Chapter 42: Assessment and Management of Patients with Obesity

Which adult will the nurse plan to teach about risks associated with obesity? • Man who has a BMI of 18 kg/m2 • Man with a 42 in waist and 44 in hips • Woman who has a body mass index (BMI) of 24 kg/m2 • Woman with a waist circumference of 34 inches (86 cm)

Ans: B Feedback: The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level of <0.80. A patient with a BMI of 18 kg/m2 is considered underweight. A BMI of 24 kg/m2 is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm).

After bariatric surgery, a patient who is being discharged tells the nurse, I prefer to be independent. I am not interested in any support groups. Which response by the nurse is best? • I hope you change your mind so that I can suggest a group for you. • Tell me what types of resources you think you might use after this surgery. • Support groups have been found to lead to more successful weight loss after surgery. • Because there are many lifestyle changes after surgery, we recommend support groups.

Ans: B Feedback: This statement allows the nurse to assess the individual patients potential needs and preferences. The other statements offer the patient more information about the benefits of support groups, but fail to acknowledge the patients preferences.

After successfully losing 1 lb weekly for several months, a patient at the clinic has not lost any weight for the last month. The nurse should first: • review the diet and exercise guidelines with the patient. • instruct the patient to weigh and record weights weekly. • ask the patient whether there have been any changes in exercise or diet patterns. • discuss the possibility that the patient has reached a temporary weight loss plateau.

Ans: C Feedback: The initial nursing action should be assessment of any reason for the change in weight loss. The other actions may be needed, but further assessment is required before any interventions are planned or implemented.

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

Cushing's disease Cushing's disease, results from excess cortisol in the blood. This increases the risk of obesity. The other diseases or conditions listed most likely causes weight loss, not weight gain.

A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers? "Sit in a semi-recumbent position while eating." "Avoid taking antacid drugs." "Keep the head of your bed propped on blocks at night." "Avoid taking non-steroidal anti-inflammatory drugs."

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

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

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

A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help the client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include? "It binds with enzymes to decrease carbohydrate absorption." "It decreases your appetite." "It works to make you feel full." "It binds with enzymes to help prevent digestion of fat."

"It binds with enzymes to help prevent digestion of fat." Orlistat (Xenical) works to bind to gastric and pancreatic lipase to prevent the digestion of 30% of ingested fat, thereby decreasing caloric intake.

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

"Older adults have a slightly higher prevalence of obesity in comparison to the general population." Older adults have a slightly higher prevalence of obesity when compared to the general population.

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

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

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

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

A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face? Both obesity and scare food sources Both undernutrition and sedentary lifestyles Both undernutrition and obesity Both low metabolism and high metabolism

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

A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI? Class I obesity Class II obesity Overweight Normal weight

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

A nurse cares for a client who is postoperative bariatric surgery and has experienced frequent episodes of dumping syndrome. The client now reports anorexia. What is the primary reason for the client's report of anorexia? Absorption of food Fear of eating Size of the stomach Taste of food

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

A nurse cares for a client with obesity. Which medication that the client takes may be contributing to the client's obesity? Metformin Topiramate Gabapentin Bupropion

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

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

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

A nurse caring for a client with obesity recognizes the client is at risk for renal complications related to obesity. Which disease or condition is associated with obesity? Glomerulonephritis Rhabdomyolysis Nephrolithiasis Renal cancer

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

A nurse works in a bariatric clinic and cares for client with obesity who will or have undergone bariatric surgery. What is the nurse's understanding of how the procedure works? Restricts the client's ability to digest fat. Restricts the client's ability to eat. Impairs gastric motility. Impairs caloric absorption.

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

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

Dizziness Tachycardia Sweating Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that is common among clients who have had bariatric surgery. Symptoms of dumping syndrome include (but are not limited to): sweating, tachycardia, nausea, vomiting, dizziness, and diarrhea. Fever and hypertension are not symptoms of dumping syndrome.

The nurse is admitting a client with traumatic injuries who also has class III obesity. When planning this client's care, the nurse should address the client's heightened risk of what nursing diagnoses related to obesity? Select all that apply. Unilateral neglect Impaired skin integrity Deficient fluid volume Impaired gas exchange Bowel incontinence

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

A nurse cares for a client with obesity who has type 2 diabetes. Which medication does the nurse recognize may assist in weight loss and is also approved to treat type 2 diabetes? Lorcaserin Orlistat Benzphetamine Liraglutide

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

A client with obesity is interested in trying orlistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication? Renal insufficiency Chronic obstructive pulmonary disease Anemia Diabetes mellitus

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

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

Stimulate GI peristalsis Early oral hydration stimulates GI peristalsis. The nurse would not give a client oral hydration to assess for intact swallowing as this may lead to aspiration. There is no reason to assume a client would have gastric perforation and this would not be appropriate. Digestive hormones are stimulated once peristalsis begins; however, this is not the primary purpose of early oral hydration.

Which assessment action will help the nurse determine if an obese patient has metabolic syndrome? A. Take the patients apical pulse. B. Check the patients blood pressure. C. Ask the patient about dietary intake. D. Dipstick the patients urine for protein.

Ans: B Feedback: Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information also may be obtained by the nurse, but it will not assist with the diagnosis of metabolic syndrome.

The nurse is caring for a 54-year-old female patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? • Bilateral crackles audible at both lung bases • Redness, irritation, and skin breakdown in skinfolds • Emesis of bile-colored fluid past the nasogastric (NG) tube • Use of patient-controlled analgesia (PCA) several times an hour for pain

Ans: C Feedback: Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected.

A nurse is caring for a client who will undergo bariatric surgery. Which nutritional recommendation will the nurse include in the client teaching? "Increase your intake of fluids at meals." "Increase your intake of plant-based proteins." "Increase your intake of complex carbohydrates." "Increase your intake of monounsaturated fats."

"Increase your intake of plant-based proteins." The client should be advised to increase protein intake, particularly plant-based protein because animal-based protein may not be tolerated well. The client should be advised to decrease fat intake, regardless of the source. Additionally, the client should be advised to decrease fluid intake at meals, not increase intake.

A client is in the bariatric clinic 1 month after having gastric bypass surgery. The client is crying and says I didnt know it would be this hard to live like this. What response by the nurse is best? A. Assess the clients coping and support systems. B. Inform the client that things will get easier. C. Re-educate the client on needed dietary changes. D. Tell the client lifestyle changes are always hard.

Ans: A Feedback: The nurse should assess this clients coping styles and support systems in order to provide holistic care. The other options do not address the clients distress.

A 61-year-old man is being admitted for bariatric surgery. Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)? • Demonstrate use of the incentive spirometer. • Plan methods for bathing and turning the patient. • Assist with IV insertion by holding adipose tissue out of the way. • Develop strategies to provide privacy and decrease embarrassment.

Ans: C Feedback: UAP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require registered nurse (RN)level education and scope of practice.

A client who is postoperative open RYGB bariatric surgery is scheduled for discharge and will have a Jackson-Pratt drain to care for while at home. Which teaching will the nurse include specific to this? Select all that apply. Recording drainage amount How to change the drain When to contact the health care provider How to empty the drain How to measure the drainage amount

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

What information will the nurse include for an overweight 35-year-old woman who is starting a weightloss plan? • Weigh yourself at the same time every morning and evening. • Stick to a 600- to 800-calorie diet for the most rapid weight loss. • Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. • Weighing all foods on a scale is necessary to choose appropriate portion sizes.

Ans: C Feedback: The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorie-restricted diets are not necessary for patients in the overweight category of obesity and need to be closely supervised. Patients should weigh weekly rather than daily.

A nurse reviews with the client the various types of medications used to treat diabetes. Which statement will the nurse use when teaching the client about liraglutide's mechanism of action? "It stimulates central noradrenergic receptors." "It diminishes intestinal absorption and metabolism of fats." "It stimulates central 5-HT2C receptors." "It causes delayed gastric emptying."

"It causes delayed gastric emptying." Liraglutide (Saxenda), a GLP-1 receptor agonist, delays gastric emptying, curbing appetite. Gastrointestinal lipase inhibitors (orlistat/Xenical), diminishes intestinal absorption and metabolism of fats. The selective serotonergic 5-HT2C receptor agonist stimulates central 5-HT2C receptors, causing appetite suppression. Sympathomimetic amines stimulate central noradrenergic receptors, causing appetite suppression.

After the nurse teaches a patient about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the initial instructions about diet have been understood? • 3 oz of lean beef, 2 oz of low-fat cheese, and a tomato slice • 3 oz of roasted pork, a cup of corn, and a cup of carrot sticks • Cup of tossed salad and nonfat dressing topped with a chicken breast • Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery

Ans: B Feedback: This selection is most consistent with the recommendation of the American Institute for Cancer Research that one third of the diet should be from animal sources and two thirds from plant source foods. The other choices all have higher ratios of animal origin foods to plant source foods than would be recommended.

A nurse is educating a client who will undergo bariatric surgery on methods to prevent dysphagia. What teaching will the nurse include? Select all that apply. "Chew your food thoroughly." "Avoid eating tough foods." "Eat slowly." "Eat bland foods such as doughy bread." "Avoid eating overcooked meats."

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

nurse cares for a client who wants to know more information about bariatric surgery. The client asks the nurse, "What weight loss can I expect?" What is the nurse's best response? "Expect to lose 45-50% of total body weight 2 to 3 years postoperatively." "Expect to lose 50 pounds in the first month after surgery." "Expect to lose 10-35% of total body weight 2 to 3 years postoperatively." "Expect to lose 10-35 pounds in the first month after surgery."

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

A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response? "The fat is absorbed in your intestines." "The fat is excreted in your urine." "The fat remains undigested in your stomach." "The fat is passed in your stools."

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

A client is scheduled for a Roux-en-Y bariatric surgery. When teaching the client about the surgical procedure, which statement will the nurse use? "The stomach is stapled to a very small pouch and the entire small intestine is rerouted. "The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." "A prosthetic device binds the stomach and creates a very small pouch and restricts oral intake." "85% of the stomach is removed surgically, leaving a much smaller tube-like structure."

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

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

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

A nurse cares for a client with a BMI of 36 kg/m2 and nonalcoholic fatty liver disease. The client asks the nurse if he is a candidate for bariatric surgery. How should the nurse respond to the client? "No, you do not have any qualifying criteria for bariatric surgery." "Yes, your BMI and chronic condition meets the criteria for bariatric surgery." "No, you have one qualifying condition but not the other; this excludes you from bariatric surgery." "Yes, your chronic condition meets the criteria for bariatric surgery but not your BMI."

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

A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population? "After surgery, your ability to conceive is decreased considerably." "After surgery, contraceptives have much less efficacy." "You should avoid pregnancy for at least 18 months after surgery." "You should avoid pregnancy for at least 9 months after surgery"

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

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

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

A nurse caring for adults with obesity recognizes that obesity is classified based on BMI. Which BMI does the nurse recognize as Class II obesity? 40 kg/m2 29 kg/m2 34 kg/m2 35 kg/m2

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

The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include? • Drink fluids between meals but not with meals. • Choose high-fat foods for at least 30% of intake. • Developing flabby skin can be prevented by exercise. • Choose foods high in fiber to promote bowel function.

Ans: A Feedback: Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin.

When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include? • Blood glucose test • Cardiac enzyme tests • Postural blood pressures • Resting electrocardiogram

Ans: A Feedback: A fasting blood glucose test >100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome although they may be used to check for cardiovascular complications of the disorder.

The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best exercise plan for weight loss? • Walking for 40 minutes 6 or 7 days/week • Lifting weights with friends 3 times/week • Playing soccer for an hour on the weekend • Running for 10 to 15 minutes 3 times/week

Ans: A Feedback: Exercise should be done daily for 30 minutes to an hour. Exercising in highly aerobic activities for short bursts or only once a week is not helpful and may be dangerous in an individual who has not been exercising. Running may be appropriate, but a patient should start with an exercise that is less stressful and can be done for a longer period. Weight lifting is not as helpful as aerobic exercise in weight loss.

A 40-year-old obese woman reports that she wants to lose weight. Which question should the nurse ask first? • What factors led to your obesity? • Which types of food do you like best? • How long have you been overweight? • What kind of activities do you enjoy?

Ans: A Feedback: The nurse should obtain information about the patients perceptions of the reasons for the obesity to develop a plan individualized to the patient. The other information also will be obtained from the patient, but the patient is more likely to make changes when the patients beliefs are considered in planning.

A client has been prescribed lorcaserin (Belviq). What teaching is most appropriate? A. Increase the fiber and water in your diet. B. Reduce fat to less than 30% each day. C. Report dry mouth and decreased sweating. D. Lorcaserin may cause loose stools for a few days.

Ans: A Feedback: This drug can cause constipation, so the client should increase fiber and water in the diet to prevent this from occurring. Reducing fat in the diet is important with orlistat. Lorcaserin can cause dry mouth but not decreased sweating. Loose stools are common with orlistat.

Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program? • Having the adults write down the caloric intake of each meal • Asking the adults about situations that tend to increase appetite • Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals • Encouraging the adults to eat small amounts frequently rather than having scheduled meals

Ans: B Feedback: Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as calorie counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior modification.

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass? • Educating the patient about the nasogastric (NG) tube • Instructing the patient on coughing and breathing techniques • Discussing necessary postoperative modifications in lifestyle • Demonstrating passive range-of-motion exercises for the legs

Ans: B Feedback: Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery.

A client is awaiting bariatric surgery in the morning. What action by the nurse is most important? • Answering questions the client has about surgery • Beginning venous thromboembolism prophylaxis • Informing the client that he or she will be out of bed tomorrow • Teaching the client about needed dietary changes

Ans: B Feedback: Morbidly obese clients are at high risk of venous thromboembolism and should be started on a regimen to prevent this from occurring as a priority. Answering questions about the surgery is done by the surgeon. Teaching is important, but safety comes first.

A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority? • Assess the clients pain. • Check the surgical incision. • Ensure an adequate airway. • Program the morphine pump.

Ans: C Feedback: All actions are appropriate care measures for this client; however, airway is always the priority. Bariatric clients tend to have short, thick necks that complicate airway management.

1. Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1000-calorie diet? • It will be necessary to change lifestyle habits permanently to maintain weight loss. • You will decrease your risk for future health problems such as diabetes by losing weight now. • You are likely to notice changes in how you feel with just a few weeks of diet and exercise. • Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.

Ans: C Feedback: Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 22-year-old patient is unlikely to be motivated by future health problems. Telling a patient that the initial weight loss is water will be discouraging, although this may be correct. Changing lifestyle habits is necessary, but this process occurs over time and discussing this is not likely to motivate the patient.

A few months after bariatric surgery, a 56-year-old man tells the nurse, My skin is hanging in folds. I think I need cosmetic surgery. Which response by the nurse is most appropriate? A. The important thing is that you are improving your health. B. The skinfolds will disappear once most of the weight is lost. C. Cosmetic surgery is a possibility once your weight has stabilized. D. Perhaps you would like to talk to a counselor about your body image.

Ans: C Feedback: Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. Skinfolds may not disappear over time, especially in older patients. The response, The important thing is that your weight loss is improving your health, ignores the patients concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counselor, it is more likely to be helpful to know that cosmetic surgery is available.

After vertical banded gastroplasty, a 42-year-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care? A. Offer sips of fruit juices at frequent intervals. B. Irrigate the nasogastric (NG) tube frequently. C. Remind the patient that PCA use may slow the return of bowel function. D. Support the surgical incision during patient coughing and turning in bed.

Ans: D Feedback: The incision should be protected from strain to decrease the risk for wound dehiscence. The patient should be encouraged to use the PCA because pain control will improve the cough effort and patient mobility. NG irrigation may damage the suture line or overfill the stomach pouch. Sugar-free clear liquids are offered during the immediate postoperative time to decrease the risk for dumping syndrome.

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

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

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

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

The nurse plans care for a client with obesity. What does the nurse recognize is the primary pathophysiological reason clients with obesity are at greater risk for developing thromboembolism? Increased blood viscosity Compromised peripheral blood flow Increased fat accumulation in the blood Impaired clotting

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

A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply. Heart failure Hypertension Heart murmur Coronary artery disease Myocardial infarction

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

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

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

A nurse working with clients with obesity understands that the hypothalamus plays an important role in hunger and satiety. Which statement best describes the role of the hypothalamus in hunger and satiety? It signals the release of neuropeptide y, which leads to feelings of satiety. It signals the release of ghrelin, which increases feelings of hunger. It signals the GI system to slow gastric motility. It signals higher neural pathways that lead to eating behaviors.

It signals higher neural pathways that lead to eating behaviors. The hypothalamus signals higher neural pathways that lead to eating behaviors. The hypothalamus does not signal the release of ghrelin or neuropeptide y, nor does it signal the GI system to slow gastric motility.

A nurse is caring for a client with a BMI of 35 kg/m2 who is wanting to lose weight. What is the initial recommendation the nurse will expect from the client's health care provider? Lifestyle modification Pharmacological management Nonsurgical interventions Surgical interventions

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

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

Low Fowler's Positioning the client in low Fowler's position best promotes comfort in the client who is post op bariatric surgery. In addition to decreasing incisional pain, this position also promotes gastric emptying.

A nurse cares for a client with obesity who reports taking "a medication of weight loss" but cannot remember the name of it. The client also reports nervousness and feeling "jittery". Which medication is the client most likely taking? Phentermine Lorcaserin Orlistat Naltrexone/bupropion

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

A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding? Excessive fat intake Rapid gastric dumping Decreased motility Decreased gastric size

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

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

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

A nurse examines the socioeconomic impact of obesity among Americans. Which statements does the nurse understand is true? Select all that apply. Income is not related to the prevalence of disease. Education is not related to the prevalence of disease. Those with less education are impacted at a greater prevalence of disease. Those with less income are impacted at a greater prevalence of disease. Those who own their own homes have a decreased prevalence of disease.

Those with less education are impacted at a greater prevalence of disease. Those with less income are impacted at a greater prevalence of disease. The socioeconomic disparities of obesity among Americans is great. In general, those who are less educated and earn less income are more likely to have obesity. Home ownership does not decrease the prevalence of obesity.

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

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

A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate? Mechanical compression and prophylactic anticoagulation Prophylactic anticoagulation only Mechanical compression only Early ambulation only

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

Place the pathophysiological steps in order of how a client with obesity is at greater risk for venous thromboembolism in comparison to the general population. Impairment of peripheral blood flow Blood stasis Formation of a thrombus Increased adipose tissue

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

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

It has over 100 times more genes than the human genome. The collective genome of the microbiota, or the gut microbiome, has more than 100 times more genes than in the human genome. Its function and relationship to disease has long been studied.

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

Over time, we have become efficient in food storage and deposition of fat stores. According to the "thrifty gene" theory, hunting for scarce food sources during prehistoric times consumed a lot of energy, and food sources were not abundant. Storing fat to provide energy sources during times of food scarcity was a physiologic adaptive response to these environmental challenges and over time, we became more efficient in food storage and fat deposition.

A nurse cares for a client who is post op bariatric surgery and the nurse offers the client a sugar-free beverage. What is the primary purpose of offering a sugar-free beverage? These ease gastric distention. These are less likely to cause dumping syndrome. These ease nausea. These are less likely to raise the blood sugar.

These are less likely to cause dumping syndrome. The primary purpose of offering a sugar-free beverage is that they are less likely to cause dumping syndrome in the client who is post op from bariatric surgery. Sugar-free beverages are less likely than sugary beverages to raise the blood sugar; however, this is not the primary purpose of offering the sugar-free beverage. Sugar-free beverages do not necessarily ease nausea or gastric distention.

Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider? • The patient frequently has liquid stools. • The patient is pale and has many bruises. • The patient complains of bloating after meals. • The patient is experiencing a weight loss plateau.

Ans: B Feedback: Because orlistat blocks the absorption of fat-soluble vitamins, the patient may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. Weight loss plateaus are normal during weight reduction.

A client with obesity is diagnosed with type 2 diabetes. In order to promote weight loss in the client and aid in glucose management, which medication will the nurse anticipate the health care provider ordering? Glyburide Metformin Glipizide Pioglitazone

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