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Which assessment action will help the nurse determine if an obese patient has metabolic syndrome?
- A. Take the patients apical pulse.
- B. Check the patients blood pressure.
- C. Ask the patient about dietary intake.
- D. Dipstick the patients 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.
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Which adult will the nurse plan to teach about risks associated with obesity?
- A. Man who has a BMI of 18 kg/m^2
- B. Man with a 42 in waist and 44 in hips
- C. Woman who has a body mass index (BMI) of 24 kg/m^2
- D. Woman with a waist circumference of 34 inches (86 cm)
Correct Answer: B
Rationale: The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level of <0.80. A patient with a BMI of 18 kg/m^2 is considered underweight. A BMI of 24 kg/m^2 is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm).
A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority?
- A. Assess the clients pain.
- B. Check the surgical incision.
- C. Ensure an adequate airway.
- D. Program the morphine pump.
Correct Answer: C
Rationale: All actions are appropriate care measures for this client; however, airway is always the priority. Bariatric clients tend to have short, thick necks that complicate airway management.
What information will the nurse include for an overweight 35-year-old woman who is starting a weight-loss plan?
- A. Weigh yourself at the same time every morning and evening.
- B. Stick to a 600- to 800-calorie diet for the most 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 and need to be closely supervised. Patients should weigh weekly rather than daily.
Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program?
- A. Having the adults write down the caloric intake of each meal
- B. Asking the adults about situations that tend to increase appetite
- C. Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals
- D. Encouraging the adults to eat small amounts frequently rather than having scheduled meals
Correct Answer: B
Rationale: Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as caloric counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior modification.
After vertical banded gastroplasty, a 42-year-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care?
- A. Offer sips of fruit juices at frequent intervals.
- B. Irrigate the nasogastric (NG) tube frequently.
- 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 because pain control will improve the 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.