Chapter 43: Nursing Management: Obesity
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is developing a weight loss plan for a young adult client who is morbidly obese.
Which of the following statements by the nurse is most likely to help the client in losing
weight on the planned 1 000-calorie diet?
a. “It will be necessary to change lifestyle habits permanently to maintain weight
loss.”
b. “You will decrease your risk for future health problems such as diabetes by losing
weight now.”
c. “Most of the weight that you lose during the first weeks of dieting is water weight
rather than fat.”
d. “You are likely to start to notice changes in how you feel with just a few weeks of
diet and exercise.”
ANS: D
Motivation is a key factor in successful weight loss and a short-term outcome provides a
higher motivation. A young adult client is unlikely to be motivated by future health
problems. Telling a client 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 client.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
2. The nurse has completed teaching a client about the recommended amounts of foods from
different food groups. Which of the following menu selections indicate that the initial
instructions about health eating have been understood?
a. 90 mL of pork roast, a cup of corn, tomatoes, and 125 mL rice
b. A chicken breast and a cup of tossed salad with nonfat dressing
c. A 180 mL can of tuna mixed with nonfat mayonnaise and chopped celery
d. 90 mL of roast beef, 60 mL of low-fat cheese, and a half-cup of carrot sticks
ANS: A
This selection is most consistent with What is a Healthy Plate? The other choices are all
missing at least one food group.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Evaluation
3. The nurse is collaborating with an obese client who is enrolled in a behaviour modification
program. Which of the following nursing actions is best?
a. Having the client write down the caloric intake of each meal
b. Asking the client about situations that tend to increase appetite
c. Encouraging the client to eat small amounts throughout the day rather than having
scheduled meals
d. Suggesting that the client have a reward, such as a piece of sugarless candy, after
achieving a weight loss goal
ANS: B
Behaviour 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. Clients are often taught to restrict eating to designated
meals when using behaviour modification.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
4. Which of the following client behaviours indicate that an overweight client has understood
the nurse’s teaching about the best exercise plan for weight loss?
a. Walking for 40 minutes six or seven days/week
b. Lifting weights with friends three times/week
c. Playing soccer for an hour on the weekend
d. Running for 10–15 minutes three times/week
ANS: A
Exercise should be done daily for at least 15–30 minutes. 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 client 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.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Evaluation
5. The nurse is providing nutritional teaching to a client who is to start on a very-low-calorie
diet. Which of the following calorie amounts should the nurse tell the client that daily
calories are not to exceed?
a. 500
b. 800
c. 1 100
d. 1 400
ANS: B
A very-low-calorie diet does not exceed 800 cal/day. A low-calorie diet is between 800
and 1 200 cal/day.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
6. Which of the following surgeries places the client at greatest risk of developing dumping
syndrome postoperatively?
a. Vertical banded gastroplasty
b. Adjustable gastric banding
c. Vertical sleeve gastrectomy
d. Lap-Band
ANS: A
A possible complication of vertical banded gastroplasty is dumping syndrome. Dumping
syndrome is not a possible complication in adjustable gastric banding, vertical sleeve
gastrectomy, or Lap-Band.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
7. A few months after bariatric surgery, an older-adult client tells the nurse, “My skin is
hanging in folds. I think I need cosmetic surgery.” Which of the following responses by
the nurse is best?
a. “Perhaps you would like to talk to a counselor about your body image.”
b. “The important thing is that your weight loss is improving your health.”
c. “The skin folds will gradually disappear once most of the weight is lost.”
d. “Cosmetic surgery is certainly a possibility once your weight has stabilized.”
ANS: D
Reconstructive surgery may be used to eliminate excess skin folds after at least a year has
passed since the surgery. Skin folds may not disappear over time, especially in older
clients. The response, “The important thing is that your weight loss is improving your
health” ignores the client’s concerns about appearance and implies that the nurse knows
what is important. Whereas it may be helpful for the client to talk to a counselor, it is more
likely to be helpful to know that cosmetic surgery is available.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
8. The nurse is caring for a client who returns to the surgical nursing unit following a vertical
banded gastroplasty with a nasogastric tube to low, intermittent suction and a
patient-controlled analgesia (PCA) machine for pain control. Which of the following
nursing actions should be included in the postoperative plan of care?
a. Irrigate the nasogastric (NG) tube frequently with normal saline.
b. Offer sips of sweetened liquids at frequent intervals.
c. Remind the client that PCA use may slow the return of bowel function.
d. Support the surgical incision during client coughing and turning in bed.
ANS: D
The incision should be protected from strain to decrease the risk for wound dehiscence.
The client should be encouraged to use the PCA since pain control will improve cough
effort and client 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.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
9. Which of the following information should the nurse plan to include in discharge teaching
for a client after gastric bypass surgery?
a. Avoid drinking fluids with meals.
b. Choose high-fat foods for at least 30% of intake.
c. Choose foods that are high in fibre to promote bowel function.
d. Development of flabby skin can be prevented by daily exercise.
ANS: A
Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices
should be low in fat and fibre. Exercise does not prevent the development of flabby skin.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
10. Which of the following assessments should the nurse do to help determine if an obese
client seen in the clinic has metabolic syndrome?
a.
b.
c.
d.
Take the client’s apical pulse.
Check the client’s blood pressure.
Ask the client about dietary intake.
Dipstick the client’s urine for protein.
ANS: B
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.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
11. Which of the following topics is of most importance for the nurse to include when
teaching a client about testing for possible metabolic syndrome?
a. Blood glucose test
b. Cardiac enzyme tests
c. Postural blood pressures
d. Resting electrocardiogram
ANS: A
A fasting blood glucose test from 4–6 mmol/L 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.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
12. What of the following specific information should the nurse include in client teaching for
an overweight client who is starting a weight loss plan?
a. Weigh yourself at the same time every morning.
b. Start dieting with a 600- to 800-calorie diet for rapid weight loss.
c. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain.
d. Weighing all foods on a scale is necessary to choose appropriate portion sizes.
ANS: C
The restrictive nature of fad diets makes the weight loss achieved by the client more
difficult to maintain. Portion size can be estimated in other ways besides weighing.
Severely calorie-restricted diets are not necessary for clients in the overweight category of
obesity and need to be closely supervised. Clients should weigh weekly rather than daily.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
13. Which of the following clients in the clinic should the nurse plan to teach about risks
associated with obesity?
a. Client who has a BMI of 18 kg/m2
b. Client with a waist circumference of 86 cm
c. Client who has a body mass index (BMI) of 24 kg/m2
d. Client whose waist measures 75 cm and hips measure 85 cm
ANS: D
The waist-to-hip ratio for this client is 0.88, which exceeds the recommended level of
<0.80. A BMI of 24 kg/m2 is normal. Health risks associated with obesity increase in
women with a waist circumference larger than 89 cm and men with a waist circumference
larger than 102 cm. A client with a BMI of 18 kg/m2 is considered underweight.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Planning
14. The nurse is caring for a client who has undergone bariatric surgery and has just arrived on
the unit from the recovery room. Which of the following actions should the nurse
implement to promote tidal flow and reduce abdominal pressure?
a. Preform passive range-of-motion exercises.
b. Elevate the head of the bed 45 degrees.
c. Inform the client that ambulation will occur in one hour.
d. Administer heparin, as ordered.
ANS: B
Maintain the head of the client at a 35- to 40-degree angle to reduce abdominal pressure
and increase tidal flow. Passive range-of-motion exercises may be completed but will not
affect abdominal pressure. Ambulation postoperatively is not expected in the first couple
of hours. Heparin may be ordered but that will not promote tidal flow or reduce abdominal
pressure.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
15. A client who has been successfully losing 0.5 kg weekly for several months is weighed at
the clinic and has not lost any weight for the last month. Which of the following actions
should the nurse do first?
a. Review the diet and exercise guidelines with the client.
b. Instruct the client to weigh weekly and record the weights.
c. Ask the client whether there have been any changes in exercise or diet patterns.
d. Discuss the possibility that the client has reached a temporary weight loss plateau.
ANS: C
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.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
16. The nurse obtains these assessment data for a client who has been taking orlistat for
several months as part of a weight loss program. Which of the following findings is most
important to report to the health care provider?
a. The client frequently has liquid stools.
b. The client is pale and has many bruises.
c. The client is experiencing a plateau in weight loss.
d. The client complains of abdominal bloating after meals.
ANS: B
Because orlistat blocks the absorption of fat-soluble vitamins, the client may not be
receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors.
Abdominal bloating and liquid stools are common adverse effects of orlistat and indicate
that the nurse should remind the client that fat in the diet may increase these adverse
effects. Weight loss plateaus are normal during weight reduction.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Evaluation
17. The nurse is developing a weight reduction plan for an obese client who wants to lose
weight. Which of the following questions should the nurse ask first?
a. “Which food types do you like best?”
b. “How long have you been overweight?”
c. “What kind of physical activities do you enjoy?”
d. “What factors do you think led to your obesity?”
ANS: D
The nurse should obtain information about the client’s perceptions of the reasons for the
obesity to develop a plan individualized to the client. The other information also will be
obtained from the client, but the client is more likely to make changes when the client’s
beliefs are considered in planning.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
18. On the first postoperative day the nurse is caring for a client who has had a Roux-en-Y
gastric bypass procedure. Which of the following assessment findings should be reported
immediately to the surgeon?
a. Use of patient-controlled analgesia (PCA) several times an hour for pain
b. Irritation and skin breakdown in skin folds
c. Bilateral crackles audible at both lung bases
d. Emesis of bile-coloured fluid past the nasogastric (NG) tube
ANS: D
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 client 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.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
19. The nurse is planning preoperative teaching for a client undergoing a Roux-en-Y gastric
bypass as treatment for morbid obesity. Which of the following interventions is priority?
a. Demonstrating passive range-of-motion exercises to the legs.
b. Discussing the necessary postoperative modifications in lifestyle.
c. Teaching the client proper coughing and deep-breathing techniques.
d. Educating the client about the postoperative presence of a nasogastric (NG) tube.
ANS: C
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 also will be discussed, but
avoidance of respiratory complications is the priority goal after surgery.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning