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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.
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What specific information should the nurse include in patient teaching for an overweight patient starting a weight loss plan?
- A. Weigh yourself at the same time every morning.
- B. Start dieting with a 600- to 800-calorie diet for rapid weight loss.
- C. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain.
- D. Weighing all foods on a scale is necessary to choose appropriate portion sizes.
Correct Answer: C
Rationale: The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorie-restricted diets are not necessary for patients in the overweight category of obesity, requiring close supervision. Patients should weigh weekly rather than daily.
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 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.
Which of the following patient behaviours indicate that an overweight patient has understood the nurse's teaching about the best exercise plan for weight loss?
- A. Walking for 40 minutes 6 or 7 days/week
- B. Lifting weights with friends three times/week
- C. Playing soccer for an hour on the weekend
- D. Running for 10-15 minutes three times/week
Correct Answer: A
Rationale: Exercise should be done daily for at least 15-30 minutes. Exercising in highly aerobic activities for short bursts or only once a week is not helpful and may be dangerous in an individual who has not been exercising. Running may be appropriate, but a patient should start with an exercise that is less stressful and can be done for a longer period. Weightlifting is not as helpful as aerobic exercise in weight loss.
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.