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The nurse is planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass as treatment for morbid obesity. Which of the following interventions is priority?
- A. Demonstrating passive range-of-motion exercises to the legs.
- B. Discussing the necessary postoperative modifications in lifestyle
- C. Teaching the patient proper coughing and deep-breathing techniques
- D. Educating the patient about the postoperative presence of a nasogastric (NG) tube
Correct Answer: C
Rationale: Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle also will be discussed, but avoidance of respiratory complications is the priority goal after surgery.
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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.
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 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.
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.