History of metabolic syndrome
A 26-year-old woman, with a history of metabolic syndrome, hypertension, and type 2 diabetes mellitus, is visiting the health care provider’s office to discuss weight loss options. She reports that she has been overweight since she was a teenager, and that she has tried many diets but has been unsuccessful. She is upset that she has gained 10 pounds since her last visit to her HCP. The nurse documents these findings as part of today’s assessment: Height: 5 ft 5 inches; weight 314.5 lbs (143 kg). Weight last visit was 304.2 lbs (138.3 kg). BMI: 52.3. Vital signs: Blood pressure 177/98 mm Hg, pulse 88 bpm, respirations 12 breaths/min, temperature 98.2°F (36.8°C). Waist circumference: 39.8 inches; Waist-to-hip ratio: 1.0; Reflexes 3 overall; no edema noted in the ankles. Fasting lab work reveals HDL 35 mg/dL; LDL 150 mg/dL mg/dL; total cholesterol 270 mg/dL; triglycerides 173 mg/d; blood glucose 185 mg/dL; BUN 15 mg/dL; creatinine 9 mg/dL; hemoglobin 11 g/dL; hematocrit 35%. She reports that her menstrual cycles are irregular, and she has not had a normal period for 6 months. She also reports that she tries to go on walks with her husband but can’t walk very far without getting short of breath.
1. NGN Item Type: Highlighting/Enhanced Hot Spot
Highlight the assessment findings that require follow-up by the nurse.
Rationale:
Cognitive Skill: Recognize Cues
2. NGN Item Type: Cloze
Choose the most likely options for the information missing from the statement, below, by selecting from the list of options provided.
The nurse recognizes that, based on the assessment data and patient’s history, the patient is currently at risk for complications, including __________, __________, __________, _________, and __________.
Options
Cardiovascular disease
Depression
Infertility
Liver cirrhosis
Lymphoma
Lumbar disk disease
Colorectal cancer
Rationale:
Cognitive Skill: Analyze Cues
Scenario: The patient discusses her options with her health care provider, her family and
her boyfriend, and ultimately decides to have bariatric surgery. Six months later, she undergoes Roux-en-Y gastric bypass surgical procedure. After the surgery, she is admitted to the bariatric surgery unit. She has a dressing over the abdominal wound, and has intravenous fluids infusing via a PICC line. She is awake and alert and asking for something to drink. She is awake and alert and asking for something to drink. Her pain level is 4/10 on a 10-point scale.
Image transcription text
Jejunum Duodenum
1. NGN Item Type: Extended Multiple Response
Based on the patient’s current treatment plan, the patient’s priority needs will be to prevent which of the following? Select all that apply.
_____ 1. Swallowing problems
_____ 2. Dehydration
_____ 3. Electrolyte imbalances
_____ 4. Dumping syndrome
_____ 5. Balloon deflation
_____ 6. Chronic anemia
_____ 7. Thrombus formation
_____ 8. Infection
Rationale:
Cognitive Skill: Prioritize Hypotheses
