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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.
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A few months after bariatric surgery, an older-adult patient tells the nurse, 'My skin is hanging in folds. I think I need cosmetic surgery.' Which of the following responses by the nurse is best?
- A. Perhaps you would like to talk to a counsellor about your body image.
- B. The important thing is that your weight loss is improving your health.
- C. The skin folds will gradually disappear once most of the weight is lost.
- D. Cosmetic surgery is certainly a possibility once your weight has stabilized.
Correct Answer: D
Rationale: Reconstructive surgery may be used to eliminate excess skin folds after at least a year has passed since the surgery. Skin folds may not disappear over time, especially in older patients. The response, 'The important thing is that your weight loss is improving your health,' ignores the patient's concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counsellor, it is more likely to be helpful to know that cosmetic surgery is available.
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 surgeries places the patient at greatest risk of dumping syndrome postoperatively?
- A. Vertical banded gastroplasty
- B. Adjustable gastric banding
- C. Vertical sleeve gastrectomy
- D. Lap-Band
Correct Answer: A
Rationale: A possible complication of vertical banded gastroplasty is dumping syndrome. Dumping syndrome is not a possible complication in adjustable gastric banding, vertical sleeve gastrectomy, or Lap-Band.
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.
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.