Chapter 40

The nurse has completed initial instruction with a patient regarding a weight loss program. The nurse determines that the teaching has been effective when the patient makes which statement? "I plan to lose 4 lb a week until I have lost the 60-lb goal." "I will keep a diary of weekly weights to illustrate my weight loss." "I will restrict my carbohydrate intake to less than 30 g/day to maximize weight loss." "I should not exercise more than my program requires because increased activity increases the appetite."

"I will keep a diary of weekly weights to illustrate my weight loss."

The nurse instructs an obese 22-yr-old man with a sedentary job about the health benefits of an exercise program. The nurse evaluates that teaching is effective when the patient makes which statement? "The goal is to walk at least 10,000 steps every day of the week." "Weekend aerobics for 2 hours is better than exercising every day." "Aerobic exercise will increase my appetite and result in weight gain." "Exercise causes weight loss by decreasing my resting metabolic rate."

"The goal is to walk at least 10,000 steps every day of the week."

The severely obese patient has elected to have the Roux-en-Y gastric bypass (RYGB) procedure. The nurse will know the patient understands the preoperative teaching when the patient makes which statement? "This surgery will preserve the function of my stomach." "This surgery will remove the fat cells from my abdomen." "This surgery can be modified whenever I need it to be changed." "This surgery decreases how much I can eat and how many calories I can absorb."

"This surgery decreases how much I can eat and how many calories I can absorb."

The nurse is caring for a patient after bariatric surgery. What should be included in the plan of care (select all that apply.)? Select all that apply. -Teach the patient to increase carbohydrate intake. -Assess for incisional pain versus anastomosis leak. -Maintain elevation of the head of bed at 35-45 degrees. -Monitor for vomiting that is a common complication. -Instruct the patient to consume liquids frequently during meals. -Assist with early independent ambulation during hospitalization.

-Assess for incisional pain versus anastomosis leak. -Maintain elevation of the head of bed at 35-45 degrees. -Monitor for vomiting that is a common complication. -Assist with early independent ambulation during hospitalization.

In developing a weight reduction program with a 45-yr-old female patient who weighs 197 lb, the nurse encourages the patient to set a weight loss goal of how many pounds in 4 weeks? 1 to 2 3 to 5 4 to 8 5 to 10

4 to 8

Which patient is at risk for developing metabolic syndrome? A 62-yr-old white man who has coronary artery disease with chronic stable angina A 54-yr-old Hispanic woman who is sedentary and has nephrogenic diabetes insipidus A 27-yr-old Asian American woman who has preeclampsia and gestational diabetes mellitus A 38-yr-old Native American man who has diabetes mellitus and elevated hemoglobin A1C

A 38-yr-old Native American man who has diabetes mellitus and elevated hemoglobin A1C

Which patient has the morbidity risk? Male 6 ft, 1 in. tall; BMI 29 kg/m2 Female 5 ft, 6 in. tall; weight 150 lb Male with waist circumference 46 in Female 5 ft, 10 in. tall; obesity class III

Female 5 ft, 10 in. tall; obesity class III

The nurse is caring for a 45-yr-old woman with a herniated lumbar disc. The patient realizes that weight loss is necessary to lessen back strain. The patient is 5'6" tall and weighs 186 lb (84.5 kg) with a body mass index (BMI) of 28 kg/m2. The nurse explains this measurement places her in which weight category? Obese Overweight Severely obese Normal weight

Overweight

In the immediate postoperative period a nurse cares for a severely obese 72-yr-old man who had surgery for repair of a lower leg fracture. Which assessment is most important? Cardiac rhythm Surgical dressing Postoperative pain Oxygen saturation

Oxygen saturation

In developing an effective weight reduction plan for an overweight patient who expresses willingness to try to lose weight, which factor should the nurse assess first? The length of time the patient has been obese The patient's current level of physical activity The patient's social, emotional, and behavioral influences on obesity Anthropometric measurements, such as body mass index and skinfold thickness

The patient's social, emotional, and behavioral influences on obesity

The nurse cares for a 34-yr-old woman after bariatric surgery. The nurse determines that discharge teaching related to diet is successful if the patient makes which statement? "A high-protein diet that is low in carbohydrates and fat will prevent diarrhea." "Food should be high in fiber to prevent constipation from the pain medication." "Three meals a day with no snacks between meals will provide optimal nutrition." "Fluid intake should be at least 2000 mL per day with meals to avoid dehydration."

"A high-protein diet that is low in carbohydrates and fat will prevent diarrhea."

The nurse is caring for a patient who is 5'6" tall and weighs 186 lb. The nurse has discussed reasonable weight loss goals and a low-calorie diet with the patient. Which statement made by the patient indicates a need for further teaching? "I will limit intake to 500 calories a day." "I will try to eat very slowly during mealtimes." "I'll try to pick foods from all of the basic food groups." "It's important for me to begin a regular exercise program."

"I will limit intake to 500 calories a day."

At the first visit to the clinic, the female patient with a BMI of 29 kg/m2 tells the nurse that she does not want to become obese. Which question used for assessing weight issues would be most effective? "What factors contributed to your current body weight?" "How is your overall health affected by your body weight?" "What is your history of gaining weight and losing weight?" "In what ways are you interested in managing your weight differently?"

"In what ways are you interested in managing your weight differently?"

A community health nurse is conducting an initial assessment of a new patient. Which assessments should the nurse include when screening the patient for metabolic syndrome (select all that apply.)? Select all that apply. -Blood pressure -Resting heart rate -Physical endurance -Waist circumference -Fasting blood glucose

-Blood pressure -Waist circumference -Fasting blood glucose

The nurse teaches a 50-yr-old woman who has a body mass index (BMI) of 39 kg/m2 about weight loss. Which dietary change would be most appropriate to recommend? Decrease fat intake and control portion size. Increase vegetables and decrease fluid intake. Increase protein intake and avoid carbohydrates. Decrease complex carbohydrates and limit fiber.

Decrease fat intake and control portion size.

A 50-yr-old African American woman has a body mass index (BMI) of 35 kg/m2, type 2 diabetes mellitus, hypercholesterolemia, and irritable bowel syndrome (IBS). She is seeking assistance in losing weight because, "I have trouble stopping eating when I should, but I do not want to have bariatric surgery." Which drug therapy should the nurse question if it is prescribed for this patient? Orlistat (Xenical) Lorcaserin (Belviq) Phentermine (Adipex-P) Phentermine and topiramate (Qsymia)

Orlistat (Xenical)