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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.
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On the first postoperative day the nurse is caring for a patient who has had a Roux-en-Y gastric bypass procedure. Which of the following assessment findings should be reported immediately to the surgeon?
- A. Use of patient-controlled analgesia (PCA) several times an hour for pain
- B. Irritation and skin breakdown in skin folds
- C. Bilateral crackles audible at both lung bases
- D. Emesis of bile-coloured fluid past the nasogastric (NG) tube
Correct Answer: D
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.
The nurse is developing a weight reduction plan for an obese patient who wants to lose weight. Which of the following questions should the nurse ask first?
- A. Which food types do you like best?
- B. How long have you been overweight?
- C. What kind of physical activities do you enjoy?
- D. What factors do you think led to your obesity?
Correct Answer: D
Rationale: The nurse should obtain information about the patient's 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 patient's beliefs are considered in planning.
The nurse is caring for a patient who returns to the surgical nursing unit following a vertical banded gastroplasty with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which of the following nursing actions should be included in the postoperative plan of care?
- A. Irrigate the nasogastric (NG) tube frequently with normal saline.
- B. Offer sips of sweetened liquids at frequent intervals.
- 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 since pain control will improve 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.
The nurse is collaborating with an obese patient who is enrolled in a behaviour modification program. Which of the following nursing actions is best?
- A. Having the patient write down the caloric intake of each meal
- B. Asking the patient about situations that tend to increase appetite
- C. Encouraging the patient to eat small amounts throughout the day rather than having scheduled meals
- D. Suggesting that the patient have a reward, such as a piece of sugarless candy, after achieving a weight-loss goal
Correct Answer: B
Rationale: Behaviour modification programs focus on how and when the person eats and de-emphasize aspects such as calorie counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behaviour modification.
The nurse is developing a weight loss plan for a young adult patient who is morbidly obese. Which of the following statements by the nurse is most likely to help the patient in losing weight on the planned calorie-reduced 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. Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.
- D. You are likely to start to notice changes in how you feel with just a few weeks of diet and exercise.
Correct Answer: D
Rationale: Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A young adult 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.