Phentermine suppresses appetite because it belongs to which drug class?
Sympathomimetic amine
✓
Lipase inhibitor
GLP-1 receptor agonist
Opioid antagonist
Correct Answer
Sympathomimetic amine
Phentermine is a sympathomimetic amine related to amphetamine that increases norepinephrine release in the brain, reducing appetite. Lipase inhibitor describes orlistat, which blocks fat absorption in the gut. GLP-1 receptor agonist describes drugs such as semaglutide and liraglutide. Opioid antagonist describes naltrexone, one component of naltrexone-bupropion.
Category: Anorexiants
Question 2
A patient taking phentermine reports new shortness of breath on exertion, chest pain, fainting and ankle swelling. Which serious adverse effect should the nurse suspect?
Acute pancreatitis
Pulmonary hypertension
✓
Hypothyroidism
Pernicious anemia
Correct Answer
Pulmonary hypertension
Anorexiants such as phentermine carry warnings for primary pulmonary hypertension and valvular heart disease, which present with exertional dyspnea, chest pain, syncope and edema; the drug is stopped and the patient evaluated. Acute pancreatitis causes severe abdominal pain radiating to the back. Hypothyroidism causes fatigue, cold intolerance and weight gain. Pernicious anemia causes fatigue and neurologic symptoms from vitamin B12 deficiency.
Category: Anorexiants
Question 3
After several weeks of phentermine, a patient says the appetite-suppressing effect has faded and asks whether to take an extra tablet. What should the nurse say?
Take an extra tablet with the evening meal
Double the dose until hunger is controlled
Do not raise the dose; tell the prescriber
✓
Add an over-the-counter stimulant for a boost
Correct Answer
Do not raise the dose; tell the prescriber
Tolerance to the anorectic effect of phentermine develops within weeks; labeling says the dose should not be increased then, and the prescriber decides whether to stop it. Taking an extra tablet with the evening meal raises misuse risk and causes insomnia. Doubling the dose until hunger is controlled exceeds labeled dosing and increases cardiovascular risk. Adding an over-the-counter stimulant for a boost adds dangerous sympathomimetic effects.
Category: Anorexiants
Question 4
Which condition in a patient's history rules out the use of phentermine?
Hypothyroidism
Osteoarthritis
Iron deficiency anemia
Coronary artery disease
✓
Correct Answer
Coronary artery disease
Phentermine raises heart rate and blood pressure, so cardiovascular disease such as coronary artery disease, stroke, dysrhythmias, heart failure or uncontrolled hypertension is a contraindication. Hypothyroidism is not a contraindication; hyperthyroidism is. Osteoarthritis is a common obesity comorbidity and does not rule out the drug. Iron deficiency anemia is not a contraindication.
Category: Anorexiants
Question 5
Before starting phentermine-topiramate, what does a patient who can become pregnant need?
A negative pregnancy test
✓
A baseline colonoscopy
A thyroid ultrasound
An overnight sleep study
Correct Answer
A negative pregnancy test
Topiramate can cause fetal harm, so labeling requires a negative pregnancy test before starting, repeated testing during treatment and effective contraception; the drug is dispensed under a REMS program. A baseline colonoscopy is not required for this drug. A thyroid ultrasound is not required before phentermine-topiramate. An overnight sleep study is not a prerequisite.
Category: Phentermine-Topiramate
Question 6
A patient who recently started phentermine-topiramate reports sudden blurred distance vision and eye pain. What should the nurse tell the patient?
Expect the symptoms to fade with time
Seek eye care right away
✓
Drink more fluids and rest the eyes
Take the next dose at bedtime instead
Correct Answer
Seek eye care right away
Topiramate can cause acute myopia with secondary angle-closure glaucoma, usually early in therapy, and untreated it can cause permanent vision loss; the drug is stopped as soon as possible and the patient is evaluated urgently. Expecting the symptoms to fade with time delays treatment. Drinking more fluids and resting the eyes does not treat raised eye pressure. Taking the next dose at bedtime instead continues the drug that caused the problem.
Category: Phentermine-Topiramate
Question 7
During hot weather, a patient taking phentermine-topiramate should watch for which problem?
Increased sweating with low blood pressure
Excess tearing and a runny nose
Decreased sweating and rising body temperature
✓
Frequent urination with low blood sodium
Correct Answer
Decreased sweating and rising body temperature
Topiramate can cause oligohidrosis, reduced sweating, which can lead to hyperthermia in heat or exercise, so patients stay hydrated and report decreased sweating or fever. Increased sweating with low blood pressure is not the topiramate effect. Excess tearing and a runny nose are not linked to this drug. Frequent urination with low blood sodium is not a recognized effect of the combination.
Category: Phentermine-Topiramate
Question 8
How should a patient taking orlistat take a daily multivitamin?
Together with each orlistat dose
Only if oily stools develop
Not at all, because orlistat supplies vitamins
At bedtime, apart from the orlistat doses
✓
Correct Answer
At bedtime, apart from the orlistat doses
Orlistat reduces absorption of fat-soluble vitamins A, D, E and K and beta-carotene, so a multivitamin containing them is taken well apart from orlistat, such as at bedtime. Together with each orlistat dose would let orlistat block the vitamins' absorption. Only if oily stools develop misses the reason for the supplement. Not at all, because orlistat supplies vitamins is false; orlistat contains no vitamins.
Category: Orlistat
Question 9
A patient taking orlistat with each main meal plans to skip lunch. What should the patient do with the lunchtime dose?
Omit it
✓
Take it with a fat-free snack
Take it with dinner as an extra dose
Take it at bedtime
Correct Answer
Omit it
Orlistat works only on fat in a meal that is eaten at the same time, so a dose can be omitted when a meal is skipped or contains no fat. Taking it with a fat-free snack gives no benefit. Taking it with dinner as an extra dose doubles the dose and increases GI effects. Taking it at bedtime serves no purpose without a meal.
Category: Orlistat
Question 10
A patient who takes levothyroxine for hypothyroidism is starting orlistat. What should the nurse teach?
Take both drugs together with breakfast
Take the two drugs at well-separated times
✓
Stop levothyroxine during weight loss
Take orlistat only on days without levothyroxine
Correct Answer
Take the two drugs at well-separated times
Orlistat can reduce levothyroxine absorption, and hypothyroidism has been reported with the combination, so the doses are separated and thyroid function is monitored. Taking both drugs together with breakfast maximizes the interaction. Stopping levothyroxine during weight loss would cause hypothyroidism. Taking orlistat only on days without levothyroxine is not workable because levothyroxine is taken every day.
Category: Orlistat
Question 11
A patient on warfarin starts orlistat. Which laboratory value should be monitored more closely?
Serum potassium
Serum amylase
INR
✓
Serum uric acid
Correct Answer
INR
Orlistat reduces absorption of vitamin K, a fat-soluble vitamin, which can change warfarin's effect, so the INR is checked more closely. Serum potassium is not affected by this interaction. Serum amylase is not a warfarin or orlistat monitoring test. Serum uric acid is not affected by this combination.
Category: Orlistat
Question 12
A patient taking semaglutide for weight management reports pain in the right upper abdomen after meals, fever and yellowing of the eyes. Which adverse effect should the nurse suspect?
Hypoglycemia
Kidney stones
Thyroid storm
Acute gallbladder disease
✓
Correct Answer
Acute gallbladder disease
GLP-1 receptor agonists used for weight loss are linked to cholelithiasis and cholecystitis, partly from rapid weight loss; right upper quadrant pain, fever and jaundice call for gallbladder evaluation. Hypoglycemia causes shakiness, sweating and confusion, not jaundice. Kidney stones cause flank pain and blood in the urine. Thyroid storm causes high fever, tachycardia and agitation without right upper quadrant pain.
Category: GLP-1 and GIP Agonists
Question 13
A patient taking tirzepatide is scheduled for a procedure under deep sedation. Why does the procedure team need to know about this drug?
Delayed gastric emptying raises the risk of aspiration
✓
It strongly potentiates opioid respiratory depression
It causes severe bleeding during surgery
It blocks the effect of local anesthetics
Correct Answer
Delayed gastric emptying raises the risk of aspiration
GLP-1 and GIP/GLP-1 agonists slow gastric emptying, and labeling warns of pulmonary aspiration during general anesthesia or deep sedation, so patients should tell providers before planned procedures. It strongly potentiates opioid respiratory depression is not a labeled effect. It causes severe bleeding during surgery is false; it is not an anticoagulant. It blocks the effect of local anesthetics is not a recognized interaction.
Category: GLP-1 and GIP Agonists
Question 14
A patient who uses an oral contraceptive is starting tirzepatide. What should the nurse teach?
Stop the contraceptive because tirzepatide prevents pregnancy
Add a barrier method or switch to a nonoral method after starting and after each dose increase
✓
Take the contraceptive and tirzepatide at exactly the same moment
No change is needed because tirzepatide does not affect oral drugs
Correct Answer
Add a barrier method or switch to a nonoral method after starting and after each dose increase
Tirzepatide delays gastric emptying and can reduce oral contraceptive exposure, so labeling advises switching to a nonoral method or adding a barrier method after starting and after each dose escalation. Stopping the contraceptive because tirzepatide prevents pregnancy is false and dangerous. Taking the contraceptive and tirzepatide at exactly the same moment does not solve the absorption problem. Saying no change is needed because tirzepatide does not affect oral drugs ignores this labeled interaction.
Category: GLP-1 and GIP Agonists
Question 15
A patient taking semaglutide for weight management has had several days of vomiting and diarrhea. Which complication is the nurse concerned about?
Rebound weight gain
Severe hypertension
Acute kidney injury from dehydration
✓
Hyperkalemia from potassium retention
Correct Answer
Acute kidney injury from dehydration
GI losses from GLP-1 agonists can cause dehydration and acute kidney injury, sometimes needing dialysis, so patients are taught to maintain fluids and report persistent vomiting or diarrhea. Rebound weight gain is not an acute danger here. Severe hypertension is not caused by fluid loss; low blood pressure is more likely. Hyperkalemia from potassium retention is unlikely; vomiting and diarrhea tend to lower potassium.
Category: GLP-1 and GIP Agonists
Question 16
A patient who recently started semaglutide for weight management has frequent nausea. Which teaching helps reduce it?
Eat large meals less often to rest the stomach
Choose high-fat foods to slow digestion
Lie down right after each meal
Eat smaller meals and stop eating when full
✓
Correct Answer
Eat smaller meals and stop eating when full
GLP-1 receptor agonists slow gastric emptying, so eating smaller meals, stopping at the first sense of fullness and limiting fatty or greasy foods help reduce nausea, which is most common when starting or increasing the dose. Eating large meals less often overfills a stomach that empties slowly. Choosing high-fat foods worsens nausea because fat further delays emptying. Lying down right after each meal promotes reflux and discomfort.
Category: GLP-1 and GIP Agonists
Question 17
A patient with hypertension has lost a large amount of weight while taking orlistat and now reports lightheadedness when standing. What should the nurse do?
Check blood pressure and report it to the prescriber
✓
Tell the patient to double the orlistat dose
Advise the patient to stop all fluids for a day
Reassure the patient that this is an orlistat side effect
Correct Answer
Check blood pressure and report it to the prescriber
As weight falls, blood pressure often improves, so the antihypertensive regimen may now be too strong; checking blood pressure, including for orthostatic changes, and reporting it lets the prescriber adjust the dose. Doubling the orlistat dose would not address low blood pressure and increases GI effects. Stopping all fluids for a day would worsen lightheadedness. Reassuring the patient that this is an orlistat side effect is wrong, because orlistat acts in the gut and new dizziness needs evaluation.
Category: Orlistat
Question 18
A patient who drinks alcohol heavily every day plans to quit abruptly on the same day naltrexone-bupropion is started. Which risk concerns the nurse?
Hypoglycemia
Seizures
✓
Pancreatitis
Bradycardia
Correct Answer
Seizures
Bupropion lowers the seizure threshold, and abrupt withdrawal from alcohol, benzodiazepines, barbiturates or antiepileptic drugs also provokes seizures, so starting naltrexone-bupropion during abrupt discontinuation of these is contraindicated. Hypoglycemia is a concern for patients with diabetes taking antidiabetic drugs, not the issue here. Pancreatitis is a warning for GLP-1 receptor agonists. Bradycardia is not expected; the drug can raise heart rate.
Category: Naltrexone-Bupropion
Question 19
Why is body mass index a limited measure of body fat for some people?
It requires a blood test to calculate
It measures only fat stored in the abdomen
It can overestimate fatness in very muscular people
✓
It shifts sharply after every meal
Correct Answer
It can overestimate fatness in very muscular people
BMI is calculated from weight and height and cannot tell muscle from fat, so it can label a muscular athlete as overweight; it is used with other measures such as waist circumference. It requires a blood test to calculate is false. It measures only fat stored in the abdomen is false; it does not locate fat at all. It shifts sharply after every meal is false; it is a fairly stable screening value.
Category: Obesity Basics
Question 20
A patient wants to try glucomannan, a soluble fiber supplement, for weight loss. Which teaching is correct?
Take it dry so it swells later
Take it at the same time as other medications
Use it in place of meals
Take it with plenty of water
✓
Correct Answer
Take it with plenty of water
Glucomannan absorbs many times its weight in water to create fullness, so it must be taken with plenty of fluid to prevent choking, esophageal or bowel obstruction and constipation. Taking it dry so it swells later risks obstruction. Taking it at the same time as other medications can reduce their absorption. Using it in place of meals is not safe, and supplements are only adjuncts to diet and activity.
Category: Supplements and Herbals