Chap. 47: Alterations in Nutritional Status

A patient tells the nurse that he or she is going on a low carbohydrate diet in order to lose weight. Which of the following should the nurse inform the patient what the carbohydrate intake should be to prevent tissue wasting and ketosis?

50-100 g/day

The nurse in the obstetrics clinic is advising a pregnant woman about nutritional needs during pregnancy. Which of these should the nurse include in the teaching plan?

A pregnant woman needs an extra 300 kcal/day above the usual caloric intake. During pregnancy, a woman needs an extra 300 kcal/day above her usual requirement. Saturated fats usually are from animal sources and remain solid at room temperature, with the exception of coconut and palm oils, and are to be avoided in healthy diets. A person requires approximately 115 kcal/kg of body weight at birth. There is no specific dietary requirement for carbohydrates; all energy requirements can be met by dietary fats and proteins.

In the phases of metabolism, which of the following requires energy rather than providing it for use by the body?

Anabolism

The nurse is assessing a patient who is in the clinic for a routine physical. The patient is female and has upper body obesity. Which of the following would the nurse describe as being the body type of this patient?

Apple shaped

The body mass index (BMI) is the measurement used to determine a person's healthy weight. A BMI between 18.5 and 24.9 is considered the lowest health risk in relation to the weight of a person. How is the BMI calculated?

BMI = weight [kg]/height [meter2]

A nurse is caring for a group of patients. Which of the following patients has the greatest caloric needs?

Breast-feeding mother who delivered 1 month ago

A client asks the nurse what the body's primary source of immediate energy is. The best response would be:

Carbohydrates

A patient with a body mass index of 32 would be classified as which of the following?

Class I obesity Class I obesity would be diagnosed based on BMI greater than 30. A normal BMI would be between 18.5 to 24.9

Which of these reflects a positive outcome to interventions provided for a 20-year-old woman undergoing treatment for anorexia nervosa?

Client has monthly menses. The individual with anorexia nervosa is expected to maintain a minimally normal body weight (e.g., at least 85% of minimal expected weight). The individual has an excessive concern over gaining weight and how the body is perceived in terms of size and shape, and amenorrhea (in girls and women after menarche). A positive outcome is reflected in less obsession over weight or appearance, and return of menses.

A nurse is speaking at a weight loss meeting about the dangers to one's health from obesity. Which condition is directly attributed to being obese?

Coronary heart disease Overweight and obesity have become global health problems and are associated with an increased risk health problems that include cardiac disease. Bone resorption is not directly affected and obese individuals are not noted to have recurrent infections. Dysrhythmias are not an identified effect of obesity.

A nurse and a patient with binge-eating disorder (BED) are developing a treatment plan. Which of the following should the primary goal of therapy focus on?

Establishing a regular, healthful eating pattern.

A nurse is volunteering in a children's clinic in a Third World country for the summer. Many children are observed to have marasmus. When assessing these children, what does the nurse recognize as an important characteristic of this disorder?

Growth failure

Which client scenario places the client at high risk for developing health problems related to obesity?

Hypertension In terms of health problems, many disorders occur more frequently in obese people. The most important and common of these are hyperlipidemia, hypertension, coronary artery disease, stroke, and type 2 diabetes mellitus. The increased weight associated with obesity stresses the bones and joints, increasing the likelihood of osteoarthritis.

A 20-year-old man who is addicted to methamphetamines has been admitted to hospital with a diagnosis of protein--calorie malnutrition after many months of inadequate food intake. Which treatment plan would the care team most likely favour?

Incremental feeding combined with vitamin and mineral supplementation. Slow administration of protein and calories combined with mineral and vitamin supplementation is important in the treatment of protein--calorie malnutrition. Albumin transfusions and total parenteral feeding would likely not be necessary because the client has no noted swallowing or metabolic problems, and rapid administration of fluids and carbohydrates may precipitate congestive heart failure.

A patient on a diet that is very low in carbohydrates and high in protein submitted a urine specimen for analysis. Which of the following does the nurse expect to see when the results come back?

Ketones A carbohydrate-deficient diet usually results in the loss of tissue proteins and the development of ketosis. Because protein and fat metabolism increase the production of osmotically active metabolic wastes that must be eliminated through the kidneys, there is a danger of dehydration and electrolyte imbalances. The specific gravity would be high. Bacteria in the urine would indicate an infectious process.

When trying to explain to parents of school-aged children how to find the "good" fats that should used for cooking, which explanation is most accurate?

Look for plant-based oils like "canola" on the label. The saturated fatty acids elevate blood cholesterol, whereas the monounsaturated and polyunsaturated fats lower blood cholesterol. Saturated fats are usually derived from animal sources and remain solid at room temperature. With the exception of coconut and palm oils (which are saturated), unsaturated fats are found in plant oils (like corn or canola)and usually are liquid at room temperature. Trans fatty acids are produced when unsaturated oils are partially hydrogenated and are called artificial trans fats. They are found primarily in vegetable shortenings and some margarines and foods.

A frail, 87-year-old female client has been admitted to a hospital after a fall and has been diagnosed with failure to thrive. Which of the following laboratory values would suggest that the client may be experiencing malnutrition?

Low prealbumin

In addition to facilitating bowel movements, a diet that is high in fiber confers which of the following benefits?

Lowering cholesterol and blood glucose Fiber binds with cholesterol and prevents it from being absorbed by the body as well as lowers blood glucose. It does not directly detoxify the body or increase intestinal absorption of vitamins and minerals. Fiber alone does not cause a reduction in blood pressure or heart rate.

The nurse is providing education to a client who has been instructed to increase the amount of protein in her diet. Which foods should the nurse recommend?

Milk and eggs

A nurse is assessing a female patient prior to educating about healthy lifestyle changes. The patient has a body mass index (BMI) of 32.4. Which of the following would the nurse classify this patient as according to the BMI?

Patient is considered obese. A BMI of 32.4 is considered to be in the obese range, which is 30.0-34.9. Underweight would be a BMI of <18.5. The normal range of BMI is considered 18.5-24.9. Overweight range is 25.0-29.9.

A nurse is caring for a patient who has been admitted to an inpatient facility for the treatment of anorexia nervosa. When planning the care of this patient, which of the following personality traits does the nurse anticipate observing?

Perfectionistic and compulsive The causes of anorexia appear to be multifactorial, with determinants that include genetic influence; personality traits of perfectionism and compulsiveness; anxiety disorders; family history of depression and obesity; and peer, familial, and cultural pressures with respect to appearance. Being easily angered, paranoid, aggressive, extroverted, introverted, and shy are not necessarily associated with the typical personality traits of anorexia nervosa.

The nurse is caring for a client with chronic renal failure who must begin restricting potassium intake. Which of these foods does the nurse emphasize should be avoided?

Potatoes

A nurse is working in an eating disorder inpatient clinic. Which of the following does the nurse recognize as one of the most challenging aspects of treatment of anorexia nervosa?

Recognizing that there is a problem One of the most challenging aspects of the treatment of anorexia is the inability of the person with anorexia to recognize that there is a problem. While overcoming depression is important to any treatment plan, it is not specific to the treatment of anorexia. Socialization with other patients is not essential to the treatment plan but may help the patient adjust to the treatment facility. Gaining weight is important but will not occur without the patient recognizing that there is a problem.

The nurse is providing dietary instruction to a client whose lab values indicate a high level of blood cholesterol. The client asks if there are any food contents that need to be avoided. The best response would be:

Saturated fatty acids The saturated fatty acids elevate blood cholesterol, whereas the monounsaturated and polyunsaturated fats lower blood cholesterol.

When a patient asks why some body fat is good, the nurse responds based on what fact?

The body stores energy in adipose tissue

A client is recovering from surgery and has been encouraged to increase his food intake to induce an anabolic state and promote healing. What phenomenon will occur while the client is experiencing anabolism?

The client will be expending energy to synthesize new cells. Anabolism is the phase of metabolic storage and synthesis of cell constituents. Anabolism does not provide energy for the body; it requires energy. Anabolism does not involve the storage of glycogen. Energy cannot be stored as heat. Catabolism, not anabolism, is the breakdown of complex molecules.

The health care provider reviews the waist-hip ratio of a male. The ratio is 1.0. The provider would interpret his result as:

Upper body obesity A waist-hip ratio greater than 1.0 in men and 0.8 in women indicates upper body obesity. Research suggests that fat distribution may be a more important factor for morbidity and mortality than overweight or obesity. The other options are lower body obesity types.

The nurse is caring for a client who has obesity. The nurse recognizes that psychological factors may contribute to obesity. It would be most important for the nurse to assess the client for:

Using food as a reward Psychological factors include using food as a reward, comfort, or means of getting attention. Eating may be a way to cope with tension, anxiety, and mental fatigue. The other choices are environmental influences.

A nurse is instructing a patient about proper nutrition. When the MyPlate model is used for healthy eating, which of the following food groups should the nurse encourage the patient to eat the most of?

Vegetables According to Figure 47.6, the MyPlate model demonstrates that the largest portion of food should come from the vegetable food group. The smallest amount of food should come from the dairy and fruit groups. Protein and grains are food groups that are equal in amounts second to vegetables.

During a humanitarian trip to an underdeveloped country a senior nursing student is assessing a 6-year-old boy who has a protuberant abdomen, dry hair, and wrinkled skin. The child's heart rate is 59 beats per minute, blood pressure 89/50, and temperature 35.1°C. The student should assess the child for:

a diet deficient in both protein and calories.

A public health nurse is teaching a group of young adults about actions to prevent obesity and promote general health. The nurse should encourage:

doing physical activity for at 30 minutes daily. Current recommendations include 30 minutes of physical exercise daily. Organic foods tend to be healthy, but this is not a central focus of obesity prevention. Excess fat intake must be avoided, but fats are a necessary dietary component that must not be eliminated.

Which of the following clients coming to a small free clinic are at high risk for malnutrition? Select all that apply.

• An 88-year-old senior citizen on a fixed budget • A 60-year-old homeless Vietnam veteran complaining of pain • A 4-year-old child who lives with a single mom in a rooming house

A child has been diagnosed with marasmus. Which clinical manifestations should the school nurse assess to confirm the diagnosis? Select all that apply.

• Bradycardia • Stunted growth pattern

A client diagnosed with a binge-eating disorder has made a goal to establish a regular, healthy eating pattern. Select the interventions the client should implement. Select all that apply.

• Exercising regularly • Making a meal plan • Keeping a daily food intake report • Avoiding alcohol

For a patient with a vitamin A deficiency, which of the following items on the menu should the nurse encourage the patient to choose for supper?

• Grilled beef liver with carrots and canteloupe Major food sources for vitamin A are liver, butter, whole milk, cheese, egg yolk; for provitamin A: carrots, green leafy vegetables, sweet potatoes, pumpkin, winter squash, apricots, cantaloupe, and fortified margarine.

Parents are concerned that their child may be at risk for the development of childhood obesity. Select the factors that would place a child at risk. Select all that apply.

• Heredity • Ethnicity • Mother had gestational diabetes during pregnancy

Which of the following individualized plans does the nurse understand will be included in the initial plan of treatment for the patient who seeks treatment for obesity? Select all that apply.

• Lifestyle modification with behavioral therapy • Reduced-calorie diet • Increased physical activity Treatment should focus on individualized lifestyle modifications through a combination of a reduced calorie diet, increased physical activity, and behavior therapy. These three modes of therapy form the basis of all weight management programs. Pharmacotherapy and surgery are available as adjuncts to lifestyle changes in people who meet specific criteria.

When explaining to a group of parents of school-aged children the importance of protein intake, the nurse emphasizes which food choices that contain all essential amino acids in adequate amounts per serving? Select all that apply.

• Milk • Eggs • Chicken

What food will a client diagnosed with anemia be encouraged to eat in order to provide adequate copper needed for hemoglobin formation? Select all that apply.

• Nuts • Grapes • Shellfish