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After the nurse teaches a patient about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the initial instructions about diet have been understood?
- A. 3 oz of lean beef, 2 oz of low-fat cheese, and a tomato slice
- B. 3 oz of roasted pork, a cup of corn, and a cup of carrot sticks
- C. Cup of tossed salad and nonfat dressing topped with a chicken breast
- D. Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery
Correct Answer: B
Rationale: This selection is most consistent with the recommendation of the American Institute for Cancer Research that one third of the diet should be from animal sources and two thirds from plant source foods. The other choices all have higher ratios of animal origin foods to plant source foods than would be recommended.
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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.
After bariatric surgery, a patient who is being discharged tells the nurse, I prefer to be independent. I am not interested in any support groups. Which response by the nurse is best?
- A. I hope you change your mind so that I can suggest a group for you.
- B. Tell me what types of resources you think you might use after this surgery.
- C. Support groups have been found to lead to more successful weight loss after surgery.
- D. Because there are many lifestyle changes after surgery, we recommend support groups.
Correct Answer: B
Rationale: This statement allows the nurse to assess the individual patients potential needs and preferences. The other statements offer the patient more information about the benefits of support groups, but fail to acknowledge the patients preferences.
Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program?
- A. Having the adults write down the caloric intake of each meal
- B. Asking the adults about situations that tend to increase appetite
- C. Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals
- D. Encouraging the adults to eat small amounts frequently rather than having scheduled meals
Correct Answer: B
Rationale: Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as caloric counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior modification.
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 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).