Nokea
A few months after bariatric surgery, an older-adult patient 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 counsellor 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.
Correct Answer: D
Rationale: 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 patients. The response, 'The important thing is that your weight loss is improving your health,' ignores the patient's concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counsellor, it is more likely to be helpful to know that cosmetic surgery is available.
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Which of the following assessments would suggest to the clinic nurse that the patient has metabolic syndrome?
- A. Take the patient's apical pulse.
- B. Check the patient's blood pressure.
- C. Ask the patient about dietary intake.
- D. Dipstick the patient's urine for protein.
Correct Answer: B
Rationale: 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.
A patient 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 patient.
- B. Instruct the patient to weigh weekly and record the weights.
- 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.
Correct Answer: C
Rationale: 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.
The nurse is providing nutritional teaching to a patient who is to start on a very-low-calorie diet. Which of the following calorie amounts should the nurse tell the patient that daily calories are not to exceed?
- A. 500
- B. 800
- C. 1100
- D. 1400
Correct Answer: B
Rationale: A very-low-calorie diet does not exceed 800 calories/day. A low-calorie diet is between 800 and 1200 calories/day.
The nurse is caring for a patient 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. Perform passive range-of-motion exercises.
- B. Elevate the head of the bed 45 degrees.
- C. Inform the patient that ambulation will occur in one hour.
- D. Administer heparin, as ordered.
Correct Answer: B
Rationale: Maintain the head of the patient 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.
The nurse is planning preoperative teaching for a patient 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 patient proper coughing and deep-breathing techniques
- D. Educating the patient about the postoperative presence of a nasogastric (NG) tube
Correct Answer: C
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 also will be discussed, but avoidance of respiratory complications is the priority goal after surgery.