Chapter 42: Assessment and Management of Patients with Obesity
32.7
A client weighs 215 lbs and is 5' 8" tall. The nurse calculate this client's body mass index (BMI) as what? 32.7 24.8 19.5 44.9
Insufficient water intake
A client who is post op from bariatric surgery reports constipation. What is the most likely cause of the client's symptoms? Impaired gastric motility Diuretic medications Gastric dysfunction Insufficient water intake
Rapid gastric dumping
A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding? Rapid gastric dumping Decreased gastric size Excessive fat intake Decreased motility
Question the order due to the client's recent bariatric surgery
A client who is recovering from bariatric surgery has not had a bowel movement for 48 hours and bowel sounds are absent on auscultation. The nurse has informed the on-call health care provider who has prescribed insertion of a nasogastric tube to low suction. What is the nurse's best action? Ensure that the NG tube inserted is at least a size 14 French Question the order because decreased bowel motility is expected postoperatively Insert the NG tube cautiously due to the client's recent GI surgery Question the order due to the client's recent bariatric surgery
Age
A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? Obesity Inactivity Age Dyslipidemia
"The fat is passed in your stools."
A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response? "The fat is excreted in your urine." "The fat is passed in your stools." "The fat is absorbed in your intestines." "The fat remains undigested in your stomach."
Cushing's disease
A nurse cares for a client who has secondary obesity. Which condition is the most likely to result in secondary obesity? Grave's disease Addison's disease Crohn's disease Cushing's disease
Class I obesity
A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI? Normal weight Overweight Class I obesity Class II obesity
"It binds with enzymes to help prevent digestion of fat."
A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include? "It binds with enzymes to help prevent digestion of fat." "It decreases your appetite." "It works to make you feel full." "It binds with enzymes to decrease carbohydrate absorption."
Low Fowler's
A nurse cares for a client who is post op bariatric surgery. Which position will the nurse place the client in order to best promote comfort? High Fowler's Upright Low Fowler's Lateral
Stimulate GI peristalsis
A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose? Assess for intact swallowing Stimulate digestive hormones Assess for gastric perforation Stimulate GI peristalsis
"Expect to lose 10-35% of total body weight 2 to 3 years postoperatively."
A nurse cares for a client who wants to know more information about bariatric surgery. The client asks the nurse, "What weight loss can I expect?" What is the nurse's best response? "Expect to lose 45-50% of total body weight 2 to 3 years postoperatively." "Expect to lose 10-35% of total body weight 2 to 3 years postoperatively." "Expect to lose 50 pounds in the first month after surgery." "Expect to lose 10-35 pounds in the first month after surgery."
"Yes, your BMI and chronic condition meets the criteria for bariatric surgery."
A nurse cares for a client with a BMI of 36 kg/m2 and nonalcoholic fatty liver disease. The client asks the nurse if he is a candidate for bariatric surgery. How should the nurse respond to the client? "No, you do not have any qualifying criteria for bariatric surgery." "Yes, your BMI and chronic condition meets the criteria for bariatric surgery." "No, you have one qualifying condition but not the other; this excludes you from bariatric surgery." "Yes, your chronic condition meets the criteria for bariatric surgery but not your BMI."
"You should avoid pregnancy for at least 18 months after surgery."
A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population? "You should avoid pregnancy for at least 18 months after surgery." "You should avoid pregnancy for at least 9 months after surgery" "After surgery, your ability to conceive is decreased considerably." "After surgery, contraceptives have much less efficacy."
"Do not drink alcohol while taking this medication."
A nurse cares for an obese client taking phentermine for weight loss. What client teaching will the nurse include when discussing precautions about the medication? "Take the medication at night before bedtime." "Do not drive while taking this medication." "Take the medication with a full glass of water." "Do not drink alcohol while taking this medication."
Males Adults with greater body mass Older adults
A nurse cares for clients with obesity who undergo bariatric surgery. Which clients will the nurse identify as having increased risk of infection after surgery? Select all that apply. Males Females Adults with greater body mass Older adults Adolescents
Waist circumference BMI Weight
A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply. Blood pressure Waist circumference BMI Weight Total cholesterol
"I should become involved in a weight loss program."
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: "I should sleep on my side all night long." "I should eat a high-protein diet." "I should become involved in a weight loss program." "I need to keep my inhaler at the bedside."
Mechanical compression and prophylactic anticoagulation
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? Early ambulation only Mechanical compression and prophylactic anticoagulation Mechanical compression only Prophylactic anticoagulation only
"Avoid taking non-steroidal anti-inflammatory drugs."
A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers? "Sit in a semi-recumbent position while eating." "Keep the head of your bed propped on blocks at night." "Avoid taking antacid drugs." "Avoid taking non-steroidal anti-inflammatory drugs."
23
A nurse is reviewing the medical records of several patients and their risk for health problems. The nurse determines that the patient with which body mass index (BMI) would have the lowest risk? 28 23 18 31
Both undernutrition and obesity
A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face? Both obesity and scare food sources Both low metabolism and high metabolism Both undernutrition and obesity Both undernutrition and sedentary lifestyles
Over time, we have become efficient in food storage and deposition of fat stores.
A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity? Over time, we have become less efficient in hunting and gathering of food. Multiple mutations of genes over time have lead to the epidemic. A single gene mutation is responsible for the epidemic. Over time, we have become efficient in food storage and deposition of fat stores.
Sugar-free pudding Sugar-free gelatin Fat-free milk
A nurse teaches homecare nutrition expectations to a client who will undergo bariatric surgery. Which foods will the nurse suggest the client keep on hand at home after surgery? Select all that apply. Sugar-free pudding Yogurt Sugar-free gelatin Ice cream Fat-free milk
All options are correct.
An older client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which factors in the client's history may have increased the risk of breast cancer? All options are correct. increased age not giving birth obesity
Reduce caffeine intake. Adhere to an exercise plan. Manage stress effectively. Restrict salt/sodium.
The nurse is caring for a client who has just received a diagnosis of hypertension. What lifestyle change(s) should the nurse recommend to the client to decrease the consequences of hypertension? Select all that apply. Reduce caffeine intake. Use smokeless tobacco. Adhere to an exercise plan. Manage stress effectively. Restrict salt/sodium.
examine his or her own preconceptions and beliefs about obesity.
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: examine his or her own preconceptions and beliefs about obesity. seek advice from a colleague who is known to provide empathic care. remind himself or herself that obesity is a treatable health problem. anticipate having some discomfort or anxiety when assessing the client.
Assist the client with ambulating as early and often as possible
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? Administer coumadin PO as prescribed Reposition the client at least every 2 hours while in bed Assist the client with performing deep breathing and coughing exercises Assist the client with ambulating as early and often as possible
The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment.
The nurse observes that a client's medical report indicates that the client has Cushing syndrome. During inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. Which of the following must the nurse keep in mind while planning the client's care? The nurse knows that a waist circumference of 40 places the client at risk. The nurse instructs the client to remember all food consumed over the next 24-hour period. Knowing that the client is obese, the nurse plans to provide dietary education to reduce the daily caloric intake using the U.S. Department of Agriculture's MyPlate pyramid. The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment. A BMI of 31 indicates obesity, and the nurse instructs the patient to keep a record of food actually consumed over the next 3 to 7 days.
Addressing obesity
The nurse provides care to a menopausal client, who states, "I read a news article that says I am at risk for coronary vascular disease due to inflammation." Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis? Avoiding use of caffeine Taking a daily multivitamin Addressing obesity Drinking at least 2 liters of water a day
26
What is the body mass index (BMI) of a client who weighs 195 lbs and is 6 feet tall? Round to the nearest whole number, and enter the correct number ONLY.
Rimonabant (Acomplia)
Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome? Sibutramine (Meridia) Alli Orlistat (Xenical) Rimonabant (Acomplia)
