Nokea
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.
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The nurse is providing nutritional teaching to a patient who is to start on a very-low-calorie diet. Which of the following calorie amounts should the nurse tell the patient that daily calories are not to exceed?
- A. 500
- B. 800
- C. 1100
- D. 1400
Correct Answer: B
Rationale: A very-low-calorie diet does not exceed 800 calories/day. A low-calorie diet is between 800 and 1200 calories/day.
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.
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.
The nurse obtains these assessment data for a patient who has been taking orlistat for several months as part of a weight loss program. Which of the following findings is most important to report to the health care provider?
- A. The patient frequently has liquid stools.
- B. The patient is pale and has many bruises.
- C. The patient is experiencing a plateau in weight loss.
- D. The patient complains of abdominal bloating after meals.
Correct Answer: B
Rationale: Because orlistat blocks the absorption of fat-soluble vitamins, the patient may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common adverse effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these adverse effects. Weight loss plateaus are normal during weight reduction.
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.