BSNC 2000 UPDATED COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS SURE A+
✔✔Causes of obesity - ✔✔- Excess body fat accumulates when there is a chronic
mismatch between energy intake and energy expenditure
✔✔Contributing factors of obesity - ✔✔- Genetics
- Diet
- Physical activity
- Socioeconomic factors
- Psychological factors
- Medications and drugs
- Medical conditions
- Sociocultural factors
✔✔Pathophysiological effects of obesity - ✔✔- Excess fat is stored in adipose tissue,
muscle and liver
- Hypertropy and hyperplasia of apidocytes occur to store excess
- Visceral adipose tissue releases adipokines, hormones and fatty acids that have
negative effects
✔✔Effects of obesity on body - ✔✔- Increased BP
- Dyslipidemia
,- Insulin resistance
- Mechanical stress
✔✔Questions to ask to assess nutritional status of patient - ✔✔- What does your typical
daily intake look like?
- How many meals do you at per day?
- What do your meals and snacks consist of?
- Has your daily intake changed recently?
What fluid do you drink every day? (Coffee, water, tea, pop, juice, milk)
- Weight decrease or increase recently
✔✔BMI - ✔✔- Ratio based on body weight and height
- High correlated with body fat
- Increased lean body mass, large muscles, edema, or large body frame can increase
BMI
✔✔Considering weight gain due to slow metabolsim - ✔✔- Age
- Hormones
- Genetics
- Low muscle mass
- Weight loss
- Medication
ROOT CAUSE OF LOW METABOLISM
✔✔Considering weight gain due to increase food intake - ✔✔- Socio-cultural factors
- Physical hunger
- Emotional eating
- Mental health issues
- Medication
ROOT CAUES OF OVEREATING
✔✔Considering weight gain due to reduced activity - ✔✔- Socio-cultural factors
- Socio-economical limitations
- Physical limitations/pain
- Emotional factors
- Medications
ROOT CAUSE OF REDUCED ACTIVITY
✔✔Central obesity- Android obesity - ✔✔- Excess body fat in the trunk and abdominal
area
- "Apple" shape
- Determined by measuring waist circumference
- Indicates increased risk of heart disease, HTN, T2DM, stroke
✔✔How to identify optimal nutrition status? - ✔✔- History
, - Dietary data
- Health BMI or waist circumference
- Physical signs of nutritional status (orientated, skin is smooth and elastic)
- Lab tests (RBC, blood glucose, lytes)
✔✔Health risks to assess - ✔✔- Age: decreasing muscle mass, decline in metabolic
- Socio-economic status: food insecurity, access to healthful foods
- Blood pressure: obesity is a major risk factor for HTN and cardiovascular disease
- Blood work: lipids, blood sugar, albumin, Hgb A1C, lytes, Hgb
- Screen for obesity related comorbidities
✔✔Treatment for patients who are obese- class 1 - ✔✔- Lifestyle management
- Co-morbidities that are expected to improve with weight loss (type 2, HTN, CVD,
osteoarthritis, dyslipidemia, sleep apnea)
- Advise patients on strategies for achieving and maintaining healthy weight through diet
and exercise
- Establish initial weight loss goal of 5-10% of original weight
- Diets that are restrictive may be harmful causing micronutrient deficiency
✔✔Considerations related to the care of a patient with obesity in the acute care setting -
✔✔- Increase risk of pressure sores and skin breakdown
- Risk for impaired perfusion and gas exchange
- Difficulty with intuiting patients if indicated
- Medication dosing considerations
✔✔Peripheral obesity - ✔✔- AKA gynoid
- Tendency to store fat in hips or thighs
- Varicose veins and mechanical issues
- Impact
✔✔Central obesity - ✔✔- Impact abdomen organs more
- AKA android, abdomen, visceral
- Tendency to store fat in trunk or abdominal area
- Risk of HTN, heart disease, T2DM, stroke
✔✔Treatment for Patients- Obese class 1 - ✔✔- Advise patients on strategies for
achieving and maintaining health weight through diet and exercise
- Patients should lose no more than 1.2/week
- Diets that are restrictive may be harmful by causing micronutrient deficiency
✔✔5 A's of treatment for obesity - ✔✔1. Ask permission to discuss weight
2. Assess staging and potential root causes
3. Provide advice on risks, discuss benefits and options
4. Agree on realistic goals
QUESTIONS AND ANSWERS SURE A+
✔✔Causes of obesity - ✔✔- Excess body fat accumulates when there is a chronic
mismatch between energy intake and energy expenditure
✔✔Contributing factors of obesity - ✔✔- Genetics
- Diet
- Physical activity
- Socioeconomic factors
- Psychological factors
- Medications and drugs
- Medical conditions
- Sociocultural factors
✔✔Pathophysiological effects of obesity - ✔✔- Excess fat is stored in adipose tissue,
muscle and liver
- Hypertropy and hyperplasia of apidocytes occur to store excess
- Visceral adipose tissue releases adipokines, hormones and fatty acids that have
negative effects
✔✔Effects of obesity on body - ✔✔- Increased BP
- Dyslipidemia
,- Insulin resistance
- Mechanical stress
✔✔Questions to ask to assess nutritional status of patient - ✔✔- What does your typical
daily intake look like?
- How many meals do you at per day?
- What do your meals and snacks consist of?
- Has your daily intake changed recently?
What fluid do you drink every day? (Coffee, water, tea, pop, juice, milk)
- Weight decrease or increase recently
✔✔BMI - ✔✔- Ratio based on body weight and height
- High correlated with body fat
- Increased lean body mass, large muscles, edema, or large body frame can increase
BMI
✔✔Considering weight gain due to slow metabolsim - ✔✔- Age
- Hormones
- Genetics
- Low muscle mass
- Weight loss
- Medication
ROOT CAUSE OF LOW METABOLISM
✔✔Considering weight gain due to increase food intake - ✔✔- Socio-cultural factors
- Physical hunger
- Emotional eating
- Mental health issues
- Medication
ROOT CAUES OF OVEREATING
✔✔Considering weight gain due to reduced activity - ✔✔- Socio-cultural factors
- Socio-economical limitations
- Physical limitations/pain
- Emotional factors
- Medications
ROOT CAUSE OF REDUCED ACTIVITY
✔✔Central obesity- Android obesity - ✔✔- Excess body fat in the trunk and abdominal
area
- "Apple" shape
- Determined by measuring waist circumference
- Indicates increased risk of heart disease, HTN, T2DM, stroke
✔✔How to identify optimal nutrition status? - ✔✔- History
, - Dietary data
- Health BMI or waist circumference
- Physical signs of nutritional status (orientated, skin is smooth and elastic)
- Lab tests (RBC, blood glucose, lytes)
✔✔Health risks to assess - ✔✔- Age: decreasing muscle mass, decline in metabolic
- Socio-economic status: food insecurity, access to healthful foods
- Blood pressure: obesity is a major risk factor for HTN and cardiovascular disease
- Blood work: lipids, blood sugar, albumin, Hgb A1C, lytes, Hgb
- Screen for obesity related comorbidities
✔✔Treatment for patients who are obese- class 1 - ✔✔- Lifestyle management
- Co-morbidities that are expected to improve with weight loss (type 2, HTN, CVD,
osteoarthritis, dyslipidemia, sleep apnea)
- Advise patients on strategies for achieving and maintaining healthy weight through diet
and exercise
- Establish initial weight loss goal of 5-10% of original weight
- Diets that are restrictive may be harmful causing micronutrient deficiency
✔✔Considerations related to the care of a patient with obesity in the acute care setting -
✔✔- Increase risk of pressure sores and skin breakdown
- Risk for impaired perfusion and gas exchange
- Difficulty with intuiting patients if indicated
- Medication dosing considerations
✔✔Peripheral obesity - ✔✔- AKA gynoid
- Tendency to store fat in hips or thighs
- Varicose veins and mechanical issues
- Impact
✔✔Central obesity - ✔✔- Impact abdomen organs more
- AKA android, abdomen, visceral
- Tendency to store fat in trunk or abdominal area
- Risk of HTN, heart disease, T2DM, stroke
✔✔Treatment for Patients- Obese class 1 - ✔✔- Advise patients on strategies for
achieving and maintaining health weight through diet and exercise
- Patients should lose no more than 1.2/week
- Diets that are restrictive may be harmful by causing micronutrient deficiency
✔✔5 A's of treatment for obesity - ✔✔1. Ask permission to discuss weight
2. Assess staging and potential root causes
3. Provide advice on risks, discuss benefits and options
4. Agree on realistic goals
