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A client is in the bariatric clinic 1 month after having gastric bypass surgery. The client is crying and says I didnt know it would be this hard to live like this. What response by the nurse is best?
- A. Assess the clients coping and support systems.
- B. Inform the client that things will get easier.
- C. Re-educate the client on needed dietary changes.
- D. Tell the client lifestyle changes are always hard.
Correct Answer: A
Rationale: The nurse should assess this clients coping styles and support systems in order to provide holistic care. The other options do not address the clients distress.
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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.
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.
Correct Answer: B
Rationale: 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.
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.
After vertical banded gastroplasty, a 42-year-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.
- 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.
Correct Answer: D
Rationale: 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.
A 40-year-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?
Correct Answer: A
Rationale: The nurse should obtain information about the patients 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 patients beliefs are considered in planning.