Chapter 31: Assessing Individuals Who Are Obese

1. The nurse is having difficulty palpating a vein when preparing to insert an intravenous catheter into a client’s arm who has a body mass index of 38 kg/m2 . Which actions would the nurse take to increase the likelihood of successful intravenous catheter insertion? Select all that apply.

A. Ask client to keep arm flexed while assessing for vein location.

B. Apply a warm compress to the client’s arm for 10-20 minutes.

C. Apply a blood pressure cuff to use as in place of a tourniquet.

D. Use bright lighting to better visualize the client’s skin and veins.

E. Rub and slap surface of the client’s skin to encourage venous dilation.

Answer: B, C, D

Rationale: Due to additional adipose tissue venipuncture and intravenous catheter placement can be more challenging in the client with obesity. Strategies to make veins easier to palpate and visualize include extending the arm to stretch the skin and thin the adipose layer rather than flexing the arm which would make locating a vein more difficult. Warm compresses can encourage vasodilation and make veins easier to palate. Using a blood pressure cuff in place of a tourniquet allows the nurse to better adjust the occlusion pressure which can prevent veins from collapsing. The nurse should also take the time to establish good lighting to increase the chances of successfully locating a vein. Slapping or rubbing the client’s skin is not a recommended approach and does not promote dilation of the vessel.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Reduction of Risk Potential

Integrated Process: Nursing Process

Reference: p. 44, Common Laboratory and Diagnostic Testing

2. The nurse assesses a client’s body mass index (BMI) as 34 kg/m2 . To accurately determine the need for medical intervention, the nurse would collect which additional assessments in addition to the BMI? Select all that apply.

A. Blood pressure

B. History of weight gain

C. Gender

D. Fasting glucose levels

E. Level of dyspnea

F. Psychopathology

Answer: A, D, E, F

Rationale: While measuring BMI can help categorize obesity, additional assessments are needed to guide interventions. Such additional assessments are included in the Edmonton Obesity Staging System (EOSS). This 5-stage scale considers obesity-related comorbidities (such as hypertension, dyslipidemia, glucose intolerance/type 2 diabetes), physical symptoms (such as dyspnea and joint pain) and psychological well-being. By staging the degree of negative health effects in addition to the client’s BMI, a more individualized and appropriate plan of care can be created. The client’s history of weight gain will not be an important factor in the current plan of care. Unlike the related assessments listed, gender does not directly inform the interventions for obesity-related health issues.

Question format: Multiple Select

Chapter: 31

Cognitive Level: Apply

Client Needs: Reduction of Risk Potential

Integrated Process: Nursing Process

Reference: p. 4, Edmonton Obesity Staging System (EOSS)

3. The nurse is assessing a group of obese clients. Which client will the nurse identify as presenting with the most significant risk factor for heart disease?

A. 50-year-old woman with a body mass index of 34 kg/m2

B. 65-year-old man with a waist circumference of 135 cm

C. 65-year-old man with a body mass index of 30 kg/m2

D. 55-year-old woman with a waist circumference of 85 cm

Answer: B

Rationale: When considering risk for heart disease among middle-and-older-aged clients, the nurse uses waist circumference to help stratify risk as this represents increased visceral fat. The 65-year-old male client with a waist circumference of 135 cm meets the criteria for increased risk for heart disease, stroke, and diabetes. A man of the same age and a BMI of 30kg/m2 is in the borderline of obesity. Without this client’s abdominal circumference, we cannot know if his risk for heart disease is as high as the client with the elevated waist circumference. The woman with a body mass index of 34 kg/m2 has class 1 obesity but again, without the waist circumference, this value alone tells us less about cardiovascular risk. Often obese women can be pear-shared which carries a lower risk for cardiovascular disease compared to abdominal obesity. The woman with an 85 cm waist circumference is below the level determined to increase risk for cardiovascular disease which is 88 cm.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Management of Care

Integrated Process: Nursing Process

Reference: p. 15, Torso

4. The nurse is creating a peer support health program about obesity for a group of school age children. Which approaches would the nurse include? Select all that apply.

A. Teaching about marketing strategies used by food companies

B. Inquiring about the participants’ interests and hobbies

C. Exploring the participants’ self-image and self-esteem

D. Asking participants to comment on each other’s appearance

E. Performing a group assessment of weight and body fat content

Answer: A, B, C

Rationale: When creating a peer-based health promotion program in school aged children, the nurse is sensitive to the participants’ specific needs. School-aged and adolescent children have been shown to be particularly targeted by food marketing. Helping the participants become more aware of marketing strategies helps them become more informed consumers. Exploring the participants’ personal interests and self-concept helps the nurse tailor activities for the group and allows participants to discover common interests and common feelings, encouraging them to offer support to one another. The nurse discourages participants from commenting on each other’s appearance to move the focus away from physical appearance and prevent embarrassing exchanges. Similarly, the nurse would not assess the participants’ weight or body fat content to protect privacy and to reduce the risk of participants focusing on comparing their physical appearance to others’.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning

Reference: p. 50, Children and Adolescents

5. The home health nurse notes a client with a body mass index of 40 kg/m2 is having increasing difficulty managing meal preparation due to mobility issues. Which action would the nurse take to best address the client’s functional limitations?

A. Arrange for a meal preparation service

B. Help the client plan easy-to-prepare meals

C. Arrange for assessment by an occupational therapist

D. Provide the client with mobility aids such as a walker.

Answer: C

Rationale: The best action by the nurse is to arrange for assessment by an occupational therapist (OT). The OT assessment can best inform the other interventions which may include mobility aids or alternate meal preparation approaches. Without the OT proper assessment, however, the nurse cannot be sure the client is getting the best options to suit their functional level.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Analyze

Client Needs: Management of Care

Integrated Process: Nursing Process

Reference: p. 7, Day-to-Day Struggles

6. A client with class 2 obesity is newly admitted for a urinary tract infection (UTI) that progressed to urosepsis. The client is currently receiving fluid resuscitation. The client admits to not seeking attention for the UTI despite having progressive symptoms for over a week. What should the nurse assess as a current priority based on this information?

A. The client’s past experiences and relationships within healthcare systems

B. The client’s knowledge about the relationship between obesity and UTIs

C. The client’s ability to perform hygiene care of the perineal and genital areas

D. The client’s readiness for incorporating lifestyle changes to improve health

Answer: A

Rationale: The fact that the client was aware of symptoms but did not seek attention should be addressed by the nurse. Failure to seek attention could be related to poor relationships or negative past experiences within healthcare systems. Stigma and shame have been shown to prevent clients with obesity from seeking medical attention. Because the nurse needs to establish a positive rapport with the client, this information is relevant in this moment. While acutely ill, the nurse should defer discussions about long-term lifestyle changes. These conversations are best saved for when the client is stable and at baseline functioning. Similarly, while acutely ill, the nurse and other staff can assist the client with hygiene. The nurse may assess selfcare abilities once the client is stable. The client’s knowledge about the links between UTIs and obesity are not relevant in this moment because the client cannot alter the fact that they are obese or that they currently have a UTI. Focusing on this now could add to feelings of shame.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Psychosocial Integrity

Integrated Process: Caring

Reference: p. 10, Weight Bias

7. The nurse assesses the vital signs of a client with class II obesity. The nurse applies knowledge regarding which physiological effects of obesity when assigning significance to the assessment findings? Select all that apply.

A. The strength of the client’s pedal pulses may appear diminished upon palpation.

B. The client’s baseline body temperature may be slightly higher than non-obese clients.

C. Diminished breath sounds may be present but may not represent a respiratory issue.

D. The client will have a decreased baseline respiratory rate compared to non-obese clients.

E. Pulse oximetry may be artificially elevated as blood vessels are closer to the skin’s surface.

Answer: A, B, C

Rationale: Due to adipose tissue, peripheral pulses may be difficult to palpate, and sometimes Doppler ultrasound may be required. The nurse does not record the pulses as weak or absent but rather difficult to palpate. Clients with obesity often have a higher mean body temperature between 0.3 to 0.5°F (0.15 to 0.25°C) higher. Excess adipose tissue may also make pulse oximetry more difficult to obtain and it would not be artificially elevated but may not register or be artificially low.

Baseline respiratory rate is often elevated due to increased work of breathing and increased energy expenditure. Breath sounds may be diminished due to the increased tissue through which auscultation must be done but this would not indicate a respiratory issue.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Physiological Adaptation

Integrated Process: Nursing Process

Reference: p. 12, Vital Signs

8. The nurse is assessing the skin of an obese client. For which risk factors will the nurse assess as increasing the risk for skin breakdown in this client? Select all that apply.

A. Increased areas of exposure to air

B. Dryness in the folds of the skin

C. Areas of skin-on-skin friction

D. Presence of a large pannus

E. Presence of peripheral edema

Answer: C, D, E

Rationale: Increased risk for skin breakdown in the obese client is often related to decreased vascularity of adipose tissue and chronic skin-on-skin friction due to skin folds. Decreased exposure to air, not increased also contributes. Skin folds trap moisture which can lead to breakdown. Dryness in skin folds would decrease the risk for breakdown. Having a large abdominal pannus is a source of a skin-on-skin friction and may also make it difficult for the client to keep genitalia clean and dry. Clients with obesity are more prone to venous insufficiency and peripheral edema which can lead to venous stasis ulcers, cellulitis, and other skin complications.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Basic Care and Comfort

Integrated Process: Nursing Process

Reference: p. 13, Skin

9. A 35-year-old client who is overweight is attending melanoma screening clinic. The nurse notes no lesions suspicious for melanoma but does note the client has numerous skin tags. Which question would the nurse ask the client related to the presence of skin tags?

A. “Do you wear sun screen when outdoors?”

B. “Have you had your blood glucose levels checked?”

C. “Do you have a history of eczema or allergies?”

D. “How long have you had these skin tags?”

Answer: B

Rationale: Because the presence of skin tags has been associated with metabolic syndrome and type 2 diabetes, the nurse should enquire about the client’s blood glucose levels. Being under the usual screening age of 40 for type 2 diabetes, this client may not have had levels checked and being overweight increases the client’s risk. Skin tags are benign and not related to sun exposure, eczema, or allergies. The length of time the client has had skin tags is not important and will not alter the focus which should be on early identification and treatment of metabolic syndrome or type 2 diabetes.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Health Promotion and Maintenance

Integrated Process: Nursing Process

Reference: p. 13, Skin

10. A young adult client with class II obesity and venous insufficiency is admitted for treatment of cellulitis of the left lower leg. Today the client has a sudden onset of dyspnea with tachypnea, and decreased oxygen saturation, but no adventitious breath sounds. Which assessment will the nurse perform as the priority?

A. Daily weight and fluid balance

B. Appearance of lower legs

C. Neurological assessment

D. Evidence of gastrointestinal bleeding

Answer: B

The hospitalized obese client with venous insufficiency is at increased risk for deep vein thrombosis (DVT) and pulmonary embolism (PE). The dyspnea and drop in oxygen saturation should make the nurse focus on a respiratory complication such as PE. Also, PE often does not present with obvious changes in breath sounds. This makes assessing the lower legs most relevant as it can help identify potential DVT.

Daily weight and fluid balance would be relevant if the nurse suspected pulmonary edema as the cause but given the lack of adventitia and the client’s age, this is far less likely. There is no indication in the scenario that this young client has any alteration in mentation, so a neurological focus is not warranted. If the client were to experience acute blood loss due to gastrointestinal bleeding, there would not be a drop in oxygen saturation so this focus is not warranted by the findings.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Reduction of Risk Potential

Integrated Process: Nursing Process

Reference: p. 14, Torso

11. A client with class III obesity and obstructive sleep apnea (OSA) reports not using the prescribed continuous positive airway pressure (CPAP) machine as the mask is uncomfortable. What information would the nurse provide as a priority?

A. “It is common for clients to report difficulty with the mask, but you will adjust to it over time.”

B. “Your healthcare provider prescribed this important treatment based on your sleep study results.”

C. “Treating OSA effectively can prevent serious complications such as cardiovascular diseases.”

D. “Losing weight could resolve your OSA so you would not need to use the CPAP machine.”

Answer: C

Rationale: The nurse’s priority is teaching the client about the consequences of not using the CPAP as prescribed. By teaching the client about the potential for serious complications related to cardiovascular complications from OSA, the client is better able to make an informed treatment choice. Simply telling the client the treatment was prescribed based on test results does not inform the client about the risks of not adhering to the treatment. Stating the client will adjust is also not informative as to the risks. While weight loss can assist in the treatment of OSA, this is a longterm goal and does not replace the need for CPAP as currently prescribed.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Reduction of Risk Potential

Integrated Process: Teaching/Learning

Reference: p. 14, Torso

12. A young adult female client with a body mass index of 35 kg/m2 reports dysmenorrhea and a recent increase in facial hair growth. Based on these reports, for which condition would the nurse assess the client?

A. Endometriosis

B. Metabolic syndrome

C. Pelvic inflammatory disease

D. Sexually transmitted infections

Answer: B

Rationale: Given the client’s age, weight, gender, and symptoms of dysmenorrhea and facial hair growth, the nurse should suspect polycystic ovary syndrome (PCOS). Polycystic ovary syndrome is a common endocrinopathy that occurs in 7-10% of overweight women of childbearing age. Due to high androgen levels effects such as hair growth and acne are seen. There is also ovulatory dysfunction which can cause infertility. Metabolic syndrome is highly correlated with PCOS and increases the client’s risk for type 2 diabetes and cardiovascular diseases. Therefore, the nurse would also assess the parameters of metabolic syndrome including abdominal circumference, lipid profile, blood pressure, and blood glucose level. Neither sexually transmitted diseases nor the related condition of pelvic inflammatory disease would lead to hair growth. Endometriosis is a condition where endometrial tissue exists outside the uterus and can cause dysmenorrhea but would not contribute to hair growth.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Physiological Adaptation

Integrated Process: Nursing Process

Reference: p. 17, Endocrine and Metabolic Functioning

13. A client with class III obesity is admitted for a biopsy procedure related to a suspected new diagnosis of esophageal cancer. What would the nurse focus on when teaching the client during this admission? Select all that apply.

A. Long-term lifestyle changes to assist with weight loss

B. Pre-and-post biopsy procedure routines and interventions

C. Signs and symptoms of complications from the biopsy procedure

D. The connections between obesity and esophageal cancer

E. How client should follow-up and obtain biopsy results

Answer: B, C, E

The client is undergoing an invasive procedure for a potentially fatal condition. In this situation, it is not appropriate for the nurse to focus on long-term lifestyle changes. Instead, the nurse focuses on teaching the client about the procedure itself including what to expect and how to identify complications. The nurse will also ensure the client knows how to obtain the results. Teaching the client about obesity as a risk factors for developing esophageal cancer is not helpful. If the client has this form of cancer, it cannot be prevented by losing weight now and focusing on the connection between obesity and cancer may bring the client guilt and shame. If the biopsy results are negative, it would be appropriate at that time to focus on health promotion and illness prevention. Currently, health promotion is not the priority.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Psychosocial Integrity

Integrated Process: Communication and Documentation

Reference: p. 21, Health Promotion

14. The nurse is assessing heart sounds on a client with a body mass index of 47 kg/m2 and notes the sounds are distant. Which actions would the nurse take to better assess the client’s heart sounds? Select all that apply.

A. Have the client lie on the right side

B. Have the client sit up and lean forward

C. Reduce any unnecessary noise from the area

D. Close eyes while auscultating sounds

E. Ask the client to bear down while auscultating

Answer: B, C, D

Rationale: Due to increased distance between the heart and the stethoscope, altering the client’s position to either left-side lying or leaning forward can move the heart closer and make auscultation easier. Right-side lying would shift the heart further from the body surface. Removing unnecessary ambient noise and closing one’s eyes can also make auscultation easier. There is no benefit to having the client bear down during auscultation.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Health Promotion and Maintenance

Integrated Process: Nursing Process

Reference: p. 38, Torso

15. A client with class II obesity, gastroesophageal reflux disease (GERD), and type 2 diabetes is admitted for intravenous antibiotic treatment of an infected diabetic foot ulcer. Which interventions will the nurse include in the plan of care? Select all that apply.

A. Assess client’s skin folds and oral cavity daily

B. Position client with head of bed elevated

C. Elevate affected foot on two pillows

D. Offer only low or no-calorie snacks

E. Request assessment by a Registered Dietician

Answer: A, B, E

Rationale: The client with obesity and who is on antibiotic therapy will be at an increased risk for yeast (Candida albicans) infection. Therefore, the nurse assesses skin folds, groin, and oral cavity as these are frequent sites of yeast infection. Because of the diagnosis of GERD, the head of the bed should be slightly elevated to reduce the risk for reflux and aspiration. The nurse should not independently decide that the client should only have low or no-calorie snacks. The need for wound healing, having an active infection, and the diagnosis of diabetes make the client’s nutritional needs complex. Instead of making this decision, the nurse would consult to a Registered Dietician for an assessment. Having a diabetic foot ulcer is evidence of poor arterial blood supply (peripheral artery disease). The nurse should not elevate the foot above the level of the heart as this will further decrease blood supply to the foot and impede healing.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Reduction of Risk Potential

Integrated Process: Nursing Process

Reference: p. 39, Torso

16. The nurse has just received report a group of clients on a bariatric surgical unit. Which client will the nurse assess first? The client who is

A. two days post gastric bypass who is due to ambulate with stand-by assist.

B. one day post gastric sleeve surgery who reports 3 on 10 abdominal pain.

C. on-call to the operating room and due for intravenous prophylactic antibiotics.

D. six hours post gastric bypass and due for routine vital sign reassessment.

Answer; C

Rationale: The nurse needs to ensure the client who is on-call to surgery has the prophylactic antibiotic started as prescribed and needs to ensure all other preoperative checks have been completed to avoid any delay in the procedure. Due to the time-sensitive nature of the pre-operative client’ situation, this is the nurse’s priority. The nurse needs to assess and treat the client who had gastric sleeve postoperative pain, and this would be the nurse’s second priority. There is no indication the client who is 6 hours post-operative has had any unstable vital signs. This routine assessment can be deferred until after the pre-operative client and the client with pain are addressed. Lastly, the nurse can delegate ambulation of the client who is two days post gastric bypass surgery.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Analyze

Client Needs: Management of Care

Integrated Process: Nursing Process

Reference: p. 39, Torso

17. The nurse is assessing a client who underwent roux-en-Y surgery 6 months ago. Which areas will the nurse assess for potential complications from the procedure? Select all that apply.

A. Skin, hair, and nails

B. Hemoglobin levels

C. Urine output and appearance

D. Abdominal discomforts

E. Bowel movements

Answer: A, B, C, D, E

Rationale: In roux-en-y, or gastric bypass surgery, the size of the client’s stomach is greatly reduced which creates early satiety and promotes weight loss. Some potential long-term complications after this procedure include nutritional deficiencies which can lead to anemia and integumentary changes making assessment of hemoglobin, skin, hair, and nails relevant. After this procedure, clients can be at an increased risk for kidney stone formation so urinary assessment is warranted. Adhesions can form postoperatively that can lead to abdominal discomfort and potential bowel obstruction. Changes in bowel movements ranging from constipation to diarrhea can occur in the bariatric client and can be evidence of the need for intervention so should be assessed.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Reduction of Risk Potential

Integrated Process: Nursing Process

Reference: p. 27, Surgical Health-Promoting Options

18. A client with a body mass index of 65 kg/m2 has been told the risks for performing gastric bypass surgery (roux-en-Y) are too great due to the client’s abdominal obesity. The client is discouraged at this news and asks the nurse what options there are now. What information would the nurse share with the client? Select all that apply.

A. “The bariatric surgeon may be able to set up a weight loss program to help you meet a safe weight for surgery.”

B. “Sometimes there are alternate surgeries that can be done for clients who are not candidates for roux-en-Y.”

C. “It is better for you to lose weight naturally if you can. The surgery carries risks that lifestyle changes do not.”

D. “Sometimes these procedures are available out of the country for a fee. If you have the resources, this may be an option.”

E. “It is best to be safe when it comes to a major surgery like this. It is a good thing that your doctor is being careful.”

Answer: A, B

Rationale: For clients with a BMI over 60 kg/m2, roux-en-Y may be deemed too risky. In these cases, stepwise surgical approaches can be used where a gastric sleeve procedure is performed and then converted to duodenal switch. The client could also lose weight in order to meet the safe threshold for the roux-en-Y procedure. While it may be true that “natural” weight loss carries less risks, if the client was being referred for bariatric surgery, this was deemed a necessary approach meaning less invasive approaches have not been successful. Oversimplifying the client’s treatment options is not helpful. The nurse would not encourage the client to seek care outside of the country at a fee-based clinic as this could put the client at risk for substandard care and serious complications. While it may be positive that the surgeon is following protocols to keep the client safe, this response does nothing to address the client’s options going forward.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Application

Client Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning

Reference: p. 26, Vertical Sleeve Gastrectomy

19. The nurse is assessing a client with a body mass index of 48 kg/m2 and notes the oxygen saturation taken on the index finger is 86% despite the client having no respiratory difficulty and clear breath sounds. Which action would the nurse take in response to these findings?

A. Obtain a reading using an oximeter sensor designed to be used on the client’s forehead.

B. Apply oxygen at 10 liters via facemask and notify the heath care provider of the change.

C. Document the oxygen saturation results and reassess respiratory status in 15 minutes.

D. Have the client perform deep breathing and coughing and recheck the saturation level.

Answer: A

Rationale: The nurse would recognize the result may be inaccurate given the client’s lack of symptoms or signs of respiratory difficulty. Excess adipose tissue has the potential to interfere with the accuracy of oxygen saturation readings so in order to obtain a more accurate reading the nurse would obtain a sensor that can be used on an area with less adipose tissue. The nurse should not delay this assessment as some serious respiratory issues may not present with overt symptoms and an accurate value needs to be determined. Because accuracy is in question, the nurse should not treat the client for hypoxemia until the client’s accurate saturation is known. Since the client’s chest sounds are clear, deep breathing and coughing is not indicated.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Health Promotion and Maintenance

Integrated Process: Nursing Process

Reference: p. 38, Pulse oximetry

20. The nurse is assessing a client with class II obesity who is suspected of having obstructive sleep apnea. The nurse places the measuring tape at which point on the client’s neck when measuring the client’s neck circumference?

A. Superior to the jugular notch

B. Superior to the cricoid cartilage

C. At the level of the mandibular angle

D. At the level of the hyoid bone

Answer: B

Rationale: In clients with obesity, greater neck circumference is associated with higher risk for obstructive sleep apnea. The landmark for accurate measurement of neck circumference is superior to the cricoid cartilage which is close to the middle of neck located between the jugular notch and hyoid bone. Measuring near the jugular notch is at the top of the sternum which is too low, and the hyoid bone is too high on the neck. The mandibular angle is at the jaw line and is not located on the client’s neck.

Question format: Multiple Choice

Chapter: 31

Cognitive Level: Apply

Client Needs: Health Promotion and Maintenance

Integrated Process: Nursing Process

Reference: p. 38, Head and Neck

21. The nurse performs a height and weight measurements on a 4-month pregnant client. The client is 5 feet 4 inches (163 cm) and 230 pounds (104.3 kg). The client remarks that she has gained 10 pounds in the past month but that she is “eating for two”. Which teaching points would the nurse provide in response? Select all that apply

A. “Your current body mass index places you in the obese category and this carries many health risks.”

B. If you change your eating now, it is possible for you to be at a normal body mass index by your delivery date.”

C. “Being overweight while pregnant increases your risk for blood clots, diabetes, and premature delivery.”

D. “It will be important to control the rate of weight gain during your pregnancy to reduce the risks to you and the baby.”

E. “It is important that you do not diet while pregnant. You can focus on losing weight once the baby is born.”

Answer: A, C, D

Rationale: The nurse notes that the client’s height and weight places her in the obese range of body mass index (about 39 kg/m2) and should inform the client of this fact. During pregnancy, obesity presents several risks to the mother and the fetus including thromboembolism, preeclampsia, gestational diabetes, increased need for cesarean deliveries, and premature delivery. The client’s weight gain is excessive for the time period and stage of pregnancy so the nurse would inform the client of these potential complications so she knows the consequences if this weight gain should continue. Weight gain can be controlled during pregnancy with a proper diet so the nurse would not tell the client not to alter her diet during the pregnancy. However, the nurse would not tell the client she could achieve a normal BMI by the time of delivery as this would require a weight loss of over 80 pounds (37 kg) which would be too aggressive during pregnancy.

Question format: Choice Multiple

Chapter: 31

Cognitive Level: Apply

Client Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning

Reference: p. 48, Women Who Are Pregnant