1430 Exam 4 Nutrition and Sleep

The night nurse goes quietly into the sleeping clients room to assess him. The client wakes up as soon as the nurse is in the room. The nurse knows that the client was most likely in which stage of sleep? 1 Stage 1: NREM 2 Stage 2: NREM 3 Stage 3: NREM 4 Stage 4: NREM

1 Stage 1 NREM includes the lightest level of sleep. Sensory stimuli such as noise easily arouses the person. The stage lasts a few minutes. Decreased physiological activity begins with gradual fall in vital signs and metabolism. Awakened, person feels as though daydreaming has occurred. Stage 2 NREM is a period of sound sleep. Stage 3 NREM involves initial stages of deep sleep. Stage 4 NREM is the deepest stage of sleep. It is very difficult to arouse the sleeper.

The nurse knows that which of the following habits may interfere with a clients sleep? 1 Listening to classical music 2 Finishing office work 3 Reading novels 4 Drinking warm milk

2 At home a client should not try to finish office work or resolve family problems before bedtime. Noise should be kept to a minimum. Soft music may be used to mask noise if necessary. Reading a light novel, watching an enjoyable television program, or listening to music helps a person to relax. Relaxation exercises can be useful at bedtime. A dairy product snack such as warm milk or cocoa that contains L-tryptophan may be helpful in promoting sleep.

The nurse is counseling a 64-year-old client that it is important to eat plenty of fruits and vegetables, but the client should avoid which of the following because it can inhibit the absorption of some drugs? 1 Oranges 2 Grapefruit 3 Pineapple 4 Asparagus

2 Caution older adults to avoid grapefruit and grapefruit juice because these will decrease absorption of many drugs.

A 9-year-old client asks the nurse, Why do I need to sleep? The nurses most age-appropriate, informative response is: 1 Everyone needs to sleep to feel rested. 2 It gives your body a chance to really rest. 3 Youll be able to do so much better in school if youre rested. 4 Your body needs to rest in order to grow and be really healthy.

4 Sleep contributes to physiological and psychological restoration, maintenance, and growth of the body at any age. The remaining options are not as effective at providing a thorough answer to the childs question. The body needs sleep to routinely restore biological processes

A client is seen in the outpatient clinic for follow-up of a nutritional deficiency. In planning for the clients dietary intake, the nurse includes a complete protein, such as: 1 Eggs 2 Oats 3 Lentils 4 Peanuts

1 A complete protein contains all essential amino acids in sufficient quantity to support growth and maintain nitrogen balance. Eggs and meats are examples of complete proteins. Incomplete proteins lack one or more of the nine essential amino acids and include oats (cereals) and legumes (lentils and peanuts).

An 11-year-old boy in middle school is currently experiencing sleep-related fatigue during classes. Which of the following is the most appropriate response by the school nurse when counseling the childs parents regarding this assessment? 1 What are the childs usual sleep patterns? 2 Establish bedtimes for the child, and withhold his allowance whenever those times are not adhered to. 3 We need to explore other health-related problems, because sleep problems are not likely the cause of his fatigue. 4 The bulbar synchronizing region of the childs central nervous system is causing these insomniac problems

1 A school-age child will be tired the following day if allowed to stay up later than usual. The nurse should ask a question to assess the childs usual sleep patterns. The nurse should first assess the childs usual sleep pattern to determine if the child is adhering to a bedtime. A sleep problem is often the cause of fatigue

Which of the following would the nurse expect to see offered on a full liquid diet? 1 Custard 2 Pureed meats 3 Soft fresh fruit 4 Canned soup

1 Custard is included in a full liquid diet. Pureed meats are allowed in a pureed diet, not a full liquid diet. Soft fresh fruit is not included in a full liquid diet. Fresh fruit is often part of a highfiber diet. Cooked or canned fruits are allowed on a mechanical soft diet. Canned soup is not part of full liquid diet because it may contain noodles or rice or vegetables. Soups are allowed on a mechanical soft diet.

Which of the following clients is most likely to experience difficulty returning to sleep? 1 A 60-year-old with benign hypertropic prostatic disease 2 A 15-year-old with type 1 diabetes 3 A 35-year-old diagnosed with hypothyroidism 4 A 55-year-old diagnosed with hypertension

1 Nocturia, or urination during the night, disrupts sleep and the sleep cycle. This condition is most common in older people with reduced bladder tone or persons with cardiac disease, diabetes, urethritis, or prostatic disease. After a person awakens repeatedly to urinate, returning to sleep is difficult. Although all the clients may have difficulty falling back to sleep when awakened, the answer represents the client with the greatest tendency to be awakened during the night.

A client is suspected of having a fat-soluble vitamin deficiency. To assist the client with this deficiency, the nurse informs the client that: 1 More exposure to sunlight and drinking milk could solve your nutritional problem 2 Eating more pork, fish, eggs, and poultry will increase your vitamin B complex intake 3 Increasing your protein intake will increase your negative nitrogen imbalance 4 Decreasing your triglyceride levels by eating less saturated fats would be a good health intervention for you

1 The fat-soluble vitamins are A, D, E, and K. With the exception of vitamin D, which can be obtained through exposure to sunlight, these vitamins are provided through dietary intake, including fortified milk. The B vitamins are not fat-soluble; they are water-soluble vitamins. Increasing protein intake will improve (decrease) a negative nitrogen imbalance, not increase it. Furthermore, increasing protein intake does not address the problem of a fat-soluble vitamin deficiency.

The nurse should instruct the client to do which of the following to promote good sleep hygiene at home? 1 Use the bedroom only for sleep or sexual activity. 2 Eat a large meal 1 to 2 hours before bedtime. 3 Exercise vigorously before bedtime. 4 Stay in bed if sleep does not come after hour.

1 The nurse should explain that, if possible, the bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity, besides sex. The nurse should instruct the client to avoid heavy meals for 3 hours before bedtime; a light snack may help. The nurse should also instruct the client to try to exercise daily, preferably in morning or afternoon, and to avoid vigorous exercise in the evening within 2 hours of bedtime. Getting out of bed and doing some quiet activity until feeling sleepy enough to go back to bed if the client does not fall asleep within 30 minutes of going to bed may also help.

A 74-year-old client has been having sleeping difficulties. To have a better idea of the clients problem, the nurse should respond: 1 What do you do just before going to bed? 2 Lets make sure that your bedroom is completely darkened at night. 3 Why dont you try napping more during the daytime? 4 Do you eat a small snack before going to bed?

1 To assess the clients sleeping problem, the nurse should inquire about predisposing factors, such as by asking What do you do just before going to bed? Assessment is aimed at understanding the characteristics of any sleep problem and the clients usual sleep habits so that ways for promoting sleep can be incorporated into nursing care. Older adults sleep best in softly lit rooms. Napping more during the daytime is often not the best solution. The nurse should first assess the clients sleeping problem. The client does not always have to eat something before going to bed.

The nurse is delegating the feeding of an older adult client to ancillary personnel. Which of the following should the nurse include in the instructions as possible warning signs of dysphagia (difficulty swallowing)? (Select all that apply.) 1 Delay in swallowing food 2 Easily triggered gag reflex 3 Absence of a gag reflex 4 Uncoordinated speech 5 Disinterest in eating 6 Pocketing food

1, 2, 3, 4, 6 Signs of dysphagia include the following: cough during eating; change in voice tone or quality after swallowing; abnormal movements of the mouth, tongue, or lips; and slow, weak, imprecise, or uncoordinated speech. Abnormal gag reflex, delayed swallowing, incomplete oral clearance or pocketing, regurgitation, pharyngeal pooling, delayed or absent trigger of swallow, and inability to speak consistently are other signs of dysphagia.

Which of the following assessment findings in an older adult increases the individuals risk for poor nutrition? (Select all that apply.) 1 Living on a Social Security income check 2 Did not graduate from high school 3 Is easily tired by activity 4 Living in a group home 5 Chronically depressed 6 Recently widowed

1, 2, 3, 5, 6 Malnutrition in older adults has multiple causes, such as income, educational level, physical functioning level to meet activities of daily living (ADLs), loss, dependency, loneliness, and transportation. Living in a managed environment is not a risk factor for poor nutrition.

Although the most common effect of obstructive sleep apnea is a disrupted sleep pattern, the condition can cause a serious decline in arterial oxygen levels that may result in: (Select all that apply.) 1 Hypertension 2 Angina attacks 3 Alzheimers disease 4 Cardiac dysrhythmias 5 Cerebral vascular accidents 6 Type 2 diabetes

1, 2, 4, 5 Obstructive apnea causes a serious decline in arterial oxygen saturation level. Clients are at risk for cardiac dysrhythmias, right-sided heart failure, pulmonary hypertension, angina attacks, stroke, and hypertension. The other options are not directly related to a diminished supply of arterial oxygen.

Which of the following client statements made by young adults suggest a risk factor for sleep disturbance problems? (Select all that apply.) 1 I have a job that requires my attention 110% of the time. 2 I really enjoy fishing; I wish we lived closer to a river or pond. 3 My wife just found out she is pregnant for the third time in5 years. 4 My father recently suffered a heart attack, and Mom is so very worried about him. 5 The kids are so active in after-school things that we never have an evening at home. 6 Gardening always gave me such a sense of accomplishment, but I dont have much free time now.

1, 3, 4, 5 It is common for the stresses of jobs, family relationships, and social activities to lead frequently to insomnia and the use of medication for sleep. The remaining options reflect a sense of loss but not necessarily of stress.

The nurse and a client are discussing possible behaviors that might be interfering with the clients ability to fall asleep. Which of the following assessment questions is most likely to identify possible problems with the clients sleep routine that possibly are contributing to the difficulty? 1 When do you usually retire for the night? 2 What do you do to help yourself fall asleep? 3 How much time does it usually take for you to fall asleep? 4 Have you changed anything about your presleep ritual lately?

2 As people try to fall asleep, they close their eyes and assume relaxed positions. Stimuli to the RAS decline. If the room is dark and quiet, activation of the RAS further declines. At some point the BSR takes over, causing sleep. If the client engages in activities such as reading or watching television as a means of falling asleep, this could be causing the problem. Although the other questions are not inappropriate, they are not as directed toward the cause of the problem.

Which assessment action will help the nurse determine if an obese patient has metabolic syndrome? a. Take the patients apical pulse. b. Check the patients blood pressure. c. Ask the patient about dietary intake. d. Dipstick the patients urine for protein.

B Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information also may be obtained by the nurse, but it will not assist with the diagnosis of metabolic syndrome

Which of the following symptoms should the nurse assess with a client who is deprived of sleep? 1 Elevated blood pressure and confusion 2 Confusion and irritability 3 Inappropriateness and rapid respirations 4 Decreased temperature and talkativeness

2 Psychological symptoms of sleep deprivation include confusion and irritability. Elevated blood pressure is not a symptom of sleep deprivation. Rapid respirations are not a symptom of sleep deprivation. There may be a decreased ability of reasoning and judgment that could lead to inappropriateness. Decreased temperature is not a symptom of sleep deprivation. The client with sleep deprivation is often withdrawn, not talkative.

A client is discussing his recent restlessness and increased irritability. Which of the following assessment questions is likely to be most helping in determining the cause of these complaints? 1 When did you start noticing these changes? 2 Has anything caused you to change your usual routine lately? 3 Do you have any idea what might be causing these problems? 4 What makes you think that you are more irritable than is normal for you?

2 When the sleep-wake cycle becomes disrupted (e.g., by working rotating shifts), other physiological functions usually change as well. For example, the person experiences a decreased appetite and loses weight. Anxiety, restlessness, irritability, and impaired judgment are other common symptoms of sleep cycle disturbances. Failure to maintain the individuals usual sleepwake cycle negatively influences the clients overall health. Although the other options are not inappropriate, they are not as directly aimed at determining the cause of the changes.

The nurse is caring for a 35-year-old father of three young children who has experienced a compound fractured femur as a result of a work-related incident. He has expressed great concern over both his physical recovery and his long-term ability to work again. This has affected both his emotional status and his sleeping patterns. The nurses most immediate concern is that: 1 The client needs medication to prevent depression 2 The lack of appropriate rest will affect his healing process 3 An occupational therapy consult should be ordered to help him regain his ability to return to his job 4 A psychiatric consult should be ordered to help the client deal with his various emotional concerns

2 You must always be aware of the clients need for rest. A lack of rest for long periods causes illness or worsening of existing illness. Although the other options are appropriate concerns, they are not as immediate in nature as is the sleep problem

The nurse and a client are discussing the importance of an effective 24-hour sleep cycle. Which of the following responses by the client may be a direct result of an inadequate sleep pattern? (Select all that apply.) 1 Gaining weight 2 Usually feeling cold 3 Always feeling tired 4 A heart that beats really fast 5 Often feeling blue or depressed 6 Feeling dizzy when getting up from a chair

2, 3, 4, 5, 6 The predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood depend on the maintenance of the 24-hour circadian cycle. Weight gain is not typically a result of poor sleep patterns.

Which of the following factors are believed to contribute to the prevalence of overweight children seen in America today? (Select all that apply.) 1 Unavailability of high-nutrient-density foods 2 Reliance on food as a stress-coping mechanism 3 Decline in an interest in physically active hobbies 4 Reliance on fast foods for major portion of daily diet 5 Increased interest in passive, technology-driven activities 6 Reduced supervision in the home, especially during afterschool hours

2, 3, 4, 5, 6 A combination of factors contributes to the problem, including a diet rich in high-calorie foods, inactivity, genetic predisposition, use of food as a coping mechanism for stress or boredom, and family and social factors. There is not a scarcity of healthy foods in this country.

A new mother is concerned that her 2-week-old daughter is not sleeping through the night. The nurse should respond that infants usually develop a nighttime pattern of sleep by: 1 1 month 2 2 months 3 3 months 4 6 months

3 Infants usually develop a nighttime pattern of sleep by 3 months of age.

When providing nutritional guidance, the nurse shares with the mother of an 8-year-old client that children of this age need to: 1 Increase their intake of B vitamins 2 Significantly increase iron intake 3 Maintain a sufficient intake of protein and vitamins A and C 4 Increase carbohydrates to meet increased energy needs

3 School-age childrens diets should be carefully assessed for adequate protein and vitamins A and C. School-age children frequently fail to eat a proper breakfast and have unsupervised intake at school. An increase in B complex vitamins is needed to support heightened metabolic activity of the adolescent, and the pregnant woman has a need to significantly increase iron intake. Increased energy needs are expected in the adolescent period.

The physiology of sleep is complex. Which of the following is the most appropriate statement in regard to this process? 1 Ultradian rhythms occur in a cycle longer than 24 hours. 2 Nonrapid eye movement (NREM) refers to the cycle that most clients experience when in a high-stimulus environment. 3 The reticular activating system is partly responsible for the level of consciousness of a person. 4 The bulbar synchronizing region (BSR) causes the rapid eye movement (REM) sleep in most normal adults.

3 The ascending reticular activating system (RAS) located in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness. Infradian rhythms, not ultradian rhythms, occur in a cycle longer than 24 hours. Nonrapid eye movement refers to the sleep cycle that most clients experience in a low-stimulus environment. The bulbar synchronizing region is the area of the brain where serotonin is released to produce sleep. It is not responsible for REM sleep.

It is determined that the client will need pharmacological treatment to assist with the clients sleep patterns. The nurse anticipates that treatment with an anxiety-reducing, relaxation promoting medication will include the use of: 1 Barbiturates 2 Amphetamines 3 Benzodiazepines 4 Tricyclic antidepressants

3 The benzodiazepines cause relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal. Withdrawal from CNS depressants, such as barbiturates, can cause insomnia and must be managed carefully. Barbiturates can cause tolerance and dependence. Central nervous system stimulants, such as amphetamines, should be used sparingly and under medical management. Amphetamine sulfate may be used to treat narcolepsy. Prolonged use may cause drug dependence. Tricyclic antidepressants can cause insomnia when withdrawn and should be managed carefully. They are used primarily to treat depression.

Which of the following may improve the sleep of an older adult client? 1 Drinking an alcoholic beverage before bedtime 2 Using an over-the-counter sleeping agent 3 Eliminating naps during the day 4 Going to bed at a consistent time even if not feeling sleepy

3 To promote sleep, daytime naps should be eliminated. If naps are used, they should be limited to 20 minutes or less twice a day. Alcohol should be limited in the late afternoon and evening because it has an insomnia-producing effect. The use of nonprescription sleeping medications is not advisable. Over the long term, these drugs can lead to further sleep disruption even when they initially seemed to be effective. Following a bedtime routine should be consistent, not necessarily going to bed. The client should engage in quiet activities that promote relaxation and then may go to bed. If the client has not fallen asleep in 30 minutes, the client should get up out of bed and do some quiet activity until feeling sleepy enough to go back to bed.

The client asks the nurse, How will I know if Im really rested? The nurses most therapeutic response is: 1 Everyones definition of rested is different. How would you define rested? 2 When you arent tired when you get up in the morning or after an afternoon nap. 3 When you are mentally, physically, and emotionally ready to go about your daily activities. 4 You are rested if you fall asleep easily and sleep uninterruptedly for at least 6 to 8 hours.

3 When people are at rest they are in a state of mental, physical, and spiritual activity that leaves them feeling refreshed, rejuvenated, and ready to resume the activities of the day. The remaining options ask questions or provide a limited view on what rested means.

A client is pregnant for the third time. In regard to her nutritional status, she should: 1 Limit her weight gain to a maximum of about 25 pounds 2 Approximately double her protein intake 3 Increase her vitamin A and milk product consumption 4 Increase her intake of folic acid

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A client has reported to the nurse that his sprained ankle resulted from a careless accident. I seem so clumsy and unfocused lately. Which of the following assessment questions is most likely to reveal information regarding the cause of these symptoms? 1 How many accidents have you had lately? 2 Have the accidents resulted in serious injuries? 3 Have there been any changes in your daily routine lately? 4 Do you have any idea what is responsible for this lack of focus?

4 A loss of REM sleep leads to feelings of confusion and suspicion. Various body functions (e.g., mood, motor performance, memory, and equilibrium) are altered when prolonged sleep loss occurs. Research estimates that traffic, home, and work-related accidents caused by falling asleep are often a result of sleep loss. This answer is the best question because it directly opens up the opportunity for the client to discuss possible sleep problems if they exist. The other questions are not inappropriate but are less likely to reveal the possible cause of the accidents.

A client is concerned that her habit of sleeping during the day and being awake at night is not healthy or normal. The nurses most therapeutic response to the clients concern is: 1 What makes you think that sleeping during the day and being up at night is unhealthy or abnormal? 2 Many people share your sleep habits. As long as you feel all right, I dont think there is anything to worry about. 3 Are you interested in changing your sleep habits for any particular reason? Is sleeping during the day a problem for you? 4 Everyone has a different biological clock that controls his or her sleep cycle. As long as you are sleeping and functioning well, your habit isnt abnormal or unhealthy.

4 All persons have biological clocks that synchronize their sleep cycles. If the sleep pattern does not adversely affect the clients health or ability to function, it is not problematic.

The nurse recognizes that the sleep patterns of older adults differ and older adults generally: 1 Are more difficult to arouse 2 Require more sleep than middle-age adults 3 Take less time to fall asleep 4 Have a decline in stage 4 sleep

4 As people age, there is a progressive decrease in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep, sleep. Older people do not become more difficult to arouse, not do they require more sleep than the middle-age adult. An older adult awakens more often during the night, and it may take more time for an older adult to fall asleep.

When assisting the client who practices Islam or Judaism with meal planning, the nurse knows that both religions share an avoidance of: 1 Alcohol 2 Shellfish 3 Caffeine 4 Pork products

4 Clients who practice Islam or Judaism share an avoidance of pork in their diet. Clients who practice Islam avoid alcohol and caffeine but will eat shellfish. Clients who practice Judaism do not restrict alcohol or caffeine intake and only eat fish with scales. Seventh-Day Adventists also avoid shellfish. Mormons also avoid caffeine.

While doing a nutritional assessment of a low-income family, the community health nurse determines the familys diet is inadequate in protein content. The nurse suggests which of the following foods to increase protein content with little increase in the food budget? 1 Oranges and potatoes 2 Potatoes and rice 3 Rice and macaroni 4 Peas and beans

4 For families on limited budgets, substitutes can be used. For example, bean or cheese dishes can often replace meat in a meal. Peas and lentils are also inexpensive food sources of protein. Oranges and potatoes are not high in protein content. Potatoes and rice are sources of carbohydrates, not protein. Rice and macaroni are carbohydrates and are not high in protein

Which of the following clients experiencing disrupted sleep patterns is most at risk for obstructive sleep apnea (OSA)? 1 A 15-year-old boy with type 1 diabetes 2 A 22-year-old diagnosed with Crohns disease 3 A 49-year-old man who is an avid cross-county runner 4 A 58-year-old woman diagnosed with chronic depression

4 Many think OSA affects middle-age men more frequently, particularly when they are obese. However, obstructive sleep apnea is also common in postmenopausal women, younger women, and children. Although the clients in all of the options may experience OSA, the postmenopausal woman has the greatest risk.

Which of the following information provided by the clients bed partner is most associated with sleep apnea? 1 Restlessness 2 Talking during sleep 3 Somnambulism 4 Excessive snoring

4 Partners of clients with sleep apnea often complain that the clients snoring disturbs their sleep. Restlessness is not most associated with sleep apnea. Sleep talking is associated with sleep-wake transition disorders; somnambulism is associated with parasomnias (specifically, arousal disorders and sleep-wake transition disorders).

The mother of a 2-year-old child is frustrated because the child does not want to go to bed at the scheduled bedtime. The nurse should suggest that the parent: 1 Offer the child a bedtime snack 2 Eliminate one of the naps during the day 3 Allow the child to sleep longer in the mornings 4 Maintain consistency in the same bedtime ritual

4 The nurse should advise the parent to maintain a regular bedtime and wake-up schedule and to reinforce patterns of preparing for bedtime. A bedtime routine (e.g., same hour for bedtime, quiet activity) used consistently helps young children avoid delaying sleep. It is most important that the parent maintains a consistent bedtime routine. If a bedtime snack is already part of that routine, then this is allowable. If it is not, then the child may only use having a snack as a measure of procrastination. After 3 years of age the child may give up daytime naps. A bedtime routine used consistently will be more effective in helping the child who resists going to sleep. The same regular bedtime and wake-up schedule should be maintained

A client shares with the nurse that My wife complains about my snoring, and I never really feel rested. Which of the following responses best attempts to explain the cause of the problem to the client? 1 Sleep disturbances can really affect all aspects of your life. How long have you been experiencing this problem? 2 You need to get help to breathe more effortlessly at night so both you and your wife can get sufficient deep stage sleep. 3 Something is interfering with your ability to breathe while you are asleep. Have you talked with your health care provider about the problem? 4 Your upper airway is blocked, and that is making it difficult for you to breathe effectively, so you are spending most of the night in the light sleep stage.

4 The upper airway becomes partially or completely blocked, and diminished nasal airflow (hypopnea) can result for as long as 30 seconds. The person attempts to breathe, which often results in loud snoring and snorting sounds. The effort to breathe during sleep results in arousals from deep sleep, often to the stage 2 cycle, causing interference with deep sleep and thus the clients not feeling rested. The remaining options are not inappropriate, but they are not as directed at explaining the problem to the client.

The nurse is completing an assessment of the clients sleep patterns. A specific question that the nurse should ask to determine the potential presence of sleep apnea is: 1 How easily do you fall asleep? 2 Do you have vivid, lifelike dreams? 3 Do you ever experience loss of muscle control or falling? 4 Do you snore loudly or experience headaches?

4 To assess for sleep apnea (unlike assessing for narcolepsy or insomnia), the nurse may ask, Do you snore loudly? and Do you experience headaches after awakening? A positive response may indicate the client experiences sleep apnea.

During a nutritional assessment, the nurse calculates that a female patient's BMI is 27. The nurse would advise the patient to follow which of these recommendations a. This measurement indicates that the patient is overweight and should follow a plan of diet and exercise to lose weight. b. This measurement indicates that the patient is underweight and will need to take measures to gain weight. c. This measurement indicates that the patient is morbidly obese and may be a candidate for bariatric surgery. d. This measurement indicates that the patient is of normal weight and should continue with current lifestyle.

A A BMI of 25-29.9 is in the overweight range. A BMI of <18.5 is in the underweight range. A BMI of 30-34.9 is obesity class I, a BMI of 35-39.9 is obesity class II, and a BMI of >40 is obesity class III (morbid obesity). A BMI of 19-24 is in the normal range.

When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include? a. Blood glucose test b. Cardiac enzyme tests c. Postural blood pressures d. Resting electrocardiogram

A A fasting blood glucose test >100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome although they may be used to check for cardiovascular complications of the disorder.

A patient complains of not being able to fall asleep at night and asks the nurse if there is a safe, non-prescription medication he can try. After consulting the healthcare provider, the nurse should recommend which naturally occurring hormone? a. Melatonin b. Cortisol c. Luteinizing hormone d. Estrogen

A A rise in the hormone melatonin at the onset of sleep helps to promote and maintain sleep, and a drop in levels leads to eventual awakening. The immune system is enhanced as well during sleep as proteins associated with fighting illness are produced. The circadian rhythm, or the typical 24 hour (more or less) cycle through which the body passes, including both awake and sleep cycles, is responsible for regulating all of the physiologic processes in the body. An adequate amount and quality of sleep, therefore, is essential to all of the regulatory mechanisms that take place in the body.

Which patient statement indicates a need for further teaching about extended-release zolpidem (Ambien CR)? a. I will take the medication an hour before bedtime. b. I should take the medication on an empty stomach. c. I should not take this medication unless I can sleep for at least 6 hours. d. I will schedule activities that require mental alertness for later in the day.

A Benzodiazepine receptor agonists such as zolpidem work quickly and should be taken immediately before bedtime. The other patient statements are correct.

Which finding for a 19-year-old female who is a vegan may indicate the need for cobalamin supplementation? a. Paresthesias b. Ecchymoses c. Dry, scaly skin d. Gingival swelling

A Cobalamin (vitamin B12 ) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, such as paresthesias, peripheral neuropathy, and anemia. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.

The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best exercise plan for weight loss? a. Walking for 40 minutes 6 or 7 days/week b. Lifting weights with friends 3 times/week c. Playing soccer for an hour on the weekend d. Running for 10 to 15 minutes 3 times/week

A Exercise should be done daily for 30 minutes to an hour. Exercising in highly aerobic activities for short bursts or only once a week is not helpful and may be dangerous in an individual who has not been exercising. Running may be appropriate, but a patient should start with an exercise that is less stressful and can be done for a longer period. Weight lifting is not as helpful as aerobic exercise in weight loss.

During a physical examination, the nurse notes that the patient's skin is dry and flaking. What additional data would the nurse expect to find to confirm the suspicion of a nutritional deficiency? a. Hair loss and hair that is easily removed from the scalp b. Inflammation of the tongue and fissured tongue c. Inflammation of peripheral nerves and numbness and tingling in extremities d. Fissures and inflammation of the mouth

A Hair loss (alopecia) and hair that is easily removed from the scalp (easy pluckability), like dry, flaking skin, is caused by essential fatty acid deficiency. Inflammation of the tongue (glossitis) and fissured tongue are manifestations of a niacin deficiency. Inflammation of peripheral nerves (neuropathy) and numbness and tingling in extremities (paresthesia) are manifestations of a thiamin deficiency. Fissures of the mouth (cheilosis) and inflammation of the mouth (stomatitis) are manifestations of a pyridoxine deficiency.

The nurse enters a patient's room and the patient startles easily and appears to jerk his arms and legs before awakening. Which stage of non-rapid eye movement sleep did the patient most likely awaken from? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

A In Stage 1 (N1 or Non-REM Stage 1), referred to as light sleep, the individual can be awakened easily. In this stage, brain waves slow and, on EEG, the slower wave pattern known as alpha waves appears. The individual at this point is likely to drift in and out of sleep and can be awakened easily. Sensations known as hypnagogic hallucinations can occur during this stage. A common sensation of this type is the feeling of falling. Uncontrolled muscle jerks sometimes occur at this stage along with sudden movements that can startle the individual and restore wakefulness.

What teaching should be included in the plan of care for a patient with narcolepsy? a. Driving an automobile may be possible with appropriate treatment of narcolepsy. b. Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy. c. Antidepressant drugs are prescribed to treat the depression caused by the disorder. d. Stimulant drugs should be used for only a short time because of the risk for abuse.

A The accident rate for patients with narcolepsy who are receiving appropriate treatment is similar to the general population. Stimulant medications are used on an ongoing basis for patients with narcolepsy. The purpose of antidepressant drugs in the treatment of narcolepsy is the management of cataplexy, not to treat depression. Changes in sleep hygiene are recommended for patients with narcolepsy to improve sleep quality.

A 40-year-old obese woman reports that she wants to lose weight. Which question should the nurse ask first? a. What factors led to your obesity? b. Which types of food do you like best? c. How long have you been overweight? d. What kind of activities do you enjoy?

A The nurse should obtain information about the patients perceptions of the reasons for the obesity to develop a plan individualized to the patient. The other information also will be obtained from the patient, but the patient is more likely to make changes when the patients beliefs are considered in planning.

A patient complains of insomnia and daytime fatigue. What is the first action the nurse should take in addressing the patients concerns? a. Question the patient about the use of over-the-counter (OTC) sleep aids. b. Suggest that the patient decrease intake of caffeine-containing beverages. c. Advise the patient to get out of bed if unable to fall asleep in 10 to 20 minutes. d. Recommend that the patient use any prescribed sleep aids for only 2 to 3 weeks.

A The nurses first action should be assessment of the patient for factors that may contribute to poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions may be appropriate, but assessment is needed first to choose appropriate interventions to improve the patients sleep.

A patient with sleep apnea who uses a continuous positive airway pressure (CPAP) device is preparing to have inpatient surgery. Which instructions should the nurse provide to the patient? a. Remind the patient to take the CPAP device to the hospital. b. Plan to schedule a nighttime polysomnography (PSG) study before surgery. c. Discourage the patient from requesting pain medication while hospitalized. d. Call the hospital to ensure that mechanical ventilation will be available for the patient.

A The patient should be told to take the CPAP device to the hospital if an overnight stay is expected. Many patients will be able to use their own CPAP equipment, but hospital policy should be checked to make sure it can be used. Patients should be treated for pain and monitored for respiratory depression. Another PSG is not required before surgery. There is no need to call the hospital if the patient takes the CPAP device to the hospital.

A healthy 28-year-old woman patient who weighs 145 pounds (66 kg) asks the nurse about the minimum daily requirement for protein. How many grams of protein will the nurse recommend? a. 53 b. 66 c. 75 d. 98

A The recommended daily protein intake is 0.8 to 1 g/kg of body weight, which for this patient is 66 kg0.8 g = 52.8 or 53 g/day.

The nurse is caring for a child with tonsillar enlargement. What is the nurse's priority concern? a. Low oxygen saturation b. Daytime fatigue c. Increased temperature d. Antibiotic administration

A Tonsillar enlargement in children often leads to obstructive sleep apnea which can cause decreased oxygen saturation levels. Low oxygen is a priority concern which carries the highest safety risk to the child. Obstructive sleep apnea occurs in an estimated 1-3% of children, though the causative factors may differ with tonsillar enlargement being a significant component in children. Infection that leads to an increased temperature and requires antibiotic therapy is a concern, but the priority health concern is low oxygen levels. Obstructive sleep apnea can interfere with sleep patterns and lead to daytime fatigue, but the highest priority of care is low oxygen.

Which of the nurses assigned patients should be referred to the dietitian for a complete nutritional assessment (select all that apply)? a. A 23-year-old who has a history of fluctuating weight gains and losses b. A 35-year-old who complains of intermittent nausea for the past 2 days c. A 64-year-old who is admitted for dbridement of an infected surgical wound d. A 52-year-old admitted with chest pain and possible myocardial infarction (MI) e. A 48-year-old with rheumatoid arthritis who takes prednisone (Deltasone) daily

A, C, E Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition.

An African American is at an increased risk for which of the following? (Select all that apply.) a. Vitamin D deficiency b. Type 1 diabetes c. Celiac disease d. Type 2 diabetes e. Hypertension f. Metabolic syndrome

A, D, E, F Type 1 diabetes and celiac disease are more common in Northern European heritage

The nurse is making rounds on the hospital unit and observes a patient sleeping. The patient's pulse and respiratory rates are slower than baseline. The nurse realizes the patient has most likely just entered which stage of non-rapid eye movement sleep? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

B In Stage 2 (N2), eye movement ceases; brain waves become even slower with the exception of an occasional burst or more rapid brain waves. Pulse rate and respirations slow and body temperature decreases as the individual moves toward deeper stages of sleep. Stage 3 (N3) and Stage 4 (N4) are the periods of deep sleep.

The home care nurse is assessing an older patient diagnosed with mild cognitive impairment (MCI) in the home setting. Which information is of concern? a. The patient's son uses a marked pillbox to set up the patient's medications weekly. b. The patient has lost 10 pounds (4.5 kg) during the last month. c. The patient is cared for by a daughter during the day and stays with a son at night. d. The patient tells the nurse that a close friend recently died.

B A 10-pound weight loss in 1 month could indicate cancer or may be an indication of further progression of memory loss. Depression is also another common cause of weight loss. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this patient. It is not unusual that an older patient would have friends who have died

The nurse is completing a nutritional assessment on a patient with hypertension. What foods would be recommended for this patient? a. Regular diet b. Low sodium diet c. Pureed diet d. Low sugar diet

B A low sodium diet will prevent water retention which could increase blood pressure. Patients with hypertension would not be on a regular diet due to sodium content. A pureed diet is indicated for stroke patients who may have impaired swallowing. A low sugar diet is indicated for patients with diabetes.

Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider? a. The patient frequently has liquid stools. b. The patient is pale and has many bruises. c. The patient complains of bloating after meals. d. The patient is experiencing a weight loss plateau

B Because orlistat blocks the absorption of fat-soluble vitamins, the patient may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. Weight loss plateaus are normal during weight reduction.

Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program? a. Having the adults write down the caloric intake of each meal b. Asking the adults about situations that tend to increase appetite c. Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals d. Encouraging the adults to eat small amounts frequently rather than having scheduled meals

B Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as calorie counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior modification.

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass? a. Educating the patient about the nasogastric (NG) tube b. Instructing the patient on coughing and breathing techniques c. Discussing necessary postoperative modifications in lifestyle d. Demonstrating passive range-of-motion exercises for the legs

B Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery.

A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports feeling too tired to eat. Which action should the nurse take first? a. Teach the patient about the importance of good nutrition. b. Serve multiple small feedings of high-calorie, high-protein foods. c. Obtain an order for enteral feedings of liquid nutritional supplements. d. Consult with the health care provider about providing parenteral nutrition (PN).

B Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patients ability to take in more nutrients. Teaching the patient may be appropriate, but will not address the patients inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally, but increasing the oral intake should be attempted first.

The nurse cares for a critically ill patient in the intensive care unit (ICU). Which intervention should the nurse include in the plan of care to improve this patients sleep quality? a. Ask all visitors to leave the ICU for the night. b. Lower the level of lights from 8:00 PM until 7:00 AM. c. Avoid the use of opioids for pain relief during the evening hours. d. Schedule assessments to allow at least 4 hours of uninterrupted sleep.

B Lowering the level of light will help mimic normal day/night patterns and maximize the opportunity for sleep. Although frequent assessments and opioid use can disturb sleep patterns, these actions are necessary for the care of critically ill patients. For some patients, having a family member or friend at the bedside may decrease anxiety and improve sleep.

The nurse manager of a medical/surgical unit wants to improve the alertness of nurses who work the night shift. Which action will be the most helpful? a. Arrange for older staff members to work most night shifts. b. Provide a sleeping area for staff to use for napping at night. c. Post reminders about the relationship of sleep and alertness. d. Schedule nursing staff to rotate day and night shifts monthly.

B Short on-site naps will improve alertness. Rotating shifts causes the most disruption in sleep habits. Reminding staff members about the impact of lack of sleep on alertness will not improve sleep or alertness. It is not feasible to schedule nurses based on their ages.

The nurse must awaken a patient from Stage 4 non-rapid eye movement sleep in order to prepare the patient for a procedure. The patient is disoriented. What is the nurse's best action? a. Notify the healthcare provider. b. Re-assess the patient's orientation. c. Administer an anti-anxiety medication. d. Cancel the patient's procedure.

B Stage 3 (N3) and Stage 4 (N4) are the periods of deep sleep. N3 is characterized by very slow brain waves called delta waves interspersed with smaller, faster waves. In Stage 4 (N4), the EEG shows almost exclusively delta waves. In this type of sleep it is difficult to awaken the individual and muscle activity is very limited or may be completely absent. A person awakened from Stage 3 or 4 of sleep could be disoriented for a brief period of time before regaining awareness.

Which action should the nurse take first when preparing to teach a frail 79-year-old Hispanic man who lives with an adult daughter about ways to improve nutrition? a. Ask the daughter about the patients food preferences. b. Determine who shops for groceries and prepares the meals. c. Question the patient about how many meals per day are eaten. d. Assure the patient that culturally preferred foods will be included.

B The family member who shops for groceries and cooks will be in control of the patients diet, so the nurse will need to ensure that this family member is involved in any teaching or discussion about the patients nutritional needs. The other information will also be assessed and used but will not be useful in meeting the patients nutritional needs unless nutritionally appropriate foods are purchased and prepared.

A severely malnourished patient reports that he is Jewish. The nurses initial action to meet his nutritional needs will be to a. have family members bring in food. b. ask the patient about food preferences. c. teach the patient about nutritious Kosher foods. d. order nutrition supplements that are manufactured Kosher.

B The nurses first action should be further assessment whether or not the patient follows any specific religious guidelines that impact nutrition. The other actions may also be appropriate, based on the information obtained during the assessment.

A 48-year-old woman has a body mass index (BMI) of 31 kg/m2 , a normal C-reactive protein level, and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patients intake of foods that are high in a. iron. b. protein. c. calories. d. carbohydrate.

B The patients C-reactive protein and transferrin levels indicate low protein stores. The BMI is in the obese range, so increasing caloric intake is not indicated. The data do not indicate a need for increased carbohydrate or iron intake.

A 19-year-old female admitted with anorexia nervosa is 5 ft 6 in (163 cm) tall and weighs 88 pounds (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which nursing diagnosis has the highest priority? a. Risk for activity intolerance related to anemia b. Risk for electrolyte imbalance related to eating patterns c. Ineffective health maintenance related to body image obsession d. Imbalanced nutrition: less than body requirements related to anorexia

B The patients hypokalemia may lead to life-threatening cardiac dysrhythmias. The other diagnoses are also appropriate for this patient but are not associated with immediate risk for fatal complications.

Which adult will the nurse plan to teach about risks associated with obesity? a. Man who has a BMI of 18 kg/m2 b. Man with a 42 in waist and 44 in hips c. Woman who has a body mass index (BMI) of 24 kg/m2 d. Woman with a waist circumference of 34 inches (86 cm)

B The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level of <0.80. A patient with a BMI of 18 kg/m2 is considered underweight. A BMI of 24 kg/m2 is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm).

After the nurse teaches a patient about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the initial instructions about diet have been understood? a. 3 oz of lean beef, 2 oz of low-fat cheese, and a tomato slice b. 3 oz of roasted pork, a cup of corn, and a cup of carrot sticks c. Cup of tossed salad and nonfat dressing topped with a chicken breast d. Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery

B This selection is most consistent with the recommendation of the American Institute for Cancer Research that one third of the diet should be from animal sources and two thirds from plant source foods. The other choices all have higher ratios of animal origin foods to plant source foods than would be recommended.

After bariatric surgery, a patient who is being discharged tells the nurse, I prefer to be independent. I am not interested in any support groups. Which response by the nurse is best? a. I hope you change your mind so that I can suggest a group for you. b. Tell me what types of resources you think you might use after this surgery. c. Support groups have been found to lead to more successful weight loss after surgery. d. Because there are many lifestyle changes after surgery, we recommend support groups.

B This statement allows the nurse to assess the individual patients potential needs and preferences. The other statements offer the patient more information about the benefits of support groups, but fail to acknowledge the patients preferences.

After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition? a. Serum albumin level is 3.5 mg/dL. b. Fluid intake and output are balanced. c. Surgical incision is healing normally. d. Blood glucose is less than 110 mg/dL.

C Because poor wound healing is a possible complication of malnutrition for this patient, normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition. Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia, but it does not indicate that the patients nutrition is adequate. The intake and output will be monitored, but do not indicate that the PN is effective. The albumin level is in the low-normal range but does not reflect adequate caloric intake, which is also important for the patient.

A mother tells the nurse she is concerned because her 8-month-old infant sleeps all day and night and is only awake about 2-3 hours per day. What is the nurse's best response? a. "This sleep pattern is very normal for an infant at this age." b. "Adding an additional feeding will keep the child awake more." c. "I recommend that you notify the child's pediatrician." d. "Be sure you are laying the child on his back to sleep at night."

C By approximately 6 months of age, the infant should sleep through the night with at least one nap during the day. 2-3 hours of wakefulness per day is not an expected finding at age 8 months and should be reported to the pediatrician to determine the underlying cause. An additional feeding may be warranted; however the pediatrician should be notified first. Lying on infant on the back to sleep is recommended to prevent sudden infant death syndrome; however the priority concern is the length of time the child is sleeping.

During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema. Which nutritional deficiency might be present? a. Vitamin C b. Vitamin B c. Essential fatty acid d. Protein

C Dry and scaly skin is a manifestation of essential fatty acid deficiency. Vitamin C deficiency causes bleeding gums, arthralgia, and petechiae. Vitamin B deficiency is too large a category to consider. Specific categories of vitamin B deficiency have been identified, such as pyridoxine and thiamine. Protein deficiency causes decreased pigmentation and lackluster hair.

A 76-year-old woman with a body mass index (BMI) of 17 kg/m2 and a low serum albumin level is being admitted by the nurse. Which assessment finding will the nurse expect to find? a. Restlessness b. Hypertension c. Pitting edema d. Food allergies

C Edema occurs when serum albumin levels and plasma oncotic pressure decrease. The blood pressure and level of consciousness are not directly affected by malnutrition. Food allergies are not an indicator of nutritional status

The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? a. Assist the patient to choose high-nutrition items from the menu. b. Monitor the patient for skin breakdown over the bony prominences. c. Offer the patient the prescribed nutritional supplement between meals. d. Assess the patients strength while ambulating the patient in the room.

C Feeding the patient and assisting with oral intake are included in UAP education and scope of practice. Assessing the patient and assisting the patient in choosing high-nutrition foods require licensed practical/vocational nurse (LPN/LVN)or registered nurse (RN)level education and scope of practice.

Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1000-calorie diet? a. It will be necessary to change lifestyle habits permanently to maintain weight loss. b. You will decrease your risk for future health problems such as diabetes by losing weight now. c. You are likely to notice changes in how you feel with just a few weeks of diet and exercise. d. Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.

C Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 22-year-old patient is unlikely to be motivated by future health problems. Telling a patient that the initial weight loss is water will be discouraging, although this may be correct. Changing lifestyle habits is necessary, but this process occurs over time and discussing this is not likely to motivate the patient

A few months after bariatric surgery, a 56-year-old man tells the nurse, My skin is hanging in folds. I think I need cosmetic surgery. Which response by the nurse is most appropriate? a. The important thing is that you are improving your health. b. The skinfolds will disappear once most of the weight is lost. c. Cosmetic surgery is a possibility once your weight has stabilized. d. Perhaps you would like to talk to a counselor about your body image.

C Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. Skinfolds may not disappear over time, especially in older patients. The response, The important thing is that your weight loss is improving your health, ignores the patients concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counselor, it is more likely to be helpful to know that cosmetic surgery is available.

A patient tells the nurse that he experiences daytime fatigue even after 7-8 hours of sleep each night. What is the best assessment question for the nurse to ask? a. Have you tried getting 10 hours of sleep instead of 8 hours? b. How long are you in the rapid eye movement (REM) stage? c. Do you also have any recent lifestyle or behavior changes? d. Do any of your close relatives have any sleep disorders?

C The best question to elicit the most pertinent information is "Do you also have any recent lifestyle or behavior changes?" The patient is getting 7-9 hours/sleep each night, which is expected for the average adult. The patient will not be able to recall an unconscious state such as REM sleep. The patient may have close relatives with sleep disorders but this does not necessarily affect the patient's own sleep habits.

A patient complains of difficulty falling asleep and daytime fatigue for the past 6 weeks. What is the best initial action for the nurse to take in determining whether this patient has chronic insomnia? a. Schedule a polysomnography (PSG) study. b. Arrange for the patient to have a sleep study. c. Ask the patient to keep a 2-week sleep diary. d. Teach the patient about the use of an actigraph.

C The diagnosis of insomnia is made on the basis of subjective complaints and an evaluation of a 1- to 2-week sleep diary completed by the patient. Actigraphy and PSG studies/sleep studies may be used for determining specific sleep disorders but are not necessary to make an initial insomnia diagnosis.

After successfully losing 1 lb weekly for several months, a patient at the clinic has not lost any weight for the last month. The nurse should first a. review the diet and exercise guidelines with the patient. b. instruct the patient to weigh and record weights weekly. c. ask the patient whether there have been any changes in exercise or diet patterns. d. discuss the possibility that the patient has reached a temporary weight loss plateau.

C The initial nursing action should be assessment of any reason for the change in weight loss. The other actions may be needed, but further assessment is required before any interventions are planned or implemented.

A 20-year-old female is being admitted for electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider? a. The patient uses laxatives daily. b. The patients knuckles are macerated. c. The patients serum potassium level is 2.9 mEq/L. d. The patient has a history of large weight fluctuations

C The low serum potassium level may cause life-threatening cardiac dysrhythmias, and potassium supplementation is needed rapidly. The other information will also be reported because it suggests that bulimia may be the etiology of the patients electrolyte disturbances, but it does not suggest imminent life-threatening complications.

Which information regarding a patients sleep is most important for the nurse to communicate to the health care provider? a. 64-year-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning b. 21-year-old student who takes melatonin to assist in sleeping when traveling from the United States to Europe c. 41-year-old librarian who has a body mass index (BMI) of 42 kg/m2 says that the spouse complains about snoring d. 32-year-old accountant who is experiencing a stressful week uses diphenhydramine (Benadryl) for several nights

C The patients BMI and snoring suggest possible sleep apnea, which can cause complications such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to affect this patients sleep quality.

What information will the nurse include for an overweight 35-year-old woman who is starting a weightloss plan? a. Weigh yourself at the same time every morning and evening. b. Stick to a 600- to 800-calorie diet for the most rapid weight loss. c. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. d. Weighing all foods on a scale is necessary to choose appropriate portion sizes.

C The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorie-restricted diets are not necessary for patients in the overweight category of obesity and need to be closely supervised. Patients should weigh weekly rather than daily.

The nurse is caring for a 54-year-old female patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? a. Bilateral crackles audible at both lung bases b. Redness, irritation, and skin breakdown in skinfolds c. Emesis of bile-colored fluid past the nasogastric (NG) tube d. Use of patient-controlled analgesia (PCA) several times an hour for pain

C Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected.

Which information obtained by the nurse about an older adult who complains of occasional insomnia indicates a need for patient teaching (select all that apply)? a. Drinks a cup of coffee every morning with breakfast b. Has a snack every evening 1 hour before going to bed c. Likes to read or watch television in bed on most evenings d. Usually takes a warm bath just before bedtime every night e. Occasionally uses diphenhydramine (Benadryl) as a sleep aid

C, E Reading and watching television in bed may contribute to insomnia. Older adults should avoid the use of medications that have anticholinergic effects, such as diphenhydramine. Having a snack 1 hour before bedtime and/or coffee early in the day should not affect sleep quality. Rituals such as a warm bath before bedtime can enhance sleep quality.

During an interview, the nurse is discussing dietary habits with a patient. Which tool would be the best choice to use as a quick screening tool to assess dietary intake? a. Food diary b. Calorie count c. Comprehensive diet history d. 24-hour recall

D A 24-hour recall is useful as a quick screening tool to assess dietary intake. A food diary provides detailed information, but it is not convenient and requires a follow-up visit. A calorie count requires several days to collect data and requires a trained dietician to analyze the results. A comprehensive diet history may provide more accurate reflection of nutrient intake, but it is time-consuming to acquire and requires a trained/skilled dietary interviewer.

A patient with chronic insomnia asks the nurse about ways to improve sleep quality. What is the nurses best response? a. Avoid aerobic exercise during the day. b. Read in bed for a few minutes each night. c. Keep the bedroom temperature slightly warm. d. Try to go to bed at the same time every evening.

D A regular evening schedule is recommended to improve sleep time and quality. Aerobic exercise may improve sleep quality but should occur at least 6 hours before bedtime. Reading in bed is discouraged for patients with insomnia. The bedroom temperature should be slightly cool.

When caring for patients with sleep disorders, which activity can the nurse appropriately delegate to unlicensed assistive personnel (UAP)? a. Interview a new patient about risk factors for obstructive sleep disorders. b. Discuss the benefits of oral appliances in decreasing obstructive sleep apnea. c. Help a patient choose an appropriate continuous positive airway pressure (CPAP) mask. d. Assist a patient to place the CPAP device correctly over the nose and mouth at bedtime.

D Because CPAP mask placement is consistently done in the same way, this is appropriate to delegate to UAP. The other actions require critical thinking and nursing judgment, and should be done by the RN.

Which menu choice indicates that the patient is implementing plans to choose high-calorie, high-protein foods? a. Baked fish with applesauce b. Beef noodle soup and canned corn c. Fresh fruit salad with yogurt topping d. Fried chicken with potatoes and gravy

D Foods that are high in calories include fried foods and those covered with sauces. High protein foods include meat and dairy products. The other choices are lower in calories and protein.

A 60-year-old man who is hospitalized with an abdominal wound infection has only been eating about 50% of meals and states, Nothing on the menu sounds good. Which action by the nurse will be most effective in improving the patients oral intake? a. Order six small meals daily. b. Make a referral to the dietitian. c. Teach the patient about high-calorie foods. d. Have family members bring in favorite foods.

D The patients statement that the hospital foods are unappealing indicates that favorite home-cooked foods might improve intake. The other interventions may also help improve the patients intake, but the most effective action will be to offer the patient more appealing foods.

The nurse is assisting a 79-year-old patient with information about diet and weight loss. The patient has a body mass index (BMI) of 31. How should the nurse instruct this patient? a. "Your weight is within normal limits. Continue maintaining with current lifestyle choices." b. "You are a little overweight. Cut down on calories and increase your activity, and you should be fine." c. "You are morbidly obese, and we would like to schedule you an appointment to speak with a bariatric specialist about surgery." d. "You are considered obese and will need to consult with your doctor about a plan that includes exercises, not diet, to decrease weight."

D This patient is at an increased risk for sarcopenia and should be instructed to increase activity that includes strength training to prevent muscle loss. Diet is not indicated. A BMI of 31 is considered obese; however, this patient does not qualify for surgical intervention until BMI reaches over 35.