Chapter 8 Nutrition
When obtaining the nutritional health history from a female client, which question would be best to elicit information about the client's knowledge of her own health status?
"What are your height and usual weight?" The question about height and usual weight provides a baseline for comparing a client's perception with actual and current measurements. The answer also indicates the client's knowledge of her own health status. Asking about a current or recent diet helps to identify chronic dieters and clients with eating disorders. Asking about fluid intake helps determine the adequacy of fluids and provide clues to possible risk for dehydration. Understanding of healthy meal choices does not necessarily inform the nurse's appraisal of the client's health status.
The nurse is preparing to perform a nutritional assessment of a newly admitted client. What question would be most appropriate for the nurse to ask when initiating the assessment?
"What have you eaten in the last 24 hours?" The assessment should begin with questions regarding the client's dietary habits and should elicit information about average daily food and fluid intake. A 24-hour diet recall would normally be the best question to gather this information. Then the nurse can gather more specific data such as meals eaten, meal pattern, and other areas such as eating out.
A nurse assesses a 175-pound adult client who is 5 feet 11 inches tall. What is the estimated body mass index (BMI) for this client?
24.4 The BMI is calculated by dividing weight in pounds by height in inches squared and then multiplying by 703. The body mass index calculated by the nurse should be 24.4 for a client who is 5 feet 11 inches tall and 175 pounds.
An adult client weighs 175 pounds and is 5 feet 6 inches tall. The nurse determines that the client's body mass index is which of the following?
28 This client's BMI is 28.2, according to the NHLBI online calculator hyperlinked in the chapter text.
An individual is considered obese when his or her BMI is:
30-39 Those persons with a BMI of 30 to 39 are considered obese. Persons with a ABMI of less than 24 are risk for problems associated with poor nutritional status. A BMI of 25 to 29 are considered overweight. Those with a BMI of greater than 40 are considered extremely obese.
Which of the following clients will have an increased metabolic rate and require nutritional interventions?
A person with a serious infection and fever. Factors that increase metabolic rate include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of some hormones. Aging, prolonged fasting, and sleep decrease metabolic rate.
What assessment parameters are included when assessing a client's nutritional status? (Mark all that apply.)
Body mass index Clinical examination findings Dietary data The sequence of assessment of parameters may vary, but evaluation of nutritional status includes one or more of the following methods: measurement of body mass index and waist circumference, biochemical measurements, clinical examination findings, and dietary data. Ethnic mores and wrist circumference are not assessment parameters for nutritional status.
The nurse should perform which priority assessment on a client with a history of a high hydrogenated fat intake?
Cardiac The cardiac assessment is of priority concern for this client. Foods made with hydrogenated fats are particularly harmful to the diet because they are the largest contributors of trans fats. Empirical evidence suggests that trans fats are as damaging to the heart and blood vessels as saturated fats (Mente de Koning, Shannon, and Anand, 2009).
A nurse is providing nutritional instruction to a client with cardiovascular disease. The nurse mentions a nutrient that is a necessary component of bile salts (which aid in digestion), serves as an essential element in all cell membranes, is found in brain and nerve tissue, and is essential for the production of several hormones such as estrogen, testosterone, and cortisone. The nurse warns the client, however, that this nutrient when consumed in excess can lead to heart attacks and strokes. To which of the following nutrients is the nurse referring?
Cholesterol Cholesterol is a fatlike substance that the liver produces. A high level of cholesterol can lead to heart attacks and strokes. However, cholesterol is important to normal bodily functions. It is necessary as a component of bile salts (which aid in digestion), serves as an essential element in all cell membranes, is found in brain and nerve tissue, and is essential for the production of several hormones such as estrogen, testosterone, and cortisone. Ingested fats are saturated, originating from animal sources or tropical oils and solid at room temperature, or unsaturated, originating from plant sources and soft or liquid at room temperature. Fats serve many functions in the body, but not the ones listed here. The primary functions of protein are growth, repair, and maintenance of body structures and tissue
A nurse recognizes that which of these are possible health risks for a client who is obese? Select all that apply.
Diabetes Hypertension Sleep apnea The health risks of obesity include diabetes, hypertension, and sleep apnea. Obesity is an excessive fat in relation to lean body mass. Malnutrition can exacerbate or facilitate diseases like bulimia and cirrhosis. Anorexia is a disorder whereby food is self-limited or refused. Cirrhosis is a chronic disease that may interfere with absorption or use of nutrients.
An older adult client has a body mass index of 15.5 and is consequently considered to be underweight. The client lives alone and states that she has "never been a heavy eater." How can the nurse most accurately assess the client's nutritional habits?
Elicit the client's 24-hour food recall. Using a 24-hour food recall is an efficient and easy method of identifying a client's intake and nutritional habits. This is more accurate than having the client describe her understanding of ideal nutrition. Anthropometric measures are important components of nutritional assessment, but none directly addresses the client's nutritional habits.
A male client who was transferred from intensive care and extubated less than 24 hours ago exhibits drooling and a weak voice. At meal time, what is the nurse's priority action?
Explain to the client why he should not eat anything by mouth yet. If the client exhibits drooling with a weak voice and has a history of recent intubation he should be kept on nothing by mouth and a swallowing evaluation should be performed before any type of oral feeding. The client should also be placed on aspiration precautions and remain in a fully upright position.
Based only on anthropometric measurements, which set of clients listed below are at the greatest risk for diabetes and cardiovascular disease?
Females with 88.9 cm (35 in) or greater waist circumference. Adults with large visceral fat stores located mainly around the waist (android obesity) are more likely to develop health-related problems than if the fat is located in the hips or thighs (gynoid obesity). These problems include an increased risk of type 2 diabetes, abnormal cholesterol and triglyceride levels, hypertension, and cardiovascular disease such as heart attack or stroke.
A nurse at a long-term care facility is completing the nutrition assessment of a man who has just moved to the facility. After determining the client's venous filling and emptying each take approximately 10 seconds, the nurse would perform further assessments related to what health problem?
Fluid volume deficit Filling and emptying should each take between 3 and 5 seconds. Delayed venous filling and emptying are suggestive of fluid volume deficit. This assessment finding is not closely associated with third-spacing, ascites, or malnutrition.
What is the most common indication of nutritional status in infants and children?
Growth Growth charts are commonly used to indicate nutritional status. As an indication of nutritional status, appetite, number of wet diapers/day, and sleep pattern are generally not used.
A client with diabetes mellitus visits the health care clinic with reports of excessive thirst and excessive urination. She states that her appetite has been low for the past 3 months, and has lost 20 pounds. Which nursing diagnosis should the nurse confirm based on this data?
Imbalanced nutrition The nurse should confirm the nursing diagnosis of imbalanced nutrition because the client has the major defining characteristics of inadequate food intake and weight loss. Fluid volume, excessive cannot be confirmed because even with the excessive urination the client is losing weight and there is no major defining characteristic present. The client made no statement about activity intolerance or that the client does not have enough knowledge to manage the diabetes properly. Reference:
When teaching a nutrition class, what would you recommend for adults older than the age of 50?
Increase foods rich in vitamin B12 and calcium Be prepared to help adolescent females and women of child-bearing age increase intake of iron and folic acid. Assist adults older than 50 years to identify foods rich in vitamin B12 and calcium. Advise older adults and those with dark skin or low exposure to sunlight to increase intake of vitamin D.
In planning to meet the nutritional needs of a critically ill client in the intensive care unit, which factor will increase the client's basal metabolic rate?
Infection Factors that increase a person's basal metabolic rate (BMR) include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones (epinephrine and thyroid hormones). Aging, prolonged fasting, and sleep all decrease BMR.
A nurse is working with a client who is Buddhist. Based on what the nurse knows of the common dietary practice of this religion, which nutrient should the nurse make sure that the client is not deficient in?
Iron Some religions and cultures influence or dictate dietary practices that can affect nutritional health. For instance, many Buddhists are strict vegetarians. Because read meat is the best source for iron, the nurse should be careful to assess those on a strict vegetarian diet for iron deficiency, which can lead to anemia. Carbohydrates, fats, and vitamin K would typically all be provided in sufficient amounts in a strict vegetarian diet.
A nurse is caring for a client with nasal infection at the healthcare facility. The dietitian has prescribed a diet rich in Vitamin A for the client. The nurse knows that Vitamin A is important for which of the following reasons?
Maintenance of healthy epithelium Vitamin A is important for maintenance of normal vision, especially in dim light, maintenance of healthy epithelium, promotion of normal skeletal and tooth development, and promotion of normal cellular proliferation. Vitamin D promotes intestinal absorption of calcium, mobilization of calcium and phosphorus from bone, renal reabsorption of calcium, and normal mineralization of bone and cartilage and maintenance of calcium extracellular fluid for normal muscle contraction.
A nurse needs to record the height of a client who refuses to stand because of blisters on the feet. What alternative method should the nurse implement to obtain the client's height?
Measure the arm span to estimate height As the client is unable to stand, the nurse should measure arm spam to estimate the height. The nurse may support or hold the client only when the client is required to stand when recording the height. The nurse should have the client stretch one arm straight out sideways to record the height and measure from the tip of the middle finger to the tip of nose and multiply by 2. The nurse should not obtain this information subjectively from the client. A standard table listing heights and weights may be used for calculating body mass index but would not be used to determine the client's height.
What precaution should the nurse take when measuring a client's abdominal girth to screen for cardiovascular risk factors?
Place the tape measure behind the client and measure at the umbilicus The nurse should place the tape measure behind the client and measure at the umbilicus. The umbilicus should be the starting point when measuring the abdomen, especially when distention is apparent. Abdominal measurement is generally taken in the morning after voiding, not after the client has had a full meal. The ideal position to measure the abdomen is standing, not sitting. The nurse informs the client that the pen mark on the abdomen should not be washed off only if the client is being monitored on a regular basis to determine progress of treatment for abdominal distention.
Which of the following problems results from a deficiency in vitamin D?
Rickets Signs of vitamin D deficiency are rickets in children, poor dental health, tetany, and osteomalacia.
A client suffering from decreased muscle strength has been diagnosed with a low Vitamin D level. The nurse should recommend that the client increase intake of which vitamin source?
Sunshine Vitamin D is obtained through exposure to sunlight. Some people who are not exposed to enough sun may require dietary supplements. Folate can be found in fortified breads, lentils, and orange juice.
The nurse's assessment reveals that a client is in a low percentile for midarm muscle circumference (MAMC) and a high percentile for triceps skin fold (TSF) thickness. Which of the following would be appropriate?
Teaching the client muscle-building exercises The MAMC decreases to the lower percentiles with malnutrition and in obesity if the TSF is high. If the MAMC is low and the TSF is high, the client may benefit from muscle-building exercise that increase muscle mass and decrease fat.
A nurse is providing care for a client who has a history of alcoholism. What would be appropriate to include in this client's discharge teaching?
To increase fruit and vegetable intake Alcohol can adversely affect the liver and its multiple functions, including protein synthesis. In addition, chronic alcohol exposure can injure the stomach and pancreas. Lack of the digestive enzymes produced by the pancreas can impair the absorption of nutrients, including fats. Alcohol intake can affect the metabolism of nutrients as well as alter the overall nutrient density of the diet. It is common for clients with a high alcohol intake to be deficient in the B vitamins and vitamin K.
When beginning a height measurement on a 14-year-old, the nurse should instruct the client to stand on the scale with heels together. True/ False
True If a scale is available, the nurse should instruct the client to stand shoeless on the scale with heels together and back straight, looking straight ahead. The nurses then should use the L-shaped measuring attachment on the scale to measure height.
The nurse might expect the client admitted with dehydration to have tachycardia. True/ False
True Tachycardia, a weak pulse and decreased blood pressure can indicate dehydration, while a bounding pulse and increased blood pressure may mean overhydration.
Bulimia differs from anorexia in that bulimics
crave food
