Chapter 41: Nursing Management: Obesity My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 41: Nursing Management: Obesity

Test Bank

MULTIPLE CHOICE

1. The nurse is developing a weight loss plan for a 21-year-old patient who is morbidly obese. Which statement by the nurse is most likely to help the patient in losing weight on the planned 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.

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.

ANS: D

Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 21-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.

DIF: Cognitive Level: Application REF: 951

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. After the nurse has completed teaching a patient about the recommended amounts of foods from animal and plant sources, which of these menu selections indicates that the initial instructions about diet have been understood?

a.

3 oz of pork roast, a cup of corn, and a sliced tomato

b.

A chicken breast and a cup of tossed salad with nonfat dressing

c.

A 6 oz can of tuna mixed with nonfat mayonnaise and chopped celery

d.

3 oz of roast beef, 2 oz of low-fat cheese, and a half-cup of carrot sticks

ANS: A

This selection is most consistent with the recommendation of the American Institute for Cancer Research that one third of the diet should be from animal sources and two thirds from plant source foods. The other choices all have higher ratios of animal origin foods to plant source foods than would be recommended.

DIF: Cognitive Level: Application REF: 952-953 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

3. When working with an obese patient who is enrolled in a behavior modification program, which nursing action is appropriate?

a.

Having the patient write down the caloric intake of each meal

b.

Asking the patient about situations that tend to increase appetite

c.

Encouraging the patient to eat small amounts throughout the day rather than having scheduled meals

d.

Suggesting that the patient have a reward, such as a piece of sugarless candy, after achieving a weight-loss goal

ANS: B

Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as calorie 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.

DIF: Cognitive Level: Application REF: 953

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

4. Which patient behavior indicates that an overweight patient has understood the nurses teaching about 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

ANS: A

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.

DIF: Cognitive Level: Application REF: 952-953 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

5. When the health care provider in the outpatient clinic is considering prescribing sibutramine (Meridia) for a patient, which patient information is most important for the nurse to discuss with the provider?

a.

The patient has a permanent pacemaker.

b.

The patients goal is to lose 90 lb (41 kg).

c.

The patients blood pressure is usually 135-145/85-95.

d.

The patient used fenfluramine (Pondimin) in the past for weight loss.

ANS: C

Side effects of sibutramine (Meridia) include hypertension. A permanent pacemaker and a history of fenfluramine use are not contraindications for sibutramine. Sibutramine is prescribed for patients who have large weight loss goals.

DIF: Cognitive Level: Application REF: 953-954

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

6. A patient has been on a 1000-calorie diet with a daily exercise routine and a prescription for sibutramine (Meridia) for 10 weeks. Which information obtained by the nurse is important to report to the health care provider?

a.

The patient has not lost any weight for the last 2 weeks.

b.

The patient tells the nurse about occasional palpitations.

c.

The patient complains about having chronic constipation.

d.

The patient reports walking only 3 days during the last week.

ANS: B

The patient may be experiencing an increase in heart rate caused by the sibutramine (Meridia) that should be evaluated further by the health care provider. Plateaus during weight loss programs are common. Chronic constipation may be a side effect of the sibutramine, and the nurse should instruct the patient in measures such as eating more high fiber foods and increasing fluid intake. The nurse should reinforce the need to exercise more frequently, but no additional intervention by the health care provider is necessary regarding the patients activity level.

DIF: Cognitive Level: Application REF: 953-954

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

7. A few months after bariatric surgery, a 62-year-old patient tells the nurse, My skin is hanging in folds. I think I need cosmetic surgery. Which response by the nurse is most appropriate?

a.

Perhaps you would like to talk to a counselor about your body image.

b.

The important thing is that your weight loss is improving your health.

c.

The skinfolds will gradually disappear once most of the weight is lost.

d.

Cosmetic surgery is certainly a possibility once your weight has stabilized.

ANS: D

Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. Skinfolds 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 patients concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counselor, it is more likely to be helpful to know that cosmetic surgery is available.

DIF: Cognitive Level: Application REF: 959

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

8. A patient 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 nursing action 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.

ANS: D

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.

DIF: Cognitive Level: Application REF: 958-959 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

9. Which information will 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 fiber to promote bowel function.

d.

Development of flabby skin can be prevented by daily exercise.

ANS: A

Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin.

DIF: Cognitive Level: Application REF: 959 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

10. Which assessment will the nurse do to help determine if an obese patient seen in the clinic 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.

ANS: B

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.

DIF: Cognitive Level: Application REF: 959-960

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

11. Which topic would be of importance for the nurse to include when teaching a patient about testing for possible metabolic syndrome?

a.

Blood glucose test

b.

Cardiac enzyme tests

c.

Postural blood pressures

d.

Resting electrocardiogram

ANS: A

A fasting blood glucose test >100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome, although they may be used to check for cardiovascular complications of the disorder.

DIF: Cognitive Level: Application REF: 959-960

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

12. What specific information will the nurse include in patient teaching for an overweight patient who is 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.

ANS: C

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.

DIF: Cognitive Level: Application REF: 951-953

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

13. Which of these patients in the clinic will the nurse plan to teach about risks associated with obesity?

a.

Patient who has a BMI of 18 kg/m2

b.

Patient with a waist circumference 34 inches (86 cm)

c.

Patient who has a body mass index (BMI) of 24 kg/m2

d.

Patient whose waist measures 30 in (75 cm) and hips measure 34 in (85 cm)

ANS: D

The waist-to-hip ratio for this patient is 0.88, which exceeds the recommended level of <0.80. A BMI of 24 kg/m2 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 patient with a BMI of 18 kg/m2 is considered underweight.

DIF: Cognitive Level: Comprehension REF: 944-945 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

14. Which nursing action included in the plan of care for a patient who is being admitted for bariatric surgery can the nurse delegate to nursing assistive personnel (NAP)?

a.

Demonstrate use of the incentive spirometer.

b.

Plan methods for bathing and turning the patient.

c.

Assist with IV insertion by holding adipose tissue out of the way.

d.

Develop strategies to provide privacy and decrease embarrassment.

ANS: C

NAP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require RN level education and scope of practice.

DIF: Cognitive Level: Application REF: 957-958

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

15. A patient who has been successfully losing 1 lb weekly for several months is weighed at the clinic and has not lost any weight for the last month. The nurse should 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.

ANS: C

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.

DIF: Cognitive Level: Application REF: 949-952

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

16. The nurse obtains these assessment data for a patient who has been taking orlistat (Xenical) for several months as part of a weight loss program. Which finding 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.

ANS: B

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 side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. Weight loss plateaus are normal during weight reduction.

DIF: Cognitive Level: Application REF: 953-954

OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

17. When developing a weight reduction plan for an obese patient who wants to lose weight, which question should the nurse ask first?

a.

Which food types do you like best?

b.

How long have you been overweight?

c.

What kind of physical activities do you enjoy?

d.

What factors do you think led to your obesity?

ANS: D

The nurse should obtain information about the patients perceptions of the reasons for the obesity to develop a plan individualized to the patient. The other information also will be obtained from the patient, but the patient is more likely to make changes when the patients beliefs are considered in planning.

DIF: Cognitive Level: Application REF: 950

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance

18. On the first postoperative day the nurse is caring for a patient who has had a Roux-en-Y gastric bypass procedure. Which assessment finding 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 skinfolds

c.

Bilateral crackles audible at both lung bases

d.

Emesis of bile-colored fluid past the nasogastric (NG) tube

ANS: D

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.

DIF: Cognitive Level: Application REF: 958-959

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

19. In planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass as treatment for morbid obesity, the nurse places the highest priority on

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.

ANS: C

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.

DIF: Cognitive Level: Application REF: 957-958

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

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