You are taking an initial history for a client seeking surgical treatment for obesity. Which of the following should be called to the attention of the surgeon before proceeding with additional history or physical assessment?

Correct Answer: B

Rationale: In this scenario, option B, "History of counseling for body dysmorphic disorder," should be called to the attention of the surgeon before proceeding with additional history or physical assessment. This is the correct answer because body dysmorphic disorder can significantly impact a patient's perception of their body image and may lead to unrealistic expectations or dissatisfaction with surgical outcomes, especially in the context of obesity treatment. Option A, "Obesity for approximately 5 years," is not a red flag that would immediately necessitate attention from the surgeon. It is a common presentation in patients seeking surgical treatment for obesity. Option C, "Failure to reduce weight with other forms of therapy," is also not a critical concern at this initial stage as many individuals seek surgical intervention after exhausting other weight loss methods. Option D, "Body weight 100% above the ideal for age, gender, and height," while concerning, is not as crucial to address initially as the patient's history of body dysmorphic disorder. From an educational standpoint, it is important for nursing students to understand the significance of mental health considerations in surgical decision-making, especially in procedures related to body image and weight management. Recognizing the impact of psychological factors on patient outcomes is essential for providing holistic and patient-centered care in the field of gastrointestinal nursing.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Undergo a colonoscopy. The rationale behind this is that finding blood in the stool of a client who is asymptomatic of colonic cancer is a red flag that warrants further investigation through a colonoscopy. A colonoscopy is a crucial diagnostic procedure that allows for direct visualization of the colon and rectum, enabling the healthcare provider to identify any abnormalities such as polyps or tumors that may be causing the presence of blood in the stool. Option A) Add fiber to the diet is incorrect because while increasing fiber intake can help with overall bowel health and regularity, it is not the appropriate next step when blood is present in the stool. Option C) Use warm soaks is unrelated to addressing the underlying cause of blood in the stool and is more commonly used for conditions like hemorrhoids. Option D) Use a stool softener is also not the most appropriate action in this situation. While stool softeners can help with constipation, they will not address the potential serious underlying cause of blood in the stool. From an educational standpoint, it is important for nurses to understand the significance of positive stool test results for blood in asymptomatic clients and the appropriate follow-up actions required in such cases. This question highlights the importance of critical thinking and prompt referral for further diagnostic evaluation when concerning findings are present, even in the absence of symptoms.

Correct Answer: D

Rationale: In a client who has undergone a colostomy procedure, the primary nutrition concern is maintaining adequate fluids and electrolyte balance. This is because after a colostomy, there can be increased risk of dehydration and electrolyte imbalances due to changes in the digestive system's ability to absorb water and electrolytes. Option A, fiber, may be important for overall gastrointestinal health, but it is not the primary concern immediately following a colostomy procedure. Excessive fiber intake can actually worsen symptoms in some cases. Option B, small frequent meals, can be beneficial for some individuals with gastrointestinal issues, but in the case of a colostomy, fluid and electrolyte balance are more critical concerns. Option C, chewing food thoroughly, is important for good digestion but is not the primary concern following a colostomy procedure. Educationally, it is important for nurses to understand the specific nutritional needs of clients post-colostomy to provide appropriate care and prevent complications. Teaching patients about the importance of maintaining hydration and electrolyte balance can help them manage their condition effectively.

Correct Answer: B

Rationale: The correct answer is B) Hyperkalemia. In severe protein depletion, failure of the sodium-potassium pump can lead to the accumulation of potassium inside the cell, resulting in hyperkalemia. The sodium-potassium pump is crucial for maintaining the balance of these electrolytes in the body. Option A) Ascites is the abnormal accumulation of fluid in the abdominal cavity and is typically associated with liver disease or heart failure, not directly related to the sodium-potassium pump failure in severe protein depletion. Option C) Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin, which can be caused by various factors such as nutritional deficiencies, chronic diseases, or blood loss. It is not directly linked to the failure of the sodium-potassium pump. Option D) Hypoalbuminemia refers to low levels of albumin in the blood, which can occur in conditions like liver disease, malnutrition, or kidney disease. While severe protein depletion can lead to hypoalbuminemia, it is not a direct result of sodium-potassium pump failure. Educationally, understanding the role of the sodium-potassium pump in maintaining electrolyte balance is essential for nursing practice, especially in conditions like severe protein depletion where electrolyte imbalances can have serious consequences on the body's functioning. Hyperkalemia, in this case, can lead to cardiac arrhythmias and other critical complications, highlighting the importance of this knowledge for patient care.

Correct Answer: C

Rationale: In caring for a severely obese patient, the correct priority decision is option C: Emphasize to the patient how important it is to lose weight to maintain health. This choice focuses on health promotion and disease prevention, aligning with the primary goal of nursing care. By addressing weight-related health risks, the nurse empowers the patient to take control of their health. Option A is incorrect because it is vague and does not provide a specific action to address the patient's health needs. Option B is incorrect as it avoids discussing an essential health issue, which could be detrimental to the patient's well-being. Option D, while important, is not the priority as planning for equipment modifications should come after addressing the patient's immediate health concerns. Educationally, it is crucial for nurses to approach sensitive topics like obesity with empathy, respect, and evidence-based information. By fostering open communication and providing support, nurses can help patients make informed decisions about their health. Understanding the impact of obesity on overall health and having effective communication skills are essential in delivering patient-centered care.