Nokea
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.
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Which of the following patients seen in the clinic should the nurse teach about risks associated with obesity?
- A. Patient who has a BMI of 18 kg/m?²
- B. Patient with a waist circumference 86 cm
- C. Patient who has a body mass index (BMI) of 24 kg/m?²
- D. Patient whose waist measures 75 cm and hips measure 85 cm
Correct Answer: D
Rationale: The waist-to-hip ratio for this patient is 0.88, which exceeds the recommended level of <0.80. A BMI of 24 kg/m?² is normal. Health risks associated with obesity increase in women with a waist circumference larger than 89 cm and men with a waist circumference larger than 102 cm. A patient with a BMI of 18 kg/m?² is considered underweight.
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.
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.
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.
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.