CH 40 EAQ Obesity
While performing a health assessment, the nurse documents a child's weight as 25 kg and height as 1.1 meters. What is the body mass index (BMI) of the child? Record the answer rounded to one decimal place.
ANS: 20.7 kg/m2 The child weighs 25 kg and measures 1.1 meters in height. Body mass index (BMI) is calculated using the formula: Body mass index = weight in kg/(height in meters) 2 = 25/(1.1) 2= 25/1.21 = 20.66 kg/m 2. Rounded to the nearest one decimal place that is 20.7 kg/m 2
The nurse determines that an obese patient has varicose veins and cellulite. Which body condition creates a high risk for this condition? a. Gynoid body shape b. Android body shape c. Primary obesity d. Secondary obesity
ANS: A A patient with gynoid obesity is at risk for osteoporosis, varicose veins, and cellulite due to fat being mainly located in the upper legs. A patient with android obesity has excess fat depositions primarily in the abdominal area. A person with either primary obesity or secondary obesity may develop varicose veins or cellulite; however, the conditions are associated with where fat accumulates on the body rather than the specific cause (primary or secondary) of the patient's obesity.
While performing the nutritional assessment of a patient, the nurse finds that the patient's height is 1.71 m and weight is 68 kg. What does the nurse interpret based on the patient's body mass index (BMI)? a. The BMI indicates the weight is normal. b. The BMI indicates a higher risk for disease. c. The BMI indicates the weight is above normal. d. The BMI indicates the weight is below normal.
ANS: A BMI is a measure of relative weight based on a patient's mass and height. It is calculated by using the following formula: actual body weight in kilograms/(height in meters) 2. For this patient, multiply 1.71 m by 1.71 m. This equals 2.9241. Next, divide 68 kg (the patient's weight) by 2.9241. This equals 23.25 kg/m 2. The patient's BMI of 23.25 falls in between 18.5 kg/m 2and 24.9 kg/m 2, so it indicates normal weight. If the patient's BMI is greater than 30 kg/m 2, it indicates a higher risk of disease. If the patient's BMI falls in between 25.0 to 29.9 kg/m 2, it indicates that the patient's weight is above normal. If the patient's BMI is less than 18.5 kg/m 2, it indicates that the patient is underweight.
Which type of bariatric surgery decreases the amount of small intestine available for nutrient absorption and also removes part of the patient's stomach? a. Biliopancreatic diversion b. Adjustable gastric banding c. Sleeve gastrectomy d. Roux-en-Y gastric bypass surgery
ANS: A Biliopancreatic diversion is a malabsorptive surgery that involves removing 70% of the stomach. This surgery decreases the amount of small intestine available for nutrient absorption. Adjustable gastric banding is a restrictive surgery in which the band encircles the stomach, creating a stoma and a gastric pouch with about 30 mL capacity. Sleeve gastrectomy is a restrictive surgery in which 85% of the stomach is removed, leaving a sleeve-shaped stomach with 60 to 150 mL capacity. Roux-en-Y gastric bypass surgery is a combination of restrictive and malabsorptive surgery in which a small pouch is created on the stomach by restrictive surgery. The small gastric pouch is connected to the jejunum and the remaining stomach and first segment of the small intestine are bypassed in this type of surgery.
During an assessment, a patient reports to the nurse that he or she has a habit of overeating and lives a mostly sedentary lifestyle. Which primary factor that leads to obesity does this example illustrate? a. Caloric intake exceeding energy expended b. Energy expended exceeding caloric intake c. Metabolic problems that relate to insulin resistance d. Corticosteroids causing increased blood sugar levels
ANS: A Caloric intake in excess of energy expended is an example of primary obesity that would occur if a patient overeats without getting physical activity. Energy expended in excess of caloric intake would lead to weight loss, not gain and obesity. Metabolic problems relating to insulin resistance and corticosteroids causing increased blood sugar are causes of secondary obesity.
The nurse recalls that levels of which hormone increase after starvation and decrease in response to food in the stomach? a. Ghrelin b. Peptide YY c. Neuropeptide Y d. Cholecystokinin
ANS: A Ghrelin is a peptide hormone, which increases appetite. The hormone levels of ghrelin increase after starvation and lower when the stomach is full. Peptide YY is a hormone that inhibits appetite by reducing gastrointestinal motility. Neuropeptide Y helps stimulate appetite by activating the hunger center. Cholecystokinin is the hormone secreted by the duodenum and jejunum that inhibits gastric signals. Peptide YY, neuropeptide Y, and cholecystokinin do not increase in response to starvation.
The nurse reviews the hormone deficiencies associated with obesity. When at a normal level, which hormone acts in the hypothalamus to suppress appetite and increase fat metabolism? a. Leptin b. Insulin c. Ghrelin d. Peptide YY
ANS: A Leptin is a hormone produced by adipocytes that inhibits the appetite and increases cell proliferation. Therefore, the patient will have a higher risk of cancer. Insulin is a hormone produced by the pancreas that suppresses appetite and is a cell growth factor. Ghrelin is a hormone that helps to regulate appetite, but it does not cause cell proliferation. Peptide YY, produced by the colon, inhibits the appetite; however, it does not cause cell proliferation.
The nurse teaches an elderly patient that aging problems can be exacerbated by obesity and includes what example? a. Arthritis b. Sinusitis c. Vision problems d. Chewing difficulty
ANS: A Obesity can place more demands on arthritic joints, and the mechanical strain on weight-bearing joints can lead to premature immobility, thereby exacerbating arthritis. Sinusitis, vision problems, and chewing difficulty are not related to obesity.
An obese patient is diagnosed with liver failure. When reviewing the patient's medical records, the nurse finds that the patient is undergoing weight loss therapy. Which medication is likely responsible for the patient's liver failure? a. Orlistat b. Diethylpropion c. Benzphetamine d. Phendimetrazine
ANS: A Orlistat is a nutrient absorption-blocking drug that blocks the breakdown of fats. The increased fat content in the liver may result in liver injury. Benzphetamine, diethylpropion, and phendimetrazines are nonamphetamines, which help to reduce obesity by suppressing appetite; they are not associated with liver failure.
A patient is prescribed phentermine/topiramate for obesity. The nurse should monitor the patient for what serious side effect? a. Hyperthyroidism b. Migraine attacks c. Seizure disorders d. Respiratory distress
ANS: A Phentermine is an anorectic, and topiramate is an anticonvulsant. These medications are commonly combined in a single drug and prescribed to overweight patients to reduce obesity by decreasing the appetite and promoting a satiated feeling. However, patients with hyperthyroidism should not use combined phentermine and topiramate because it may cause severe complications. Phentermine is an anorectic drug, which controls the severity of migraines. Topiramate is an anticonvulsant, so it helps to reduce seizures. Anticonvulsants such as topiramate will help reduce respiratory distress. Therefore, severe complications are not anticipated for patients with migraines, seizures, or respiratory distress.
During the initial postoperative period following bariatric surgery, the nurse recognizes the importance of monitoring obese patients for respiratory insufficiency based on what knowledge? a. The body stores anesthetics in adipose tissue. b. Postoperative pain may cause a decreased respiratory rate. c. Intubation may be difficult because of extra chin skin folds. d. The patient's head must remain flat for a minimum of 2 hours postprocedure.
ANS: A The body stores anesthetics in adipose tissue, placing patients with excess adipose tissue at risk for resedation. As adipose cells release anesthetics back into the bloodstream, the patient may become sedated after surgery, increasing the risk of hypoventilation and resultant respiratory insufficiency. Pain usually increases respiratory rate. Difficult intubation does not cause respiratory insufficiency. The patient's head should be elevated after bariatric surgery to decrease abdominal pressure and facilitate respirations.
The nurse assesses a patient who is obese. What psychosocial health risks are associated with obesity? Select all that apply. a. Depression b. Discrimination c. Impaired flexibility d. Stress incontinence e. Exercise intolerance
ANS: A B Depression and discrimination are the psychosocial health risks associated with obesity. Impaired flexibility is a musculoskeletal health risk associated with obesity. Stress incontinence is a genitourinary health risk associated with obesity. Exercise intolerance is a respiratory health risk associated with obesity.
A severely obese patient has undergone Roux-en-Y gastric bypass (RYGB) surgery. The nurse will monitor for dumping syndrome, which is characterized by which symptoms? Select all that apply. a. Diarrhea b. Sweating c. Faintness d. Constipation e. Nausea and vomiting
ANS: A B C E A complication of RYGB is dumping syndrome, in which gastric contents empty too rapidly into the small intestine, overwhelming its ability to digest nutrients. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea. Patients are discouraged from eating sugary foods after surgery to avoid dumping syndrome. Constipation is not a symptom of dumping syndrome.
The nurse is teaching a class about weight management and should include what health risks associated with obesity? Select all that apply. a. Sleep apnea b. Breast cancer c. Atrial fibrillation d. Hyperthyroidism e. Gastroesophageal reflux disease (GERD)
ANS: A B C E Health risks associated with obesity include cardiovascular disease (related to increased low-density lipoprotein levels, increased triglyceride levels, and decreased high-density lipoprotein levels), hypertension, atrial fibrillation, sleep apnea, obesity hypoventilation syndrome, reduced chest wall compliance, increased work of breathing, and decreased total lung capacity and functional residual capacity, type 2 diabetes mellitus (i.e., hyperinsulinemia and insulin resistance), osteoarthritis, hyperuricemia, gout, gastroesophageal reflux disease, gallstones, nonalcoholic steatohepatitis, fatty liver and cirrhosis, cancer (i.e., breast, endometrial, kidney, colorectal, pancreas, esophagus, and gallbladder), psychosocial problems (i.e., employment, education, and health care), low self-esteem, withdrawal from social interactions, and major depression. Patients with excess thyroid hormone are thin, not obese.
The nurse reviews the medical record of a patient with obesity and identifies that the patient is at risk for which conditions? Select all that apply. a. Gallstones b. Sleep apnea c. Hypothyroidism d. Esophageal cancer e. Systemic lupus erythematosus (SLE)
ANS: A B D Gallstones are more prevalent in obese people. Gallstones occur due to supersaturation of the bile with cholesterol. The types of cancer most strongly linked to excess body fat are breast, endometrial, kidney, colorectal, pancreatic, esophageal, and gallbladder cancer. Esophageal cancer may be secondary to acid reflux caused by abdominal obesity. The increased fat mass associated with obesity may lead to sleep apnea. Hypothyroidism and SLE are not health risks associated with obesity.
After completing an assessment, the nurse classifies a patient as overweight based on which body mass index (BMI) range? a. 18.5 to 24.9 kg/m 2 b. 25 to 29.9 kg/m 2 c. 30 to 40 kg/m 2 d. Greater than 40 kg/m 2
ANS: B A BMI between 18.5 to 24.9 kg/m 2 reflects a normal body weight, and a BMI of 25 to 29.9 kg/m 2 is considered overweight. A BMI at 30 kg/m 2 or above indicates obesity, and more than 40 kg/m 2 indicates extreme obesity.
The nurse is caring for a patient with a herniated lumbar disc whose body mass index (BMI) is 28 kg/m 2. The nurse identifies that the BMI places the patient in which weight category? a. Normal weight b. Overweight c. Obese d. Severely obese
ANS: B A normal BMI is 18.5 to 24.9 kg/m 2, whereas a BMI of 25 to 29.9 kg/m 2 is considered overweight. A BMI of 30.0 to 39.9 kg/m 2 is considered obese, and a BMI of 40 kg/m 2 or greater is severely obese.
The nurse reviews the medical record of a patient and notes documentation of class I obesity. This determination was made because the patient has which body mass index (BMI)? a. 26 kg/m 2 b. 32 kg/m 2 c. 37 kg/m 2 d. 42 kg/m 2
ANS: B A patient who has a BMI between 30 and 35 kg/m 2 is class I obese. A patient who has a BMI between 25 and 29.9 kg/m 2 is overweight but not obese. A patient with a BMI between 35 and 40 kg/m 2 is class II obese. A patient who has a BMI that is more than 40 kg/m 2 is a severely obese or class III obese patient.
The nurse recalls that which anatomical change is observed after biliopancreatic diversion surgery? a. The stomach is sleeve shaped with a 60- to 150-mL capacity. b. There is an anastomosis between the stomach and the intestine. c. A band encircles the stomach, creating a stoma and a gastric pouch. d. A gastric pouch is connected to the jejunum, and the remaining stomach is bypassed.
ANS: B Biliopancreatic diversion surgery is a malabsorptive surgery in which the patient will undergo a 70 percent stomach removal with a duodenal switch. The stomach appears like a tube. The surgery creates an anastomosis between the stomach and the intestine. A vertical sleeve gastrectomy is a surgical procedure where 85 percent of the stomach is removed, leaving a sleeve-shaped stomach with a 60- to 150-mL capacity. A vertical banded gastroplasty is a restrictive surgery in which the patient will have a band encircling the stomach, creating a stoma and a gastric pouch. A Roux-en-Y gastric bypass is a combined malabsorptive and restrictive surgery in which the patient will have a gastric pouch connected to the jejunum and the remaining stomach will be bypassed.
A patient has a height of 180 cm and weighs 70 kg. In which weight category should the patient be placed? a. Underweight b. Normal weight c. Overweight d. Obese
ANS: B Body mass index (BMI) is a measure of weight for height. It can be calculated with the formula BMI = weight in kilograms / (height in meters) 2. A patient with a BMI of less than 18.5 kg/m 2 is considered underweight, normal weight is a BMI between 18.5 and 24.9 kg/m 2, and overweight is a BMI between 25 and 29.9 kg/m 2. A BMI of 30 kg/m 2 or greater is obese. The BMI of the patient is 21.6 kg/m 2, and hence the weight is normal.
The nurse provides education to a patient about reducing the risk of obesity. Which statement made by the patient indicates the need for further teaching? a. "I should eat two ounces of baked chicken for dinner." b. "I should incorporate canned fruits into my everyday diet." c. "I should eat vegetables and salad at lunch and dinner." d. "I should include a cup of low-fat milk at breakfast."
ANS: B Canned fruits contain excess sugars, so the patient will have a higher risk of obesity. Therefore, the patient should avoid canned fruits. Two ounces of baked chicken should be included with dinner because baked foods have a lower fat content. Vegetables and salads should be included in the diet because vegetables contain protein and vitamins for effective growth. Low-fat milk does not contain excess fat and provides adequate calcium for development, so it should be included in the diet.
Two weeks after a subtotal gastrectomy, a patient reports the sudden onset of faintness, weakness, and diaphoresis after eating a meal. The nurse suspects what complication? a. Acute pancreatitis b. Dumping syndrome c. Acute myocardial infarction d. Mesenteric artery embolism
ANS: B Dumping syndrome is the most likely cause of these symptoms about 2 weeks after surgery. Dumping syndrome is believed to be caused by food directly entering the jejunum without first being processed in the stomach. Acute pancreatitis would present with acute abdominal pain, nausea, vomiting, and tachycardia. In addition to complaints of feeling clammy, weak, and diaphoretic, an acute myocardial infarction would likely manifest with chest pain and pressure. Mesenteric artery embolism would also manifest as nausea, vomiting, and abdominal pain. The nurse should further question the patient to determine the cause of the episode, including other associated symptoms and what types and quantities of foods were eaten at the meal.
An obese patient tells the nurse, "I just can't stop eating." The nurse recalls that which hormone that is primarily produced in the stomach plays a role in compulsive eating? a. Cholecystokinin b. Ghrelin c. Leptin d. Insulin
ANS: B Ghrelin is a hormone that is primarily produced in the stomach. It is associated with the reward system that triggers overeating and is thought to play a part in compulsive eating. Cholecystokinin is produced in the small intestine and inhibits gastric emptying. Leptin is produced in the adipocytes and suppresses appetite and hunger. Insulin is produced in the pancreas and decreases appetite.
An obese patient tells the nurse, "I feel hungry all the time." The nurse suspects that what hormone abnormality is causing the patient's symptom? a. Increased levels of insulin hormone b. Decreased levels of leptin hormone c. Decreased levels of ghrelin hormone d. Increased levels of peptide YY hormone
ANS: B Lack of sleep results in the reduction of leptin hormone levels, which leads to increased appetite. Insulin is secreted by the pancreas, and it reduces appetite. Ghrelin increases appetite, so the patient with reduced ghrelin hormone levels will not have an increased appetite. Peptide YY hormone inhibits appetite by reducing gastrointestinal motility. Therefore, the patient with increased peptide YY hormone levels will have reduced motility.
The nurse recognizes that which surgical procedure is mosteffective in enhancing facial appearance after weight loss? a. Lipectomy b. Liposuction c. Restrictive surgery d. Malabsorptive surgery
ANS: B Liposuction is a cosmetic surgery that helps improve facial appearance around the chin, jaw, and nasal folds after weight loss. Lipectomy is a cosmetic surgery that improves body image. It is effective for the breasts, abdomen, and lumbar and femoral areas but not for the facial areas. Restrictive and malabsorptive surgeries are bariatric surgeries, which reduce the size of the stomach but do not affect the facial appearance.
The nurse reviews the height and weight measurements of a group of patients. Which patient will the nurse document as having a normal body weight? Patient A Patient B Patient C Patient D
ANS: B Patient B weighs 40 kg and measures 1.4 meters, so patient B has a body mass index equal to 40/(1.4) 2 = 20.4 kg/m 2. A BMI between 18.5 and 24.9 kg/m 2 indicates a normal body weight. Patient A weighs 100 kg and measures 2 meters in height. The body mass index (BMI) of patient A is 100/(2) 2=2 5 kg/m 2. A BMI between 25 and 29.9 kg/m 2indicates that the patient is overweight. Patient C weighs 35 kg and measures 1.6 meters in height. The BMI of patient C is 70/(1.6) 2= 70/2.56 = 27.3 kg/m 2, which indicates that the patient is overweight. Patient D weighs 56 kg and measures 1.8 meters in height. The BMI of patient D is 56/(1.8) 2 = 56/3.24 = 17.28 kg/m 2. A BMI below 18.5 kg/m 2indicates that the patient is underweight.
The nurse calculates that a patient's body mass index is 28 kg/m 2. What does the nurse interpret from the finding? a. The patient is obese. b. The patient is overweight. c. The patient has severe obesity. d. The patient has a normal body weight.
ANS: B Patients with a body mass index (BMI) between 25 and 29.9 kg/m 2 are overweight. A patient with a BMI between 30 and 40 kg/m 2 is considered obese. A BMI of more than 40 kg/m 2 indicates that the patient has severe obesity. A patient with a BMI between 18.5 and 24.9 kg/m 2 has a normal body weight.
A patient underwent an irreversible bariatric surgical procedure that involved creating a small gastric pouch and attaching it directly to the small intestine using a piece of the small bowel. The nurse recognizes that the patient had what surgical procedure? a. Biliopancreatic diversion b. Roux-en-Y gastric bypass (RYGB) c. Adjustable gastric banding d. Sleeve gastrectomy
ANS: B The RYGB procedure is a combination of restrictive and malabsorptive surgery. This surgical procedure is the most common bariatric procedure performed in the United States. This procedure, which is irreversible, involves creating a small gastric pouch and attaching it directly to the small intestine using a Y-shaped limb of the small bowel. After the procedure, food bypasses 90% of the stomach, the duodenum, and a small segment of jejunum. A biliopancreatic diversion removes 70% of the stomach horizontally and creates an anastomosis between the stomach and the intestine. Adjustable gastric banding is reversible (the band can be adjusted to be tighter or looser). Sleeve gastrectomy removes 85% of the stomach, leaving a sleeve-shaped stomach with 60 to 150 mL capacity.
The nurse recalls that which type of bariatric surgery may result in calcium and folic acid deficiency? a. Biliopancreatic diversion b. Roux-en-Y gastric bypass c. Sleeve gastrectomy d. Vertical banded gastroplasty
ANS: B The Roux-en-Y gastric bypass is a restrictive and malabsorptive surgery in which the patient may have a small gastric pouch connected to the jejunum. The patient who undergoes a roux-en-Y gastric bypass may have complications like folic acid deficiency and calcium deficiency. Biliopancreatic diversion is a malabsorptive bariatric surgery in which 70 percent of the stomach is removed horizontally. A patient who undergoes biliopancreatic diversion may experience protein-calorie malnutrition and iron deficiency. Sleeve gastrectomy is a restrictive surgery in which 85 percent of the stomach is removed. The patient undergoing a vertical sleeve gastrectomy may have limited weight loss. Vertical banded gastroplasty is a restrictive surgery in which a band is placed on the patient's stomach vertically and may cause dumping syndrome. Calcium and folic acid deficiency is not associated with biliopancreatic diversion, vertical sleeve gastrectomy, and vertical banded gastroplasty.
An obese patient is scheduled for cosmetic surgery for body image enhancement. The nurse provides education about reducing the risk of obesity recurrence. Which statement made by the patient indicates the need for further teaching? a. "I can include baked food in my diet." b. "I can eat candy and honey any time." c. "I need to exercise every day." d. "I need to drink low-fat milk and eat salads."
ANS: B The patient is undergoing a lipectomy, which is a cosmetic surgery to reduce body fat. However, there is still a risk of recurrence of obesity unless the patient maintains a proper diet. Candies and honey contain excess sugar, which increases the risk of obesity. Therefore, the patient should prefer fresh fruits to candies. Baked foods are lower in fat, so they can be included in the diet. Exercise is necessary to maintain proper body structure and reduce the risk of obesity. Low-fat milk and salads provide adequate nutrition and reduce the risk of obesity.
A male patient's waist circumference is 36 inches and body mass index (BMI) is 38.0 kg/m 2. What does the nurse interpret from these findings? a. The patient is at high risk for disease. b. The patient is at very high risk for disease. c. The patient is at increased risk for disease. d. The patient is at extremely high risk for disease.
ANS: B Waist circumference is used to assess and classify the patient's weight. Patients who have visceral fat with truncal obesity are at a greater health risk. If the waist circumference of the male patient is less than 40 inches, it indicates that the patient is at increased risk for disease. A waist circumference of 36 inches and BMI of 38.0 kg/m 2 indicates a very high risk for disease. A waist circumference of 36 inches and BMI between 30.0 and 34.9 kg/m 2 indicates a high risk for disease. A waist circumference of 36 inches and BMI between 25.0 and 29.9 kg/m 2 indicates an increased risk for disease. A waist circumference of 36 inches and BMI greater than 40.0 kg/m 2 indicates an extremely high risk for disease.
While performing a physical assessment, the nurse observes that the patient has fat primarily in the abdominal area. The fat is also distributed over the arms, neck, and shoulders. The nurse determines that the patient has which health risks? Select all that apply. a. Osteoporosis b. Hypertension c. Varicose veins d. Diabetes mellitus e. Endometrial cancer
ANS: B D E Fat deposition in the abdominal area and upper body like arms, neck, and shoulders are the characteristics of an apple-shaped body, which indicates that the patient has android obesity. Body shape is one of the methods of identifying patients who are at greater risk for health problems. Health risks associated with android obesity are hypertension, diabetes mellitus, and endometrial cancer. This occurs due to the presence of more active visceral fat. Osteoporosis and varicose veins are the health risks associated with gynoid obesity in patients with a pear-shaped body.
The nurse reviews the medical record of a female patient who may have metabolic syndrome. Which of the patient's assessment findings are criteria for metabolic syndrome? Select all that apply. Focused assessment results: Temp 98.2'F Pulse 88 RR 12 BP 120/80 Waist circumference 37 Wt 72.7 Ht 5'4'' BMI 28 kg/m2 Lab Studies: Triglyceride 220 HDL 40 FBS 136 a. Body mass index (BMI) b. High-density lipoprotein (HDL) c. cholesterol results d. Blood pressure (BP) e. Waist circumference f. Triglyceride level results
ANS: B E F Three of the five criteria must be met for a diagnosis of metabolic syndrome. Waist circumference ( >40 inches in men, >35 inches in women), triglycerides (>150 mg/dL or drug treatment for elevated triglyceride levels), high-density lipoprotein (HDL) cholesterol.
The nurse recognizes that a patient with a pear-shaped body is at high risk for which health problem? a. Heart disease b. Breast cancer c. Varicose veins d. Diabetes mellitus
ANS: C A patient with a pear-shaped body will have fat deposition in the upper legs. Therefore, the patient will have an increased risk of varicose veins. A patient with an apple-shaped body will have fat deposition in the abdomen and the upper body and will have a higher risk of heart disease, breast cancer, and diabetes mellitus.
The nurse identifies that a patient with android obesity is at risk for what disease? a. Reproductive disease b. Genitourinary disease c. Heart disease d. Respiratory disease
ANS: C A patient with android obesity has excess fat in the abdominal area. The patient has a high risk of heart disease. A patient who is pear-shaped or has excess fat in the upper thighs has a high risk of osteoporosis and varicose veins.
The nurse concludes that a patient has metabolic syndrome based on what abnormal laboratory result? a. Platelet count b. Creatinine level c. Cholesterol level d. White blood cell count
ANS: C A patient with metabolic syndrome will have abnormal lipid or cholesterol levels because the metabolism is affected. A patient with an abnormality in his or her bone marrow may show an abnormal platelet count. A patient with kidney impairment or cardiovascular disease will have abnormal creatinine levels, but not a patient with metabolic syndrome. A patient who has an infection will have an abnormal white blood cell count.
Which type of bariatric surgery is shown in the figure? a. Biliopancreatic diversion b. Adjustable gastric banding c. Sleeve gastrectomy d. Vertical banded gastroplasty
ANS: C A sleeve gastrectomy is depicted in the figure. The stomach has the shape of a sleeve with sutures, and about 85 percent of the stomach was removed. A biliopancreatic diversion creates an anastomosis between the stomach and the intestine. In adjustable gastric banding, a band is placed around the fundus of the stomach. Vertical banded gastroplasty features a band around the stomach, which is stapled to create a gastric pouch.
The nurse is reviewing cultural and ethnic factors related to obesity. Which statement does the nurse identify as being true? a. Among men, Hispanics have the lowest prevalence of being overweight or obese. b. Native Americans have a lower prevalence of being overweight than the general population. c. Among women, African Americans have the highest prevalence of being overweight or obese. d. Asian Americans have the same prevalence of being overweight and obese compared with the general population.
ANS: C African Americans and Hispanics have a higher prevalence of obesity than whites. Among women, African Americans have the highest prevalence of being overweight or obese, and 15% are severely obese. Among men, Mexican Americans have the highest prevalence of being overweight or obese. Native Americans have a higher prevalence of being overweight than the general population. Asian Americans have the lowest prevalence of being overweight and obese compared with the general population.
After performing a physical assessment, the nurse determines that the patient has a pear-shaped body consistent with gynoid obesity. Which assessment finding supports gynoid obesity? a. Fat deposition in the neck b. Fat deposition in the shoulders c. Fat deposition in the upper legs d. Fat deposition in the abdominal area
ANS: C Gynoid obesity presents as deposition of fat, mainly in the upper legs. Fat deposition in the neck, shoulders, and abdominal areas is characteristic of the apple-shaped body and is referred to as android obesity.
The nurse measures the waist circumferences of four patients and identifies that which patient has a high risk of obesity? a. A 20-year-old male with a waist circumference of 32 inches b. A 40-year-old male with a waist circumference of 40 inches c. A 30-year-old female with a waist circumference of 38 inches d. A 22-year-old female with a waist circumference of 30 inches
ANS: C Males who have a waist circumference greater than 40 inches and females who have a waist circumference greater than 35 inches have a high risk of obesity. A waist circumference of 38 inches in a 30-year-old female indicates an increased risk of obesity. A 20-year-old male with a waist circumference of 32 inches has a normal waist circumference. A 22-year-old female with a waist circumference of 30 inches is not at high risk. A 40-year-old male with a waist circumference of 40 inches is at the upper limit of normal risk.
After reviewing the laboratory reports of an obese patient, the nurse determines that the patient has nonalcoholic steatohepatitis (NASH). Which condition does the nurse associate with this finding? a. Hyperkalemia b. Hyperuricemia c. Hyperglycemia d. Hyperinsulinemia
ANS: C Nonalcoholic steatohepatitis is the excess deposition of fat in the liver associated with obesity. Liver glucose levels increase due to excessive metabolism of fat in the liver, which indicates that the patient has hyperglycemia. Hyperkalemia is observed in patients with anorexia nervosa. Hyperuricemia is observed in patients with metabolic syndrome and obesity. A patient with colorectal cancer will have hyperinsulinemia.
The nurse reviews a patient's prescription for a weight loss medication and identifies that the medication will only be used short-term because of the potential for abuse. Which type of medication was prescribed to the patient? a. An antidiabetic drug b. A serotonin agonist c. A nonamphetamine d. A nutrient absorption-blocking drug
ANS: C Nonamphetamines are sympathomimetic drugs that should only be used short-term because of the potential for drug abuse. Antidiabetic drugs, serotonin agonists, and nutrient absorption-blocking drugs help reduce weight effectively, and the patient is not at an increased risk of abuse.
The nurse is caring for an obese patient who takes orlistat. The nurse should monitor the patient for which adverse effect? a. Insomnia b. Dizziness c. Fecal incontinence d. Abnormal heart rate
ANS: C Orlistat is a nutrient absorption-blocking drug that blocks fat breakdown and absorption. This action of the drug may result in fecal incontinence. Insomnia and dizziness are the side effects associated with appetite-suppressing drugs like nonamphetamines. Phentermine and topiramate are anticonvulsant drugs that may cause an abnormal heart rate.
An obese patient receives a prescription for orlistat for weight loss. What should the nurse include in the patient's medication teaching? a. "Take a stool softener." b. "Consume a high-calorie diet." c. "Take vitamin supplements." d. "Take folic acid supplements."
ANS: C Orlistat is a nutrition absorption-blocking drug that acts by blocking fat breakdown and absorption in the intestine. Fat-soluble vitamins may also decrease in patients taking this medication. Therefore, the nurse instructs the patient to take vitamin supplements. Orlistat may cause diarrhea; therefore, the nurse should not instruct the patient to take a stool softener because it would aggravate diarrhea. The patient is obese, so a high-calorie diet should not be recommended. The patient who is on orlistat will not experience a folic acid deficiency or anemia.
The nurse calculates a patient's body mass index (BMI) to be 27 kg/m 2. This BMI would fall under which classification? a. Underweight b. Normal body weight c. Overweight d. Obese
ANS: C The most common measure of obesity is the body mass index (BMI). BMI is calculated by dividing a person's weight (in kilograms) by the square of the height in meters. Individuals with a BMI of less than 18.5 kg/m 2 are considered underweight, whereas those with a BMI between 18.5 and 24.9 kg/m 2 reflect a normal body weight. A patient with a BMI of 25 to 29.9 kg/m 2 is classified as being overweight, and those with values at 30 kg/m 2 or above are considered obese. The term severely (morbidly, extremely) obese is used for those with a BMI greater than 40 kg/m 2.
The primary health care provider prescribes short-term weight-loss management for an obese patient with a seizure disorder. The nurse recognizes that which medication will be most effective for the patient? a. Orlistat b. Lorcaserin c. Phentermine/topiramate d. Benzphetamine
ANS: C Topiramate is an anticonvulsant that is taken in combination with a nonamphetamine like phentermine. It is effective in treating seizures and treating obesity. Orlistat is a nutrition-absorption blocking drug that helps to reduce obesity by blocking fat breakdown and absorption in the intestine. However, it is not effective in treating migraine episodes. Lorcaserin is a serotonin agonist that reduces the risk of obesity by promoting a feeling of satiety. However, lorcaserin does not reduce the incidence of migraines. Benzphetamine is a nonamphetamine that reduces the risk of obesity because it secretes norepinephrine. However, it is not effective in treating seizures.
The nurse assesses a patient with Alzheimer's disease and determines that the patient's body mass index (BMI) is 28.8 kg/m 2. The nurse concludes that the patient most likely has what type of obesity? a. The patient has gynoid obesity. b. The patient has primary obesity. c. The patient has android obesity. d. The patient has secondary obesity.
ANS: D A BMI of 28.8 kg/m 2 indicates that the patient is overweight. Alzheimer's disease is one of the types of central nervous system lesions. Patients with this disease may become obese due to cognitive loss and functional inabilities. Secondary obesity may result from central nervous system lesions or congenital anomalies. Therefore, the nurse infers that the patient has secondary obesity. If an obese patient has a greater amount of fat in the upper body, it indicates that the patient has gynoid obesity. If the calorie intake is more than the calorie expenditure for the body's metabolic demands, it is called primary obesity. If an obese patient has a greater proportion of fat deposited in the abdominal area, it indicates that the patient has android obesity.
The nurse reviews the laboratory reports of an obese patient who is diagnosed with gout. Which finding does the nurse associate with the patient's condition? a. Hypovolemia b. Hyperkalemia c. Hyponatremia d. Hyperuricemia
ANS: D A patient with gout will have crystallization of uric acid, which is deposited in joints and causes inflammation. This condition is associated with hyperuricemia. Obesity and gout are not associated with loss of blood or hypovolemia. Obesity and gout do not affect the potassium and sodium electrolyte balance. Therefore, hyperkalemia and hyponatremia are not observed in obese patients who are diagnosed with gout.
During the physical examination of a patient, the nurse records the patient's height as 1.72 m and weight as 108 kg. What does the patient's body mass index (BMI) indicate? a. The patient is underweight. b. The patient is at a normal weight. c. The patient falls into class I obesity. d. The patient falls into class II obesity.
ANS: D BMI is a measure of relative weight based on a patient's weight and height. It is calculated using the following formula: weight in kilograms/(height in meters) 2. For this patient, multiply 1.72 by 1.72. This equals 29,584. Then divide 108 (the patient's weight) by 2.9584. This equals 36.51 kg/m 2. If the patient's BMI falls between 35.0 kg/m 2 and 39.9 kg/m 2, the patient falls into class II obesity. If the patient's BMI is less than 18.5 kg/m 2, it indicates that the patient is underweight. If the patient's BMI falls between 18.5 kg/m 2 and 24.9 kg/m 2, it indicates normal weight. If the patient's BMI falls between 30.0 kg/m 2 and 34.9 kg/m 2, the patient falls into class 1 obesity.
What is the cause of primary obesity? a. The development of metabolic disorders b. The presence of congenital abnormalities c. The presence of lesions in the central nervous system d. The excess caloric intake over the metabolic demand
ANS: D Excess calorie intake over energy expenditure for the body's metabolic demands causes primary obesity. Metabolic disorders, congenital abnormalities, and lesions in the central nervous system can result in secondary obesity.
The nurse reviews the medical records of four patients and identifies that which patient is a good candidate for liposuction? a. The patient is 75 years old and experiences altered body image concerns. b. The patient has excessive fat around the ankles. c. The patient is obese and desires weight reduction. d. The patient has achieved weight reduction but has excessive fat under the chin.
ANS: D Liposuction is a surgical procedure used for cosmetic purposes, and a patient with reduced weight but excessive fat around the chin is the most suitable for liposuction. Liposuction is not recommended for the aged because the skin is less elastic and will not accommodate the new underlying shape. Liposuction is for patients with excess fat under the chin, along the jaw line, in the nasolabial folds, over the abdomen, or around the waist and upper thighs. The patient who is obese and aims at weight reduction is not suitable because liposuction is not for weight reduction.
The nurse recalls that lorcaserin reduces the risk of obesity through what mechanism? a. It activates insulin receptors. b. It blocks the breakdown of fat cells. c. It increases the availability of norepinephrine. d. It activates serotonin receptors to suppress the appetite.
ANS: D Lorcaserin is a serotonin agonist that helps to reduce the risk of obesity by activating serotonin receptors, which, in turn, suppress the appetite and create a feeling of satiety. Lorcaserin is not an insulin agonist; therefore, insulin receptors are not activated by this medication. Orlistat is a nutrient absorption-blocking drug that helps to reduce the risk of obesity by blocking fat breakdown. Nonamphetamines stimulate the central nervous system, which increases norepinephrine. An increase in norepinephrine helps to reduce weight.
A patient presents with a body mass index (BMI) of 20 kg/m 2. What should the nurse document about the patient's weight classification? a. Obese b. Overweight c. Underweight d. Normal weight
ANS: D Patients with a BMI between 18.5 and 24.9 kg/m 2 are considered to have a normal body weight. Patients with a BMI less than 18.5 kg/m 2 are considered underweight, those with a BMI of 25 to 29.9 kg/m 2 are overweight, and those with a BMI of 30 kg/m 2 or above are considered obese.
A patient who underwent restrictive bariatric surgery has a sleeved-shaped stomach with a 60 to 150 mL capacity and no bypass of the intestine. The nurse recognizes that the patient had what type of surgery? a. Biliopancreatic diversion b. Roux-en-Y gastric bypass c. Adjustable gastric banding d. Sleeve gastrectomy
ANS: D Sleeve gastrectomy is a restrictive surgery in which about 85 percent of the stomach is removed, leaving a sleeve-shaped stomach with a 60 to 150 mL capacity. The patient undergoing sleeve gastrectomy has no bypass of the intestine and no risk of malabsorption because it avoids all complications of obstruction, anemia, and vitamin deficiencies. Biliopancreatic surgery is a malabsorptive surgery, and the patient will have the risk of malabsorption of fat-soluble vitamins after the surgery. Roux-en-Y gastric bypass is a restrictive surgery and malabsorptive surgery, which reduces the incidence of malnutrition. However, the patient will still be at risk of anemia and folic acid deficiency. Adjustable gastric banding is a restrictive bariatric surgery in which the patient will have a gastric pouch with a 30 mL capacity after the surgery.
The nurse provides teaching to a severely obese patient who is scheduled for a Roux-en-Y gastric bypass (RYGB) procedure. Which statement made by the patient indicates effective learning? a. "This surgery will preserve the function of my stomach." b. "This surgery will remove the fat cells from my abdomen." c. "This surgery can be modified whenever I need it to be changed." d. "This surgery decreases how much I can eat and how many calories I can absorb."
ANS: D The RYGB decreases the size of the stomach to a gastric pouch and attaches it directly to the small intestine so food bypasses 90% of the stomach, the duodenum, and a small segment of the jejunum. The vertical sleeve gastrectomy removes 85% of the stomach but preserves the function of the stomach. Lipectomy and liposuction remove fat tissue from the abdomen or other areas. Adjustable gastric banding can be modified or reversed at a later date.
While performing a nutritional assessment on a 25-year-old patient, the nurse finds that the patient's height is 1.71 m and weight is 68 kg. What should the nurse interpret from these findings based on the patient's body mass to height index? a. The patient is obese. b. The patient is overweight. c. The patient is underweight. d. The patient has a normal weight.
ANS: D The body mass index ( BMI) is a measure of relative weight based on a patient's weight and height. It is calculated by the formula: actual body weight (kilograms)/(height in meters) 2. Calculating 68/(1.71 × 1.71) = 23.25 kg/m 2. Because the patient's BMI falls between 18.5 and 24.9 kg/m 2, it indicates a normal weight. If the patient's BMI is greater than 30 kg/m 2, it indicates that the patient is obese. If the patient's BMI falls between 25.0 and 29.9 kg/m 2, it indicates that the patient is overweight. If the patient's BMI is less than 18.5 kg/m 2, it indicates that the patient is underweight.
The nurse recalls that which organ secretes the neuropeptide Y hormone to control obesity? a. Colon b. Pancreas c. Stomach d. Hypothalamus
ANS: D The hypothalamus secretes the hormone neuropeptide Y, which stimulates appetite. An imbalance of neuropeptide Y results in obesity. The colon secretes the hormone peptide YY to inhibit appetite. The pancreas secretes insulin, which reduces appetite. The stomach secretes ghrelin hormone, which stimulates appetite.
Which patient has the highest morbidity risk? a. Male: height 73 inches; body mass index (BMI) 29 kg/m 2 b. Female: height 66 inches; weight 150 lbs. c. Male: waist circumference 46 in. d. Female: 70 inches; obesity class III
ANS: D The patient in class III obesity has the highest risk for disease because class III denotes severe obesity or a BMI greater than 40 kg/m 2. The female who is 66 inches tall has a normal weight for her height. The male patient who is over 6 feet tall is overweight, which increases his risk of disease, but a more precise determination cannot be made without the waist circumference. The patient with a waist circumference of 46 inches has a high risk for disease, but, without the BMI or obesity class, a more precise determination cannot be made.
The nurse recognizes that which finding indicates that a patient has gynoid obesity? a. Apple-shaped body b. Waist-to-hip ratio of 0.7 c. Waist circumference of 32 inches d. Deposition of fat in the upper legs
ANS: D The presence of a pear-shaped body with distribution of fat in the upper legs indicates that the patient has gynoid obesity. An apple-shaped body occurs when fat is deposited in the abdominal area, which indicates android obesity. A normal waist-to-hip ratio should be less than 0.8; a waist-to-hip ratio of 0.7 indicates that the patient has a normal waist. The normal waist circumference for females is less than 35 inches and less than 40 inches for males; the patient has a waist circumference of 32 inches, which indicates that the patient has a normal waist circumference.
