Nokea
A client has been prescribed lorcaserin (Belviq). What teaching is most appropriate?
- A. Increase the fiber and water in your diet.
- B. Reduce fat to less than 30% each day.
- C. Report dry mouth and decreased sweating.
- D. Lorcaserin may cause loose stools for a few days.
Correct Answer: A
Rationale: This drug can cause constipation, so the client should increase fiber and water in the diet to prevent this from occurring. Reducing fat in the diet is important with orlistat. Lorcaserin can cause dry mouth but not decreased sweating. Loose stools are common with orlistat.
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Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1000-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. You are likely to notice changes in how you feel with just a few weeks of diet and exercise.
- D. Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.
Correct Answer: C
Rationale: Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 22-year-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.
The nurse is caring for a 54-year-old female patient on the first postoperative day after a Roux-en-Y 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
- C. Emesis of bile-colored fluid past the nasogastric (NG) tube
- D. Use of patient-controlled analgesia (PCA) several times an hour for pain
Correct Answer: C
Rationale: 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.
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
Correct Answer: A
Rationale: A fasting blood glucose test >100 mg/dL 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.
Which adult will the nurse plan to teach about risks associated with obesity?
- A. Man who has a BMI of 18 kg/m^2
- B. Man with a 42 in waist and 44 in hips
- C. Woman who has a body mass index (BMI) of 24 kg/m^2
- D. Woman with a waist circumference of 34 inches (86 cm)
Correct Answer: B
Rationale: The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level of <0.80. A patient with a BMI of 18 kg/m^2 is considered underweight. A BMI of 24 kg/m^2 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).
A few months after bariatric surgery, a 56-year-old man tells the nurse, My skin is hanging in folds. I think I need cosmetic surgery. Which response by the nurse is most appropriate?
- A. The important thing is that you are improving your health.
- B. The skinfolds will disappear once most of the weight is lost.
- C. Cosmetic surgery is a possibility once your weight has stabilized.
- D. Perhaps you would like to talk to a counselor about your body image.
Correct Answer: C
Rationale: Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. Skinfolds may not disappear over time, especially in older patients. The response, The important thing is that your weight loss is improving your health, ignores the patients concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counselor, it is more likely to be helpful to know that cosmetic surgery is available.