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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.
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The nurse is developing a weight loss plan for a young adult patient who is morbidly obese. Which of the following statements by the nurse is most likely to help the patient in losing weight on the planned calorie-reduced diet?
- A. It will be necessary to change lifestyle habits permanently to maintain weight loss.
- B. You will decrease your risk for future health problems such as diabetes by losing weight now.
- C. Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.
- D. You are likely to start to notice changes in how you feel with just a few weeks of diet and exercise.
Correct Answer: D
Rationale: Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A young adult patient is unlikely to be motivated by future health problems. Telling a patient that the initial weight loss is water will be discouraging, although this may be correct. Changing lifestyle habits is necessary, but this process occurs over time and discussing this is not likely to motivate the patient.
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.
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 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.
Which of the following information should the nurse plan to include in discharge teaching for a patient after gastric bypass surgery?
- A. Avoid drinking fluids with meals.
- B. Choose high-fat foods for at least 30% of intake.
- C. Choose foods that are high in fibre to promote bowel function.
- D. Development of flabby skin can be prevented by daily exercise.
Correct Answer: A
Rationale: Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fibre. Exercise does not prevent the development of flabby skin.