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Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass?
- A. Educating the patient about the nasogastric (NG) tube
- B. Instructing the patient on coughing and breathing techniques
- C. Discussing necessary postoperative modifications in lifestyle
- D. Demonstrating passive range-of-motion exercises for the legs
Correct Answer: B
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 will also be discussed, but avoidance of respiratory complications is the priority goal after surgery.
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Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1000-calorie 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. You are likely to notice changes in how you feel with just a few weeks of diet and exercise.
- D. Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.
Correct Answer: C
Rationale: Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 22-year-old 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.
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.
A client has been prescribed lorcaserin (Belviq). What teaching is most appropriate?
- A. Increase the fiber and water in your diet.
- B. Reduce fat to less than 30% each day.
- C. Report dry mouth and decreased sweating.
- D. Lorcaserin may cause loose stools for a few days.
Correct Answer: A
Rationale: This drug can cause constipation, so the client should increase fiber and water in the diet to prevent this from occurring. Reducing fat in the diet is important with orlistat. Lorcaserin can cause dry mouth but not decreased sweating. Loose stools are common with orlistat.
The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best exercise plan for weight loss?
- A. Walking for 40 minutes 6 or 7 days/week
- B. Lifting weights with friends 3 times/week
- C. Playing soccer for an hour on the weekend
- D. Running for 10 to 15 minutes 3 times/week
Correct Answer: A
Rationale: Exercise should be done daily for 30 minutes to an hour. 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. Weight lifting is not as helpful as aerobic exercise in weight loss.
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.