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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.
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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.
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.
Which of the following topics is of most importance for the nurse to include when teaching a patient about testing for possible metabolic syndrome?
- A. Blood glucose test
- B. Cardiac enzyme tests
- C. Postural blood pressures
- D. Resting electrocardiogram
Correct Answer: A
Rationale: A fasting blood glucose test from 4-6 mmol/L 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.
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.
Which of the following patients seen in the clinic should the nurse teach about risks associated with obesity?
- A. Patient who has a BMI of 18 kg/m?²
- B. Patient with a waist circumference 86 cm
- C. Patient who has a body mass index (BMI) of 24 kg/m?²
- D. Patient whose waist measures 75 cm and hips measure 85 cm
Correct Answer: D
Rationale: The waist-to-hip ratio for this patient is 0.88, which exceeds the recommended level of <0.80. A BMI of 24 kg/m?² is normal. Health risks associated with obesity increase in women with a waist circumference larger than 89 cm and men with a waist circumference larger than 102 cm. A patient with a BMI of 18 kg/m?² is considered underweight.