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# Lewis: Medical-Surgical Nursing, 7th Edition

Test Bank

## Chapter 41: Nursing Management: Obesity

MULTIPLE CHOICE

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

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/m2 is normal. A patient 6 ft tall and
weighing 150 lb would have a BMI of 20 kg/m2, well within the normal range. A 5 ft 4 in
patient weighing 120 lb would have a BMI of 21 kg/m2; additionally, carrying most of the
weight in the hips and thighs would place the patient at lower risk.

## Cognitive Level: Application Text Reference: p. 974

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

2. 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?
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.

Rationale: Motivation is essential for a successful outcome and will predict the chance
for success more than the patient’s initial BMI, previous history of weight loss, and
activity level.

## Cognitive Level: Application Text Reference: p. 978

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

## Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 41-3

3. 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
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.

Rationale: The initial nursing action should be assessment of any reason for the failure to
lose weight. The other actions may be needed, but further assessment is required before
any interventions are planned or implemented.

## Cognitive Level: Application Text Reference: p. 976

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

4. 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?
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.”

Rationale: Motivation is a key factor in successful weight loss and a short-term outcome
provides a higher motivation. A 21-year-old patient is developmentally 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.

## Cognitive Level: Application Text Reference: p. 979

Nursing Process: Implementation NCLEX: Psychosocial Integrity

## 5. Which of these menu selections by a patient who is attempting to lose weight

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

Test Bank 41-4

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

Rationale: 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.

## Cognitive Level: Application Text Reference: p. 979

Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance

## 6. 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
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

Rationale: 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.

## Cognitive Level: Application Text Reference: p. 980

Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

## 7. 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
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.

## Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 41-5

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.

## Cognitive Level: Application Text Reference: p. 980

Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance

8. 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
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.

Rationale: 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.

## Cognitive Level: Application Text Reference: p. 981

Nursing Process: Assessment NCLEX: Physiological Integrity

9. 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?
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.

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 side effects of orlistat and
indicate that the nurse should remind the patient that fat in the diet may increase these
side effects. The patient’s weight loss indicates that the diet and medication are successful
and should be continued.

## Cognitive Level: Analysis Text Reference: p. 981

Nursing Process: Evaluation NCLEX: Physiological Integrity

## Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 41-6

10. 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?
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.

Rationale: 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 patient’s activity level.

## Cognitive Level: Application Text Reference: p. 981

Nursing Process: Evaluation NCLEX: Physiological Integrity

11. 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?
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.”

Rationale: Reconstructive surgery may be used to eliminate excess skin folds after at
least a year has passed since the surgery. Skin folds 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 patient’s 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 possible later.

## Cognitive Level: Application Text Reference: p. 986

Nursing Process: Implementation NCLEX: Physiological Integrity

12. 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?
a. “What kind of physical activities do you enjoy?”

Test Bank 41-7

## 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?”

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

## Cognitive Level: Application Text Reference: p. 976

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

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

Rationale: Drugs can assist with weight loss, but should be just one part of a program
that includes diet and exercise changes, or weight gain will occur when the drugs are
stopped. Orlistat can decrease the absorption of fat-soluble vitamins, but vitamin
supplements can be used to prevent deficiency. A reply indicating that the patient is
lacking in willpower is judgmental and nontherapeutic. Orlistat may be used for weight
maintenance as well as for weight loss and does not cause serious side effects.

## Cognitive Level: Application Text Reference: p. 981

Nursing Process: Implementation NCLEX: Physiological Integrity

## 14. 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. 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.

## Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 41-8

Rationale: Coughing, deep breathing, and turning can prevent major postoperative
complications such as carbon monoxide retention, hypoxemia, and deep vein thrombosis.
Passive range of motion is not as helpful in preventing deep vein thrombosis and other
complications of immobility as active range of motion. The patient will be instructed
about the NG tube, but this is not as important as pulmonary function. The focus during
the preoperative teaching is the immediate recovery from the surgery, rather than the
long-term lifestyle changes that are needed.

## Cognitive Level: Application Text Reference: p. 985

Nursing Process: Planning NCLEX: Physiological Integrity

15. 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
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.

Rationale: Wound dehiscence is a more common problem in obese patients
postoperatively and the patient should cough and deep breathe every 2 hours. 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 and should only be done by
the health care provider. The patient’s head should be elevated to allow better respiratory
effort.

## Cognitive Level: Application Text Reference: p. 986

Nursing Process: Implementation NCLEX: Physiological Integrity

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

## Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 41-9

Rationale: Fluids and high carbohydrate foods tend to cause dumping syndrome and
diarrhea. The patient transitions to pureed foods at about 2 to 4 weeks and by 4 to 6
weeks is eating solid foods. The diet after bariatric surgery should be high in protein and
low in carbohydrates and roughage. Exercise and massage will not prevent the
development of flabby skin.

## Cognitive Level: Application Text Reference: p. 986

Nursing Process: Implementation NCLEX: Physiological Integrity

17. 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?
a. Take the patient’s apical pulse.
c. Measure the patient’s waist size.
d. Determine the patient’s ethnic origin.

Rationale: Waist size greater than 40 inches in men or 35 inches in women is one of the
diagnostic criteria for metabolic syndrome. The other criteria are: increased triglycerides,
low high-density lipoprotein (HDL), hypertension, and increased fasting glucose. Dietary
intake and ethnicity are risk factors for metabolic syndrome but will not help determine
whether the patient has this disorder. Cardiovascular disease may occur in patients with
metabolic syndrome, but the pulse rate will not assist in the diagnosis of metabolic
syndrome.

## Cognitive Level: Application Text Reference: p. 987

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

18. A patient is being evaluated at the clinic for possible metabolic syndrome. The nurse
will instruct the patient about the purpose of the
a. resting electrocardiogram.
b. fasting blood glucose test.
c. postural blood pressures.
d. cardiac enzyme tests.

Rationale: 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.

## Cognitive Level: Application Text Reference: p. 987

Nursing Process: Implementation

Test Bank 41-10