Chapter 10 Disorders of Nutritional Status PrepU Mastery

Frustrated with his inability to lose weight despite attempting numerous fad diets, a 42 year-old male who is 5'11" and 270 lbs. has visited a clinic to gain tools to achieve long term weight loss. Which of the following statements by the clinician is most accurate?

"A combined approach of behavior therapy, changing your lifestyle habits and increased physical activity gives the highest chance of long term success."

An extremely obese patient has been researching bariatric surgery after trying to lose weight for many years with dietary changes and exercise, without success. The patient informs the nurse that he is interested in having the Roux-en-Y gastric bypass. Which of the following statements by the patient indicates the need for further education?

"After the surgery, I will be able to eat what I want and will still continue to lose weight."

As part of the intake protocol at an eating disorders clinic, an interview precedes a physical examination. Which of the following questions would a clinician be justified in excluding from an intake interview of a 16 year-old female referred by her pediatrician for the treatment of anorexia nervosa?

"Have you had any episodes of shortness of breath in the recent past?"

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

BMI = weight [kg]/height [meter2]

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

Carbohydrates

A nurse is educating a group of patients about adequate nutrition. Which of the following should the nurse include when discussing diets that are adequate in calories but deficient in protein?

Patients may be at risk for developing kwashiorkor.

Fat is a necessary part of the diet. The Food and Nutrition Board has set what adult AMDR for fats?

25% - 35%

A nurse is assigned to care for a group of patients. Which of the following patients is most likely to be diagnosed with malabsorption syndrome?

A 40-year-old with severe inflammatory bowel disease

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

Perfectionistic and compulsive

Which of the following factors does the nurse recognize as being independent predictors of risk factors and mortality for obese patients?

Presence of excess fat in the abdomen out of proportion to total body fat

When educating students about the differences between brown fat versus white fat, the instructor will share that brown fat has iron in its mitochondria that will facilitate:

Production of a protein that releases the energy generated from metabolism as heat

A patient presents to the clinic with severe edema. Which of the following types of deficiency should be suspected in this patient?

Protein

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

Saturated fatty acids

A patient is on a high-protein diet in order to increase weight loss. The nurse is aware that high-protein meals increase the normal metabolic rate significantly and lasts 3-12 hours. Which of the following does the nurse tell the patient what this phenomenon is referred to?

Specific dynamic action of proteins

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

The body stores energy in adipose tissue

A 43 year-old male who is 5'10" tall and weighs 216 lbs. has been informed by his nurse practitioner that his body mass index (BMI) is 31. Which of the following clinical conclusions based on these data would his nurse be most justified in rejecting?

The client is borderline obese but is not yet at the point of significantly increased risks to health.

A nurse assessing a female patient obtains a waist circumference of 92 cm from the patient. Which of the following does this finding indicate to the nurse?

The patient may have increased health risks associated with this finding.

The nurse is teaching an extremely obese patient who is having bariatric surgery about the benefits related to weight-loss surgery. Which of the following should the nurse include when discussing the priority benefit to the patient?

There will be a resolution of comorbid disease states.

A nurse is explaining how the majority of body energy is stored in the body. The best explanation would be through:

Triglycerides

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

Using food as a reward

The nurse is caring for a hospital patient with chronic obstructive pulmonary disease with peripheral obesity. When performing an assessment of this client, which of the following does the nurse anticipate finding?

Varicose veins

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

Vegetables

Two types of obesity are recognized: upper body obesity and lower body obesity. How is the type of obesity determined?

Waist/hip circumference

The poison control nurse is helping calm a hysterical mother who called because her child ingested 10 tablets of B-complex vitamins. The mother keeps repeating over and over again, "Is my child is going to die?" Which of these should the nurse convey to the mother?

Water-soluble vitamins are excreted into the urine, making toxicity less likely.

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

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

A nurse is assessing a patient who is suspected of having anorexia nervosa (AN). Which of the following characteristics does the nurse anticipate finding? Select all that apply.

• Constipation • Bradycardia • Amenorrhea

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

• Ethnicity • Heredity • Mother had gestational diabetes during pregnancy

A child asks about the purpose (function) of "white" fat. Which responses by the nurse are best? Select all that apply.

• It store energy for the body to use. • It regulates temperature through insulation. • It cushions vital organs of the body

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

• Milk • Eggs • Chicken

The nurse is caring for a very ill client. When evaluating this client's protein status, the nurse should look at which lab/diagnostic test results?

Prealbumin and albumin

Which of the following clients would be most reasonably expected to have the highest basal metabolic rate (BMR), assuming none is obese or malnourished?

A 60 year-old man, 72 inches tall, who is recovering from heart surgery

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

Hypertension

A patient tells the nurse that "if my cholesterol is high, I guess I should try and eliminate all cholesterol in my diet." Which of the following should the nurse inform the patient what the importance of cholesterol is? Select all that apply.

• Produce hormones • Metabolize many vitamins • Affect cell permeability

A client developed malnutrition while hospitalized for an illness. The client does not understand how that could have happened. The best response would be:

"Malnutrition is also common during illness, recovery from trauma, and hospitalization."

A patient is having difficulty with a weight loss plan and asks the nurse, "What is wrong with me? Why can't I lose this weight?" Which of the following rationales might the nurse offer to this patient?

"Obesity ultimately results from an energy imbalance of eating too many calories and not getting enough exercise."

A homeless client asks, "Why can't I get this wound on my foot to heal?" Knowing that the client is not receiving good nutrition on a regular basis, the nurse will reply:

"Right now your immune system is decreased because you are not eating a balanced diet."

A dietitian is working with a morbidly obese client in an effort to facilitate weight loss. Which of the dietitian's following teaching points about the nature of adipose tissue should be included in the client education?

"Your fat cells can be considered to be one large energy-storage organ that also has a role in hormone production."

In order to prevent muscle wasting, what is the minimal range of carbohydrates that must be consumed per day?

50 to 100 grams

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

50-100 g/day

When counseling a group of overweight individuals, the nurse should stress that during parties, the oxidation of alcohol provides how many kilocalorie/gram to ones diet?

7 kcal/g.

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

A pregnant woman needs an extra 300 kcal/day above the usual caloric intake.

Which of the following statements about types of obesity is most accurate?

A waist-hip ratio greater than 1.0 in men can be interpreted to mean upper body obesity.

During a humanitarian trip to an underdeveloped country a medical student is assessing a 6 year-old male who has a protuberant abdomen, dry hair and wrinkled skin. The child's heart rate is 59 beats per minute, blood pressure 89/50 and temperature 95.2°F (35.1°C). What is the most likely etiology of the child's health problems?

A diet deficient in both protein and calories.

Which statement is true concerning energy requirements across the lifespan?

A newborn requires more kcal/kg of body weight than a 10 year old.

When caring for a client in the medical clinic who has tried to lose weight multiple times, the client asks the nurse if she should try a high-protein, very low-calorie restricted diet. The nurse encourages her to seek guidance from the health care provider as these diets may cause which complication?

Cardiac dysrhythmias

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

Apple shaped

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

Breast-feeding mother who delivered 1 month ago

An 18-year-old client is seen in the emergency department after fainting at school. The client reports severe indigestion, and the nurse notes tooth erosion and an irregular heartbeat. The nurse suspects the client may have developed:

Bulimia nervosa

A client asks the nurse the best way to estimate protein utilization by the body. The best response would be:

By measuring the amount of nitrogen excreted in the urine

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

Client has monthly menses.

Anorexia nervosa, bulimia nervosa, and binge-eating disorder are becoming more and more common, with assessments for these disorders being made as young as 9 years of age. In the adult population, what means of controlling binge eating is most prevalent in men?

Compulsive exercise

A nurse is teaching a patient about the difference between saturated and unsaturated fats. Which of the following should the nurse inform the patient is the best source for unsaturated fats?

Corn oil

A nurse is assisting a group of patients with a weight loss program and is to determine the obesity type that each patient has. Which of the following would help the nurse determine the type of obesity?

Dividing the waist measurement by the hip circumference

Childhood obesity has now been recognized as a major problem in the pediatric population. What diseases are pediatricians now seeing in their clients as a direct result of childhood obesity?

Dyslipidemia

A client asks how the body recognizes that enough food has been consumed during a meal. The best response would be:

Gastrointestinal stretch receptors

Digested dietary carbohydrates are primarily converted to:

Glucose

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

Ketones

A patient informs the nurse that he or she feels as though he or she have a kidney stone again. The patient is on a diet for weight loss and feels as though this may be a contributing factor as it never occurred before going on the diet. Which of the following diets does the nurse suspect the patient may be on?

Low-carbohydrate/high protein

A nurse is caring for a patient with bulimia nervosa who has been admitted to the hospital with weakness, hypotension, and abdominal discomfort. Which of the following types of acid-base imbalance should the nurse assess the patient for?

Metabolic acidosis

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

Milk and eggs

When examining types of energy expenditure, which of the following statements is accurate?

More active and people who fidget may have less fat gain than those with decreased non-exercise activity thermogenesis.

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

Patient is considered obese.