Nokea
A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority?
- A. Assess the clients pain.
- B. Check the surgical incision.
- C. Ensure an adequate airway.
- D. Program the morphine pump.
Correct Answer: C
Rationale: All actions are appropriate care measures for this client; however, airway is always the priority. Bariatric clients tend to have short, thick necks that complicate airway management.
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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 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.
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.
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.
Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y 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
Correct Answer: B
Rationale: 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.