Topic 5 Digestion & Nutrition PrepU (Gero Exam 2)

The client is educating an older adult client about the risk factors of obesity. Which statement by the client requires further follow up by the nurse? "If my body mass index is too high, I may be at a higher risk for a stroke." "If I appropriately control my weight, I can be assured that my risk for other diseases is lower." "If my body mass index is above 30 kilograms per meters squared, I am considered obese." "If my weight is within an acceptable range, I don't have to worry about excess fat on my body."

"If my weight is within an acceptable range, I don't have to worry about excess fat on my body." Explanation: "If my weight is within an acceptable range, I don't have to worry about excess fat on my body," is inaccurate and requires further follow up by the nurse. Abdominal obesity (also called central obesity) defined as a waist circumference more than 102 and 88 cm or waist-to-hip ratio of 0.95 and 0.88 for men and women, respectively, can occur even in people with normal BMI. "If I appropriately control my weight, I can be assured that my risk for other diseases is lower, " "If my body mass index is too high, I may be at a higher risk for a stroke," and, "If my body mass index is above 30 kilograms per meters squared, I am considered obese," are all appropriate and do not require further follow up by the nurse.

The nurse has been providing care for an older adult client who lives in the community. The client has experienced a steady loss of weight and muscle mass over several months, in the absence of any known contributing diagnoses. Which health promotion teaching should the nurse provide? "It is important to ensure that you are getting enough protein in your diet." "Avoid drinking beverages during meals so that you do not feel full too quickly." "Make sure to avoid over-the-counter laxatives so that you can absorb nutrients." "Increase your intake of dietary sources of calcium and iron."

"It is important to ensure that you are getting enough protein in your diet." Explanation: Protein intake is imperative for maintaining muscle mass; chronic insufficiency results in muscle wasting. Although it is important to have adequate calcium and iron intake, deficiencies in these nutrients are not normally linked to weight loss or muscle wasting. Over-the-counter laxatives should be avoided, but their use is not a common cause of malnutrition or malabsorption of nutrients. There is no evidence that beverages lead to early satiety.

An older adult client asks if it is "normal" to have to move the bowels twice within the same hour. What should the nurse respond to this client? "It happens to people who do not drink enough fluid." "This is a normal age-related change." "This means you are constipated." "This is caused by your medications."

"This is a normal age-related change." Explanation: There is a tendency for older adults to not empty the bowel with one movement. Thirty to 45 minutes after the initial movement, the remainder of the bowel movement may need to occur. Having to move the bowels more than once in an hour does not indicate constipation. This is not caused by medication and does not occur in individuals who are fluid volume depleted.

A 78-year-old client states eating 3 full servings of fruits and vegetables per day. What is the nurse's best response? "You should incorporate at least 2 more servings into your diet." "Avoid eating too much broccoli due to the risk of high calcium consumption." "The majority of this intake should be green vegetables." "Substitute 1 or 2 of those servings with yogurt or gelatin dessert."

"You should incorporate at least 2 more servings into your diet." Explanation: It is recommended that older adults eat at least five servings of fruit and vegetables daily. The nurse can suggest a variety of ways to consume them by mixing them with yogurt or gelatin dessert; but yogurt and gelatin desserts are not substitutes for fruits and vegetables. The older adult should consume a variety of fruits and vegetables. Broccoli does not need to be specifically limited

An older adult client occasionally experiences fecal incontinence. Which action should the nurse take first when determining the reason for the client's incontinence? Assess for an impaction. Administer an enema. Increase dietary fiber. Restrict fluids.

Assess for an impaction. Explanation: Fecal incontinence is most often associated with fecal impaction. For this reason, the initial step is to assess for the presence of an impaction. Restricting fluids, performing an enema, and increasing dietary fiber will not assist the nurse to determine the reason for a client experiencing fecal incontinence

After reviewing a client's list of medications the nurse asks if the client ever experiences a dry mouth. Which medication on the list caused the nurse to ask the client this question? Oral hypoglycemic agent Anticoagulant Diuretic Vasodilator

Diuretic Explanation: Many of the medications used by older adults, such as diuretics, can affect salivation and cause a dry mouth. Vasodilators, anticoagulants, and oral hypoglycemic agents are not identified as adversely affecting salivation.

An older adult client asks about natural means to promote bowel elimination. What should the nurse encourage the client to incorporate into a daily routine? Select all that apply. A variety of vegetables Organic foods Increased fluid intake Regular physical activity Increased fruit intake

Increased fluid intake Increased fruit intake A variety of vegetables Regular physical activity Explanation: Fluid, fruits, vegetables, and activity are important to incorporate into a daily routine to promote bowel elimination. Foods do not need to be organic to enhance bowel function.

During a physical examination, the nurse notes that the older adult client has a smooth red tongue. Which follow-up intervention would the nurse anticipate? Biopsy any lesions Nutritional screening Screening for lead poisoning Scraping of the tongue

Nutritional screening Explanation: A smooth red tongue can be an indication of an iron, vitamin B12, or niacin deficiency. There is no need to biopsy the tongue, scrape it, or screen for lead poisoning.

For several months, a nurse has been providing care to a resident of a long-term care facility who has dementia. For the past several days, the resident has been uncharacteristically resistant to the nurse providing oral care. What action should the nurse take? Provide oral care at a time of day when the client is settled and drowsy. Perform oral assessment to determine any possible causes of pain. Encourage a trusted family member to attempt oral care. Postpone oral care for 24 hours then gently try again.

Perform oral assessment to determine any possible causes of pain. Explanation: An older adult resident with dementia who resists oral care should be carefully assessed for lesions or other potential causes of pain that may be contributing to resistance. This assessment should be performed promptly rather than temporarily forgoing oral care and then trying again. If the resident is experiencing pain, changing the timing of care or having the family participate will be ineffective.

An older adult states experiencing heart palpitations ever since adding a vitamin and nutrient supplement to the diet. The nurse checks the label of the client's supplement. For which vitamin or nutrient is the nurse assessing? Vitamin D Calcium Folic acid Potassium

Potassium Explanation: High doses of potassium can cause cardiac problems or even lead to cardiac arrest. Excess in vitamin D can lead to calcium deposits in the kidneys and arteries. Excess calcium can lead to kidney stones or impaired ability to absorb other minerals. Excess folic acid can mask vitamin B12 deficiency.

The nurse is caring for an older adult client with dysphagia. Which intervention(s) will the nurse implement for this client? Select all that apply. Providing client with frequent oral care Minimizing distractions during the client's mealtimes Instructing client to throw head back while swallowing Advising client to alternate between small amounts of solids and liquids Encouraging client to perform regular swallowing exercises

Providing client with frequent oral care Encouraging client to perform regular swallowing exercises Advising client to alternate between small amounts of solids and liquids Minimizing distractions during the client's mealtimes Explanation: Providing client with frequent oral care, encouraging client to perform regular swallowing exercises, advising client to alternate between small amounts of solids and liquids, and minimizing distractions during the client's mealtimes are all interventions the nurse will implement for the older adult client with dysphagia. It is not advisable that the client throw his or her head back while swallowing. Instead, the client may use the chin-tuck technique for successful swallowing.

The nurse is caring for an unresponsive client who wears partial dentures. Which action will the nurse take to provide oral care for this client? Provide oral care using lemon-glycerin swabs. Remove dentures and place in drawer while the client is responsive. Brush teeth and dentures while in the mouth on a daily basis. Remove dentures, brush teeth and dentures daily.

Remove dentures, brush teeth and dentures daily. Explanation: The partial dentures of an unresponsive client should be removed and brushed at least daily. The nurse should also dry brush the teeth and return the partial appliance to the mouth to maintain form. Brushing the teeth and dentures while in the mouth will not allow for cleaning underneath the dentures. Lemon-glycerin swabs should not be used; they dry the oral mucosa and erode tooth enamel.

A client diagnosed with dysphagia has difficulty moving food from the mouth to the esophagus. Which instruction(s) would the nurse provide when teaching the client how to manage this disorder? Select all that apply. Cut food into small bites. Include foods high in fiber. Follow a bland diet. Drink milkshakes or other thickened liquids. Sit upright to avoid choking.

Sit upright to avoid choking. Cut food into small bites. Drink milkshakes or other thickened liquids Explanation: A client with dysphagia should be monitored closely for aspiration. Therefore, the client should be instructed to sit upright and ingest small bites in an unhurried manner. Often, milkshakes or other thickened liquids will be more easily swallowed and can provide a supplement to missing minerals and vitamins in the diet. A bland diet would be needed for clients with peptic ulcers and a diet high in fiber would be needed for a client with diverticulitis.

The nurse is preparing to facilitate a referral for an older adult client with dysphagia. To which member of the multidisciplinary team will the nurse place the referral? Speech-language therapist Geriatric nurse specialist Rehabilitation therapist Registered dietician

Speech-language therapist Explanation: The nurse will facilitate a referral to the speech-language therapist, whose specialty involves addressing dysphagia. The rehabilitation therapist specializes in addressing conditions that affect eating and recommends adaptive equipment; the nurse will not facilitate a referral to this specialty. The registered dietician addresses nutritional status, identifies and addresses risks, and establishes a nutritional plan of care for the client; the client's dysphagia is not directly addressed by this specialty. The geriatric nurse specialist is a nurse with focused expertise in providing nursing care to older adult clients, but does not directly address dysphagia, therefore the nurse will not place a referral to this team member.

The nurse is caring for a client who is diagnosed with xerostomia related to age-related decline in saliva production. Which intervention will the nurse implement for this client? Suck on hard candy during the day. Drink carbonated beverages. Avoid fluids at mealtime. Sip cold water throughout the day.

Suck on hard candy during the day. Explanation: The nurse should recommend the client chew sugarless gum or suck on sugarless candy because these actions can stimulate salivary flow. The nurse should recommend the client sip room-temperature water throughout the day and night and avoid drinking water at an extreme water temperature (very hot or very cold) which can inhibit salivary flow. The client should avoid carbonated beverages, because they often contain sodium that can cause dryness of the mouth. Drinking at mealtime helps to moisten food to ease consumption

The nurse is teaching a class to older adults about oral health practices. What health promotion activity should the nurse recommend? Visit a dentist every three months after the age of 80 Schedule visits to a dentist solely on the basis of tooth pain Visit a dentist every six months to detect oral diseases Visit a dentist every six months to check dentures

Visit a dentist every six months to detect oral diseases Explanation: For older adults, visiting a dentist every six months to detect oral diseases is necessary due to the risk for oral disease in this population. Less frequent visits are acceptable for those using a full set of dentures. Dental care should be proactive, not only on the basis of pain. Clients older than 80 years of age do not normally need to see a dentist every three months

The nurse is teaching a class to older adults about oral health practices. What health promotion activity should the nurse recommend? Visit a dentist every three months after the age of 80 Visit a dentist every six months to detect oral diseases Visit a dentist every six months to check dentures Schedule visits to a dentist solely on the basis of tooth pain

Visit a dentist every six months to detect oral diseases Explanation: For older adults, visiting a dentist every six months to detect oral diseases is necessary due to the risk for oral disease in this population. Less frequent visits are acceptable for those using a full set of dentures. Dental care should be proactive, not only on the basis of pain. Clients older than 80 years of age do not normally need to see a dentist every three months.

The nurse suspects that an older adult's diarrhea is related to medications. Which medication should the nurse consider as causing this client's problem? prednisone ampicillin codeine propranolol

ampicillin Explanation: Ampicillin is identified as having the potential to cause diarrhea. Codeine is identified as having the potential to cause constipation. Prednisone is identified as having the potential to cause fluid and electrolyte disturbances. Propranolol is identified as having the potential to cause anorexia.

The nurse suspects that an older adult client is having problems with eating. What assessment finding may cause the nurse to make this clinical determination? dentures in a glass of water in the bathroom dentures fitted with a liner 6 months ago last dental appointment 3 months ago completes mouth care twice a day

dentures in a glass of water in the bathroom Explanation: Not wearing the dentures could indicate that they are ill-fitting or uncomfortable. Conducting mouth care, seeing a dentist regularly, and having the dentures fitted and adjusted would not indicate a problem with the dentures.

The nurse is concerned that an older adult client is experiencing undiagnosed malnutrition. What information may cause the nurse to make this clinical determination? serum calcium level 9 mg/dL (2.25 mmol/L) hematocrit level 37% (0.37) hemoglobin level 13 g/dL (130 g/L) serum albumin level 2.8 g/dL (28 g/L)

serum albumin level 2.8 g/dL (28 g/L) Explanation: A clinical sign of malnutrition is a serum albumin level below 3.5 g/dL (35 g/L). Other clinical signs include a hematocrit level below 35% (0.35) and hemoglobin level below 12 g/dL (120 g/L). Serum calcium is not use as an indicator of malnutrition

An older adult client is embarrassed because of increased flatulence. What will the nurse recommend to this client? consume meals faster sit upright after meals avoid drinking fluids with meals drink warm tea before bedtime

sit upright after meals Explanation: Sitting upright after meals is helpful in allowing flatulence, or gas, to rise to the fundus of the stomach and be expelled. Consuming meals faster may increase flatulence as more air is typically swallowed when eating faster. The increased swallowed air becomes flatulence. Warm tea has no therapeutic effect on the development of flatus. Flatus is not caused by drinking fluids with meals.

A health care provider has prescribed a calcium supplement for an older adult client. Which other important nutrients should the nurse teach the client to eat to promote calcium absorption? sodium and vitamin B12 vitamin E and potassium potassium and vitamin K vitamin D and magnesium

vitamin D and magnesium Explanation: The nurse should include in the teaching that a good intake of vitamin D and magnesium facilitates calcium absorption. Potassium and vitamin K, sodium and vitamin B12, and vitamin E and potassium are not included in the teaching because they do not have significant effects on the reabsorption of calcium.