Chapter 42: Assessment and Management of Patients with Obesity

Question 1

1. 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?
   A. Loss of adipose tissue
   B. Loss of skeletal muscle
   C. Inability to convert adipose tissue to energy
   D. Inability to maintain normal body mass

Answer 1

ANS: B
Rationale: Nutritional energy requirements are met by breaking down lean body mass. In this catabolic process, skeletal muscle mass is broken down even when the client has large stores of fat or adipose tissue. Loss of skeletal muscle greatly prolongs the client’s recovery time. Loss of adipose tissue, the inability to convert adipose tissue to energy, and the inability to maintain normal body mass are not main concerns in meeting nutritional energy requirements for this client.

Question 2

2. 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?
   A. Hyperglycemia
   B. Azotemia
   C. Falls
   D. Infection

Answer 2

ANS: D
Rationale: Like age, obesity increases the risk and severity of complications associated with surgery. During surgery, fatty tissues are especially susceptible to infection. In
addition, obesity increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound separation) and wound infections are more common. A
postoperative client who is obese will not likely be at greater risk for hyperglycemia, azotemia, or falls.

Question 3

3. 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?
   A. Adenoiditis
   B. Chronic tonsillitis
   C. Obstructive sleep apnea
   D. Laryngeal cancer

Answer 3

ANS: C
Rationale: Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring.
Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This client’s symptoms are not suggestive of laryngeal cancer.

Question 4

4. 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?
   A. Gender, obesity, family history, and smoking
   B. Inactivity, stress, gender, and smoking
   C. Cholesterol levels, hypertension, and smoking
   D. Stress, family history, and obesity

Answer 4

ANS: C
Rationale: Four modifiable risk factors—cholesterol abnormalities, tobacco use, hypertension, and diabetes—are established risk factors for CAD and its complications.
Gender and family history are risk factors that cannot be controlled.

Question 5

5. 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?
   A. Upper respiratory infections
   B. Diabetes
   C. Hypotension
   D. Pernicious anemia

Answer 5

ANS: B
Rationale: Clients are at a high risk for diabetes with a concurrent diagnosis of obesity.

Question 6

6. The nurse is caring for a client that has undergone bariatric surgery. Which indication
   is a complication from the surgery?
   A. Dumping syndrome
   B. Cushing syndrome
   C. Malnutrition
   D. Diverticulitis

Answer 6

ANS: A
Rationale: After surgery, the nurse assesses the client for complications from bariatric surgery, such as changes in bowel habits, hemorrhage, venous thromboembolism (VTE),
bile reflux, dumping syndrome, dysphagia, and bowel or gastric outlet obstruction. Cushing syndrome, malnutrition, and diverticulitis risk are not associated with bariatric
surgery.

Question 7

7. A nurse is caring for a client after bariatric surgery and is assessing for hemorrhage.
   What is a sign of hemorrhage?
   A. Increase in blood pressure
   B. Frank red bleeding from the surgical site
   C. Clear drainage from the surgical wound
   D. Decrease in heart rate

Answer 7

ANS: B
Rationale: Frank red bleeding from the surgical site could indicate a disruption. Changes in vital signs during hemorrhage would be a decrease in blood pressure and an increase in heart rate. Bloody drainage would be assessed from the surgical site or wound if there is suspected hemorrhage, not clear drainage.

Question 8

8. 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?
   A. Continuation of current diet and activity level
   B. Increase in exercise and reduction in calorie intake
   C. Possible referral to an eating disorder clinic
   D. Increase in daily calorie intake

Answer 8

ANS: B
Rationale: A BMI of 31 is considered clinically obese; dietary and exercise modifications would be indicated. People who have a BMI lower than 24 (or who are 80% or less of their
desirable body weight for height) are at increased risk for problems associated with poor nutritional status. Those who have a BMI of 25 to 29.9 are considered overweight; those
with a BMI of 30 or greater are considered to be obese.

Question 9

9. 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?
   A. Have blood glucose levels checked annually.
   B. Stop using tobacco in any form.
   C. Undergo eye examinations regularly.
   D. Lose weight, if obese.

Answer 9

ANS: D
Rationale: Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been
diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent diabetes.

Question 10

10. 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?
    A. “I read that a pancreas transplant will provide a cure for my diabetes.”
    B. “I will take my oral antidiabetic agents when my morning blood sugar is high.”
    C. “I will make sure to follow the weight loss plan designed by the dietitian.”
    D. “I will make sure I call the diabetes educator when I have questions about my
    insulin.”

Answer 10

ANS: C
Rationale: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise
are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral
agents may be used. Some clients may require insulin on an ongoing or on a temporary basis during times of acute psychological stress, but it is not the central component of
type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.

Question 11

11. 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?
    A. Set up appointment times at a local fitness center for the client to attend.
    B. Have a family member ensure the client follows a suggested exercise plan.
    C. Construct an exercise program and have the client follow it.
    D. Identify barriers with the client that inhibit his lifestyle change.

Answer 11

ANS: D
Rationale: Nurses cannot expect sedentary clients to develop a sudden passion for exercise or that they will rearrange their day to accommodate time-consuming exercise plans. The client may not be ready or willing to accept this lifestyle change. This is why it is important that the nurse and client identify barriers to change.

Question 12

12. 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?
    A. Perform 15 minutes of physical activity at least three times per week.
    B. Avoid taking aspirin to treat pain or fever.
    C. Take multivitamins as prescribed and eating organic foods whenever possible.
    D. Maintain a healthy body weight.

Answer 12

ANS: B
Rationale: Aspirin and other NSAIDs are implicated in chronic gastritis because of their irritating effect on the gastric mucosa. Organic foods and vitamins confer no protection. Exercise and maintaining a healthy body weight are beneficial to overall health but do not prevent gastritis.

Question 13

13. 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

Answer 13

ANS: A, C, D, E
Rationale: Obesity is a multifactorial health problem, which involves contributions related to physical activity, family history, genetics and hormonal factors. The role of the
microbiota is also being investigated as an etiologic factor. Disruptions to normal neurologic function, however, have not been identified as possible causes of obesity.

Question 14

14. 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?
    A. “It would be very helpful if you could integrate more physical activity into your
    routine.”
    B. “You’re considered to be overweight, so you should be diligent about
    maintaining a healthy diet.”
    C. “You might want to consider some of the surgical options that have been
    developed for treating obesity.”
    D. “With your permission, I’d like you to refer to a support group for individuals
    who live with severe obesity.”

Answer 14

ANS: A
Rationale: A BMI of 33.5 is considered to be class I obesity. As such, health promotion advice will encompass advice about diet and exercise. The individual is not severely
obese or overweight/pre-obese. Surgical options are not often used in the treatment of class I obesity and are not a first-line treatment.

Question 15

15. The nurse provides care for several clients who have obesity. Which client’s obesity is
    most likely to resolve with medication?
    A. An obese client whose parents and siblings are not obese
    B. A client whose obesity is characterized as android rather than gynoid
    C. A client whose obesity has been attributed to hypothyroidism
    D. A client with long-standing obesity who has recently been diagnosed with type 2
    diabetes

Answer 15

ANS: C
Rationale: Hypothyroidism is a potential cause of obesity and may resolve with the administration of thyroid supplements. Medication can help manage an obese client’s
diabetes but will not directly resolve the underlying obesity. The lack of a family history does not suggest that obesity can be treated with medication. There are different risks
between android obesity and gynoid obesity, but neither is necessarily amenable to pharmacologic treatment.

Question 16

16. 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?
    A. Teach the client about the relationship between lifestyle and body weight
    B. Identify the client’s desired goals for weight loss
    C. Teach the client exercises that are physically achievable and easy to perform
    D. Review the client’s most recent blood glucose and hemoglobin A1c results

Answer 16

ANS: B
Rationale: Assessment should precede educational interventions. In this case, the nurse should assess the client’s goals and expectations in addition to other forms of assessment. The client’s glycemic control may or may not have a significant effect on prospects for weight loss.

Question 17

17. 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?
    A. “We’ll work together to ensure you don’t exceed food intake of 2000 calories per
    day.”
    B. “Try to perform both aerobic and muscle-training exercises every day.”
    C. “It might be challenging to start an exercise program, but we’ll start with a few
    minutes per day.”
    D. “I’ll make sure that you’re screened for type 2 diabetes before you start your
    weight-loss program.”

Answer 17

ANS: C
Rationale: Clients with obesity who were previously sedentary and deconditioned may not be able to achieve this at the start; however, as little as 10 minutes of daily physical activity can result in weight loss and improved exercise tolerance. Exercise must be performed regularly, but it is not necessary to include aerobic and strength-building exercises every day. A client with obesity should be counseled to plan a caloric deficit of between 500 and 1000 calories daily from baseline; however, this does not necessarily result in a threshold of 2000 calories for every client. Diabetes screening is not a prerequisite for clients who lack signs or symptoms.

Question 18

18. 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?
    A. The client’s spouse is also trying to lose weight at the same time.
    B. The client has a history of gastroesophageal reflux disease.
    C. The client takes levothyroxine for the treatment of hypothyroidism.
    D. The client takes a tricyclic antidepressant and has done so for several years.

Answer 18

ANS: D
Rationale: Tricyclic antidepressants are associated with weight gain and may impair weight-loss efforts. Thyroid supplements do not cause weight gain and the spouse’s
concurrent efforts to lose weight would be likely to enhance the client’s efforts. GERD is not likely to be a cause of obesity.

Question 19

19. 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?
    A. The client will need to increase fluid intake during therapy.
    B. It is important to maintain a nutrient-rich diet and take multivitamins.
    C. The client will need to have blood levels of the medication drawn after 2 weeks.
    D. It is necessary to increase potassium intake and reduce sodium intake.

Answer 19

ANS: B
Rationale: Because of the possibility of malabsorption, the client is usually encouraged to take a multivitamin. A nutrient-rich diet is important during weight loss. Blood levels are not necessary and increased fluid intake is not required. Similarly, intake of sodium and potassium does not need to be changed.

Question 20

20. A client with long-standing obesity has been prescribed phentermine/topiramate-ER.
    What statement by the client suggests that further health education is necessary?
    A. “I’m so relieved to start this medication. I really don’t like having to exercise or
    change what I eat.”
    B. “It’s hard to believe that there are actually medications that can treat obesity.”
    C. “I’m a bit nervous to start this medication because I know I’ll need blood tests
    sometimes.”
    D. “I’m going to have to do some rearranging of my finances to make sure I can
    afford this medication.”

Answer 20

ANS: A
Rationale: Antiobesity medications are used to complement, not replace, lifestyle changes. Blood tests will be necessary to monitor electrolytes and kidney function. As with all medications, financial considerations are an important reality for many clients.

Question 21

21. 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?
    A. “Spinach is very healthy, but eating it too often can be hard on your kidneys.”
    B. “That’s a healthy practice, but you might find that your blood clots more slowly
    than usual.”
    C. “Be careful that you don’t eat too many other foods that contain a lot of iron.”
    D. “That’s great. Spinach has a lot of vitamins and nutrients and very few calories.”

Answer 21

ANS: D
Rationale: There is no contraindication between taking phentermine/topiramate-ER and spinach or other green leafy vegetables. Consequently, there is no need to caution the client about iron, vitamin K, or renal function unless there is some other corresponding health disorder.

Question 22

22. 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

Answer 22

ANS: A, B, E
Rationale: Naltrexone/bupropion is contraindicated in cases of uncontrolled hypertension. Alcohol intake is contraindicated. It is also contraindicated in clients who
express suicidal ideation, so the nurse should monitor the client’s mood and affect. Naltrexone/bupropion does not normally affect cognition or skin integrity.

Question 23

23. 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:
    A. that the medication should be taken 30 minutes before each meal.
    B. about the need to avoid grapefruit and grapefruit juice.
    C. the signs and symptoms of acute kidney injury.
    D. how to self-administer subcutaneous injections.

Answer 23

ANS: D
Rationale: Liraglutide is given by daily injection, which the client will have to learn to administer. This medication is not a given before meals and there is no need to avoid grapefruit. Liraglutide is not noted to be nephrotoxic.

Question 24

24. 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?
    A. “I’m sure that must be difficult for you. That’s actually a sign that your body is
    breaking down fat tissue.”
    B. “That sounds stressful for you. That’s definitely one of the adverse effects of this
    medication.”
    C. “Wearing an adult incontinence pad in the short term should resolve that
    problem for you.”
    D. “Have you made any changes in your diet that might be contributing to this
    problem?”

Answer 24

ANS: B
Rationale: Orlistat is known to cause fecal incontinence and/or oily stools, which can be distressing for the client. This may necessitate the use of incontinence pads, but these
certainly do no constitute a resolution of the problem. This adverse effect is related to changes in fat absorption, not metabolism of adipose tissue. It is likely unrelated to dietary changes.

Question 25

25. 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?
    A. The client reports a diminished appetite and fewer cravings.
    B. The client is having one to two bowel movements daily, with fat present in stool.
    C. The client is losing at least 6 pounds (2.7 kg) per week, on average.
    D. The client is able to adhere to a low-carbohydrate, high-protein diet.

Answer 25

ANS: A
Rationale: Naltrexone/bupropion inhibits central opioid receptors and inhibits reuptake of dopamine and norepinephrine selectively, resulting in diminished appetite and cravings. Weight loss of 6 pounds (2.7 kg) weekly is unsafe and unsustainable. The medication is not intended to affect bowel movements. A low-carbohydrate, high-protein diet is not indicated for every client, and this medication is not intended to be combined with this particular diet.

Question 26

26. 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?
    A. Lorcaserin
    B. Orlistat
    C. Liraglutide
    D. Phentermine

Answer 26

ANS: B
Rationale: Orlistat can cause oily stools because it inhibits fat absorption. The other listed medications affect appetite, rather than absorption, and do not cause this adverse effect.

Question 27

27. 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?
    A. “Commercial weight-loss programs have been shown to be ineffective.”
    B. “The majority of commercial programs don’t work, and a large proportion of
    them are actually dangerous.”
    C. “It would be unethical for me to recommend or warn against a commercial
    weight-loss program.”
    D. “We can help you make a plan that wouldn’t require you to join a commercial
    program.”

Answer 27

ANS: D
Rationale: Clients should know that it is not essential to join a commercial program in order to lose weight. However, this does not mean that they are ineffective or dangerous. There are no ethical prohibitions against having a discussion about this matter with the client.

Question 28

28. 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?
    A. Report the possibility of balloon rupture to the primary provider.
    B. Monitor the client closely for nausea and vomiting.
    C. Document the therapeutic effects of the intragastric balloon.
    D. Encourage the client to consider having the balloon removed in the next 4
    weeks.

Answer 28

ANS: A
Rationale: Balloon rupture can cause intestinal obstruction, which must be promptly addressed by the primary provider. Waiting to perform further monitoring and assessment would be inadequate and the nurse should not place the onus for follow-up on the client.

Question 29

29. 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?
    A. Weight gain as a natural, age-related change
    B. Loss of skeletal muscle with aging
    C. Changes in food cravings that are common in older adults
    D. Changes in metabolism that accompany the aging process

Answer 29

ANS: D
Rationale: Basal metabolism drops by 2% for each additional decade of adult life. Therefore, older adults are more likely to gain weight unless they either increase activity
levels or decrease their caloric intake. Weight gain is not considered a normal age-related change and older adults are not noted to have more cravings. Skeletal muscle decreases with age, but this phenomenon does not cause weight gain.

Question 30

30. The community health nurse is leading a health education workshop for older adults.
    When addressing nutrition, what guideline should the nurse provide to participants?
    A. Clients should aim to get at least 30% of their caloric intake from fiber.
    B. Clients should aim to consume at least five servings of fruits or vegetables each
    day.
    C. Protein should make up around one third of daily calories.
    D. Clients should eliminate fat from their diet, if possible.

Answer 30

ANS: B
Rationale: Older adults are recommended to eat five servings of fruits and vegetables daily. Fiber does not contain calories. Protein should make up 10% to 20% of caloric intake. Fat is an important dietary component and should be limited to 30% of calories.

Question 31

31. 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?
    A. Perform a focused respiratory assessment.
    B. Assess for impaired skin integrity.
    C. Teach the client deep breathing and coughing exercises.
    D. Obtain a prescription for nebulized bronchodilators.

Answer 31

ANS: A
Rationale: The increased neck and chest circumference of clients with obesity creates a risk for respiratory disorders. Consequently, the nurse should carefully assess the client’s
respiratory status. This assessment must precede interventions such as obtaining new prescriptions. The client likely has an increased risk for impaired skin integrity as well,
but this does not address the client’s respiratory status.

Question 32

32. 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?
    A. Keep physical activity to a minimum.
    B. Keep the head of the client’s bed at a 90-degree angle.
    C. Ambulate the client at least every 2 hours.
    D. Keep the client in a low Fowler position when in bed.

Answer 32

ANS: D
Rationale: The client has signs of obesity hypoventilation syndrome, which can be mitigated by maintaining the client in the low Fowler position, maximizing diaphragmatic
chest expansion. Ambulation every 2 hours may be unrealistic and will not necessarily relieve this health problem. Eliminating or minimizing activity, however, may exacerbate it and create additional health risks associated with inactivity.

Question 33

33. 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?
    A. The client may require higher doses of opioids than clients without obesity.
    B. The client is more likely to experience relief with NSAIDs than with opioids.
    C. The client’s renal function must be monitored more closely during pain
    treatment than in clients without obesity.
    D. Adverse effects of opioids may be more difficult to assess than in clients without
    obesity.

Answer 33

ANS: A
Rationale: Clients with obesity who require opioid agents to treat pain many times require higher dosages of opioid agents to achieve pain relief, but are more likely to have
serious adverse effects of sedation and respiratory depression. These adverse effects are not more subtle and there is no reason to prioritize NSAIDs over opioids. Risks of acute kidney injury are not heightened with obesity.

Question 34

34. 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:
    A. cleaning and drying regularly within the client’s skin folds.
    B. avoiding the use of pillows to position the client.
    C. making a referral to physical therapy.
    D. ensuring the client receives a high-calorie, high-protein diet.

Answer 34

ANS: A
Rationale: The presence of more folds in the skin is associated with more skin moisture and increased skin friction, which are pressure ulcer risks. Consultation with a
wound-ostomy-continence (WOC) nurse, not a physical therapist, may be advisable. There is no obvious need to avoid using pillows.

Question 35

35. 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?
    A. “In most cases, clients have to be older than 25 in order to be candidates for
    bariatric surgery.”
    B. “Depending on the results of your assessments, you can likely have surgery very
    soon.”
    C. “Bariatric surgery does help many clients lose weight, but it’s normally reserved
    for clients with more severe obesity than yours.”
    D. “Bariatric surgery is often very effective, but it usually happens after a lengthy
    process of consultations and referrals.”

Answer 35

ANS: D
Rationale: The preliminary process may necessitate months of counseling, education, and evaluation by a multidisciplinary team, including social workers, dietitians, a nurse counselor, a psychologist or psychiatrist, and a bariatric surgeon. Clients do not need to be 25 years old and many clients with class II obesity have bariatric surgery successfully.

Question 36

36. 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?
    A. The client has poorly controlled type 2 diabetes
    B. The client drinks six to eight cans of beer daily
    C. The client smokes half a pack of cigarettes daily
    D. The client has a strong family history of obesity

Answer 36

ANS: B
Rationale: Consumption of six to eight drinks daily would constitute alcohol abuse, especially in a female client; alcohol abuse is an exclusion for bariatric surgery. The client
would be strongly encouraged to stop smoking and gain glycemic control prior to surgery, but these factors are not absolute exclusions. The client’s family history of obesity does not rule out bariatric surgery.

Question 37

37. 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:
    A. explain that the surgery will not affect the absorption of nutrients.
    B. validate what the client understands about the surgical procedure.
    C. teach the client that RYGB does not restrict food intake.
    D. encourage the client to discuss the procedure with the surgeon.

Answer 37

ANS: B
Rationale: RYGB involves restrictive and malabsorptive components; the client’s understanding is accurate. There is no obvious need for the client to bring the discussion to the surgeon.

Question 38

38. 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?
    A. Encouraging the client to lose at least 2% of body weight by lifestyle means prior
    to surgery
    B. Encouraging the client to lose at least 4% of body weight by lifestyle means prior
    to surgery
    C. Determining whether the client is an appropriate candidate for surgery
    D. Screening the client for exclusions to bariatric surgery such as frequent cycles of
    weight loss and weight gain

Answer 38

ANS: C
Rationale: The preliminary process preceding bariatric surgery is essential to ensuring good outcomes. The client is carefully screened for exclusions, but frequent weight-loss
and weight-gain cycles are not an exclusion. The client is encouraged to adopt lifestyle changes in anticipation of surgery, but there is no absolute requirement for weight loss
prior to surgery.

Question 39

39. 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?
    A. Monitor the client’s body mass index (BMI) weekly.
    B. Monitor the client’s hemoglobin and hematocrit results.
    C. Measure the client’s abdominal girth and review electrolyte levels.
    D. Assess the client’s skin integrity and nutritional status.

Answer 39

ANS: C
Rationale: Monthly vitamin B12 intramuscular injections are given to prevent pernicious anemia. Consequently, the nurse would review the client’s red cell indices. This vitamin is
not given to promote weight loss, maintain electrolyte levels, or enhance nutritional status.

Question 39

40. 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?
    A. Slow the client’s oral intake in consultation with the dietitian to prevent further
    dumping syndrome.
    B. Communicate the findings to the health care provider because the client may
    have an anastomotic leak.
    C. Insert a nasogastric tube as prescribed to facilitate STAT gastric decompression.
    D. Report the signs and symptoms of a possible surgical site infection to the health
    care provider.

Answer 39

ANS: B
Rationale: Clients with anastomotic leaks typically exhibit nonspecific signs and symptoms that include fever, abdominal pain, tachycardia, and leukocytosis. These
symptoms are not consistent with dumping syndrome, which does not cause a fever, and insertion of an NG tube does not resolve an anastomotic leak. A surgical site infection would be less likely on postoperative day 2 because these usually take longer to develop.