Chapter 71: Weight Management

Chapter 71: Weight Management

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A woman comes to the clinic to talk about weight reduction. The primary care nurse practitioner (NP) calculates a body mass index (BMI) of 28. The woman’s waist measures 34 inches. The woman tells the NP that she would like to lose 20 lb for her daughter’s wedding in 6 months. The NP should:

ANS:  C

This woman’s BMI is in the moderate range for overweight, and her waist circumference is 34, which is not diagnostic for metabolic syndrome. Because her apparent motivation for losing weight is based on an upcoming event, the NP first should determine what her short-term and long-term weight loss goals are before initiating therapy. Orlistat is used long-term and would not be appropriate in this case. Phentermine should be used short-term and, because of serious risks, should be used only as adjunct therapy to lifestyle modifications. The initial intervention for weight loss is physical activity and diet modification.

DIF:    Cognitive Level: Applying (Application)                           REF:   774

2. A man with a BMI of 38 and a waist size of 48 inches is seen in the clinic for an annual well check-up. The primary care NP orders laboratory tests and notes a fasting plasma glucose of 110 mg/dL, triglyceride level of 220 mg/dL, and high-density lipoprotein level of 40 mg/dL. The man’s blood pressure is 160/110 mm Hg. The man has a history of cardiovascular disease and tells the NP he has tried to lose weight numerous times. The NP should consider:

ANS:  A

This man’s BMI and waist circumference indicate that he is obese, and he has more than three indicators of metabolic syndrome. Because of his history of cardiovascular disease, his past failed attempts to lose weight, and his elevated blood pressure, treatment is indicated. Phentermine would be a good initial choice but carries significant risks in patients with cardiovascular disease and high blood pressure. Orlistat is a safer choice for pharmacologic therapy. An oral antidiabetic agent would be used if insulin resistance were present, but his fasting plasma glucose is normal. A strict change in diet is warranted but in this case should be combined with pharmacologic treatment.

DIF:    Cognitive Level: Applying (Application)                           REF:   774

3. A patient who weighs 170 lb wishes to lose weight, with a target weight goal of 125 lb. To initiate a program that will result in a loss of 1 lb per week, the primary care NP should recommend a dietary intake of _____ kcal.

ANS:  B

To lose weight, a patient must decrease intake to below the level needed to maintain weight. The patient must decrease daily calorie consumption by 500 kcal for each pound he or she wishes to lose weekly. Because it takes approximately 10 kcal per pound to maintain weight, the NP can assume that the patient currently takes in 1700 kcal/day and should recommend a diet of 1200 kcal/day for weight loss.

DIF:    Cognitive Level: Applying (Application)                           REF:   755