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A nurse is performing the admission assessment of a patient whose high body mass index (BMI) corresponds to class III obesity. In order to ensure empathic and patient-centered care, the nurse should do which of the following?
- A. Examine ones own attitudes towards obesity in general and the patient in particular.
- B. Dialogue with the patient about the lifestyle and psychosocial factors that resulted in obesity.
- C. Describe ones own struggles with weight gain and weight loss to the patient.
- D. Elicit the patients short-term and long-term goals for weight loss.
Correct Answer: A
Rationale: Studies suggest that health care providers, including nurses, harbor negative attitudes towards obese patients. Nurses have a responsibility to examine these attitudes and change them accordingly. This is foundational to all other areas of assessing this patient.
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A patient who is obese has been unable to lose weight successfully using lifestyle modifications and has mentioned the possibility of using weight-loss medications. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity?
- A. Weight loss drugs have many side effects, and most doctors think theyll all be off the market in a few years.
- B. There used to be a lot of hope that medications would help people lose weight, but its been shown to be mostly a placebo effect.
- C. Medications can be helpful, but few people achieve and maintain their desired weight loss with medications alone.
- D. Medications are rapidly become the preferred method of weight loss in people for whom diet and exercise have not worked.
Correct Answer: C
Rationale: Though antiobesity drugs help some patients lose weight, their use rarely results in loss of more than 10% of total body weight. Patients are consequently unlikely to attain their desired weight through medication alone. They are not predicted to disappear from the market and results are not attributed to a placebo effect.
A nurse is preparing to discharge a patient after recovery from gastric surgery. What is an appropriate discharge outcome for this patient?
- A. The patients bowel movements maintain a loose consistency.
- B. The patient is able to tolerate three large meals a day.
- C. The patient maintains or gains weight.
- D. The patient consumes a diet high in calcium.
Correct Answer: C
Rationale: Expected outcomes for the patient following gastric surgery include ensuring that the patient is maintaining or gaining weight (patient should be weighed daily), experiencing no excessive diarrhea, and tolerating six small meals a day. Patients may require vitamin B12 supplementation by the intramuscular route and do not require a diet excessively rich in calcium.
A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis. Following her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the patient is diaphoretic. What is the nurses best action?
- A. Insert a nasogastric tube promptly.
- B. Reposition the patient supine.
- C. Monitor the patient closely for further signs of dumping syndrome.
- D. Assess the patient for signs and symptoms of aspiration.
Correct Answer: C
Rationale: The patients symptoms are characteristic of dumping syndrome, which results in a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. Aspiration is a less likely cause for the patients symptoms. Supine positioning will likely exacerbate the symptoms and insertion of an NG tube is contraindicated due to the nature of the patients surgery.
A nurse is providing anticipatory guidance to a patient who is preparing for bariatric surgery. The nurse learns that the patient is anxious about numerous aspects of the surgery. What intervention is most appropriate to alleviate the patients anxiety?
- A. Emphasize the fact that bariatric surgery has a low risk of complications.
- B. Encourage the patient to focus on the benefits of the surgery.
- C. Facilitate the patients contact with a support group.
- D. Obtain an order for a PRN benzodiazepine.
Correct Answer: C
Rationale: Support groups can be highly beneficial in relieving preoperative and postoperative anxiety and in promoting healthy coping. This is preferable to antianxiety medications. Downplaying the risks of surgery or focusing solely on the benefits is a simplistic and patronizing approach.
A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patients continuing care in the home setting, what assessment question is most relevant?
- A. Does anyone in your family have experience at giving injections?
- B. Are you going to be anywhere with strong sunlight in the next few months?
- C. Are you aware of your blood type?
- D. Do any of your family members have training in first aid?
Correct Answer: A
Rationale: Patients with malabsorption of vitamin B12 need information about lifelong vitamin B12 injections; the nurse may instruct a family member or caregiver how to administer the injections or make arrangements for the patient to receive the injections from a health care provider. Questions addressing sun exposure, blood type, and first aid are not directly relevant.