PrepU Chapter 42: Assessment and Management of Patients with Obesity

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 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 50 pounds in the first month after surgery." "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."

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

"It binds with enzymes to help prevent digestion of fat."

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? "85% of the stomach is removed surgically, leaving a much smaller tube-like structure." "A prosthetic device binds the stomach and creates a very small pouch and restricts oral intake." "The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." "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 client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response? "Your dose may need to be adjusted." "This is an expected finding with this medication." "Taking this medication with meals decreases this symptom." "How much water are drinking?"

"This is an expected finding with this medication."

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? "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." "No, you do not have any qualifying criteria for bariatric surgery." "No, you have one qualifying condition but not the other; this excludes you from bariatric surgery."

"Yes, your BMI and chronic condition meets the criteria for bariatric surgery."

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

$147 billion

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? 23 31 18 28

23

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

32.9

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? 250-400 calories 500-1,000 calories 1,000-1,500 calories 300-600 calories

500-1,000 calories

At its most fundamental level, what does obesity result from? A genetic alteration A metabolic imbalance A lifestyle imbalance A hormone imbalance

A metabolic imbalance

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) "excreted in your urine." C) "The fat remains undigested in your stomach." D) "The fat is absorbed in your intestines."

A) "The fat is passed in your stools."

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? A) Question the order due to the client's recent bariatric surgery B) Ensure that the NG tube inserted is at least a size 14 French C) Insert the NG tube cautiously due to the client's recent GI surgery D) Question the order because decreased bowel motility is expected postoperatively

A) Question the order due to the client's recent bariatric surgery

The nurse is teaching injection techniques for a client prescribed liraglutide for the treatment of obesity. Which areas of the body will the nurse suggest for injection sites? Select all that apply. A) Upper thigh B) Abdomen C) Upper arm D) Buttocks E) Lower thigh

A) Upper thigh B) Abdomen C) Upper arm E) Lower thigh

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 Addressing obesity Drinking at least 2 liters of water a day Taking a daily multivitamin

Addressing obesity

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

Age

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 drive while taking this medication." B) "Do not drink alcohol while taking this medication." C) "Take the medication with a full glass of water." D) "Take the medication at night before bedtime."

B) "Do not drink alcohol while taking this medication."

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) Heart murmur B) Hypertension C) Heart failure D) Coronary artery disease E) Myocardial infarction

B) Hypertension C) Heart failure D) Coronary artery disease E) Myocardial infarction

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

BMI Weight Waist circumference

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

Both undernutrition and obesity

A nurse cares for a client with obesity who is also diagnosed with depression. Which medication does the nurse expect the health care provider will prescribe, which also aids in weight loss? Bupropion Nortriptyline Amitriptyline Doxepin

Bupropion

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 performing deep breathing and coughing exercises B) Reposition the client at least every 2 hours while in bed C) Assist the client with ambulating as early and often as possible D) Administer coumadin PO as prescribe

C) Assist the client with ambulating as early and often as possible

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

D) Those with less education are impacted at a greater prevalence of disease. A) Those with less income are impacted at a greater prevalence of disease.

A nurse cares for a client with sepsis who had bariatric surgery two weeks ago. What is the most likely source of the sepsis? Perforation of the gastric contents. Disruption at the site of anastomosis. Colonization of bacteria in the bladder. Bacterial infiltration at the surgical site of the skin.

Disruption at the site of anastomosis.

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? Glipizide Glyburide Pioglitazone Metformin

Metformin

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

Osteoarthritis

A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity? 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 less efficient in hunting and gathering of food. Over time, we have become efficient in food storage and deposition of fat stores.

Over time, we have become efficient in food storage and deposition of fat stores.

A nurse teaches a client who will undergo bariatric surgery the importance of avoiding problematic foods post surgery. Which foods will the nurse suggest the client avoid? Select all that apply. Rice Mashed potatoes Doughy breads Overcooked meats Pasta

Rice Doughy breads Pasta Overcooked meats

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 Stimulate digestive hormones Assess for intact swallowing

Stimulate GI peristalsis

A nurse is caring for a client with obesity and diabetes after abdominal surgery. What is the client at increased risk for? Wound dehiscence Contractures Phlebitis Hypotension

Wound dehiscence

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: anticipate having some discomfort or anxiety when assessing the client. examine his or her own preconceptions and beliefs about obesity. remind himself or herself that obesity is a treatable health problem. seek advice from a colleague who is known to provide empathic care.

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. remind himself or herself that obesity is a treatable health problem. anticipate having some discomfort or anxiety when assessing the client. seek advice from a colleague who is known to provide empathic care.

examine his or her own preconceptions and beliefs about obesity.

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

obesity

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

"You should avoid pregnancy for at least 18 months after surgery."

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

26.4

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

32.7

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

All options are correct.

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

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

"Avoid taking non-steroidal anti-inflammatory drugs."

A nurse provides nutritional teaching to a client who is scheduled to have bariatric surgery. Which statements will the nurse include on fluid intake after the procedure? Select all that apply. "Drink liquids 30-60 minutes after eating." "Drink water at meals." "Drink plenty of water." "Avoid drinking liquid calories." "Drink frequent, small amounts of liquids."

"Drink liquids 30-60 minutes after eating." "Drink plenty of water." "Avoid drinking liquid calories." "Drink frequent, small amounts of liquids."

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 become involved in a weight loss program." "I need to keep my inhaler at the bedside." "I should eat a high-protein diet."

"I should become involved in a weight loss program."

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) Decreased gastric size E) Decreased motility F) Excessive fat intake

A) Rapid gastric dumping

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? Assist the client with ambulating as early and often as possible 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

A client with obesity will undergo intragastric balloon therapy for weight loss. What teaching will the nurse include when educating the client about this procedure? Select all that apply. A) "This procedure has shown greater weight loss results when compared to bariatric surgery." B) "The balloon will remain in place for 3 to 6 months." C) "This procedure works by causing malabsorption of fat." D) "The balloon via a minimally-invasive surgery." E) "Nausea and vomiting are the most commonly reported side effects."

B) "The balloon will remain in place for 3 to 6 months." E) "Nausea and vomiting are the most commonly reported side effects."

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) Prophylactic anticoagulation only B) Mechanical compression and prophylactic anticoagulation C) Mechanical compression only D) Early ambulation only

B) Mechanical compression and prophylactic anticoagulation

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? A) 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. B) The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment. C) 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. D) A BMI of 31 indicates obesity, and the nurse instructs the

B) The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment.

A nurse is planning care for a client who will undergo bariatric surgery in a week. What goals are acceptable during this point in the client's care? Select all that apply. Client will understand preoperative and postoperative dietary restrictions. Client will become knowledgeable about the procedure. Client will become knowledgeable about vitamin requirements. Client will have decreased anxiety about the procedure. Client will understand how to maintain normal bowel function.

Client will understand preoperative and postoperative dietary restrictions. Client will become knowledgeable about the procedure. Client will have decreased anxiety about the procedure.

The nurse is working with a client who has difficulty controlling blood sugar. The client is classified as overweight. The client does not adhere to a low-calorie diet and forgets to take medications and check blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, what action will the take first? Collaborates with the client to establish an agreed-upon goal Informs the client about what goal the nurse wants the client to achieve Sets the long-term goal as "the client's glycohemoglobin will be 6.9% in 3 months" Plans the short-term goal as "the client's blood sugar each AM will be less than 110 mg/dL"

Collaborates with the client to establish an agreed-upon goal

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 plant-based proteins." "Increase your intake of monounsaturated fats." "Increase your intake of complex carbohydrates." "Increase your intake of fluids at meals."

"Increase your intake of plant-based proteins."

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. A) When to contact the health care provider B)How to change the drain C)How to measure the drainage amount D)Recording drainage amount E)How to empty the drain

A) When to contact the health care provider C)How to measure the drainage amount D)Recording drainage amount E)How to empty the drain