CSOWM Miscellaneous UPDATED
ACTUAL Exam Questions and CORRECT
Answers
The PCP prescribes short-term weight-loss management for an obese pt w/ migraine headaches.
The nurse recognizes that which med will be most effective for the patient?
a. Orlistat
b. Topiramate
c. Phendimetrazine - CORRECT ANSWER - Answer: B
Rationale: Topiramate is an anticonvulsant that is taken in combination with a nonamphetamine
like phentermine. It is effective in reducing migraines & treating obesity.
The Obesity Surgery Mortality Risk Score (OS-MRS) identified what 5 preoperative risk factors
that predicted increased risk of 30-day morbidity & mortality after RYGB - CORRECT
ANSWER - 1. Advanced age: > 45 y/o
2. "Super-obesity": BMI > 50
3. HTN
4. Male gender
5. Pulmonary Embolism (PE) or surrogate (i.e. DVT, OSA)
Which pts should be offered bariatric surgery? - CORRECT ANSWER - BMI >40 kg/m2
BMI >35 kg/m2 & > 1 severe obesity-related comorbid (i.e. T2DM, HTN, OSA,
NAFLD/NASH, HLD, GERD, osteoarthritis, GI disorders, heart disease)
There is insufficient evidence to recommending a bariatric surgical procedure specifically for
what conditions, independent of BMI? - CORRECT ANSWER - - glycemic control alone
- lipid lowering alone
- CVD risk alone
,The best bariatric surgical procedure to be offered should be based on what? - CORRECT
ANSWER - 1. individualized goals of therapy
2. available local-regional expertise
3. patient preference
4. personalized risk stratification
In general, ____________ bariatric procedures are preferred over ____ bariatric procedures d/t
lower early post-op _________ & _________. - CORRECT ANSWER - laparoscopic >
open; morbidity & mortality
Exercise caution when rec. BPD/DS or related procedures d/t _______ nutritional risks RT
_________ length of bypassed small intestine. - CORRECT ANSWER - greater nutritional
risks; increased length
What must be included in the preoperative evaluation? - CORRECT ANSWER --
comprehensive medical Hx
- psychosocial Hx
- physical examination
- appropriate lab testing to assess surgical risk
How should potential candidates for bariatric surgery be managed preoperatively? - CORRECT
ANSWER - - preoperative evaluation
- documented medical necessity
- informed consent regarding risks & benefits, procedural options, choice of surgeon/medical
institution
- need for long-term f/up & vitamin supplementation
- provided with financial information
- encourage preoperative weight loss
,What should be encouraged to reduce liver volume (may also improve technical aspects of
surgery in enlarged or fatty liver disease)? - CORRECT ANSWER - preoperative weight
loss, often through a 2 week "liver shrink diet"
Pre-op glycemic control should be optimized using a diabetes comprehensive care plan including
what? - CORRECT ANSWER - - healthy dietary patterns
- MNT
- PA
- prn pharmacotherapy
Reasonable pre-op targets of glycemic control, which may be associated w/ improved bariatric
surgery outcomes include:
- HbA1C?
- fasting BG?
- 2 hr PPBG? - CORRECT ANSWER - - HbA1C <6.5-7.0%
- Fasting BG <110mg/dL
- 2 hr PPBG <140mg/dL
NOTE: HbA1C of 7-8% should be considered in pts w/ microvascular or macro-vascular
complications, extensive comorbids, or long-standing DM. HbA1c >8% use clinical judgement.
True or False: Routine screening for primary hypothyroidism before bariatric surgery is NOT
recommended. - CORRECT ANSWER - True; only patients at risk should have TSH
screened & treated with L-thyroxine monotherapy if hypothyroid
True or False: A fasting lipid panel should be obtained in all pts w/ obesity. - CORRECT
ANSWER - True; and treatment should be initiated if indicated
Candidates for bariatric surgery should avoid pregnancy pre-op, and how many months post-op?
- CORRECT ANSWER - 12-18 months
, True or False: All women of reproductive age should be counseled on contraceptive choices
following bariatric surgery. - CORRECT ANSWER - True
Pts who become pregnant following bariatric surgery should have nutritional surveillance & lab
screening when? What deficiencies should be monitored? - CORRECT ANSWER - Every
trimester. Monitor iron, folate & B12, calcium & fat-soluble vitamins
True or False: Estrogen therapy should be d/c before bariatric surgery to reduce risks of post-op
thromboembolic phenomena. - CORRECT ANSWER - True:
1 cycle of oral contraceptives in premenopausal women
3 weeks of hormone replacement in postmenopausal women
Women w/ PCOS should be advised that fertility status might be what post-op? - CORRECT
ANSWER - Improved fertility status
True or False: Noninvasive cardiac testing beyond EKG is determined on basis of individual risk
& pts w/ known heart disease may require a formal cardiology consult. - CORRECT
ANSWER - True; pts at risk for heart disease should undergo evaluation for perioperative
b-adrenergic blockade.
What standardized screening should be done for OSA? - CORRECT ANSWER - Chest
radiograph & confirmatory polysomnography
If positive, pts w/ intrinsic lung disease or disordered sleep patterns should have a formal
pulmonology consult including arterial blood gas measurement
Tobacco use should be avoided at all times by all pts. Smoke cessation is rec'd at least _______
before bariatric surgery? - CORRECT ANSWER - 6 weeks before
NOTE: tobacco should also be avoided after surgery d/t increased risk of poor wound healing,
anastomotic ulcer & overall impaired health
ACTUAL Exam Questions and CORRECT
Answers
The PCP prescribes short-term weight-loss management for an obese pt w/ migraine headaches.
The nurse recognizes that which med will be most effective for the patient?
a. Orlistat
b. Topiramate
c. Phendimetrazine - CORRECT ANSWER - Answer: B
Rationale: Topiramate is an anticonvulsant that is taken in combination with a nonamphetamine
like phentermine. It is effective in reducing migraines & treating obesity.
The Obesity Surgery Mortality Risk Score (OS-MRS) identified what 5 preoperative risk factors
that predicted increased risk of 30-day morbidity & mortality after RYGB - CORRECT
ANSWER - 1. Advanced age: > 45 y/o
2. "Super-obesity": BMI > 50
3. HTN
4. Male gender
5. Pulmonary Embolism (PE) or surrogate (i.e. DVT, OSA)
Which pts should be offered bariatric surgery? - CORRECT ANSWER - BMI >40 kg/m2
BMI >35 kg/m2 & > 1 severe obesity-related comorbid (i.e. T2DM, HTN, OSA,
NAFLD/NASH, HLD, GERD, osteoarthritis, GI disorders, heart disease)
There is insufficient evidence to recommending a bariatric surgical procedure specifically for
what conditions, independent of BMI? - CORRECT ANSWER - - glycemic control alone
- lipid lowering alone
- CVD risk alone
,The best bariatric surgical procedure to be offered should be based on what? - CORRECT
ANSWER - 1. individualized goals of therapy
2. available local-regional expertise
3. patient preference
4. personalized risk stratification
In general, ____________ bariatric procedures are preferred over ____ bariatric procedures d/t
lower early post-op _________ & _________. - CORRECT ANSWER - laparoscopic >
open; morbidity & mortality
Exercise caution when rec. BPD/DS or related procedures d/t _______ nutritional risks RT
_________ length of bypassed small intestine. - CORRECT ANSWER - greater nutritional
risks; increased length
What must be included in the preoperative evaluation? - CORRECT ANSWER --
comprehensive medical Hx
- psychosocial Hx
- physical examination
- appropriate lab testing to assess surgical risk
How should potential candidates for bariatric surgery be managed preoperatively? - CORRECT
ANSWER - - preoperative evaluation
- documented medical necessity
- informed consent regarding risks & benefits, procedural options, choice of surgeon/medical
institution
- need for long-term f/up & vitamin supplementation
- provided with financial information
- encourage preoperative weight loss
,What should be encouraged to reduce liver volume (may also improve technical aspects of
surgery in enlarged or fatty liver disease)? - CORRECT ANSWER - preoperative weight
loss, often through a 2 week "liver shrink diet"
Pre-op glycemic control should be optimized using a diabetes comprehensive care plan including
what? - CORRECT ANSWER - - healthy dietary patterns
- MNT
- PA
- prn pharmacotherapy
Reasonable pre-op targets of glycemic control, which may be associated w/ improved bariatric
surgery outcomes include:
- HbA1C?
- fasting BG?
- 2 hr PPBG? - CORRECT ANSWER - - HbA1C <6.5-7.0%
- Fasting BG <110mg/dL
- 2 hr PPBG <140mg/dL
NOTE: HbA1C of 7-8% should be considered in pts w/ microvascular or macro-vascular
complications, extensive comorbids, or long-standing DM. HbA1c >8% use clinical judgement.
True or False: Routine screening for primary hypothyroidism before bariatric surgery is NOT
recommended. - CORRECT ANSWER - True; only patients at risk should have TSH
screened & treated with L-thyroxine monotherapy if hypothyroid
True or False: A fasting lipid panel should be obtained in all pts w/ obesity. - CORRECT
ANSWER - True; and treatment should be initiated if indicated
Candidates for bariatric surgery should avoid pregnancy pre-op, and how many months post-op?
- CORRECT ANSWER - 12-18 months
, True or False: All women of reproductive age should be counseled on contraceptive choices
following bariatric surgery. - CORRECT ANSWER - True
Pts who become pregnant following bariatric surgery should have nutritional surveillance & lab
screening when? What deficiencies should be monitored? - CORRECT ANSWER - Every
trimester. Monitor iron, folate & B12, calcium & fat-soluble vitamins
True or False: Estrogen therapy should be d/c before bariatric surgery to reduce risks of post-op
thromboembolic phenomena. - CORRECT ANSWER - True:
1 cycle of oral contraceptives in premenopausal women
3 weeks of hormone replacement in postmenopausal women
Women w/ PCOS should be advised that fertility status might be what post-op? - CORRECT
ANSWER - Improved fertility status
True or False: Noninvasive cardiac testing beyond EKG is determined on basis of individual risk
& pts w/ known heart disease may require a formal cardiology consult. - CORRECT
ANSWER - True; pts at risk for heart disease should undergo evaluation for perioperative
b-adrenergic blockade.
What standardized screening should be done for OSA? - CORRECT ANSWER - Chest
radiograph & confirmatory polysomnography
If positive, pts w/ intrinsic lung disease or disordered sleep patterns should have a formal
pulmonology consult including arterial blood gas measurement
Tobacco use should be avoided at all times by all pts. Smoke cessation is rec'd at least _______
before bariatric surgery? - CORRECT ANSWER - 6 weeks before
NOTE: tobacco should also be avoided after surgery d/t increased risk of poor wound healing,
anastomotic ulcer & overall impaired health
