✅ ch 42

The nurse in the ICU is caring for a 47-year-old, obese male client who is in shock following a motor vehicle accident. What would be the main challenge in meeting this client's elevated energy requirements during prolonged rehabilitation?

Loss of skeletal muscle

The nurse is creating the care plan for a 70-year-old obese client who has been admitted to the postsurgical unit following a colon resection. This client's age and increased body mass index mean that the client is at increased risk for what complication in the postoperative period?

Infection

A 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem?

Obstructive sleep apnea

The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified?

Cholesterol levels, hypertension, and smoking

A nurse is performing a health history on a client with obesity. Which condition is the client most at risk for with a diagnosis of obesity?

Diabetes

The nurse is caring for a client that has undergone bariatric surgery. Which indication is a complication from the surgery?

Dumping syndrome

A nurse is caring for a client after bariatric surgery and is assessing for hemorrhage. What is a sign of hemorrhage?

Frank red bleeding from the surgical site

The school nurse is working with a high school junior whose BMI is 31. When planning this client’s care, the nurse should identify what goal?

Increase in exercise and reduction in calorie intake

A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes?

Lose weight, if obese.

A diabetes educator is teaching a client about type 2 diabetes. The educator recognizes that the client understands the primary treatment for type 2 diabetes when the client states what?

"I will make sure to follow the weight loss plan designed by the dietitian."

A client has recently been diagnosed with type 2 diabetes. The client is clinically obese and has a sedentary lifestyle. How can the nurse best begin to help increase the client’s activity level?

Identify barriers with the client that inhibit his lifestyle change.

The nurse is providing care for a client who was recently diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease?

Avoid taking aspirin to treat pain or fever.

The nurse is providing care for an adult client who has sought care for the treatment of obesity. When performing an assessment of this client, the nurse should address what potential contributing factors? Select all that apply.

A. Activity level

B. Neurologic factors

C. Family history and genetics

D. Endocrine factors

E. Microbiota

Activity level, Family history and genetics, Endocrine factors, Microbiota

The nurse has completed the admission assessment of a client and has determined that the client's body mass index (BMI) is 33.5 kg/m2. What health promotion advice should the nurse provide to the client?

"It would be very helpful if you could integrate more physical activity into your routine."

The nurse provides care for several clients who have obesity. Which client's obesity is most likely to resolve with medication?

A client whose obesity has been attributed to hypothyroidism

The community health nurse is performing a home visit to a client who has obesity, peripheral vascular disease, and type 2 diabetes. The client has expressed a desire to lose weight. What is the nurse's best initial action?

Identify the client's desired goals for weight loss

The nurse is working with a sedentary adult client who has expressed a determination to lose weight over the next several months, despite the presence of other major health problems. What is the nurse's best advice for this client?

"It might be challenging to start an exercise program, but we'll start with a few minutes per day."

The nurse is providing care for an adult client who has expressed frustration at the inability to lose weight, despite trying to reduce food intake. What aspect of this client's current health status should the nurse address?

The client takes a tricyclic antidepressant and has done so for several years.

A client with class II obesity has been unable to lose weight despite trying to increase activity and limit food intake. The health care provider has prescribed orlistat. What health education should the nurse provide to the client?

It is important to maintain a nutrient-rich diet and take multivitamins.

A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?

"I'm so relieved to start this medication. I really don't like having to exercise or change what I eat."

A client with obesity has recently begun treatment with phentermine/topiramate-ER. The client tells the nurse, "I'm eating a lot of spinach and other leafy green vegetables, both cooked and in salads." What is the nurse's best response?

"That's great. Spinach has a lot of vitamins and nutrients and very few calories."

The nurse is caring for a client who has obesity and who has been prescribed naltrexone/bupropion. What assessments should the nurse perform? Select all that apply.

A. Alcohol intake

B. Mood and affect

C. Cognition and orientation

D. Skin integrity

E. Blood pressure

Alcohol intake, Mood and affect, Blood pressure

A client with obesity has been prescribed liraglutide by the primary provider. When providing the client with health education, the nurse should teach the client:

how to self-administer subcutaneous injections.

A client with obesity has been taking orlistat for the past several days. During the client's most recent follow-up assessment with the nurse, the client states, "I'm embarrassed to even say it, but I've had a few episodes of leaking stool since I've started this medication." What is the nurse's best response?

"That sounds stressful for you. That's definitely one of the adverse effects of this medication."

The nurse is assessing a client with obesity who has been taking naltrexone/bupropion for the past several weeks. What assessment finding most clearly suggests that the medication is having a desired effect?

The client reports a diminished appetite and fewer cravings.

The nurse is performing a health assessment of a client who has been taking antiobesity medications for several weeks. During the nurse's gastrointestinal assessment, the client reports bowel movements described as "greasy" and "oily." What medication is the client most likely taking?

Orlistat

A client with obesity has expressed a desire to lose weight and states that his previous efforts have been unsuccessful. The client states that he would like to sign up for a commercial weight-loss program. What is the nurse's best response?

"We can help you make a plan that wouldn't require you to join a commercial program."

The nurse is caring for a client who had an intragastric balloon placed 5 months ago for the treatment of obesity. The client's abdominal girth has increased over the past 48 hours and the last bowel movement was 72 hours ago. What is the nurse's best action?

Report the possibility of balloon rupture to the primary provider.

A 69-year-old client has maintained a consistent diet and activity level throughout adulthood. Over the past few years, however, the client has reported a gradual increase in adipose tissue. When providing health education, the nurse should address what topic?

Changes in metabolism that accompany the aging process

The community health nurse is leading a health education workshop for older adults. When addressing nutrition, what guideline should the nurse provide to participants?

Clients should aim to consume at least five servings of fruits or vegetables each day.

The nurse is admitting a client who has class III obesity. Inspection reveals that the client's neck and chest have a much larger than usual circumference. What is the nurse's best action?

Perform a focused respiratory assessment.

The nurse is assessing a hospital client who has severe obesity. The nurse's review of the client's latest arterial blood gases reveals PaCO2 of 48 mm Hg and PaO2 of 76 mm Hg. Inspection reveals a respiratory rate of 22 breaths per minute with shallow ventilation. What intervention should be included in the client's plan of care?

Keep the client in a low Fowler position when in bed.

The nurse is assessing a client who has a chronic pain disorder and who also has class II obesity. What principle should guide the care team's choice of pain treatments for this client?

The client may require higher doses of opioids than clients without obesity.

The nurse is caring for a hospitalized client who has class II obesity and who has limited mobility. The nurse should address the client's risk for skin breakdown by:

cleaning and drying regularly within the client's skin folds.

The nurse is speaking with a 20-year-old client who has class II obesity. The client states, "No matter what I do, I can't lose weight. How soon do you think I could get bariatric surgery?" What is the nurse's best response?

"Bariatric surgery is often very effective, but it usually happens after a lengthy process of consultations and referrals."

An adult female client has a body mass index of 34.5 kg/m2 and has expressed interest in bariatric surgery. What characteristic of the client's health status may exclude her from being an appropriate surgical candidate?

The client drinks six to eight cans of beer daily

A client with obesity is early in the process of preparing for a Roux-en-Y gastric bypass (RYGB). The client states, "After the surgery, the amount of food that I consume will be limited and I'll absorb fewer calories from what I do eat." When responding to the client, the nurse should:

validate what the client understands about the surgical procedure.

A client with obesity has expressed interest in bariatric surgery and has presented for an initial appointment at a bariatric clinic. The care team at the client should prioritize what action in the client's subsequent care?

Determining whether the client is an appropriate candidate for surgery

The nurse is caring for a client who had bariatric surgery several months ago and who has been prescribed monthly vitamin B12 injections. How should the nurse best assess for the therapeutic effect of these injections?

Measure the client's abdominal girth and review electrolyte levels.

An adult is postoperative day 2 following bariatric surgery. The nurse's most recent assessment reveals abdominal pain that the client rates at 8 out of 10, heart rate of 102 beats per minute and an oral temperature of 38.1°C (100.6°F). What is the nurse's best action?

Communicate the findings to the health care provider because the client may have an anastomotic leak.