# Situation: A 34-year-old woman with a body mass index (BMI) of 42 kg/m², hypertension, and obstructive sleep apnea treated with continuous positive airway pressure (CPAP) undergoes laparoscopic Roux-en-Y gastric bypass. She has no diabetes. Before discharge, the nurse reviews her home care. Which statement shows a need for **FURTHER** teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630369  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 34-year-old woman with a body mass index (BMI) of 42 kg/m², hypertension, and obstructive sleep apnea treated with continuous positive airway pressure (CPAP) undergoes laparoscopic Roux-en-Y gastric bypass. She has no diabetes.

Before discharge, the nurse reviews her home care. Which statement shows a need for **FURTHER** teaching?

## 보기

1. "I will eat the protein foods first at each of my meals."
2. "I will stop eating as soon as I start to feel full."
3. "I will not drink any fluids together with my meals."
4. "I will eat my usual portion sizes at three meals a day." **✔ 정답**

**정답: 4**

## 해설

After gastric bypass the pouch holds only small amounts, so clients eat 3 small meals a day, take protein first, and chew small bites thoroughly. Returning to usual portion sizes overfills the pouch and causes pain and vomiting. Stopping at the first sense of fullness, separating fluids from meals, and eating protein first are correct habits.

## 심화 해설

The statement that needs further teaching
"I will eat my usual portion sizes at three meals a day" shows a need for further teaching. After Roux-en-Y gastric bypass, the new gastric pouch holds only a small amount. Clients eat about 3 small meals a day, take protein first, and chew small bites thoroughly. Returning to usual portion sizes overfills the pouch and causes pain, nausea, and vomiting, and over time can stretch the pouch and undermine weight loss.

Why the pouch changes eating habits
The surgery reduces the stomach to a small pouch connected directly to the jejunum. Food reaches the small intestine quickly, and the pouch signals fullness after very little intake. Eating normal portions works against both features: it causes discomfort and vomiting, increases the risk of dumping syndrome when large amounts pass rapidly into the jejunum, and defeats the purpose of the operation. Portion control is therefore one of the most important habits taught before discharge.

| Statement | Assessment | Reason |
| --- | --- | --- |
| Eat protein foods first at each meal | Correct | Meets protein needs with a small pouch and supports healing |
| Stop eating as soon as I feel full | Correct | Prevents overfilling and vomiting |
| Do not drink fluids together with meals | Correct | Prevents early fullness and dumping |
| Eat my usual portion sizes at three meals | Needs further teaching | Overfills the pouch; pain and vomiting |

Why the other habits are right
Protein first matters because the small pouch limits total intake, and protein is needed to preserve muscle and support wound healing; protein deficiency is a recognized complication. Stopping at the first sense of fullness protects the pouch. Separating fluids from meals, typically by about 30 minutes before and after, keeps fluids from filling the pouch and pushing food into the intestine too quickly, which reduces dumping. Watch out! Separating fluids does not mean drinking less overall: clients must sip fluids steadily between meals to avoid dehydration.

Additional discharge teaching
The nurse also teaches avoidance of concentrated sweets, which trigger dumping; slow eating with small, well-chewed bites; lifelong vitamin and mineral supplements; and warning signs such as persistent vomiting, inability to keep fluids down, severe abdominal pain, fever, or signs of a leak. Because she has obstructive sleep apnea treated with CPAP, she continues CPAP at home, and her sleep apnea may improve with weight loss.

Exam takeaway
Key point! After gastric bypass: small meals, protein first, stop at fullness, fluids between meals rather than with them. Any statement about eating usual or large portions shows a need for further teaching.

## 임상 시나리오

Eating After Gastric BypassRecognizing a need for further teaching
The pouch holds only small amounts. Eating usual portion sizes overfills it and causes pain and vomiting, so that statement needs further teaching.

Correct habits: about 3 small meals a day, protein first, stop at the first sense of fullness, and take fluids apart from meals.

Sip fluids steadily between meals to prevent dehydration, and avoid concentrated sweets that trigger dumping syndrome.

CautionPersistent vomiting, inability to keep fluids down, severe abdominal pain, or fever after discharge needs prompt evaluation.

## 핵심 개념

- **Roux-en-Y gastric bypass** — Bariatric surgery creating a small gastric pouch joined directly to the jejunum.
- **Gastric pouch** — The small upper portion of the stomach that remains for food intake after bypass.
- **Dumping syndrome** — Rapid passage of food into the small bowel causing cramping, sweating, and dizziness.
- **Protein-first eating** — Eating protein foods before other foods to meet protein needs with limited capacity.
- **Bariatric surgery** — Surgery on the stomach or intestines to produce weight loss in severe obesity.

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