CSOWM MISCELLANEOUS EXAM ACTUAL

CSOWM MISCELLANEOUS EXAM (ACTUAL

QUESTIONS AND VERIFIED 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?

• Orlistat
• Topiramate
• Phendimetrazine

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

1. Advanced age: > 45 y/o

2. "Super-obesity": BMI > 50

3. HTN

• Male gender
• Pulmonary Embolism (PE) or surrogate (i.e. DVT, OSA)
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Insufficient evidence supports the routine screening & supplementation of what mineral?selenium

Routine screening for what mineral deficiency should occur after malabsorptive procedures? Who should receive routine supplementation?

• zinc
• BPD/DS require supplementation

What mineral deficiency presents as hair loss, pica, significant dysgeusia, or in male pts w/ hypogonadism or erectile disfunction?zinc deficiency

Routine screening of copper is NOT indicated but should be evaluated in pts w/ anemia, neutropenia, myeloneuropathy, & poor wound healing. What dose should be included as part of daily MVI? Treatment includes?

• 2 mg/d of copper supplementation 2 / 4

• Severe deficiency treatment includes IV copper 2-4 mg/d for
• days, subsequent treatment of mild-mod oral copper sulfate

or gluconate 3-8 mg/d until levels normalize & symptoms resolve

When being treated for zinc deficiency or using supplemental zinc for hair loss, what other supplement should be taken?

• mg copper for every 8-15 mg zinc (zinc replacement can

cause copper deficiency)

Thiamine supplementation should be included as part of daily MVI. Routine screening is not recommended unless post-op

patient is experiencing:

rapid weight loss, protracted vomiting, PN, excessive ETOH use, neuropathy or encephalopathy, or heart failure

How should thiamine deficiency be treated?severe- IV thiamine 500mg for 3-5 days, followed by 250mg for 3-5 days or until resolution of Sx, then consider 100mg/d thiamine orally indefinitely or until risk factors resolved mild- IV thiamine 100mg for 7-14 days recalcitrant or recurrent deficiency w/o 1 of the above risks= antibiotics for SIBO 3 / 4

Lipid levels & need for lipid-lowering meds should be periodically evaluated as the effect of weight loss on dyslipidemia is ________. Meds should not be stopped unless what?

• variable
• clearly indicated

The effect of weight loss on BP is ________. When should antihypertensive meds be evaluated & stopped?

• variable
• evaluated routinely, stopped only when clearly indicated

Persistent & severe GI sx warrant evaluation. What is the gold standard eval for celiac disease or bacterial overgrowth?When should a stool sample be obtained?

• upper endoscopy w/ small bowel biopsies & aspirates
• screen stool if presence of Clostridium difficile colitis is

suspected

Which of the following components of her presentation contributes most strongly to her personal risk of diabetes?

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