lOMoARcPSD|4511989 C40 - ch 40 test bank Med Surg (Fortis College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by kim tan (E3432292@student.dcccd.edu) lOMoARcPSD|4511989 Chapter 40: Obesity Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet? a. “It will be necessary to change lifestyle habits permanently to maintain weight loss.” b. “You are likely to notice changes in how you feel after a few weeks of diet and exercise.” c. “You will decrease your risk for future health problems such as diabetes by losing weight now.” d. “Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.” ANS: B Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 22-yr-old patient is unlikely to be motivated by future health problems. Telling a patient that the initial weight loss is water will be discouraging, although this may be correct. Changing lifestyle habits is necessary, but this process occurs over time, and discussing this is not likely to motivate the patient. DIF: Cognitive Level: Analyze (analysis) REF: 881 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 2. After the nurse teaches a patient about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the initial instructions about diet have been understood? a. 3 oz of lean beef, 2 oz of low-fat cheese, and a sliced tomato b. 3 oz of roasted pork, a cup of corn, and a cup of carrot sticks c. Cup of tossed salad and nonfat dressing topped with a chicken breast d. Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery ANS: B This selection is most consistent with the recommendation of the American Institute for Cancer Research that one third of the diet should be from animal sources and two thirds from plant source foods. The other choices all have higher ratios of animal origin foods to plant source foods than would be recommended. DIF: Cognitive Level: Apply (application) REF: 883 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 3. Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program? a. Having the adults write down the caloric intake of each meal b. Asking the adults about situations that tend to increase appetite c. Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals d. Encouraging the adults to eat small amounts frequently rather than having Downloaded by kim tan (E3432292@student.dcccd.edu) lOMoARcPSD|4511989 scheduled meals ANS: B Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as calorie counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior modification. DIF: Cognitive Level: Apply (application) REF: 883 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best exercise plan for weight loss? Walking for 40 minutes 6 or 7 days/week Lifting weights with friends 3 times/week Playing soccer for an hour on the weekend Running for 10 to 15 minutes 3 times/week a. b. c. d. ANS: A Exercise should be done daily for 30 minutes to an hour. Exercising in highly aerobic activities for short bursts or only once a week is not helpful and may be dangerous in an individual who has not been exercising. Running may be appropriate, but a patient should start with an exercise that is less stressful and can be done for a longer period. Weight lifting is not as helpful as aerobic exercise in weight loss. DIF: Cognitive Level: Analyze (analysis) REF: 883 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 5. A few months after bariatric surgery, a 56-yr-old male patient tells the nurse, “My skin is hanging off of me. I think I might want to surgery to remove the skinfolds.” Which response by the nurse is most appropriate? a. “The important thing is that you are improving your health.” b. “The skinfolds show everyone how much weight you have lost.” c. “Perhaps you should talk to a counselor about your body image.” d. “Cosmetic surgery may be possible once your weight has stabilized.” ANS: D Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. The responses, “The important thing is that your weight loss is improving your health,” and “The skinfolds show everyone how much weight you have lost, “ignore the patient’s concerns about appearance and implies that the nurse knows what is important. It may be helpful for the patient to talk to a counselor, however, there is no indication given that the concern about skinfolds is dysfunctional. DIF: Cognitive Level: Apply (application) REF: 889 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 6. After sleeve gastrectomy, a 42-yr-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care? a. Offer sips of fruit juices at frequent intervals. b. Irrigate the nasogastric (NG) tube frequently. Downloaded by kim tan (E3432292@student.dcccd.edu) lOMoARcPSD|4511989 c. Remind the patient that PCA use may slow the return of bowel function. d. Support the surgical incision during patient coughing and turning in bed. ANS: D The incision should be protected from strain to decrease the risk for wound dehiscence. The patient should be encouraged to use the PCA because pain control will improve the cough effort and patient mobility. NG irrigation may damage the suture line or overfill the stomach pouch. Sugar-free clear liquids are offered during the immediate postoperative time to decrease the risk for dumping syndrome. DIF: Cognitive Level: Apply (application) REF: 888 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 7. The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include? Drink fluids between meals but not with meals. Choose high-fat foods for at least 30% of intake. Developing flabby skin can be prevented by exercise. Choose foods high in fiber to promote bowel function. a. b. c. d. ANS: A Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin. DIF: Cognitive Level: Apply (application) REF: 889 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 8. Which assessment action will help the nurse determine if an obese patient has metabolic syndrome? Take the patient’s apical pulse. Check the patient’s blood pressure. Ask the patient about dietary intake. Dipstick the patient’s urine for protein. a. b. c. d. ANS: B Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information will not assist with the diagnosis of metabolic syndrome. DIF: Cognitive Level: Apply (application) REF: 890 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 9. When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include? a. Blood glucose test b. Cardiac enzyme tests c. Postural blood pressures d. Resting electrocardiogram ANS: A A fasting blood glucose test greater than 100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome, but they may be used to check for cardiovascular complications of the disorder. DIF: Cognitive Level: Apply (application) REF: 890 Downloaded by kim tan (E3432292@student.dcccd.edu) lOMoARcPSD|4511989 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 10. What information will the nurse include for an overweight 35-yr-old woman who is starting a weight-loss plan? Weigh yourself at the same time every morning and evening. Stick to a 600- to 800-calorie diet for the most rapid weight loss. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. Weighing all foods on a scale is necessary to choose appropriate portion sizes. a. b. c. d. ANS: C The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorierestricted diets are not necessary for patients in the overweight category and need to be closely supervised. Patients should weigh weekly rather than daily. DIF: Cognitive Level: Apply (application) REF: 882 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11. Which adult will the nurse plan to teach about risks associated with obesity? a. Man who has a BMI of 18 kg/m2 b. Man with a 42 in waist and 44 in hips c. Woman who has a body mass index (BMI) of 24 kg/m2 d. Woman with a waist circumference of 34 inches (86 cm) ANS: B The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level of less than 0.80. A patient with a BMI of 18 kg/m2 is considered underweight. A BMI of 24 kg/m2 is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm). DIF: Cognitive Level: Understand (comprehension) REF: 875 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 12. A patient is being admitted for bariatric surgery. Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)? a. Demonstrate use of the incentive spirometer. b. Plan methods for turning the patient after surgery. c. Assist with IV insertion by holding adipose tissue out of the way. d. Develop strategies to provide privacy and decrease embarrassment. ANS: C UAP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require registered nurse (RN)–level education and scope of practice. DIF: Cognitive Level: Apply (application) REF: 885 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 13. After successfully losing 1 lb weekly for several months, a patient at the clinic has not lost any weight for the past month. The nurse should first a. review the diet and exercise guidelines with the patient. Downloaded by kim tan (E3432292@student.dcccd.edu) lOMoARcPSD|4511989 b. instruct the patient to weigh and record weights weekly. c. ask the patient whether there have been any changes in exercise or diet patterns. d. discuss the possibility that the patient 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: Analyze (analysis) REF: 883 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 14. Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider? a. The patient frequently has liquid stools. b. The patient is pale and has many bruises. c. The patient complains of bloating after meals. d. The patient is experiencing a weight loss plateau. ANS: B Because orlistat blocks the absorption of fat-soluble vitamins, the patient may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. Weight loss plateaus are normal during weight reduction. DIF: Cognitive Level: Analyze (analysis) REF: 884 OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 15. A 40-yr-old obese woman reports that she wants to lose weight. Which question should the nurse ask first? a. “What factors led to your obesity?” b. “Which types of food do you like best?” c. “How long have you been overweight?” d. “What kind of activities do you enjoy?” ANS: A The nurse should obtain information about the patient’s perceptions of the reasons for the obesity to develop a plan individualized to the patient. The other information also will be obtained from the patient, but the patient is more likely to make changes when the patient’s beliefs are considered in planning. DIF: Cognitive Level: Analyze (analysis) REF: 881 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 16. The nurse is caring for a patient on the first postoperative day after a Roux-en- gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? a. Bilateral crackles audible at both lung bases b. Redness, irritation, and skin breakdown in skinfolds Downloaded by kim tan (E3432292@student.dcccd.edu) lOMoARcPSD|4511989 c. Emesis of bile-colored fluid past the nasogastric (NG) tube d. Use of patient-controlled analgesia (PCA) several times an hour for pain ANS: C Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected. DIF: Cognitive Level: Analyze (analysis) REF: 886 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 17. Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en- gastric bypass? a. Educating the patient about the nasogastric (NG) tube b. Instructing the patient on coughing and breathing techniques c. Discussing necessary postoperative modifications in lifestyle d. Demonstrating passive range-of-motion exercises for the legs ANS: B Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery. DIF: Cognitive Level: Analyze (analysis) REF: 888 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 18. After bariatric surgery, a patient who is being discharged tells the nurse, “I prefer to be independent. I am not interested in any support groups.” Which response by the nurse is best? a. “I hope you change your mind so that I can suggest a group for you.” b. “Tell me what types of resources you think you might use after this surgery.” c. “Support groups have been found to lead to more successful weight loss after surgery.” d. “Because there are many lifestyle changes after surgery, we recommend support groups.” ANS: B This statement allows the nurse to assess the individual patient’s potential needs and preferences. The other statements offer the patient more information about the benefits of support groups but fail to acknowledge the patient’s preferences. DIF: Cognitive Level: Analyze (analysis) REF: 884 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 19. To evaluate an obese patient for adverse effects of lorcaserin (Belviq), which action will the nurse take? a. Take the apical pulse rate. b. Check sclera for jaundice. c. Ask about bowel movements. d. Assess for agitation or restlessness. Downloaded by kim tan (E3432292@student.dcccd.edu) lOMoARcPSD|4511989 ANS: C Constipation is a common side effect of lorcaserin. The other assessments would be appropriate for other weight-loss medications. DIF: Cognitive Level: Apply (application) REF: 884 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE 1. Which information in this male patient’s electronic health record as shown in the accompanying figure will the nurse use to confirm that the patient has metabolic syndrome (select all that apply)? a. b. c. d. e. f. Weight Waist size Blood glucose Blood pressure Triglyceride level Total cholesterol level ANS: B, C The patient’s waist circumference, high-density lipoprotein level, and fasting blood glucose level indicate that he has metabolic syndrome. The other data are not used in making a metabolic syndrome diagnosis or do not meet the criteria for this diagnosis. DIF: Cognitive Level: Analyze (analysis) REF: 890 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity Downloaded by kim tan (E3432292@student.dcccd.edu)
