gastrointestinal disorders. What could be the possible reason for this patient's condition? Deficiency of pyridoxine and iron Deficiency of vitamin A and riboflavin Deficiency of pyridoxine, zinc, and niacin Deficiency of pyridoxine, riboflavin, and iron

Deficiency of pyridoxine, zinc, and niacin Nausea, vomiting, and diarrhea occur due to pyridoxine, zinc, and niacin deficiencies. Pyridoxine and iron deficiency leads to cheilosis. Vitamin A deficiency and riboflavin deficiency cause the tongue to turn magenta. Stomatitis is caused by pyridoxine, riboflavin, and iron deficiencies.

A patient is being seen one week after having gastric bypass surgery. The patient has dry mucous membranes and poor skin turgor. Vital signs are blood pressure 102/62, pulse 110, oxygen saturation 95% on room air, temperature 99.2° F. What complication should the nurse assess for? Panniculus Dehydration Dumping syndrome Pulmonary embolism

Dehydration Dehydration can occur after gastric bypass surgery and is indicated by the patient's signs and symptoms and vital signs. Panniculus, dumping syndrome, and pulmonary embolism are not consistent with the patient's symptoms or vital signs.

What teaching should be provided regarding side effects of orlistat prior to a patient starting the medication? Diarrhea Abdominal cramping

Diarrhea and abdominal cramping are common side effects of orlistat. Headaches, loss of hair, and problems with memory are not common side effects of orlistat.

A morbidly obese patient who had a laparoscopic sleeve gastrectomy two days ago reports nausea and severe abdominal cramping. The patient's vital signs are blood pressure 140/85, pulse 118, respirations 22, and oxygenation of 95% on room air. What complication does the nurse suspect? Anastomotic leak Wound dehiscence Dumping syndrome < Pulmonary embolism

Dumping syndrome The symptoms of nausea and severe abdominal cramping along with the patient's vital sign findings are consistent with dumping syndrome. Anastomotic leak, wound dehiscence, and pulmonary embolism do not have these symptoms.

A patient being treated with lorcaserin for obesity calls the health care provider's office and reports feeling depressed with suicidal thoughts. What nursing action is priority? Encourage the patient to go to the emergency room Instruct the patient to stop taking weight-loss medication Request that the patient come in for a follow-up appointment Reassure the patient that this is a normal finding during the first month of weight loss

Encourage the patient to go to the emergency room The priority is to encourage the patient to go to the emergency room because one of the side effects of lorcaserin is suicidal thoughts. Instructing the patient to stop taking the medication is important, but the priority is seeing a health care provider immediately. Suicidal thoughts are not a normal finding with this medication. The patient should not wait to follow up; the patient should be seen immediately.

A patient receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the patient most likely experiencing?

Fluid volume overload CHF and pulmonary edema are symptoms of fluid overload. Calcium imbalance, fluid volume deficit, and potassium imbalance do not manifest with CHF and pulmonary edema.

An older adult patient living in a health care facility dislikes the food. What may encourage the patient to eat? Favorite foods from home

Foods brought in by the family that reflects the cultural preferences of the patient may encourage the older adult patient to increase food intake. Nutritional supplements are often needed for patients whose nutrient intake is insufficient. Six small meals throughout the day instead of three large meals may encourage anorexic and older patients to eat. Pureed or soft foods are often used when patients experience difficulty chewing.

A patient wishes to lose 2 pounds per week. How many calories should be eliminated per day? Record your answer as a whole number. 1000 calories

For weight loss of 2 pounds per week, it is recommended to subtract 1,000 calories each day.

A patient who is three days postoperative is experiencing nausea and vomiting after eating. What intervention is priority? Order a clear liquid diet. Reinsert the nasogastric tube. Encourage the patient to drink slower. Have the patient reduce the amount of fluid she is drinking.

Have the patient reduce the amount of fluid she is drinking. Having the patient reduce the amount of fluids she is drinking should reduce nausea and vomiting likely related to too much liquid ingestion. Ordering a clear liquid diet is not indicated. Reinserting a nasogastric tube is not indicated. Encouraging the patient to drink slower will not decrease the amount of fluid.

The nurse is performing a health assessment on an obese patient who states, "I have tried many diets in an effort to lose weight, but have been unsuccessful." How does the nurse assess whether the patient's response to stress is related to the patient's obesity? "Tell me what you do to relieve stress in your daily life."

Having the patient talk about what he or she does to relieve stress allows the patient to verbalize stress-relieving mechanisms. It is also a question that cannot be answered with a simple "yes" or "no" response. Asking the patient about mental health problems will cause the patient to feel uncomfortable with the assessment; problems in handling stress do not mean mental health or depression problems. More effective methods can be used to determine the patient's alcohol and drug habits. Having the patient tell you what makes him or her uncomfortable about obesity will only cause the patient to restate the obvious; it does not determine the effect that stress has on the patient.

What does the nurse suggest to a vegan patient for adequate nutrition? Have an egg at least twice a week for protein. Consider adding refined grain to regular meals. Consume adequate amounts of fat-free milk for calcium. Include a cooked breakfast cereal fortified with vitamin B 12.

Include a cooked breakfast cereal fortified with vitamin B 12. Vegans can develop anemia as a result of vitamin B 12 deficiency; therefore, these patients should include a breakfast cereal fortified with vitamin B 12. All vegans must ensure that they get adequate amounts of calcium, iron, zinc, and vitamins D and B 12. Most of the foods that contain refined grain also contain solid fats, added sugar, and sodium; therefore, such foods must be avoided. Vegans eat only foods of plant origin; therefore, it is not appropriate to ask them to consume fat-free milk for calcium or an egg at least twice a week for protein.

An older patient has muscle wastage and loss of subcutaneous fat in the extremities. What nutritional intervention does the nurse suggest to the patient and caregiver? Add vitamin A supplements to the diet. Take iron and folic supplements daily. Include foods rich in calories and proteins. Choose foods rich in calcium and vitamin D.

Include foods rich in calories and proteins. Muscle wastage and loss of subcutaneous fat in the extremities occurs due to a lack of calories and proteins. The energy expended by the patient is more than the caloric intake. Vitamin A supplements are recommended for the patient with dryness and scaling of the skin; vitamin A also aids in eye health. The patient with osteoporosis and other bone-related deficiencies should consume foods rich in calcium and vitamin D. The patient at a risk for anemia should take iron and folic supplements daily.

The nurse is assessing an adult patient who is postoperative for bariatric surgery. Which assessment finding requires immediate intervention by the nurse? Increased back pain

Increased back pain is a clinical manifestation associated with anastomotic leaks (a leak of digestive juices and partially digested food through an anastomosis). This is the most common serious complication and cause of death after bariatric surgery. This assessment finding should be reported to the surgeon immediately. Increased flatus is a finding that indicates the nasogastric tube placed postsurgery can be removed. Decreased, not increased, urine output is a clinical manifestation associated with anastomotic leaks. Increased bowel sounds is an indication that the patient may be able to begin the progression to a regular diet postsurgery.

Which food items is the nurse likely to discuss excluding from the diet plan for a Mexican American patient? Cheese Yogurt

Lactose intolerance is common among Mexican Americans, so if this patient reports any lactose sensitivity, cheese and yogurt should be excluded from the diet plan. Eggs, peas, and beans are not high in lactose and may be nutritional parts of the plan.

A patient is placed on orlistat as part of a treatment regimen for morbid obesity. What side effects does the nurse tell the patient to expect from using this drug? Dry mouth, constipation, and insomnia Insomnia, dry mouth, and blurred vision Palpitations, constipation, and restlessness Loose stools, abdominal cramps, and nausea

Loose stools, abdominal cramps, and nausea Loose stools, abdominal cramps, and nausea are side effects unique to orlistat. Dry mouth, constipation, and insomnia are not side effects of orlistat. Insomnia, dry mouth, blurred vision, palpitations, constipation, and restlessness are all side effects of short-term therapy drugs such as phentermine, diethylpropion, and phendimetrazine.

A young adult man says that he cannot stay on a diet because of trouble finding one that will incorporate his food preferences. How does the nurse effectively plan nutritional care for this patient? Maintains a 24-hour recall (diary) of his food intake

Maintaining a 24-hour recall of food intake will determine the patient's food preferences and eating patterns so that they can be incorporated into the diet to the greatest extent possible. Although calculating a BMI and measuring height and weight are important parts of a nutritional assessment, they do not address the issue of the patient's food preferences. Keeping an activity diary will also not reveal any information related to the patient's food preferences.

A patient is admitted to the hospital with symptoms of lethargy and poor wound healing. The nurse suspects that the patient has marasmus based on what additional assessment finding? Normal levels of serum proteins

Malnutrition leads to complications such as impaired wound healing and lethargy. Marasmus is a type of protein-energy malnutrition that includes wasting of body fat and protein. A finding of normal serum protein levels and wasting of body protein is an indication of marasmus. Patients with kwashiorkor have near-normal body weight. Wasting of body fat and calories indicates marasmus. A habit of self-induced starvation indicates anorexia nervosa. Binge eating followed by purging indicates bulimia nervosa.

What assessment finding is commonly seen with marasmus? Normal body weight Decrease in serum protein Wastage of body fat Chronic starvation

Marasmus is a caloric malnutrition in which the patient's body fat and protein is wasted. Serum proteins are often preserved. The patient with kwashiorkor, another form of malnutrition, has normal body weight with a decrease in serum protein. The patient with marasmic-kwashiorkor has combined protein and energy malnutrition; this patient is chronically starved.

Which nursing care activity for a malnourished patient does the nurse safely delegate to unlicensed assistive personnel (UAP)? Determining body mass index (BMI) Measuring current height and weight Completing the Mini Nutritional Assessment Estimating body fat using skinfold measurements

Measuring current height and weight Determining height and weight is the only activity that can be safely delegated to the UAP. The nurse is responsible for completing the Mini Nutritional Assessment, determining the patient's BMI, and estimating body fat using skinfold measurements.

What foods can be included in the diet 24 to 48 hours after clear liquids have been tolerated by a postoperative gastrectomy patient? Milk Soft foods Ground meat Fruits and vegetables

Milk Milk can be introduced to the diet of a postoperative gastrectomy patient 24 to 48 hours after clear liquids or tolerated. Soft foods, ground meat, and fruit and vegetables are not introduced until after six weeks.

A postoperative gastric bypass surgical patient is restless with a heart rate of 115. Urine output is 20 mLs in the last 2 hours. What should the nurse do first? Notify the surgeon Administer oxygen Check the patient's blood pressure Place the patient in high Fowler's position

Notify the surgeon The surgeon should be notified immediately because these are signs of an anastomotic leak. Administering oxygen is not indicated. Checking the patient's blood pressure should be done after the surgeon is notified. Placing the patient in high Fowler's position is not indicated.

A female patient is concerned that her inability to conceive a child is connected to her morbid obesity. How does the nurse respond? "Tell me about changes, if any, in your menstrual cycle each month."

Obesity has been known to produce changes in the menstrual cycle, thus causing difficulties in getting pregnant. Asking the patient about her menstrual cycle directly addresses the patient's concern and is designed to elicit helpful assessment information. Asking the patient if she feels her obesity is keeping her from getting pregnant only asks the patient to restate the obvious. It is also a closed question that requires only a "yes" or "no" response. Telling the patient that adoption is an option is an intrusive response by the nurse and may alienate the patient. It also does not address the patient's concern about obesity. Asking what her health care provider told her is an evasive response from the nurse and does not address the patient's concerns.

Which statement about obesity is correct?

Obesity is an excess amount of body fat when compared to lean muscle mass. Obesity refers to the excess amount of body fat when compared to muscle (lean) mass. A person is said to be overweight if his or her body weight is up to 10% greater than the ideal body weight. Morbid or extreme obesity is an increase in body weight more than 100% above the ideal body weight. The normal amount of body fat in men is between 15% and 20% of body weight. In women, the normal amount is between 18% to 32%.

What dietary recommendations are suggested by the U.S. Department of Agriculture (USDA) for older adults? Include a high-fiber diet in daily meals. Reduce cholesterol-containing foods. Take daily supplements of calcium and vitamin D.

Older adults should include a high-fiber diet in daily meals to prevent constipation and impaction as well as reduce cholesterol-containing foods to maintain a healthy body weight. With aging, the absorption ability of the body is reduced, so older adults are encouraged to include daily supplements of calcium and vitamin D. Older adults must have at least 8 glasses of water (unless contraindicated) to prevent dehydration and constipation. Older adults should have no more than 1500 mg of salt in their daily diet to reduce the risk for hypertension.

Which statement about normal weight considerations for an older adult is true? Older patients must maintain a BMI between 23 and 27.

Older patients should have a BMI between 23 and 27. As people get older, they become less hungry and eat less, even if they are healthy. The least risk for malnutrition is associated with BMI scores between 18.5 and 25. Nutritional status must be evaluated if a weight loss of 10% occurs within 6 months. Weight should be monitored daily, several times a week, or weekly for status and effectiveness of nutritional support, depending on the patient's needs.

What manifestations should the nurse assess for if a patient is suspected of having anastomotic leaks following gastric bypass surgery? Oliguria Restlessness Shoulder pain

Oliguria, restlessness, and shoulder pain are all manifestations of anastomotic leaks following gastric bypass surgery. Headache and bradycardia are not manifestations of this complication.

A patient reports bleeding while brushing the teeth. The nurse observes swollen gums, multiple small red spots on the patient's skin, and a corkscrew appearance of the hair. The nurse should recommend an increase of what food item in the patient's diet? Lentils Oranges Fish oils Green leafy vegetables

Oranges Swollen and bleeding gums, a corkscrew appearance of the hair, and petechiae are characteristic signs and symptoms of vitamin C deficiency. Petechiae are caused by bleeding of small capillaries into the skin and appear as tiny reddish purple spots on the skin. Oranges are rich in vitamin C. Lentils are a rich source of protein and are recommended for patients with protein deficiency. Some manifestations of protein deficiency include dull, gray, easily shed hair, muscle wasting, and hepatomegaly. Fish oils contain high amounts of vitamin D and are recommended for patients with rickets or osteomalacia. The nurse recommends that a patient with vitamin A deficiency increase intake of green leafy vegetables. Bitot's spots, keratomalacia, and conjunctival dryness are some manifestations of vitamin A deficiency.

Which hormone plays a role in increasing hunger? Ghrelin

Orexins are appetite-stimulating hormones; ghrelin, the "hunger hormone," is an orexin secreted by the stomach. The secretion of ghrelin increases while fasting and decreases after a meal. Leptin and insulin are anorexins that decrease appetite. Adiponectin is an anti-inflammatory and insulin-sensitizing hormone.

Which is the orexin secreted by the intestines? Peptide YY

Orexins are appetite-stimulating substances whose levels increase during a state of fasting and decrease after eating. The orexin secreted by the intestines is called peptide YY. Leptin is a hormone secreted by adipocytes and gastric cells. Leptin controls the appetite by acting on the hypothalamus. Ghrelin is an orexin that is secreted by the stomach. Resistin is secreted by fat cells and functions by producing resistance to the activity of insulin.

When caring for obese patients, what major complication should the nurse discuss in teaching? Urolithiasis Renal failure Osteoarthritis < Irritable bowel disease

Osteoarthritis is a complication with obese patients. Urolithiasis, renal failure, and irritable bowel disease are not complications of obesity.

What solution is commonly used to flush a clogged feeding tube? Water

Patency of a feeding tube can be ensured by flushing it with 30 mL of water and applying gentle pressure with a 50 mL piston syringe. The tube is never flushed with cranberry juice because the solution may be mistaken for blood. It is not necessary to use saline to flush feeding tubes. Heparin is often used to flush intravenous lines, but never feeding tubes.

A patient with malnutrition begins receiving nutritional support. The nurse assesses the patient a week after the initiation of the feeding and expects what lab value? Hemoglobin level of 11 g/dL Prealbumin value of 20 mg/dL Cholesterol level below 150 mg/dL Total lymphocyte count below 1400 cells per mm 3

Prealbumin value of 20 mg/dL Prealbumin level is an indicator of nutritional deficiency that is used to assess an improvement in a patient's nutritional status. A prealbumin level of 20 mg/dL would be expected one week after the initiation of the feeding, as the normal range is 15 to 36 mg/dL. A decrease in hemoglobin level indicates anemia, which could be caused by malnutrition. A hemoglobin count of 11 g/dL is low for an adult and would not be expected a week after the initiation of feeding. A cholesterol level of 150 mg/dL indicates malnutrition. After initiation of the feeding, the expected cholesterol level should be between 160 and 200 mg/dL. The expected total lymphocyte count after treatment for malnutrition should be above 1500 cells per mm 3.

The home health nurse is visiting an older patient who has a decreased appetite. What does the nurse teach caregiver about promoting nutritional intake? Avoid hurrying the patient while eating. Ensure the patient has toileted and receives mouth care before mealtime. Give analgesics and antiemetic drugs at least 1 hour before mealtime.

Prescribed analgesics and antiemetics should be given at least 1 hour before mealtime to provide pain relief and control nausea. The patient must have toileted and received mouth care to allow the patient to freshen up before the meal. The patient must not be hurried. He or she must be allowed to use eyeglasses and hearing aids during mealtime to help the patient enjoy the visual appeal of the food and increase the appetite. Disturbances such as television or visitors should be avoided during mealtimes so the patient is able to concentrate on eating.

A patient has undergone bariatric surgery. Which nursing intervention is the highest priority in preventing dehydration in this patient? Ambulating the patient as quickly as possible after surgery Providing six small feedings daily and offering fluids frequently Applying an abdominal binder daily when the patient is out of bed Observing for tachycardia, nausea, diarrhea, and abdominal cramping

Providing six small feedings daily and offering fluids frequently Small daily feedings and adequate fluids will prevent the development of dehydration in the patient after bariatric surgery, which is the priority intervention. Ambulation will prevent pulmonary embolism and other circulatory problems. An abdominal binder will help support the abdomen and may prevent dehiscence of the wound. Observing for tachycardia, nausea, diarrhea, and abdominal cramping will prevent the development of postoperative dumping syndrome. All of these interventions are important, but preventing dehydration is the priority.

While providing care for an obese patient immediately following gastrectomy surgery, what intervention is priority? Respiratory assessment Turning and repositioning Assessing the surgical site Measuring the abdominal girth

Respiratory assessment Respiratory assessment to maintain an airway is the most important intervention immediately following gastrectomy surgery. Assessing the surgical site is important, but it is not as important as maintaining the airway. Turning and repositioning is not a priority in the immediate postoperative period. Measuring the patient's abdominal girth is not priority.

An obese patient has been taking orlistat 60 mg orally three times a day for 4 weeks, but has only lost 10 pounds. The health care provider doubles the dosage and recommends behavioral changes. What behavioral changes does the nurse include in the teaching plan? Increasing exercise Keeping a daily food diary Identifying emotional and situational factors that stimulate eating

Self-monitoring techniques include keeping a record of foods eaten (food diary), exercise patterns, and emotional and situational factors. Stimulus control involves controlling the external cues that promote overeating. Cognitive restructuring involves modifying negative beliefs by learning positive coping self-statements. Healthy eating behaviors must be learned or modified by the patient as an individual; copying or modeling others' behaviors does not change the patient's way of coping.

In which position will the nurse place a patient who has had bariatric surgery in order to reduce the risk of sleep apnea?

Semi-Fowler's A postoperative patient should be placed in semi-Fowler's position to reduce the risk of sleep apnea; this will promote lung expansion in the patient. The patient should not be placed in Fowler's or side-lying positions as these may increase the risk of obstructive sleep apnea (OSA). Trendelenburg position does not improve airway patency.

What position is indicated for a postoperative gastrectomy patient?

Semi-Fowler's Semi-Fowler's position will improve breathing and decrease risk for sleep apnea and other complications. Prone, supine, and high Fowler's are contraindicated and will not assist with breathing or postsurgical complications.

What diseases are major risk factors for patients with central obesity? Stroke Breast cancer Type 2 diabetes

Stroke, breast cancer, and type 2 diabetes are all linked to central obesity. Crohn's disease and acute renal failure have not been associated with central obesity.

A patient who is six months post bariatric surgery is concerned about all of his loose abdominal tissue. The patient asks when the tissue can be removed. What statement by the nurse is appropriate? "In about 18 to 24 months."

Surgery to move excess skin can be done at about 18 to 24 months after surgery once the weight stabilizes. The patient does not have to be at his optimal weight when this procedure is done. Getting excess skin removed at 6 months is likely to be too soon. The skin will not return to elasticity.

To assess a patient's nutritional status, the nurse uses a rapid, reliable, two-part assessment tool that can be completed within 15 minutes. How does the nurse measure the patient's muscle mass and subcutaneous fat when using this tool? By measuring the midarm circumference

The Mini Nutritional Assessment (MNA) tool is a rapid, reliable, two-part tool that comprises questions that can be completed within 15 minutes. With the MNA tool, the patient's muscle mass and subcutaneous fat can be measured using midarm circumference and calf circumference. A triceps skinfold measurement helps calculate midarm muscle mass. Midarm muscle mass is an effective indicator of protein reserves and is not used in the MNA tool. Body mass index helps to estimate total body fat on the basis of body height and weight. The subscapular skinfold is measured with a special caliper; it is not used in the MNA tool.

Based on nutritional screening findings and assessments, which patient will be most successful with surgical treatment for obesity? Woman with a BMI of 42, weight 100% above ideal body weight

The best candidate for surgical intervention is the one with a BMI of 40 or more and a weight 100% above the ideal body weight. The other patients do not have a high enough BMI-to-weight ratio to be considered for surgical intervention.

What are the roles of interdisciplinary team members when caring for obese patients in community care settings? Encouraging decreased fat intake Examining psychological problems and concerns Teaching about the importance of increased physical activity

The interdisciplinary team should encourage decreased fat intake, examine any psychological problems or concerns the patient may have, and teach about importance of increased physical activity. The role of the interdisciplinary team in the community is not to determine patient's readiness for bariatric surgery. The interdisciplinary team should discourage reliance on appetite-reducing drugs, not discuss adherence to them.

When advised to exercise daily, an obese patient says, "Gyms are too expensive, and I hardly have time to work out." What is the most appropriate statement by the nurse? "Try to walk for 20 minutes a day."

The nurse can teach an obese older adult patient to exercise regularly by walking for 20 minutes. This does not cost money, it is a short period of time, and it provides health benefits such as strengthening joints and improving cardiovascular health. Suggesting the patient join a gym anyway is unhelpful if he or she is unwilling or unable to pay for it. An hour three times a week may be too big of a time commitment for this patient to comply, and it is unnecessary for health benefits. Including fruits and vegetables in the diet is a good suggestion, but it does not address exercise.

The nurse is caring for a patient receiving total enteral nutrition through a gastrostomy tube. How does the nurse care for the maintenance of the feeding tube? Assess the insertion site and change the dressing at least once a day.

The nurse must assess the insertion site for signs of infection or excoriation. The site is covered with a dry sterile dressing and must be changed once a day. The tube should be rotated 360 degrees each day and checked for in-and-out play of about 0.6 cm every day. The health care provider should be notified if the tube cannot be moved. Residual volume should be checked and recorded every 4 to 6 hours by aspirating stomach contents into a syringe; appropriate intervention is taken as per the provider's prescription if residual feeding is obtained. The feeding bag and tubing should be changed every 24 to 48 hours and the irrigation set must not be used for more than 24 hours to maintain patency of the tube and keep the site infection-free.

Which morbidly obese patient is the least likely candidate for bariatric surgery? 34-year-old woman experiencing mental confusion

The patient who is experiencing mental confusion is not a good candidate for bariatric surgery because the patient may have difficulty complying with the postoperative treatment regimen. The patient with hypertension, the patient with sleep apnea, and the patient with diabetes are all candidates for bariatric surgery despite having these complications.

Which statement accurately describes the laparoscopic sleeve gastrectomy (LSG) procedure? An adjustable band is used to create a small proximal pouch. The stomach, duodenum, and part of the jejunum are bypassed surgically. LSG is a common surgery that involves biliopancreatic diversion. The portion of the stomach that secretes ghrelin is surgically removed.

The portion of the stomach that secretes ghrelin is surgically removed. LSG is a gastric restrictive surgery to remove a portion of the stomach where ghrelin, the "hunger hormone," is secreted. The laparoscopic adjustable gastric band (LAGB) procedure is a gastric restrictive surgery in which an adjustable band is used to create a small proximal stomach pouch. The Roux-en-Y-gastric bypass (RNYGB) procedure (commonly called gastric bypass) is a malabsorption surgery in which the stomach, duodenum, and part of the jejunum are bypassed surgically so that fewer calories are absorbed. Biliopancreatic diversion is yet another malabsorption procedure, but it is rarely performed.

Which fats are known to be linked to obesity and coronary artery disease (CAD)? Saturated fats Trans fatty acids Cholesterol

The presence of significant amounts of saturated fats, trans fatty acids (TFAs), and cholesterol in the diet are linked to obesity and CAD. Monounsaturated fats and polyunsaturated fats are healthy fats.

Which statement describing the administration of enteral nutrition using the bolus feeding method is accurate? A specific amount of enteral product is fed intermittently every 4 hours.

There are three methods of tube feeding administration. Bolus feeding is an intermittent feeding of a specified amount of enteral product typically administered every 4 hours (not every 8 hours). This is done either manually or by infusion through a mechanical pump or controller device. In continuous feeding, small amounts are infused continuously over a specified time, similar to intravenous therapy. Cyclic feeding is similar to continuous feeding except that infusion is stopped for about 6 hours in a 24-hour period. The down time is to allow for bathing, treatments, and other activities.

A patient who is receiving total enteral nutrition (TEN) exhibits acute confusion and shallow breathing and says, "I feel weak." As the patient begins to have a generalized seizure, how does the nurse interpret this patient's signs and symptoms? This is refeeding syndrome. Abdominal distention is present. Severe hyperglycemia is present. The enteral tube is misplaced or dislodged.

This is refeeding syndrome. Symptoms of refeeding syndrome include shallow respirations, weakness, acute confusion, seizures, and increased bleeding tendency. If the enteral tube becomes misplaced or dislodged, the patient may develop aspiration pneumonia displayed by increased temperature, increased pulse, dehydration, diminished breath sounds, and shortness of breath. Abdominal distention is most frequently accompanied by nausea and vomiting. In refeeding syndrome, insulin secretion decreases in response to the physiologic changes in the body; when refeeding begins, insulin production resumes and the cells take up glucose and electrolytes from the bloodstream, thus depleting serum levels.

The primary health care provider asks the nurse to provide continuous positive airway pressure (CPAP) ventilation to a patient who is recovering from bariatric surgery. Why has the provider asked the nurse to do this? To monitor oxygen saturation To reduce the risk of sleep apnea To prevent pulmonary embolism (PE) To prevent venous thromboembolism (VTE)

To reduce the risk of sleep apnea A bariatric surgical patient may develop postoperative complications. Using CPAP ventilation and placing the patient in a semi-Fowler's position will help reduce the risk of sleep apnea, pneumonia, and atelectasis. CPAP ventilation will not help monitor oxygen saturation. Applying sequential compression stockings will help in the prevention of PE and VTE.

What laboratory test is used to assess a patient's immune function? Hemoglobin Serum albumin Total lymphocyte count (TLC) Thyroxine-binding prealbumin

Total lymphocyte count (TLC) TLC values can be used to assess immune function. The TLC is usually below 1500/mm 3 in a malnourished patient. Hemoglobin levels can assess for anemia, hemorrhage, or hemodilution. Serum albumin and thyroxine-binding prealbumin are plasma proteins that reflect nutritional status.

What is an appropriate nursing intervention for the care of a patient with malnutrition? Provide interventions for comfort

Treatment for malnourished patients includes interventions provided to make the patient feel comfortable. The patient should have mouth care before meals to eliminate any bad tastes in the mouth. The nurse should encourage malnourished patients to eat. The patient should be provided enough time to finish the food so that the patient does not feel rushed.

What type of vitamin deficiency is an anemic patient on a vegan diet expected to have? Vitamin B 12

Vegans only eat foods of plant origin, so they are likely to develop anemia due to vitamin B 12 deficiency. Vitamin B 12 is the only vitamin of those listed that contributes to the production of red blood cells. Vitamin A contributes to vision, vitamin C to healing, and vitamin D to bone growth and maintenance. Fruits and vegetables contain a rich source of vitamins A and C. The patient on a vegan diet must include vitamins B 12 and D, and calcium supplements in their daily diet.

Which nutrient supplement should be taken by the patient with swollen, bleeding gums? Protein Folic acid Vitamin A Vitamin C <

Vitamin C The patient with swollen, bleeding gums may have a vitamin C deficiency, and should take vitamin C supplements. A protein deficiency can cause muscle wastage and edema in the extremities. It also causes decreased pigmentation and loss of hair. Folic acid is essential in preventing anemia. Vitamin A deficiency can cause xerosis of the conjunctiva, keratomalacia, and Bitot's spots. It also may cause dry and scaling skin and follicular hyperkeratosis.

Which nutrient deficiency leads to alopecia? Zinc Protein Vitamin C Vitamin A

Zinc Zinc is important for normal cell growth. A zinc deficiency in the diet causes alopecia, or hair loss. A protein deficiency can result in the hair losing its luster. Corkscrew hair is a sign of Vitamin C deficiency. A lack of Vitamin A can lead to follicular hyperkeratosis of the skin.