Ch 42 Assessment and Management of Patients with Obesity
A client who is post op from bariatric surgery reports constipation. What is the most likely cause of the client's symptoms? A) Gastric dysfunction B) Insufficient water intake C) Diuretic medications D) Impaired gastric motility
B
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? A) Pioglitazone B) Metformin C) Glipizide D) Glyburide
B
A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose? A) Assess for gastric perforation B) Stimulate GI peristalsis C) Stimulate digestive hormones D) Assess for intact swallowing
B
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? A) "It works to make you feel full." B) "It binds with enzymes to decrease carbohydrate absorption." C) "It binds with enzymes to help prevent digestion of fat." D) "It decreases your appetite."
C
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? A) These ease gastric distention. B) These are less likely to raise the blood sugar. C) These are less likely to cause dumping syndrome. D) These ease nausea.
C
A nurse researches the cost and financial impact of obesity in America. What is the annual health care cost tied to obesity? A) $3 trillion B) $1 trillion C) $147 billion D) $118 billion
C
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? A) Lateral B) Upright C) Low Fowler's D) High Fowler's
C
A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply. A) Blood pressure B) BMI C) Total cholesterol D) Weight E) Waist circumference
D, B, and E
A client weighs 215 lbs and is 5' 8" tall. The nurse calculate this client's body mass index (BMI) as what? A) 19.5 B) 24.8 C) 32.7 D) 44.9
C
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? A) Both undernutrition and sedentary lifestyles B) Both obesity and scare food sources C) Both undernutrition and obesity D) Both low metabolism and high metabolism
C
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? A) "Yes, your chronic condition meets the criteria for bariatric surgery but not your BMI." B) "No, you have one qualifying condition but not the other; this excludes you from bariatric surgery." C) "No, you do not have any qualifying criteria for bariatric surgery." D) "Yes, your BMI and chronic condition meets the criteria for bariatric surgery."
D
A nurse working with clients undergoing bariatric surgery understands that there are various types of bariatric procedures. Which statements represent the types of bariatric procedures? Select all that apply. A) Restrictive B) Both restrictive and malabsorptive C) Obstructive D) Malabsorptive E) Unobstructive
A, B, and D
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? A) 40 kg/m2 B) 35 kg/m2 C) 29 kg/m2 D) 34 kg/m2
B
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
A nurse teaches a client with obesity about the various medication options for the treatment of obesity. Which medication will the nurse include when teaching the client about the class of medications that stimulate noradrenergic receptors? A) Liraglutide B) Phentermine C) Lorcaserin D) Orlistat
B
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) Administer coumadin PO as prescribed B) Assist the client with ambulating as early and often as possible C) Reposition the client at least every 2 hours while in bed D) Assist the client with performing deep breathing and coughing exercises
B
The nurse working with clients who have obesity understand that gut microbes perform numerous digestive, metabolic, and immunologic functions. What is the nurse's understanding of how these microbes contribute to obesity? Select all that apply. A) Individuals with obesity have dysfunctional gut microbes. B) Specific gut microbes have been linked to a leaner body shape. C) Individuals with obesity have a decreased amount of microbes than those of normal weight. D) Specific gut microbes have been linked to a larger body shape. E) Individuals with obesity have less diverse gut microbes than those of normal weight.
B and E
A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply. A) Race B) Tobacco use C) Obesity D) Gender E) Hyperlipidemia
B, C, and E
A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has? A) Inflammatory arthritis B) Necrotizing arthritis C) Osteoarthritis D) Rheumatoid arthritis
C
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: A) remind himself or herself that obesity is a treatable health problem. B) seek advice from a colleague who is known to provide empathic care. C) examine his or her own preconceptions and beliefs about obesity. D) anticipate having some discomfort or anxiety when assessing the client.
C
Which clients will the nurse recognize as being at high risk for complication if taking Lorcaserin for obesity? Select all that apply. A) Client taking medication for cholesterol B) Client with asthma C) Client taking medication for migraines D) Client with type 2 diabetes E) Client taking medication for depression
C, D, and E
A male client in a wheelchair comes in for his yearly physical examination. He is unable to stand. The nurse retrieves the wheelchair scale to obtain an accurate weight. The nurse understands the importance of this assessment with this client. What is the nurse's reasoning for obtaining an accurate weight? A) A wheelchair-bound client is usually depressed about his or her weight. B) Weight is more difficult to control if a client is wheelchair-bound. C) Wheelchairs make clients very self-conscious about their weight. D) People with disabilities have an increased incidence of obesity.
D
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? A) "It stimulates central noradrenergic receptors." B) "It diminishes intestinal absorption and metabolism of fats." C) "It stimulates central 5-HT2C receptors." D) "It causes delayed gastric emptying."
D
The nurse establishes a learning contract with an overweight client. The contract is best if it A) is an oral contract between the nurse and the client B) has an overall goal of 30-pound weight loss in six months C) contains an agreement to ingest a well-balanced diet D) includes an incremental goal of 1-2 pound weight loss this week
D
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. A) Blood stasis B) Impairment of peripheral blood flow C) Formation of a thrombus D) Increased adipose tissue
D, B, A, and C
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? A) "Older adults have a slightly higher prevalence of obesity in comparison to the general population." B) "Older adults have the same prevalence of obesity in comparison to the general population." C) "Older adults have a greatly reduced prevalence of obesity in comparison to the general population." D) "Older adults have a slightly reduced prevalence of obesity in comparison to the general population."
A
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: A) "I should sleep on my side all night long." B) "I should eat a high-protein diet." C) "I should become involved in a weight loss program." D) "I need to keep my inhaler at the bedside."
C
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? A) Naltrexone/bupropion B) Phentermine C) Orlistat D) Lorcaserin
B
A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI? A) Normal weight B) Overweight C) Class I obesity D) Class II obesity
C
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? A) Surgical interventions B) Lifestyle modification C) Pharmacological management D) Nonsurgical interventions
B
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? A) "After surgery, your ability to conceive is decreased considerably." B) "You should avoid pregnancy for at least 9 months after surgery" C) "You should avoid pregnancy for at least 18 months after surgery." D) "After surgery, contraceptives have much less efficacy."
C
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? A) "Avoid taking antacid drugs." B) "Sit in a semi-recumbent position while eating." C) "Avoid taking non-steroidal anti-inflammatory drugs." D) "Keep the head of your bed propped on blocks at night."
C
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) "The fat is excreted in your urine." C) "The fat remains undigested in your stomach." D) "The fat is absorbed in your intestines."
A
A nurse epidemiologist examines the overall decrease in life expectancy related to obesity. What finding is true? A) There is a 6-20 year decrease in overall life expectancy for those with obesity. B) There is a 21-28 year decrease in overall life expectancy for those with obesity. C) There is a 2-4 year decrease in overall life expectancy for those with obesity. D) There is a 25-30 year decrease in overall life expectancy for those with obesity.
A
A nurse admits a wealthy client who is 8 weeks postpartum after her third child and overweight. The client reports severe right upper quadrant pain that radiates to the back after eating Thanksgiving dinner with turkey and gravy earlier in the evening. What factors lead the nurse to suspect gallbladder disease? Select all that apply. A) Multiparous B) Eating a high fat diet C) Obese D) Wealthy E) Female gender
A, B, C, and E
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) Myocardial infarction B) Hypertension C) Coronary artery disease D) Heart murmur E)Heart failure
A, B, C, and E
A nurse cares for older adult clients with obesity and understands that older adults have greater risk for developing obesity than the general population. What pathophysiological concepts contribute to this? Select all that apply. A) Lean skeletal mass decreases as an individual ages. B) Adipose tissue increases as an individual ages. C) Carbohydrate metabolism is impaired as an individual ages. D) Metabolism decreases as an individual ages. E) Glucose metabolism is impaired as an individual ages.
A, B, and D
A client who is obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states A) "You need to work harder to achieve your goal." B) "You have succeeded in making positive progress." C) "You are not achieving satisfactory weight loss." D) "We will have to re-evaluate your goal."
B
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? A) Nortriptyline B) Bupropion C) Doxepin D) Amitriptyline
B
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? A) "The stomach is stapled to a very small pouch and the entire small intestine is rerouted. B) "85% of the stomach is removed surgically, leaving a much smaller tube-like structure." C) "The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." D) "A prosthetic device binds the stomach and creates a very small pouch and restricts oral intake."
C
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? A) Chronic obstructive pulmonary disease B) Diabetes mellitus C) Anemia D) Renal insufficiency
D
A client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response? A) "Taking this medication with meals decreases this symptom." B) "How much water are drinking?" C) "Your dose may need to be adjusted." D) "This is an expected finding with this medication."
D
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) Excessive fat intake B) Rapid gastric dumping C) Decreased motility D) Decreased gastric size
B
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 drink alcohol while taking this medication." B) "Do not drive while taking this medication." C) "Take the medication at night before bedtime." D) "Take the medication with a full glass of water."
A
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) Over time, we have become efficient in food storage and deposition of fat stores. B) A single gene mutation is responsible for the epidemic. C) Over time, we have become less efficient in hunting and gathering of food. D) Multiple mutations of genes over time have lead to the epidemic.
A
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? A) Restricts the client's ability to eat. B) Restricts the client's ability to digest fat. C) Impairs caloric absorption. D) Impairs gastric motility.
A
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) Insert the NG tube cautiously due to the client's recent GI surgery B) Question the order due to the client's recent bariatric surgery C) Question the order because decreased bowel motility is expected postoperatively D) Ensure that the NG tube inserted is at least a size 14 French
B
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? A) Increased blood viscosity B) Impaired clotting C) Compromised peripheral blood flow D) Increased fat accumulation in the blood
C
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? A) Drinking at least 2 liters of water a day B) Avoiding use of caffeine C) Addressing obesity D) Taking a daily multivitamin
C
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? A) 28 B) 18 C) 31 D) 23
D
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? A) All options are correct. B) obesity C) increased age D) not giving birth
A
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 education are impacted at a greater prevalence of disease. B) Those who own their own homes have a decreased prevalence of disease. C) Income is not related to the prevalence of disease. D) Education is not related to the prevalence of disease. E) Those with less income are impacted at a greater prevalence of disease.
A and E
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? A) Sets the long-term goal as "the client's glycohemoglobin will be 6.9% in 3 months" B) Plans the short-term goal as "the client's blood sugar each AM will be less than 110 mg/dL" C) Collaborates with the client to establish an agreed-upon goal D) Informs the client about what goal the nurse wants the client to achieve
C
