Obesity Prep U

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

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 client who is postoperative bariatric surgery is diagnosed with bile reflux. Which conditions are associated with bile reflux? Select all that apply. a. Gastritis b. Esophagitis c. Pharyngitis d. Laryngitis e. Tonsillitis

a, b Bile reflux may cause gastritis or esophagitis. Pharyngitis, laryngitis, and tonsillitis are associated with pulmonary conditions and not associated with bile reflux.

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? a. Compromised peripheral blood flow b. Increased blood viscosity c. Impaired clotting d. Increased fat accumulation in the blood

a. 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 caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client? a. Drink a minimum of 12 ounces of fluid with each meal. b. Eat several small meals daily spaced at equal intervals. c. Choose foods that are high in simple carbohydrates. d. Sit upright when eating and for 30 minutes afterward.

b. The client with dumping syndrome should consume small meals at intervals to reduce symptoms. The client should not consume fluids with meals. Carbohydrates should be limited and sitting upright does not relieve the symptoms.

A nurse cares for an older adult client with obesity who also has glaucoma. Which obesity medication is contraindicated in this client? a. Orlistat b. Phentermine c. Lorcaserin d. Liraglutide

b. Sympathomimetic amines, such as phentermine, are contraindicated in clients with glaucoma. The other answer choices represent obesity medications; however, these are not contraindicated in clients with glaucoma.

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

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

The nurse cares for clients with obesity and understands that causes are multifactorial. What factors contribute to the development of obesity? Select all that apply. a. Behavior b. Environment c. Physiology d. Genetics e. Immunology

a, b, c, d The causes of obesity are complex and multifactorial, and include behavioral, environmental, physiologic, and genetic factors.

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? a. 500-1,000 calories b. 250-400 calories c. 300-600 calories d. 1,000-1,500 calories

a. A client with obesity should be counseled to plan a caloric deficit of between 500 and 1000 calories daily from baseline, in order to achieve a 5% to 10% reduction in weight within about 6 months.

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? a. Both undernutrition and obesity b. Both low metabolism and high metabolism c. Both obesity and scare food sources d. Both undernutrition and sedentary lifestyles

a. 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 post op bariatric surgery. Which position will the nurse place the client in order to best promote comfort? a. High Fowler's b. Low Fowler's c. Upright d. Lateral

b. 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 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem? a. Adenoiditis b. Chronic tonsillitis c. Obstructive sleep apnea d. Laryngeal cancer

c. Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This client's symptoms are not suggestive of laryngeal cancer.

x The nurse is presenting health education to a 48-year-old man who was just diagnosed with type 2 diabetes. The client has a BMI of 35 and leads a sedentary lifestyle. The nurse gives the client information on the risk factors for his diagnosis and begins talking with him about changing behaviors around diet and exercise. The nurse knows that further client teaching is necessary when the client tells you what? a. "I need to start slow on an exercise program approved by my doctor." b. "I know there's a chance I could have avoided this if I'd always eaten better and exercised more." c. "There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented." d. "I want to have a plan in place before I start making a lot of changes to my lifestyle."

c. The major causes of chronic diseases are known, and if these risk factors were eliminated, at least over 80% of heart disease, stroke, and type 2 diabetes would be prevented. In addition, over 40% of cancers would be prevented. The other listed options are accurate statements.

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

c. 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 client with obesity has recently begun treatment with phentermine/topiramate-ER. The client tells the nurse, "I'm eating a lot of spinach and other leafy green vegetables, both cooked and in salads." What is the nurse's best response? a. "Spinach is very healthy, but eating it too often can be hard on your kidneys." b. "That's a healthy practice, but you might find that your blood clots more slowly than usual." c. "Be careful that you don't eat too many other foods that contain a lot of iron." d. "That's great. Spinach has a lot of vitamins and nutrients and very few calories."

d. There is no contraindication between taking phentermine/topiramate-ER and spinach or other green leafy vegetables. Consequently, there is no need to caution the client about iron, vitamin K, or renal function unless there is some other corresponding health disorder.

x 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. a. Hypertension b. Coronary artery disease c. Heart failure d. Myocardial infarction e. Heart murmur

a,b,c,d 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 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? a. Mechanical compression and prophylactic anticoagulation b. Mechanical compression only c. Prophylactic anticoagulation only d. Early ambulation only

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

a. 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.

What statement best describes a client with severe or extreme obesity? a. A BMI >40 kg/m2 b. A BMI >35 kg/m2 c. Waist-to-hip ratio <30 inches in females d. Waist-to-hip ratio <33 inches in males

a. Extreme or severe obesity (previously morbid obesity) is best defined as a BMI >40kg/m2. Waist-to-hip ratios are measured to determine severity of obesity; however, waist-to-hip ratios of >35 inches in women or >40 inches in men are associated with greater risk from obesity.

A nurse is teaching an adult female client about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension? a. Obesity and high intake of sodium and saturated fat b. Diabetes and use of oral contraceptives c. Metabolic syndrome and smoking d. Renal disease and coarctation of the aorta

a. Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, renal disease, and coarctation of the aorta are causes of secondary hypertension.

The nurse is performing a health assessment of a client who has been taking antiobesity medications for several weeks. During the nurse's gastrointestinal assessment, the client reports bowel movements described as "greasy" and "oily." What medication is the client most likely taking? a. Lorcaserin b. Orlistat c. Liraglutide d. Phentermine

b. Orlistat can cause oily stools because it inhibits fat absorption. The other listed medications affect appetite, rather than absorption, and do not cause this adverse effect.

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? a. Lifestyle modification b. Pharmacological management c. Nonsurgical interventions d. Surgical interventions

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

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? a. Risk for impaired gas exchange b. Impaired mobility c. Impaired tissue integrity d. Activity intolerance

a. A postoperative bariatric client with uncontrolled pain is at great risk for pulmonary complications because the client is unable to take deep breaths. The other nursing diagnoses are appropriate for the client; however, these are not priority.

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

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

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? a. "You will be injecting the medication on a daily basis." b. "You will be taking the medication for a short-term only." c. "You will be taking the medication with meals." d. "You will be taking the medication with another medication."

a. Liraglutide (Belviq) is administered via subcutaneous injection. The other answer choices are incorrect.

A client with obesity is early in the process of preparing for a Roux-en-Y gastric bypass (RYGB). The client states, "After the surgery, the amount of food that I consume will be limited and I'll absorb fewer calories from what I do eat." When responding to the client, the nurse should: a. explain that the surgery will not affect the absorption of nutrients. b. validate what the client understands about the surgical procedure. c. teach the client that RYGB does not restrict food intake. d. encourage the client to discuss the procedure with the surgeon.

b. RYGB involves restrictive and malabsorptive components; the client's understanding is accurate. There is no obvious need for the client to bring the discussion to the surgeon.

The nurse is providing care for a client who had a biliopancreatic diversion with duodenal switch 2 days ago. How should the nurse best address the client's risk for postoperative venous thromboembolism? a. Assist the client with ambulating as early and often as possible b. Administer coumadin PO as prescribed c. Assist the client with performing deep breathing and coughing exercises d. Reposition the client at least every 2 hours while in bed

a. Early ambulation is a key intervention in the prevention of VTE. Coumadin is not used for postoperative VTE prophylaxis. Breathing exercises prevent respiratory complications, not VTE. Repositioning preserves the client's skin integrity.

The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease? a. Performing 15 minutes of physical activity at least three times per week b. Avoid taking aspirin to treat pain or fever c. Taking multivitamins as prescribed and eating organic foods whenever possible d. Maintaining a healthy body weight

b. Aspirin and other NSAIDs are implicated in chronic gastritis because of their irritating effect on the gastric mucosa. Organic foods and vitamins confer no protection. Exercise and a healthy body weight are beneficial to overall health but do not prevent gastritis.

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? a. Serotonin syndrome b. C-difficile infection c. Acute gastritis d. Cushing's syndrome

a. Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, may rarely cause serotonin syndrome, a life-threatening condition. Symptoms of serotonin syndrome include: high fevers, brisk reflexes, agitation, and diarrhea. C-difficile infection and acute gastritis may cause similar symptoms; however, the client most likely has serotonin syndrome due to the medication the client is taking. Cushing's syndrome results from an excess of cortisol and does not present as a febrile condition with diarrhea.

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

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

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

a. 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 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? a. "It binds with enzymes to help prevent digestion of fat." b. "It decreases your appetite." c. "It works to make you feel full." d. "It binds with enzymes to decrease carbohydrate absorption."

a. Orlistat (Xenical) works to bind to gastric and pancreatic lipase to prevent the digestion of 30% of ingested fat, thereby decreasing caloric intake.

A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary? a. "I'm so relieved to start this medication. I really don't like having to exercise or change what I eat." b. "It's hard to believe that there are actually medications that can treat obesity." c. "I'm a bit nervous to start this medication because I know I'll need blood tests sometimes." d. "I'm going to have to do some rearranging of my finances to make sure I can afford this medication."

a. Antiobesity medications are used to complement, not replace, lifestyle changes. Blood tests will be necessary to monitor electrolytes and kidney function. As with all medications, financial considerations are an important reality for many clients.

A client with obesity taking lorcaserin reports feeling agitated lately and has had diarrhea for several days. What is the nurse's priority response? a. Notify the health care provider. b. Assess the frequency of bowel movements. c. Prepare for intravenous fluid replacement. d. Obtain a stool sample.

a. The client may be developing serotonin syndrome, a potentially life-threatening condition which the health care provider needs to know about right away.

The nurse is caring for a hospitalized client who has class II obesity and who has limited mobility. The nurse should address the client's risk for skin breakdown by: a. cleaning and drying regularly within the client's skin folds. b. avoiding the use of pillows to position the client. c. making a referral to physical therapy. d. ensuring the client receives a high-calorie, high-protein diet.

a. The presence of more folds in the skin is associated with more skin moisture and increased skin friction, which are pressure ulcer risks. Consultation with a wound-ostomy-continence (WOC) nurse, not a physical therapist, may be advisable. There is no obvious need to avoid using pillows.

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

a. Increased fat stores increases the level of leptin in the bloodstream.

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? a. Rapid gastric dumping b. Excessive fat intake c. Decreased motility d. Decreased gastric size

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

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

a. 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 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? a. "The fat is passed in your stools." b. "The fat is excreted in your urine." c. "The fat is absorbed in your intestines." d. "The fat remains undigested in your stomach."

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

A client has recovered well from bariatric surgery 3 weeks ago, but during the nurse's most recent assessment, the client states, "I'm having some trouble swallowing my food, and that was never an issue before." What is the nurse's best initial action? a. Encourage the client to eat slowly and chew food thoroughly b. Arrange for the client to receive a soft or pureed diet c. Assess the client for signs and symptoms of dumping syndrome d. Teach the client about the need to avoid raw fruits and vegetables as well as complex carbohydrates

a. Dysphagia may be prevented by educating patients to eat slowly, to chew food thoroughly, and to avoid eating tough foods such as steak or dry chicken or doughy bread. There is no need to avoid fruits, vegetables, or carbohydrates because these do not exacerbate the problem. Conservative measures should be attempted before resorting to a textured diet. Dysphagia is unrelated to dumping syndrome.

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? a. "The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." b. "A prosthetic device binds the stomach and creates a very small pouch and restricts oral intake." c. "85% of the stomach is removed surgically, leaving a much smaller tube-like structure." d. "The stomach is stapled to a very small pouch and the entire small intestine is rerouted.

a. In Roux-en-Y bariatric surgery, a horizontal row of staples across the fundus of the stomach creates a pouch with a capacity of 20 to 30 mL. The jejunum is divided distal to the ligament of Treitz, and the distal end is anastomosed to the new pouch. The proximal segment is anastomosed to the jejunum.

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

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

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

a. 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 with class II obesity has been unable to lose weight despite trying to increase activity level and limit food intake. The health care provider has prescribed orlistat. What health education should the nurse provide to the client? a. The client will need to increase fluid intake during therapy. b. It is important to maintain a nutrient-rich diet and take multivitamins. c. The client will need to have blood levels of the medication drawn after 2 weeks. d. It is necessary to increase potassium intake and reduce sodium intake.

b. Because of the possibility of malabsorption, the client is usually encouraged to take a multivitamin. A nutrient-rich diet is important during weight loss. Blood levels are not necessary and increased fluid intake is not required. Similarly, intake of sodium and potassium does not need to be changed.

A nurse who provides care in a campus medical clinic is performing an assessment of a 21-year-old student who has presented for care. After assessment, the nurse determines that the client has a BMI of 45. What does this indicate? a. The client is of normal weight. b. The client is extremely obese. c. The client is overweight. d. The client is mildly obese.

b. Individuals who have a BMI between 25 and 29.9 are considered overweight. Obesity is defined as a BMI of greater than 30 (WHO, 2011). A BMI of 45 would indicate extreme obesity.

The school nurse is working with a female high school junior whose BMI is 31. When planning this girl's care, the nurse should identify what goal? a. Continuation of current diet and activity level b. Increase in exercise and reduction in calorie intake c. Possible referral to an eating disorder clinic d. Increase in daily calorie intake

b. A BMI of 31 is considered clinically obese; dietary and exercise modifications would be indicated. People who have a BMI lower than 24 (or who are 80% or less of their desirable body weight for height) are at increased risk for problems associated with poor nutritional status. Those who have a BMI of 25 to 29.9 are considered overweight; those with a BMI of 30 or greater are considered to be obese.

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? a. Increase fluid intake b. Avoid high-fat foods c. Eat a wide variety of foods d. Increase protein intake

b. Reducing the amount of fat will have a direct beneficial effect on the number and quality of bowel movements a client may have. Increasing fluid intake will help, but it is not the most beneficial. The client should not be encouraged to eat a wide variety of foods; rather, instruction on foods that will be best tolerated will be encouraged. Protein intake does not have a direct correlation to the client's quality of bowel movements post-bariatric surgery.

The nurse in the ICU is caring for a 47-year-old, obese male client who is in shock following a motor vehicle accident. What would be the main challenge in meeting this client's elevated energy requirements during prolonged rehabilitation? a. Loss of adipose tissue b. Loss of skeletal muscle c. Inability to convert adipose tissue to energy d. Inability to maintain normal body mass

b. Nutritional energy requirements are met by breaking down lean body mass. In this catabolic process, skeletal muscle mass is broken down even when the client has large stores of fat or adipose tissue. Loss of skeletal muscle greatly prolongs the client's recovery time. Loss of adipose tissue, the inability to convert adipose tissue to energy, and the inability to maintain normal body mass are not main concerns in meeting nutritional energy requirements for this client.

The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified? a. Gender, obesity, family history, and smoking b. Inactivity, stress, gender, and smoking c. Cholesterol levels, hypertension, and smoking d. Stress, family history, and obesity

c. Four modifiable risk factors-cholesterol abnormalities, tobacco use, hypertension, and diabetes-are established risk factors for CAD and its complications. Gender and family history are risk factors that cannot be controlled.

The nurse is working with a sedentary adult client who has expressed a determination to lose weight over the next several months, despite the presence of other major health problems. What is the nurse's best advice for this client? a. "We'll work together to ensure you don't exceed food intake of 2000 calories per day." b. "Try to perform both aerobic and muscle-training exercises every day." c. "It might be challenging to start an exercise program, but we'll start with a few minutes per day." d. "I'll make sure that you're screened for type 2 diabetes before you start your weight-loss program."

c. Patients with obesity who were previously sedentary and deconditioned may not be able to achieve this at the start; however, as little as 10 minutes of daily physical activity can result in weight loss and improved exercise tolerance. Exercise must be performed regularly, but it is not necessary to include aerobic and strength-building exercises every day. A patient with obesity should be counseled to plan a caloric deficit of between 500 to 1000 calories daily from baseline; however, this does not necessarily result in a threshold of 2000 calories for every client. Diabetes screening is not a prerequisite for clients who lack signs or symptoms.

The nurse is preparing to assess a new client who has class III obesity. In order to provide empathic and holistic care for this client, the nurse should first: a. seek advice from a colleague who is known to provide empathic care. b. remind himself or herself that obesity is a treatable health problem. c. examine his or her own preconceptions and beliefs about obesity. d. anticipate having some discomfort or anxiety when assessing the client.

c. The first step in addressing preconceptions or biases toward clients with obesity is to engage in self-reflection. Obesity is treatable, but this fact does not mitigate nurses' biases. Collaborating with a colleague may or may not be necessary and appropriate. Anticipating anxiety does not necessarily address its underlying source.

A 69 year-old client has maintained a consistent diet and activity level throughout adulthood. Over the past few years, however, the client has reported a gradual increase in adipose tissue. When providing health education, the nurse should address what topic? a. Weight gain as a natural, age-related change b. Loss of skeletal muscle with aging c. Changes in food cravings that are common in older adults d. Changes in metabolism that accompany the aging process

d. Basal metabolism drops by 2% for each additional decade of adult life. Therefore, older adults are more likely to gain weight unless they either increase activity levels or decrease their caloric intake. Weight gain is not considered a normal age-related change and older adults are not noted to have more cravings. Skeletal muscle decreases with age, but this phenomenon does not cause weight gain.

The postoperative nurse is attending beginning-of-shift report and learns that a client who is recovering from bariatric surgery has been experiencing bile reflux. What is the nurse's most appropriate action? a. Encourage the client to eat smaller amounts and to eat more slowly b. Administer calcium chloride and pancreatic enzymes as prescribed c. Prepare the client for an emergency cholecystectomy d. Administer proton pump inhibitors as prescribed

d. Bile reflux may be managed with proton pump inhibitors, not calcium supplements or pancreatic enzymes. This complication does not necessitate a cholecystectomy and changes in food intake do not resolve it.

A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes? a. Have blood glucose levels checked annually b. Stop using tobacco in any form c. Undergo eye examinations regularly d. Lose weight, if obese

d. Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent diabetes.

The nurse is creating the care plan for a 70-year-old obese client who has been admitted to the postsurgical unit following a colon resection. This client's age and increased body mass index mean that she is at increased risk for what complication in the postoperative period? a. Hyperglycemia b. Azotemia c. Falls d. Infection

d. Like age, obesity increases the risk and severity of complications associated with surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound separation) and wound infections are more common. A postoperative client who is obese will not likely be at greater risk for hyperglycemia, azotemia, or falls.