NUR209 – Medical-Surgical Nursing II
Exam 3 Questions with Answers– Fortis College
1. A patient has a BMI of 32 kg/m². The nurse classifies this as:
A. Normal weight
B. Overweight
C. Obesity Class I
D. Obesity Class III (morbid obesity)
Answer: C
Rationale: A BMI of 30.0-34.9 kg/m² is classified as Obesity Class I. Overweight is 25-
29.9, Class II obesity is 35-39.9, and Class III (severe/morbid obesity) is ≥40 kg/m².
2. Which waist circumference measurement indicates increased cardiometabolic risk
in a male patient?
A. Less than 35 inches
B. Greater than 40 inches
C. Exactly 30 inches
D. Waist circumference is not a risk indicator
Answer: B
Rationale: A waist circumference greater than 40 inches (102 cm) in men (or >35 in/88
cm in women) indicates excess visceral adiposity and increased risk for metabolic
syndrome, type 2 diabetes, and cardiovascular disease.
3. A patient with obesity is prescribed orlistat. The nurse should teach the patient to
expect which side effect?
A. Constipation
B. Oily stools/fecal urgency and fat-soluble vitamin malabsorption
C. Hypertension
D. Weight gain
Answer: B
Rationale: Orlistat inhibits pancreatic lipase, reducing fat absorption; this causes GI side
effects such as oily spotting, fecal urgency, and flatulence, and can impair absorption of
fat-soluble vitamins (A, D, E, K), which should be supplemented separately.
,4. Which statement reflects appropriate preoperative teaching for a patient
undergoing bariatric (gastric bypass) surgery?
A. "You will be able to eat normal-sized meals immediately after surgery."
B. "You will need to progress through liquid, pureed, then soft diet stages, eating
small frequent meals and avoiding high-sugar foods."
C. "Vitamin supplementation is not necessary after surgery."
D. "You should drink fluids with meals to aid digestion."
Answer: B
Rationale: After bariatric surgery, patients progress slowly through diet stages (clear
liquids to pureed to soft to regular), eat small frequent meals, avoid concentrated sweets
to prevent dumping syndrome, and require lifelong vitamin/mineral supplementation.
5. A patient post-gastric bypass reports dizziness, diaphoresis, palpitations, and
abdominal cramping 20 minutes after eating a high-sugar meal. The nurse suspects:
A. Dumping syndrome
B. Wound dehiscence
C. Peritonitis
D. Normal postoperative recovery
Answer: A
Rationale: Dumping syndrome occurs when rapid emptying of hyperosmolar food into
the small intestine causes fluid shifts, producing symptoms like dizziness, diaphoresis,
tachycardia, and cramping; it is managed by avoiding concentrated sweets and eating
small, frequent meals.
6. Which nursing intervention is most appropriate to prevent skin breakdown in a
patient with severe obesity?
A. Avoid repositioning to reduce discomfort
B. Frequent repositioning, keeping skin folds clean and dry, and using appropriately
sized equipment
C. Apply powder to skin folds only once daily
D. Restrict mobility entirely
Answer: B
Rationale: Patients with obesity are at increased risk for skin breakdown in skin folds
due to moisture and friction; frequent repositioning, keeping intertriginous areas clean
and dry, and using bariatric-appropriate equipment reduce this risk.
,7. Which comorbidity is most commonly associated with obesity due to excess adipose
tissue around the neck and airway?
A. Obstructive sleep apnea
B. Hyperthyroidism
C. Addison's disease
D. Hypocalcemia
Answer: A
Rationale: Excess adipose tissue around the neck, tongue, and pharynx narrows the
upper airway, predisposing patients with obesity to obstructive sleep apnea,
characterized by repeated airway collapse during sleep.
8. A patient with a BMI of 45 kg/m² is scheduled for bariatric surgery. Which
preoperative assessment is a priority due to the high prevalence of comorbid
conditions in obesity?
A. Visual acuity testing only
B. Screening for obstructive sleep apnea, diabetes, and cardiovascular disease
C. Hearing assessment
D. Dental examination only
Answer: B
Rationale: Patients with severe obesity have a high prevalence of obstructive sleep
apnea, type 2 diabetes, hypertension, and cardiovascular disease, all of which increase
perioperative risk and require thorough preoperative screening and optimization.
9. Which lifestyle modification is recommended as first-line therapy for weight
management in a patient with obesity and no immediate surgical indication?
A. Very low-calorie diet without physician supervision
B. Combination of reduced-calorie diet, increased physical activity, and behavioral
therapy
C. Appetite suppressant medication alone, without lifestyle change
D. Bariatric surgery as the only option
Answer: B
Rationale: First-line obesity management combines a reduced-calorie diet, increased
physical activity (at least 150 minutes/week), and behavioral therapy to support
sustainable weight loss before considering pharmacologic or surgical options.
10. A patient after bariatric surgery is at risk for which nutritional deficiency due to
bypass of the duodenum?
, A. Vitamin C excess
B. Iron, vitamin B12, and calcium deficiency
C. Vitamin A toxicity
D. Sodium excess
Answer: B
Rationale: Bypassing the duodenum and proximal jejunum reduces absorption of iron,
vitamin B12 (also affected by reduced intrinsic factor), calcium, and vitamin D, requiring
lifelong monitoring and supplementation.
11. Which finding in a patient with obesity is most suggestive of metabolic
complications requiring further evaluation?
A. BMI of 24 kg/m²
B. Elevated fasting glucose, hypertension, and dyslipidemia in addition to central
obesity
C. Normal blood pressure and lipid panel
D. Regular exercise history
Answer: B
Rationale: The combination of central obesity, elevated fasting glucose, hypertension,
and dyslipidemia suggests the patient may meet criteria for metabolic syndrome,
warranting further evaluation and intervention.
12. Semaglutide (a GLP-1 receptor agonist) is prescribed for chronic weight
management. The nurse should teach the patient about which common side effect?
A. Hypertension
B. Nausea, vomiting, and delayed gastric emptying
C. Hair loss only
D. Hyperglycemia
Answer: B
Rationale: GLP-1 receptor agonists like semaglutide slow gastric emptying and act
centrally to reduce appetite; common side effects include nausea, vomiting, diarrhea,
and constipation, which often improve with gradual dose titration.
13. Which statement by a patient after bariatric surgery indicates a need for further
teaching regarding dietary progression?
A. "I will eat slowly and chew my food thoroughly."
B. "I will drink a large glass of water with each meal to help me feel full."
C. "I will avoid carbonated beverages."
Exam 3 Questions with Answers– Fortis College
1. A patient has a BMI of 32 kg/m². The nurse classifies this as:
A. Normal weight
B. Overweight
C. Obesity Class I
D. Obesity Class III (morbid obesity)
Answer: C
Rationale: A BMI of 30.0-34.9 kg/m² is classified as Obesity Class I. Overweight is 25-
29.9, Class II obesity is 35-39.9, and Class III (severe/morbid obesity) is ≥40 kg/m².
2. Which waist circumference measurement indicates increased cardiometabolic risk
in a male patient?
A. Less than 35 inches
B. Greater than 40 inches
C. Exactly 30 inches
D. Waist circumference is not a risk indicator
Answer: B
Rationale: A waist circumference greater than 40 inches (102 cm) in men (or >35 in/88
cm in women) indicates excess visceral adiposity and increased risk for metabolic
syndrome, type 2 diabetes, and cardiovascular disease.
3. A patient with obesity is prescribed orlistat. The nurse should teach the patient to
expect which side effect?
A. Constipation
B. Oily stools/fecal urgency and fat-soluble vitamin malabsorption
C. Hypertension
D. Weight gain
Answer: B
Rationale: Orlistat inhibits pancreatic lipase, reducing fat absorption; this causes GI side
effects such as oily spotting, fecal urgency, and flatulence, and can impair absorption of
fat-soluble vitamins (A, D, E, K), which should be supplemented separately.
,4. Which statement reflects appropriate preoperative teaching for a patient
undergoing bariatric (gastric bypass) surgery?
A. "You will be able to eat normal-sized meals immediately after surgery."
B. "You will need to progress through liquid, pureed, then soft diet stages, eating
small frequent meals and avoiding high-sugar foods."
C. "Vitamin supplementation is not necessary after surgery."
D. "You should drink fluids with meals to aid digestion."
Answer: B
Rationale: After bariatric surgery, patients progress slowly through diet stages (clear
liquids to pureed to soft to regular), eat small frequent meals, avoid concentrated sweets
to prevent dumping syndrome, and require lifelong vitamin/mineral supplementation.
5. A patient post-gastric bypass reports dizziness, diaphoresis, palpitations, and
abdominal cramping 20 minutes after eating a high-sugar meal. The nurse suspects:
A. Dumping syndrome
B. Wound dehiscence
C. Peritonitis
D. Normal postoperative recovery
Answer: A
Rationale: Dumping syndrome occurs when rapid emptying of hyperosmolar food into
the small intestine causes fluid shifts, producing symptoms like dizziness, diaphoresis,
tachycardia, and cramping; it is managed by avoiding concentrated sweets and eating
small, frequent meals.
6. Which nursing intervention is most appropriate to prevent skin breakdown in a
patient with severe obesity?
A. Avoid repositioning to reduce discomfort
B. Frequent repositioning, keeping skin folds clean and dry, and using appropriately
sized equipment
C. Apply powder to skin folds only once daily
D. Restrict mobility entirely
Answer: B
Rationale: Patients with obesity are at increased risk for skin breakdown in skin folds
due to moisture and friction; frequent repositioning, keeping intertriginous areas clean
and dry, and using bariatric-appropriate equipment reduce this risk.
,7. Which comorbidity is most commonly associated with obesity due to excess adipose
tissue around the neck and airway?
A. Obstructive sleep apnea
B. Hyperthyroidism
C. Addison's disease
D. Hypocalcemia
Answer: A
Rationale: Excess adipose tissue around the neck, tongue, and pharynx narrows the
upper airway, predisposing patients with obesity to obstructive sleep apnea,
characterized by repeated airway collapse during sleep.
8. A patient with a BMI of 45 kg/m² is scheduled for bariatric surgery. Which
preoperative assessment is a priority due to the high prevalence of comorbid
conditions in obesity?
A. Visual acuity testing only
B. Screening for obstructive sleep apnea, diabetes, and cardiovascular disease
C. Hearing assessment
D. Dental examination only
Answer: B
Rationale: Patients with severe obesity have a high prevalence of obstructive sleep
apnea, type 2 diabetes, hypertension, and cardiovascular disease, all of which increase
perioperative risk and require thorough preoperative screening and optimization.
9. Which lifestyle modification is recommended as first-line therapy for weight
management in a patient with obesity and no immediate surgical indication?
A. Very low-calorie diet without physician supervision
B. Combination of reduced-calorie diet, increased physical activity, and behavioral
therapy
C. Appetite suppressant medication alone, without lifestyle change
D. Bariatric surgery as the only option
Answer: B
Rationale: First-line obesity management combines a reduced-calorie diet, increased
physical activity (at least 150 minutes/week), and behavioral therapy to support
sustainable weight loss before considering pharmacologic or surgical options.
10. A patient after bariatric surgery is at risk for which nutritional deficiency due to
bypass of the duodenum?
, A. Vitamin C excess
B. Iron, vitamin B12, and calcium deficiency
C. Vitamin A toxicity
D. Sodium excess
Answer: B
Rationale: Bypassing the duodenum and proximal jejunum reduces absorption of iron,
vitamin B12 (also affected by reduced intrinsic factor), calcium, and vitamin D, requiring
lifelong monitoring and supplementation.
11. Which finding in a patient with obesity is most suggestive of metabolic
complications requiring further evaluation?
A. BMI of 24 kg/m²
B. Elevated fasting glucose, hypertension, and dyslipidemia in addition to central
obesity
C. Normal blood pressure and lipid panel
D. Regular exercise history
Answer: B
Rationale: The combination of central obesity, elevated fasting glucose, hypertension,
and dyslipidemia suggests the patient may meet criteria for metabolic syndrome,
warranting further evaluation and intervention.
12. Semaglutide (a GLP-1 receptor agonist) is prescribed for chronic weight
management. The nurse should teach the patient about which common side effect?
A. Hypertension
B. Nausea, vomiting, and delayed gastric emptying
C. Hair loss only
D. Hyperglycemia
Answer: B
Rationale: GLP-1 receptor agonists like semaglutide slow gastric emptying and act
centrally to reduce appetite; common side effects include nausea, vomiting, diarrhea,
and constipation, which often improve with gradual dose titration.
13. Which statement by a patient after bariatric surgery indicates a need for further
teaching regarding dietary progression?
A. "I will eat slowly and chew my food thoroughly."
B. "I will drink a large glass of water with each meal to help me feel full."
C. "I will avoid carbonated beverages."
