Unit 7 Chapter 17 Altered Nutrition

Frustrated with his inability to lose weight despite attempting numerous fad diets, a 42 year-old male who is 5'11" (1.8 m) and 270 lbs (122.7 kg) has visited a clinic to gain tools to achieve long term weight loss. Which statement 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."

A client 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 rationale might the nurse offer to this client?

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

A parent brings her 12-year-old to the clinic and informs the nurse that the child may have anorexia nervosa (AN). Using the diagnostic criteria for AN, what subjective data should the nurse obtain during the assessment? Select all that apply. -"Does the child require constant attention from others?" -"Does the child seem to have an distorted idea of what the body size looks like?" -"Does the child have a fear of gaining weight?" -"Does the child seem to have a loss of interest in daily activities?" -"Has there been an inability to maintain normal body weight for age and height?"

-"Has there been an inability to maintain normal body weight for age and height?" -"Does the child have a fear of gaining weight?" -"Does the child seem to have an distorted idea of what the body size looks like?"

When educating a client with newly diagnosed celiac disease, which statement(s) are accurate to include? Select all that apply. -"Oatmeal for breakfast is a good alternative to boxed cereals for your breakfast." -"Rice noodles will be easier for you to digest." -"You may be prescribed anti-inflammatory drugs." -"You can eat cornbread made with corn meal and no flour as an alternative to wheat bread." -"You can safely eat pizza if the crust is made with wheat flour." -"Cancer of the bowel can result if you do not follow the treatment plan."

-"You can eat cornbread made with corn meal and no flour as an alternative to wheat bread." -"Rice noodles will be easier for you to digest." -"You may be prescribed anti-inflammatory drugs." -"Cancer of the bowel can result if you do not follow the treatment plan."

Which of the following clients coming to a small free clinic are at high risk for malnutrition? Select all that apply. -A 32-year-old construction working having muscle spasms in his back -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 17-year-old female who thinks she might have been exposed to syphilis -A 60-year-old homeless Vietnam veteran complaining of pain

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

A nurse is assessing a client who is suspected of having anorexia nervosa (AN). Which characteristic does the nurse anticipate finding? Select all that apply. -Amenorrhea -Thick fingernails -Dysmenorrhea -Bradycardia -Constipation

-Constipation -Bradycardia -Amenorrhea

When working with a family whose newborn was diagnosed with phenylketonuria (PKU), which teaching(s) does the nurse provide? Select all that apply. -Use sugar rather than aspartame to sweeten foods. -Encourage a diet that includes fruits and nonstarchy vegetables. -Strictly avoid intake of tyrosine, a dietary supplement used to improve alertness. -Supplement nuts and beans rather than meats for protein choices. -Avoid high protein meats and dairy products. -Administer sapropterin, a cofactor, as prescribed.

-Encourage a diet that includes fruits and nonstarchy vegetables. -Use sugar rather than aspartame to sweeten foods. -Avoid high protein meats and dairy products. -Administer sapropterin, a cofactor, as prescribed.

While educating a client about dietary fat intake, which function(s) will the nurse mention during this education? Select all that apply. -Fats promote clot formation. -Fats insulate body organs to maintain core temperature. -Fats support digestion by decreasing gastrointestinal motility. -Fats maintain blood pressure by causing vasoconstriction. -Fats stimulate secretion of pancreatic enzyme.

-Fats stimulate secretion of pancreatic enzyme. -Fats support digestion by decreasing gastrointestinal motility.

In order for a client to have effective cellular metabolism, which body fuels will be required? Select all that apply. -Glucose -Vitamin D -Folic acid -Amino acids -Fats

-Glucose -Fats -Amino acids

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. -Regular balanced eating pattern -Mother had gestational diabetes during pregnancy -Excessive exercise -Underweight parents -Ethnicity -Heredity

-Heredity -Ethnicity -Mother had gestational diabetes during pregnancy

The nurse educates a young adult client with poorly controlled Crohn disease (an inflammatory bowel disease) about digestive enzymes that fail to be secreted properly due to intestinal inflammation of the small intestine. Which digestive enzymes will the nurse discuss? Select all that apply. -trypsin -pancreatic lipases -lactase -intestinal lipase -aminopeptidases

-Lactase -aminopeptidases -intestinal lipase

Adipose tissue is now known to be both an endocrine and a paracrine organ because of the factors it secretes. What are these factors? Select all that apply. -Insulin resistance factor -Leptin -Adipokines -Adiponectin -Growth hormone

-Leptin -Adiponectin -Adipokines

Which individualized plan does the nurse understand will be included in the initial plan of treatment for the client who seeks treatment for obesity? Select all that apply. -Lifestyle modification with behavioral therapy -Surgery -Increased physical activity -Medications -Reduced-calorie diet

-Lifestyle modification with behavioral therapy -Reduced-calorie diet -Increased physical activity

When explaining how digestive enzymes and bile take consumed food and convert it to absorbable components, which accessory organ(s) will the nurse include? Select all that apply. -appendix -salivary glands -pancreas -liver -esophagus

-Liver -Salivary Glands -Pancreas

A client is diagnosed with kwashiorkor. Which assessment finding(s) correlate with a lack of protein intake plus inability to synthesize new proteins? Select all that apply. -abdominal distention -protruding blood vessels -petechiae -severe edema -palpable enlarged liver -wasting syndrome

-severe edema -abdominal distention -palpable enlarged liver

When presenting a nutritional overview, the nurse emphasizes that most adults should consume what percentage of protein in their daily diet?

10% to 35%

Fat is a necessary part of the diet. The Health and Medicine Division's Food and Nutrition Board has set what adult Acceptable Macronutrient Distribution Ranges (AMDR) for fats?

25%-35%

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

A 40-year-old with severe inflammatory bowel disease

Which statement 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 lecture, an instructor asks a student to give an example of feedback messages from the gastrointestinal tract to the hypothalamus. What is the student's best response?

After a meal, food triggers gastrointestinal tract stretch receptors and insulin secretion, resulting in a decrease in appetite

The nurse is caring for a client diagnosed with a vitamin K deficiency. Which other finding should the nurse anticipate?

Altered coagulation

Which function is performed by saliva?

Antimicrobial protection

A 17-year-old female has announced to her family physician a desire to wholly eliminate fats from her diet. Which aspect of the role of fats would underlie the physician's response to the client?

Apart from providing energy, fats are necessary as carriers of certain vitamins and are precursors to prostaglandins.

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]

Which client has the greatest caloric needs?

Breast-feeding mother who delivered 1 month ago

Which enzymes adhere to the border of the villus structures to allow access to carbohydrate and protein molecules?

Brush Border

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

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

Carbohydrates

A client with a body mass index of 32 would be classified as:

Class I obesity

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

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

Clients may be at risk for developing kwashiorkor.

A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What will the individual's body do with the excess carbohydrates provided by this meal?

Convert them into glucose and store them in the liver and muscles

A school nurse has identified a student with noticeable loss of lean tissues and muscle mass likely due to protein-calorie malnutrition. The nurse should assess for which clinical manifestation to help confirm a diagnosis?

Diarrhea

Which aspect of gastrointestinal function is performed by the brush border enzymes of the villus structures?

Digestion of carbohydrates

When caring for a client with Crohn disease who has a large portion of the small intestine inflamed, how does the nurse explain what happens to nutrient absorption at this time?

Due to the inflammation in the intestine, the absorption of nutrients does not occur, resulting in malabsorption.

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

Similarities between women with anorexia nervosa and bulimia nervosa include which clinical manifestation?

Electrolyte imbalances

The nurse is caring for a client exhibiting anemia, decreased appetite, fatigue, and headaches. Which nutritional deficiency does the nurse suspect?

Folate

During the first prenatal clinic visit, the nurse encourages the client to eat a diet high in foods fortified with folate. Which reason is provided as to why folate is encouraged?

Folate prevents neural tube defects in the fetus.

Which measures would likely be rejected as part of a first-line weight loss plan for a client with a BMI of 30.2, type 2 diabetes, and hypertension?

Gastric Bypass

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

Gastrointestinal stretch receptors

The body converts dietary carbohydrates into which substance?

Glucose

Ghrelin produced in the mucosal layer of the stomach has a role in regulation of which hormone that contributes to the regulation of weight?

Growth Hormone

In collecting assessment data on the school-aged population, which factor could be the most significant predictor of childhood obesity?

Having parents who are obese

Which characteristic distinguishes kwashiorkor from marasmus?

High intake of carbohydrates

The nurse is caring for a client with a diagnosis of vitamin C deficiency. Which complication does the nurse anticipate?

Increased risk of Infection

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

Incrementally feeding combined with vitamin and mineral supplementation

Which substance necessary for vitamin B12 absorption is produced by the parietal cells in the stomach?

Intrinsic factor

Which body mechanism is necessary for food intake control?

Leptin Receptor stimulation

An older adult client is frail and has been diagnosed with severe protein-energy malnutrition. Which laboratory value is correlated with this diagnosis?

Low prealbumin

In addition to facilitating bowel movements, a high-fiber diet performs which other benefit to the body?

Lowering cholesterol and moderating blood glucose

When examining types of energy expenditure, which statement is accurate?

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

Protein contains nitrogen. A negative nitrogen balance represents:

More nitrogen excreted than consumed

The nurse is performing an assessment on a client diagnosed with a vitamin E deficiency. Which assessment finding should the nurse anticipate?

Muscle Weakness

Which explanation does the nurse provide a client regarding a diagnosis of Peyer patches in the small intestine?

Peyer patches house the lymphocytes used to protect against gastrointestinal pathogens.

A client at the clinic reports leg pain, edema, and bruising. X-ray reveals several fractures in the tibia/fibula region. The nurse recognizes which vitamin or mineral supplement may be responsible for this development when taken in excess?

Phosphorus

Which statement best conveys the endocrine function of adipose tissue?

Produces leptin, which mediates body weight.

A nurse who works on an oncology ward is providing care for a 68-year-old female client with a diagnosis of lung cancer with bone metastases. The client is experiencing rapid weight loss and is exhibiting the signs and symptoms of malnutrition. The nurse would recognize that which factor is most likely contributing to the client's malnutrition?

Protein mass is being lost from the liver and other organs and the liver is synthesizing fewer serum proteins.

A client presents to the clinic with severe edema. Which type of deficiency should be suspected in this client?

Proteins

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

Recognizing there is a problem

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

Saturated Fatty Acids

Which assessment should be the priority when caring for a client with anorexia nervosa?

Serum electrolyte levels

While educating a class about adipose tissue, the faculty will emphasize that adipocyte cells serve as storage sites but also perform which other function?

Synthesize triglycerides

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 clinical conclusion 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.

The nurse is teaching a basic nutrition course for the community. Which statement should the nurse include about fat-soluble vitamins?

The fat-soluble vitamins are stored in adipose tissue and may reach toxic levels.

The nurse is providing nutritional support education to the family of an obese 10-year-old. The most important information to provide would be:

The weight loss intervention should include all family members.

It is the hypothalamus that tells us when we are hungry or full. Its message is mediated by input from the gastrointestinal tract. There are also centers in the hypothalamus that regulate energy balance and metabolism based on the secretion of what hormones?

Thyroid and adrenocortical hormones

The health care provider reviews the waist-hip ratio of a male client. The ratio is 1.0. Which interpretation is most accurate for this result?

Upper body obesity

The nurse is caring for an obese client. It would be most important for the nurse to assess the client for which possible psychological factor that contributes to obesity?

Using food as a coping strategy

A client is unable to absorb fats. Which vitamin deficiencies should the nurse assess the laboratory results for?

Vitamin A

During a nutritional discussion with a client, the nurse will mention that taking too high a dose of which vitamin can lead to toxicity, thereby leading to liver disease, peeling of the skin, and bone fractures?

Vitamin A

The nurse is reviewing the care plan for altered nutritional status with a client who is exhibiting signs of impaired calcium and phosphorus absorption. Which nutritional deficiency should the nurse suspect?

Vitamin D

While the nurse is removing the IV catheter for a client with altered nutritional status, the nurse notes that the client exhibits prolonged bleeding. For which nutrient does the nurse anticipate a deficiency?

Vitamin K

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

Waist/hip circumference

Which of the following clients is most likely to be in positive nitrogen balance? A client:

Who has been admitted to the hospital in early labor

A male client has experienced a hemorrhagic stroke. Upon collecting health data from the spouse, which remark leads the nurse to suspect it could be the cause of this emergent event?

client takes 50,000 mg/day of vitamin E supplements daily

During a humanitarian trip to an underdeveloped country a senior nursing student is assessing a 6-year-old child who has a protuberant abdomen, dry hair, and wrinkled skin. The child's heart rate is 59 beats/min, blood pressure 89/50 mm Hg, and temperature 95.1°F (35.1°C). For which should the student assess the child?

diet deficient in both protein and calories

The nurse is caring for a client diagnosed with marasmus. The nurse would expect the client to manifest:

loss of subcutaneous tissue, stunted growth, protuberant abdomen.

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

milk and eggs

A nurse is assessing a female client prior to educating about healthy lifestyle changes. The client has a body mass index (BMI) of 32.4. According to the BMI, the nurse would classify this client as:

obese

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.

The nurse caring for a client with alcohol use disorder may require which supplement to prevent Wernicke encephalopathy, a brain disorder manifested by confusion?

thiamin (vitamin B1)