Question 1

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

Accepted Answer

A)   Having the patient write down the caloric intake of each meal
B)   Asking the patient about situations that tend to increase appetite
C)   Suggesting that the patient have a reward, such as a piece of sugarless candy, after achieving a weight-loss goal
D)   Encouraging the patient to eat small amounts throughout the day rather than having scheduled meals B

Question 2

A moderately obese 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?

Accepted Answer

A)   The patient has not lost any weight for the last 2 weeks.
B)   The patient complains about having chronic constipation.
C)   The patient tells the nurse about occasional palpitations.
D)   The patient reports walking only 3 days during the last week. C

Question 3

The nurse is developing a weight loss plan for a 21-year-old obese patient. Which statement by the nurse is most likely to help the patient in losing weight on the planned 800-calorie diet?

Accepted Answer

A)   "You will decrease your risk for future health problems such as diabetes by losing weight now."
B)   "You are likely to start to notice changes in how you feel with just a few weeks of diet and exercise."
C)   "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat."
D)   "It will be necessary to change lifestyle habits permanently to maintain weight loss." B

Question 4

A patient returns to the surgical nursing unit following a vertical banded gastroplasty with a nasogastric tube to low, intermittent suction and a PCA machine for pain control. During the postoperative care of the patient, the nurse recognizes the need to

Accepted Answer

A)   promote return of bowel sounds by discouraging excessive PCA use.
B)   maintain patency of the NG tube with frequent normal saline irrigations.
C)   support the surgical incision during coughing to prevent dehiscence of the wound.
D)   position the patient flat in bed on the right side to promote normal stomach emptying.

Question 5

When developing a weight-reduction plan for an obese patient who is starting a weight-loss program, which question is most important for the nurse to ask?

Accepted Answer

A)   "What kind of physical activities do you enjoy?"
B)   "How long have you been overweight?"
C)   "What factors do you think led to your obesity?"
D)   "Have you been on any previous diets?"

Question 6

A patient has a new prescription for sibutramine (Meridia). Which information about the patient indicates that the nurse should discuss the medication with the health care provider before administration?

Accepted Answer

A)   The patient has a history of hypertension.
B)   The patient has a permanent pacemaker to prevent bradycardia.
C)   The patient's goal is to lose 90 lb (41 kg) .
D)   The patient used fenfluramine (Pondimin)  in the past for weight loss.

Question 7

A patient who has been consistently following a diet and exercise program and 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

Accepted Answer

A)   review the diet and exercise guidelines with the patient.
B)   instruct the patient to weigh weekly and record the weights.
C)   discuss the possibility that the patient has reached a temporary weight loss plateau.
D)   ask the patient whether there have been any changes in exercise or diet patterns.

Question 8

The nurse in the clinic is assessing a new patient who has abdominal obesity and hypertension. What further assessment should the nurse do to assess for possible metabolic syndrome?

Accepted Answer

A)   Take the patient's apical pulse.
B)   Ask the patient about dietary intake.
C)   Measure the patient's waist size.
D)   Determine the patient's ethnic origin.

Question 9

Which of these menu selections by a patient who is attempting to lose weight indicates that the initial instructions about diet have been understood?

Accepted Answer

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

Question 10

The nurse is assessing patients at the outpatient clinic. Which of these patients is at risk for health complications related to weight?

Accepted Answer

A)   A 24-year-old with a waist measurement of 30 in (75 cm)  and a hip measurement of 34 in (85 cm) 
B)   A 33-year-old who has a body mass index (BMI)  of 24 kg/m2
C)   A 56-year-old who is 6 ft (180 cm)  tall and weighs 150 lb (68 kg) 
D)   A 71-year-old who is 5 ft 4 in (160 cm) , weighs 120 lb (55 kg) , and carries most of the weight in the thighs

Question 11

The nurse provides discharge instructions to a patient following gastric bypass surgery for treatment of obesity. The nurse teaches the patient to

Accepted Answer

A)   avoid foods high in carbohydrates and not to drink fluids with meals.
B)   maintain a liquid diet for about 6 weeks until gastric healing is complete.
C)   eat a high carbohydrate, high-roughage diet to promote bowel function when solid foods are allowed.
D)   exercise and massage to prevent the development of flabby skin resulting from massive weight loss.

Question 12

When taking the health history from an obese patient, which information obtained by the nurse is most helpful in determining whether the patient will be successful in losing weight?

Accepted Answer

A)   The patient's body mass index is 39 kg/m2.
B)   The patient has a history of losing weight successfully in the past.
C)   The patient says, "I am ready to make some changes in my lifestyle."
D)   The patient's rides a stationary bicycle.

Question 13

A patient has been taking orlistat (Xenical) for several months as part of a weight loss program which also includes a low-fat diet. Which of these data obtained by the nurse indicate that a change in therapy may be needed?

Accepted Answer

A)   The patient complains of abdominal bloating after meals.
B)   The patient has lost 31 lb (14 kg)  of the original 65 lb (30 kg)  goal.
C)   The patient frequently has liquid stools.
D)   The patient is pale and has many bruises.

Question 14

An obese patient asks the nurse about using orlistat (Xenical) for weight reduction. The nurse advises the patient that

Accepted Answer

A)   this drug can cause serious depletion of fat-soluble vitamins and should be used for only several weeks.
B)   weight-reduction drugs of any type are used for only those who do not have the willpower to reduce their intake of food.
C)   drugs may be helpful in weight loss, but weight gain is likely to recur unless changes in diet and exercise are maintained.
D)   the long-term effect of orlistat is not known, and the drug may cause serious side effects such as heart valve problems.

Question 15

A patient is being evaluated at the clinic for possible metabolic syndrome. The nurse will instruct the patient about the purpose of the

Accepted Answer

A)   resting electrocardiogram.
B)   fasting blood glucose test.
C)   postural blood pressures.
D)   cardiac enzyme tests.

Question 16

After discussing appropriate exercise activities with an overweight patient who is starting to exercise as part of a weight-loss program, the nurse will determine that the instructions have been understood when the patient reports

Accepted Answer

A)   playing soccer for an hour on the weekend.
B)   running for 10 to 15 minutes 3 times/week.
C)   walking for 40 minutes 6 or 7 days a week.
D)   lifting weights with friends three times a week.

Question 17

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

Accepted Answer

A)   demonstrating passive range-of-motion exercises to the legs.
B)   teaching the patient about the postoperative presence of a NG tube connected to suction.
C)   teaching the patient proper coughing and deep-breathing techniques and methods of turning and positioning.
D)   discussing the necessary postoperative modifications in lifestyle.

Question 18

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

Accepted Answer

A)   "The skin folds will gradually disappear once most of the weight is lost."
B)   "The important thing is that your weight loss is improving your health."
C)   "Perhaps you would like to talk to a counselor about your body image."
D)   "Cosmetic surgery is certainly a possibility once your weight has stabilized."

Exam 41: Nursing Management: Obesity