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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.
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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.
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.
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.
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.
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.