CH 39 EAQ Nutritional Problems

The nurse recalls that what minimum body mass index (BMI) value is classified as obese? Record the answer using a whole number. Fill in the blank.

ANS: 30 kg/m2 Body mass index includes the measurement of height and weight. The condition in which the body mass index is 30 kg/m 2 and above is considered obesity.

The nurse recalls that one gram of protein yields how many calories? Record the answer using a whole number.

ANS: 4 calories Proteins are required for tissue growth, repair, and maintenance; body regulatory functions; and energy production. One gram of protein yields 4 calories.

Which disorder is associated with swollen salivary glands and macerated knuckles? a. Bulimia nervosa b. Anorexia nervosa c. Binge-eating disorder d. Malabsorption disorder

ANS: A A patient with bulimia nervosa has loss of control related to eating and a persistent concern with body image. The patient exhibits dental problems, broken blood vessels in the eyes, swollen salivary glands, and macerated knuckles. Anorexia nervosa is characterized by self-imposed weight loss. Hair loss, constipation, yellow skin, and sensitivity to cold are the signs of anorexia nervosa. Binge-eating disorder is less severe than bulimia nervosa. A patient with binge-eating disorder is generally overweight or obese. Malabsorption syndrome refers to impaired absorption of nutrients from the gastrointestinal tract. It is associated with frequent episodes of disease in the patient.

A patient experiences abnormal weight loss, hair loss, sensitivity to cold, irregular menstruation, dry and yellowish skin, and constipation. The patient reports being extremely conscious about weight and appearance. The nurse recognizes that the assessment findings are indicative of which disorder? a. Anorexia nervosa b. Hypophosphatemia c. Refeeding syndrome d. Megaloblastic anemia

ANS: A Anorexia nervosa is a serious mental illness. It shows symptoms like weight loss, hair loss, sensitivity to cold, irregular menstruation, dry and yellowish skin, and constipation. It occurs more frequently in women. Hypophosphatemia is commonly associated with refeeding syndrome. Refeeding syndrome is characterized by fluid retention and electrolyte imbalances. Megaloblastic anemia is associated with deficiency of cobalamin.

A family member of a patient tells the nurse, "My spouse has no control over eating and vomits frequently." The patient's assessment findings include swollen salivary glands and elevated serum amylase levels. The nurse suspects which disorder? a. Bulimia nervosa b. Anorexia nervosa c. Refeeding syndrome d. Short bowel syndrome

ANS: A Bulimia nervosa is an eating disorder characterized by frequent eating and self-induced vomiting, swollen salivary glands, and elevated serum amylase levels. Anorexia nervosa is self-imposed weight loss due to a fear of weight gain. In refeeding syndrome, there is fluid retention and electrolyte imbalance. Refeeding syndrome can occur when a malnourished patient is started on aggressive nutritional support. Short bowel syndrome occurs due to the repeated removal of sections of the small intestine as treatment for disease conditions.

Which disease process contributes to primary protein-calorie malnutrition (PCM)? a. Anorexia nervosa b. Major trauma c. Cancer d. Obesity

ANS: A Primary protein-calorie malnutrition (starvation-related malnutrition) is caused when nutritional needs are not met, such as in the case of anorexia nervosa. Major trauma is an example of injury-related malnutrition, which is associated with a marked inflammatory response. Cancer and obesity are examples of chronic disease-related malnutrition, which is associated with mild-to-moderate inflammation.

Which conditions can cause bulimia nervosa? Select all that apply. a. Anxiety b. Substance abuse c. Affective disorder d. Chronic alcoholism e. Endocrine dysfunction

ANS: A B C Anxiety, substance abuse, and affective disorder can cause bulimia nervosa. Chronic alcoholism may cause malnutrition and also increases the risk of refeeding syndrome. Anorexia nervosa is characterized by endocrine dysfunction.

A nurse is advising a patient to include complex carbohydrates in the diet. Which food items contain complex carbohydrates? Select all that apply. a. Cereals b. Potatoes c. Legumes d. Milk e. Table sugar

ANS: A B C Complex carbohydrates are also called polysaccharides and include starches found in cereals, potatoes, and legumes. Milk consists of disaccharide lactose. Table sugar consists of disaccharide sucrose.

A patient who is receiving tube feedings develops diarrhea. The nurse recognizes what possible reasons for the diarrhea? Select all that apply. a. Certain medications b. Rate of feeding is too fast c. Low-fiber formula d. Contamination of the formula e. Improper placement of tube

ANS: A B C D During tube feeding, the patient may develop diarrhea, which may be due to sorbitol in liquid medications or to antibiotics. An increased feeding rate may stimulate peristalsis and lead to diarrhea; therefore, the feeding rate should be decreased. A low-fiber formula may increase the risk of diarrhea; therefore, a formula with high fiber should be used. Contamination of the formula may also lead to diarrhea; therefore, any outdated formula should be discarded. Improper placement of the tube leads to vomiting or aspiration.

The nurse provides care for patients on a medical-surgical unit and identifies that patients with which conditions are at increased risk for malnutrition? Select all that apply. a. Trauma b. Dementia c. Depression d. Hypertension e. Chronic alcoholism

ANS: A B C E Malnutrition is a deficit, excess, or imbalance of essential nutrients. Trauma leads to hypermetabolism, increasing the risk of malnutrition if the increased nutritional demands are not met. Dementia and depression affect the intake of food by affecting judgment. Chronic alcoholism depresses appetite and leads to malnutrition. Hypertension causes increases in blood pressure level; it is not a cause of malnutrition.

The nurse reviews a patient's history and recognizes that which conditions increase the risk of malnutrition? Select all that apply. a. Certain medications b. Excessive dieting c. Swallowing disorders d. Fracture of a bone e. Chronic alcoholism

ANS: A B C E Medications may cause dry mouth, alter the taste of food, or decrease appetite, leading to a decrease in food intake and causing malnutrition. Excessive dieting for weight management results in the loss of nutrients from the body. A swallowing disorder can impair the ability to lubricate, masticate, and swallow food. Chronic alcoholism depresses appetite and leads to malnutrition. A fracture of a bone does not affect food intake and is not related to malnutrition.

What are manifestations of potassium deficiency in a patient with anorexia nervosa? Select all that apply. a. Leukopenia b. Renal failure c. Muscle weakness d. Metabolic alkalosis e. Cardiac dysrhythmias f. Swollen salivary glands

ANS: A B C E Potassium deficiency occurs in patients with anorexia nervosa due to a lack of potassium in the diet and loss of potassium in the urine. Manifestations of potassium deficiency include renal failure, muscle weakness, and cardiac dysrhythmias. Leukopenia, hypoglycemia, hyponatremia, hypomagnesemia, and hypophosphatemia may also be present. Metabolic alkalosis and swollen salivary glands are observed in patients with bulimia nervosa.

The nurse assesses a patient who is diagnosed with malnutrition. Which assessment findings support the diagnosis? Select all that apply. a. Anemia b. Infection c. Hyperglycemia d. Delayed wound healing e. Wasted and flabby muscle

ANS: A B D E Malnutrition leads to a decrease in iron and folic acid level, resulting in anemia. The patient is more susceptible to infection because humoral and cell-mediated immunity are deficient in malnutrition. Also, wound healing may be delayed due to decreased protein levels. Because protein intake is severely reduced, the muscles are wasted and flabby, leading to weakness and fatigability. Hyperglycemia commonly occurs in diabetic patients and is often associated with an increase in glucose levels.

The nurse provides care for patients on a medical surgical unit. Which patients are likely candidates for parenteral nutrition? Select all that apply. a. A patient with a gastrointestinal (GI) obstruction b. A patient experiencing intractable diarrhea c. A patient diagnosed with megaloblastic anemia d. A patient with severe anorexia nervosa e. A patient that had a complicated surgery

ANS: A B D E Parenteral nutrition helps in the administration of nutrients by a route other than the GI tract. It is used when the GI tract cannot be used for the ingestion, digestion, and absorption of essential nutrients. In GI obstruction, there is a problem of digestion, so parenteral nutrition is preferred. Intractable diarrhea is a severe condition and requires parenteral nutrition for instant supply of nutrients. In severe anorexia nervosa, the patient is unable to receive nutrients from oral feeding. In complicated surgery or trauma, the need for calories and protein is increased, and this need is met through parenteral nutrition. Megaloblastic anemia occurs due to the deficiency of cobalamin. Only cobalamin supplements are required, and there is no need of parenteral nutrition.

The nurse is providing care for a patient who is diagnosed with anorexia. The patient is receiving enteral nutrition through a nasogastric tube and has developed constipation. Which factors may be responsible for the constipation? Select all that apply. a. Certain drugs b. The rate of feeding is too fast c. Poor fluid intake d. Excessive vomiting e. Formula components

ANS: A C E Enteral nutrition is provided through the gastrointestinal (GI) tract via a tube, catheter, or stoma that delivers nutrients distal to the oral cavity. Certain drugs tend to slow peristalsis, leading to constipation. Poor fluid intake also leads to constipation by making the feces hard and difficult to pass. Therefore, fluid intake should be increased. Formula components may produce the problem of constipation. A primary healthcare provider may be consulted to change the formula. Feeding too fast leads to diarrhea due to increased peristalsis. Excessive vomiting causes dehydration.

The nurse recalls that which socioeconomic factors contribute to the development of malnutrition? Select all that apply. a. Elderly on a fixed income b. Alcoholism c. Hospitalization d. Food insecurity e. Food-drug interactions

ANS: A D Elderly people tend to eat less nutritious food due to functional disability and limited access to resources. Assistance of a registered dietician can guide older adults to meet their nutritional requirements with available resources. Food insecurity arises in families with low income levels. They opt for filling foods with high calorific value and less nutritional value. Alcoholism is not a direct cause of malnutrition. Hospitalization due to surgery, illness, or trauma can result in a reduced metabolic rate and diet restrictions but is not a direct cause of malnutrition. Food-drug interactions can result in decreased appetite and loss in effectiveness of the drug but are not direct causes of malnutrition.

The nurse recognizes that which food items are complete proteins? Select all that apply. a. Eggs b. Corn c. Peanuts d. Milk products e. Sesame seeds

ANS: A D Protein is one of the major sources of a balanced diet. Dietary proteins are of both plant and animal origin. Food stuffs such as eggs and milk contain the nine essential amino acids and are classified as complete proteins. Peanuts, corn, and sesame seeds may lack one or more essential amino acids and are called incomplete proteins.

Which laboratory findings indicate malnutrition? Select all that apply. a. Elevated potassium levels b. Elevated lymphocyte count c. Decreased levels of liver enzymes d. Elevated levels of water-soluble vitamins e. Decreased serum levels of fat-soluble vitamins

ANS: A E In malnutrition, potassium levels are elevated and serum levels of fat-soluble vitamins are lowered. The total lymphocyte count is reduced, liver enzymes are elevated, and serum levels of water-soluble vitamins are lowered due to malnutrition.

What is an expected assessment finding for a patient who has a vitamin C deficiency? a. Osteomalacia b. Poor wound healing c. Neurological deficits d. Parasthesias

ANS: B A patient who is deficient in vitamin C will exhibit poor wound healing, as vitamin C is required for the synthesis of collagen. Osteomalacia is a softening of the bones due to vitamin D deficiency. Neurological deficits can be attributed to lack of vitamin E. Parasthesias can result from a lack of vitamin B1 (thiamine).

Which disorder is characterized by self-imposed weight loss? a. Bulimia nervosa b. Anorexia nervosa c. Binge-eating disorder d. Malabsorption syndrome

ANS: B Anorexia nervosa is characterized by self-imposed weight loss. Hair loss, constipation, yellow skin, and sensitivity to cold are the signs of anorexia nervosa. A patient with bulimia nervosa has loss of control related to eating and has a persistent concern with body image. Binge-eating disorder is less severe than bulimia nervosa. A patient with binge-eating disorder is generally overweight or obese. Malabsorption syndrome refers to impaired absorption of nutrients from the gastrointestinal tract. It is associated with frequent episodes of disease in the patient.

The nurse is assessing a group of patients for risk for malnutrition. Which of these patients has the highest risk of malnutrition? a. A 65-year-old man who had hernia surgery 2 days ago b. A 55-year-old woman who has a history of alcohol abuse c. A 25-year-old woman who wants to lose 20 pounds after giving birth d. A 70-year-old man who has been fasting since midnight in preparation for a colonoscopy

ANS: B Conditions that increase the risk for malnutrition include dementia, depression, chronic alcoholism, excessive dieting to lose weight, and swallowing disorders. Hernia repair does not place the patient at risk for malnutrition. A woman who wants to lose 20 pounds after giving birth is not at risk for malnutrition; it is normal to want to lose post-baby weight. A patient who is NPO for a colonoscopy is not at risk for malnutrition because this is short-term status.

A patient is diagnosed with malnutrition. On assessment, the nurse finds that the patient has edema on the face and legs. What is the probable reason for the edema? a. Infection b. Protein depletion c. Increase in oncotic pressure d. Reduction in blood volume

ANS: B Due to protein depletion, the synthesis of protein decreases and leads to lowering of the oncotic pressure. Protein maintains the osmotic pressure of the blood. Due to the decreased oncotic pressure, body fluids shift from the vascular space into the interstitial compartment, producing edema. Infection, increase in oncotic pressure, and reduction in blood volume do not produce edema.

Which tube feeding reduces the risk of aspiration in patients with chronic reflux? a. Gastrostomy b. Jejunostomy c. Orogastric tubing d. Nasogastric tubing

ANS: B Jejunostomy tube feeding prevents recurrent aspiration pneumonia. Gastrostomy feeding is advised for patients who require enteral nutrition over a prolonged period of time. Orogastric and nasogastric tubes present a high risk for aspiration and mucosal damage.

The nurse recalls that, according to the rule of thumb estimation, what should the total calorie intake be to maintain weight? a. 20 to 25 cal/kg body weight b. 25 to 30 cal/kg body weight c. 30 to 35 cal/kg body weight d. 35 to 40 cal/kg body weight

ANS: B Kilocalorie is the unit for estimating the total intake and expenditure of calories. The average intake of calories of an adult for weight management is 25 to 30 cal/kg body weight. An intake of 20 to 25 cal/kg body weight is necessary for weight loss in adults. Intake of more than 30 to 35 cal/kg body weight favors weight gain in adults.

What psychosocial issue may contribute to poor nutrition in an older adult? a. Poor vision b. Living alone c. Arthritis d. Ability to feed oneself

ANS: B Living alone is a psychosocial issue that may contribute to poor nutrition due to isolation. Poor vision is a physiological change, arthritis is a chronic illness, and the inability to feed oneself is a functional inability.

Which finding supports the nurse's conclusion that a patient with dry skin, mouth ulcers, and irritability is experiencing primary protein-calorie malnutrition? a. Obesity b. Anorexia nervosa c. Closed head injury d. Rheumatoid arthritis

ANS: B Primary protein-calorie malnutrition is also called starvation-related malnutrition. It is a condition in which there is chronic starvation without inflammation. Anorexia nervosa is caused by severely restricting caloric intake due to a fear of weight gain. Obesity is associated with secondary protein-calorie malnutrition. Closed head injury is associated with acute-disease or injury-related malnutrition. Rheumatoid arthritis may cause secondary protein-calorie malnutrition.

Which patient with nutritional disorders does the nurse suspect to have primary protein-calorie malnutrition? a. The patient with bulimia nervosa b. The patient with anorexia nervosa c. The patient with refeeding syndrome d. The patient with binge-eating disorder

ANS: B Primary protein-calorie malnutrition is starvation-related malnutrition that occurs when nutritional needs are not met due to low intake of food. There is chronic starvation with no inflammation. Anorexia nervosa is associated with primary protein-calorie malnutrition. In bulimia nervosa and binge-eating disorder, the patient exhibits no control over eating and consumes large quantities of food in a short time. These conditions are not associated with starvation-related malnutrition. Refeeding syndrome is observed in enteral feedings.

A patient voices a desire to lose weight. The nurse is reviewing the caloric needs of the patient. To lose weight, the patient should consume how many calories per kilogram? a. 15 to 20 cal/kg body weight b. 20 to 25 cal/kg body weight c. 25 to 30 cal/kg body weight d. 30 to 35 cal/kg body weight

ANS: B Rule-of-thumb estimations are that an individual should consume 20 to 25 cal/kg body weight to lose weight, 25 to 30 cal/kg to maintain body weight, and 30 to 35 cal/kg to gain weight.

Which fluid and electrolyte change occurs with malnutrition? a. Shift of potassium to vascular space b. Movement of sodium within the cell c. Shift of potassium to the interstitial space d. Movement of fluids to extracellular space

ANS: B Sodium is an extracellular ion. In malnutrition, as the fluid shifts to interstitial space, sodium also moves with the fluid, resulting in increased amounts of sodium within the cells. There is a fluid shift, rather than a potassium shift, to interstitial spaces. Potassium, which is a predominant intracellular ion, is shifted to the extracellular space. Fluids move to the interstitial space rather than to the extracellular space.

Which body mass index (BMI) indicates that a patient is overweight? a. A BMI of 32.0 kg/m 2 b. A BMI of 28.7 kg/m 2 c. A BMI of 24.9 kg/m 2 d. A BMI of 23.7 kg/m 2

ANS: B The BMI is a measure of relative weight based on a patient's mass and height. If the patient's BMI is between 25.0 and 29.9 kg/m 2, it indicates that the patient is overweight. If the BMI is greater than 30 kg/m 2, the patient is obese. If the BMI is between 18.5 and 24.9 kg/m 2, the patient is considered to be normal weight.

A patient is deficient in macronutrients. Which dietary component might the patient be lacking? a. Electrolytes b. Proteins c. Minerals d. Vitamins

ANS: B The major components of the basic food groups are macronutrients; these include proteins as well as carbohydrates and fats. Electrolytes, minerals, and vitamins are considered micronutrients.

A patient presents to a clinic with bleeding gums, loose teeth, and dry, itchy skin. The patient states, "I have very little money, but I make sure that my children are fed. Sometimes it means that I don't have much to eat." The nurse suspects that the patient is lacking which vitamin? a. Folic acid b. Vitamin C c. Vitamin D d. Vitamin K

ANS: B This patient is lacking Vitamin C as evidenced by the bleeding gums, loose teeth, and dry, itchy skin. Clinical manifestations of folic acid deficiency include megaloblastic anemia, anorexia, fatigue, sore tongue, diarrhea, or forgetfulness. Clinical manifestations of Vitamin D deficiency include muscular weakness, excess sweating, diarrhea, bone pain, rickets, or osteomalacia. Clinical manifestations of Vitamin K deficiency include defective blood coagulation.

A patient with severe trauma is scheduled for surgery. The nurse identifies that the patient will require which nutritional components to promote wound healing? a. Carbohydrates and proteins b. Proteins and calories c. Vitamins and minerals d. Carbohydrates and calories

ANS: B With increased stress, such as surgery, severe trauma, or sepsis, the patient requires increased protein and calories. Wound healing requires increased protein synthesis. Carbohydrates, vitamins, and minerals are important as well, but increased protein and calories are most effective for promoting wound healing.

A patient is hospitalized with malnutrition. The nurse recalls that, during the starvation process, which changes are the results of alterations in cytokines? Select all that apply. a. Decreased glucose turnover b. Increased protein breakdown c. Increased positive phase protein d. Increased skeletal muscle breakdown e. Decreased basal metabolic rate (BMR)

ANS: B C D In inflammatory states, there are alterations in the expression of proinflammatory and antiinflammatory cytokines. These cytokine changes result in increased protein breakdown, increased positive acute phase protein production, and increased skeletal muscle breakdown. There is increased glucose turnover and increased BMR.

What signs of malnutrition can a nurse assess in a patient's eyes? Select all that apply. a. Hard cornea b. Pale conjunctivae c. Fissuring of eyelid corners d. Blood vessel growth in cornea e. Gray keratinized epithelium on conjunctiva

ANS: B C D E In patients with malnutrition, the conjunctiva becomes pale or red. The eyelid corners fissure and blood vessel growth occurs in the cornea. Keratinized epithelium on conjunctiva turns gray. Soft corneas, not hard corneas, are associated with malnutrition.

A patient with malnutrition experiences a Vitamin D deficiency. The nurse expects what clinical manifestations? Select all that apply. a. Bleeding gums b. Excessive sweating c. Bone pain d. Glossitis e. Diarrhea

ANS: B C E Excessive sweating, bone pain, and diarrhea are manifestations of Vitamin D deficiency. Bleeding gums is a manifestation of Vitamin C deficiency. Glossitis is a manifestation of Vitamin B 12 deficiency.

The nurse recognizes that parenteral nutrition is often prescribed for which patient conditions? Select all that apply. a. Cancer b. Complicated surgery c. Severe malabsorption d. Nutritional disorders e. Gastrointestinal obstruction

ANS: B C E Parenteral nutrition refers to the administration of nutrients from routes other than the gastrointestinal tract. The most common route of parenteral nutrition is the intravenous route of administration. It is practiced in patients under attentive medical care for the daily nutritional requirement. Patients who have undergone complicated surgeries have decreased absorption of nutrients and need parenteral nutrition to meet their nutritional needs. Malabsorption in patients can be due to several intestinal pathogens and several physiologic conditions. Gastrointestinal obstructions occur due to the alterations in the normal physiologic conditions. A cancer patient does not have reduced absorption level and can have an oral intake of food. Patients with nutritional disorders are recommended a balanced diet and they can have reduced absorption, but they do not need parenteral nutrition.

Which diagnostic finding in the laboratory reports supports the nurse's suspicion that a patient with burn injuries is experiencing malnutrition? Select all that apply. a. Increased creatinine b. Decreased transferrin c. Increased liver enzymes d. Increased serum albumin e. Decreased blood urea nitrogen

ANS: B C E Transferrin is a globulin that transports iron in the plasma. Transferrin levels decrease due to severe injuries and cause malnutrition. Liver enzymes are increased as an adverse effect of inadequate protein. Blood urea nitrogen (BUN) is an indicator of the amount of nitrogen in the blood, which comes from waste-product urea; therefore, BUN is lowered in malnutrition. Creatinine levels will be decreased due to reduced muscle mass in patients with malnutrition. Malnutrition occurs when there is a loss of protein, which will be reflected in a low serum albumin level.

Which are manifestations of anorexia nervosa? Select all that apply. a. Vomiting b. Constipation c. Dental problems d. Irregular menstruation e. Broken blood vessels in the eyes

ANS: B D Anorexia nervosa is self-imposed weight loss due to fear of becoming overweight. Constipation and irregular menstruation are observed in patients with anorexia nervosa. Vomiting, dental problems, and broken blood vessels in the eyes are symptoms of bulimia nervosa.

Which changes in laboratory parameters occur in a patient with bulimia nervosa? Select all that apply. a. Leukopenia b. Hypokalemia c. Hypoglycemia d. Metabolic alkalosis e. Elevated serum amylase

ANS: B D E Abnormal laboratory parameters, including hypokalemia, metabolic alkalosis, and elevated serum amylase may occur with frequent vomiting. Leukopenia and hypoglycemia are manifestations of potassium deficiency in patients with anorexia nervosa.

The body mass index (BMI) of a patient is 26 kg/m 2. How should the nurse interpret the assessment finding? a. The patient is obese. b. The patient is normal. c. The patient is overweight. d. The patient is underweight.

ANS: C A BMI of 25 to 29.9 kg/m 2 indicates that the patient is overweight. A BMI of 30 kg/m 2 or greater indicates that the patient is obese. A BMI of 18.5 to 24.9 kg/m 2 indicates that the patient is normal. A BMI of less than 18.5 kg/m 2 indicates that the patient is underweight.

The nurse performs a dietary assessment on a patient. The nurse recalls that the Dietary Reference Intake (DRI) recommends that what percentage of total calories should come from carbohydrates? a. 10% to 15% of total calories should come from carbohydrates. b. 30% to 45% of total calories should come from carbohydrates. c. 45% to 65% of total calories should come from carbohydrates. d. 70% to 80% of total calories should come from carbohydrates.

ANS: C Carbohydrates should constitute between 45% and 65% of caloric needs, compared with 20% to 35% from fats and 10% to 35% from proteins.

The nurse reviews the medication history of a patient experiencing dry and scaly lips, brittle nails, and mouth crusting. The nurse suspects that the patient is malnourished. Which type of medication in the patient's history supports the nurse's conclusion? a. Diuretics b. Laxatives c. Corticosteroids d. Antidepressants

ANS: C Corticosteroids have catabolic properties, which supports the nurse's suspicion of malnutrition. Diuretics and laxatives contribute to bulimia nervosa. Antidepressants are used in the treatment of bulimia nervosa.

A patient presents with a fever, nausea, vomiting, loss of appetite, and increased basic metabolic rate (BMR). The nurse suspects that which medication in the patient's medication history is the cause of the patient's clinical manifestations? a. Diuretics b. Laxatives c. Antibiotics d. Antidepressants

ANS: C Nausea, vomiting, and loss of appetite with an increase in the BMR indicate malabsorption syndrome. Several drugs have undesirable gastrointestinal side effects and alter normal digestive and absorptive processes. Antibiotics disturb the flora of the intestine, which decreases the ability of the body to synthesize biotin. Diuretics and laxatives are used in bulimia nervosa. Antidepressants do not cause malabsorption syndrome but may be used to treat eating disorders.

The nurse reviews the pathophysiology of starvation. When carbohydrate (glycogen) stores are depleted, what does the body convert to glucose for energy? a.Body protein b. Fat c. Skeletal protein d. Muscle

ANS: C Once carbohydrate stores are depleted in starvation, the body converts skeletal protein into glucose for energy. Visceral and body proteins are used when the fat stores are gone. Within five to nine days after starvation, the body mobilizes fat to supply much of the needed energy. Carbohydrate stores found in muscle tissue are minimal and can be totally depleted within 18 hours.

Which lab result is associated with steatorrhea in a patient with malnutrition? a. Decreased serum albumin b. Altered serum electrolytes c. Elevated serum levels of liver enzymes d. Decreased serum levels of fat-soluble vitamins

ANS: D A deficiency of fat-soluble vitamins leads to decreased absorption of fats in the body; they are excreted into the feces, resulting in steatorrhea (fatty stools). Decreased serum albumin, altered serum electrolytes, and elevated liver enzymes are associated with malnutrition but they do not cause steatorrhea.

Which component of nutritional assessment includes determining a patient's body mass index, height, weight, and amount of weight loss? a. Health history b. Functional status c. Physical examination d. Anthropometric measurements

ANS: D Anthropometry refers to the measurement of the human individual. It helps in understanding human physical variation. Usually height, weight, and organ size are measured in anthropometric studies. Because body mass index calculation involves both height and weight, it is also included under anthropometric measurement. Assessing the patient's acute or chronic illness and personal and family history is part of the health history component of nutritional assessment. Measuring the patient's ability to perform basic daily activities is part of the functional status component of nutritional assessment. Assessing the patient's physical appearance, muscle mass, and strength is part of the physical examination component of nutritional assessment.

The nurse is caring for a patient who is malnourished. The nurse expects what assessment finding? a. Increased serum vitamin levels b. Decreased liver enzymes c. Increased hemoglobin levels d. Increased sensitivity to cold

ANS: D Because of loss of body mass, there is increased sensitivity to cold in patients with malnutrition. Also, because of depletion of proteins in malnutrition, wound healing is delayed. Because of increased enzyme protein synthesis, liver enzymes increase in malnutrition, and because of decreased intake of nutrients, serum vitamin levels decrease in malnutrition. Hemoglobin levels are also low, owing to decreased protein synthesis and to iron deficiency.

Which statement about the gastrointestinal changes observed in patients who are undernourished is inaccurate? a. "Glossitis occurs." b. "Atrophic papillae are present." c. "Teeth will be absent or loose." d. "Bowel sounds will be increased."

ANS: D Bowel sounds are created by the peristaltic movement of the intestines when food passes through the intestine. Undernourished patients have inadequate intake of food, resulting in decreased, not increased, bowel motility and bowel sounds. The tongue of an undernourished patient is swollen, is beefy red (glossitis), and has atrophic papillae. Patients who are undernourished may have loose teeth.

Which acute phase protein is elevated during inflammation? a. Albumin b. Transferrin c. Prealbumin d. C-reactive protein (CRP)

ANS: D C-reactive protein (CRP) is a positive acute phase protein that is elevated during inflammation and helps in predicting morbidity and mortality. Negative acute phase proteins such as albumin, transferrin, and prealbumin are decreased during an inflammatory response.

Which is a positive acute phase protein? a. Albumin b. Prealbumin c. Transferrin d. C-reactive protein

ANS: D C-reactive protein is a positive acute phase protein whose levels are elevated during inflammation. Albumin is a negative acute phase protein with a half-life of 20 to 22 days. Prealbumin is a negative acute phase protein and is the best indicator of the patient's recent nutritional status. Transferrin is a negative acute phase protein synthesized by the liver; it is used to transport iron.

What is the hallmark of refeeding syndrome? a. Hypokalemia b. Hyponatremia c. Hypomagnesemia d. Hypophosphatemia

ANS: D Hypophosphatemia is the hallmark of refeeding syndrome, which is associated with serious outcomes. Hypokalemia is also present in refeeding syndrome but is not considered the hallmark of refeeding syndrome. Hyponatremia is associated with anorexia nervosa. Hypomagnesemia is also present in refeeding syndrome, but it also is not considered a hallmark of refeeding syndrome.

A patient is hospitalized with malnutrition. The nurse recalls that what laboratory result is associated with disease-related malnutrition with inflammation? a. Decreased glucose turnover b. Decreased nitrogen excretion c. Decreased basic metabolic rate d. Increased C-reactive protein (CRP)

ANS: D Inflammation is an important aspect of the nutritional status and it affects nutrient metabolism. In inflammation, there is an increase in CRP protein due to alterations in the expression of proinflammatory and inflammatory cytokines. In disease-related malnutrition, there is an increased glucose turnover. Decreased nitrogen excretion and basal metabolic rate indicate starvation-related malnutrition.

A patient with metastatic lung cancer is suspected to have malnutrition. The nurse reviews the results of the serum albumin and serum prealbumin laboratory studies. How should the nurse interpret the findings? a. If the albumin level is normal, the patient does not have protein malnutrition. b. The albumin level is an excellent indicator of acute changes in nutritional status. c. Decreased levels of both indicate that malnutrition is present. d. The prealbumin level more accurately reflects the patient's nutritional status.

ANS: D Prealbumin has a half-life of 2 days and is a better indicator of recent or current nutritional status. Serum albumin has a half-life of approximately 20 to 22 days. This makes albumin a poor indicator of acute changes in nutritional status. Low or below normal levels of albumin and prealbumin may indicate an inflammatory state rather than accurately depicting nutritional status.

Which condition does the nurse suspect in a patient with refeeding syndrome? a. Hyperkalemia b. Hypermagnesemia c. Hyponatremia d. Hypophosphatemia

ANS: D Refeeding syndrome is associated with a decrease in serum phosphorus levels. Therefore, the nurse expects to find hypophosphatemia. Refeeding syndrome is associated with hypokalemia and hypomagnesemia, not hyperkalemia, hypermagnesemia, or hyponatremia.

Which finding supports the nurse's conclusion that a patient has anorexia nervosa? a. Paresthesia b. Respiratory arrest c. Macerated knuckles d. Soft, downy hair on the body except on the palms and soles

ANS: D Soft, downy hair on the body except on the palms and soles is called lanugo. It is a manifestation of anorexia nervosa. Paresthesia is observed in refeeding syndrome. Respiratory arrest and macerated knuckles are manifestations of bulimia nervosa.

A patient is diagnosed with anorexia nervosa. The nurse expects what clinical manifestations? a. Tan skin, blonde hair, and diarrhea b. Sensitivity to heat, fatigue, and polycythemia c. Dysmenorrhea, gastric ulcer pain, and hunger d. Hair loss, dry, yellowish skin, and constipation

ANS: D The patient with anorexia nervosa, along with abnormal weight loss, is likely to have hair loss, dry, yellow skin, constipation, sensitivity to cold, and absent or irregular menstruation. Other signs of malnutrition also are noted during physical examination. The anorexic patient will not have tan skin, may have hair color other than blonde, and will not have diarrhea.

A patient who is a strict vegan avoids taking any vitamin and mineral supplements. The nurse recognizes that the patient is predisposed to which condition? a. Sepsis b. Dementia c. Depression d. Megaloblastic anemia

ANS: D The primary deficiency of a strict vegan is lack of cobalamin. This vitamin is obtained from animal protein, special supplements, or foods that have been fortified with the vitamin. The patient who avoids eating any vitamin and mineral supplements is susceptible to the development of megaloblastic anemia, which is due to deficiency of cobalamin. Sepsis, dementia, and depression are not associated with cobalamin deficiency. These are conditions that increase the risk of malnutrition.

When teaching a patient to use the "MyPlate" dietary guidelines, the nurse should explain that which food group should constitute the largest portion? a. Fruits b. Protein c. Grains d. Vegetables

ANS: D Vegetables represent the largest portion in the "MyPlate" dietary recommendations. In descending order, grains, protein, and fruits follow vegetables.