Chapter 11: Nutritional Assessment (Jarvis)
The nurse is performing a nutritional assessment on a 15-year-old girl who tells the nurse that she is so fat. Assessment reveals that she is 5 feet 4 inches and weighs 110 pounds. The nurses appropriate response would be:
A) How much do you think you should weigh?
The nurse is providing nutrition information to the mother of a 1-year-old child. Which of these statements represents accurate information for this age group?
A) Maintaining adequate fat and caloric intake is important for a child in this age group.
The nurse is assessing the body weight as a percentage of ideal body weight on an adolescent patient who was admitted for suspected anorexia nervosa. The patients usual weight was 125 pounds, but today she weighs 98 pounds. The nurse calculates the patients ideal body weight and concludes that the patient is:
B) Experiencing moderate malnutrition. (By dividing her current weight [98 lbs]by her usual weight [125 lbs] and [98 /125] then multiplying by 100, a percentage of 78.4% is obtained, which means that her current weight is 78.4% of her ideal body weight. A current weight of 80% to 90% of ideal weight suggests mild malnutrition A current weight of 70% to 80% of ideal weight suggests moderate malnutrition A current weight of less than 70% of ideal weight suggests severe malnutrition.)
A mother and her 13-year-old daughter express their concern related to the daughters recent weight gain and her increase in appetite. Which of these statements represents information the nurse should discuss with them?
B) Snacks should be high in protein, iron, and calcium. (After a period of slow growth in late childhood, adolescence is characterized by rapid physical growth and endocrine and hormonal changes. Caloric and protein requirements increase to meet this demand. Because of bone growth and increasing muscle mass [and, in girls, the onset of menarche] calcium and iron requirements also increase.)
A 16-year-old girl is being seen at the clinic for gastrointestinal complaints and weight loss. The nurse determines that many of her complaints may be related to erratic eating patterns, eating predominantly fast foods, and high caffeine intake. In this situation, which is most appropriate when collecting current dietary intake information?
C) Having the patient complete a food diary for 3 days, including 2 weekdays and 1 weekend day
A pregnant woman is interested in breastfeeding her baby and asks several questions about the topic. Which information is appropriate for the nurse to share with her?
D) Breast milk provides the nutrients necessary for growth, as well as natural immunity
The nurse is discussing appropriate foods with the mother of a 3-year-old child. Which of these foods are recommended?
D) Finger foods and nutritious snacks that cannot cause choking (Small portions, finger foods, simple meals, and nutritious snacks help improve the dietary intake of young children. Foods likely to be aspirated should be avoided [such as, hot dogs, nuts, grapes, round candies, popcorn])
The nurse is evaluating patients for obesity-related diseases by calculating the waist-to-hip ratios. Which one of these patients would be at increased risk?
a. 29-year-old woman whose waist measures 33 inches and hips measure 36 inches (The waist-to-hip ratio assesses body fat distribution as an indicator of health risk. A waist-to-hip ratio of 1.0 or greater in men or 0.8 or greater in women is indicative of android [upper body obesity] and increasing risk for obesity-related disease and early death. The 29-year-old woman has a waist-to-hip ratio of 0.92, which is greater than 0.8.)
The nurse recognizes which of these persons is at greatest risk for undernutrition?
a. 5-month-old infant (Vulnerable groups for undernutrition are infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults.)
The nurse is providing care for a 68-year-old woman who is complaining of constipation. What concern exists regarding her nutritional status?
a. Absorption of nutrients may be impaired.
During a nutritional assessment, why is it important for the nurse to ask a patient what medications he or she is taking?
a. Certain drugs can affect the metabolism of nutrients.
In teaching a patient how to determine total body fat at home, the nurse includes instructions to obtain measurements of:
a. Height and weight.
When considering a nutritional assessment, the nurse is aware that the most common anthropometric measurements include:
a. Height and weight.
If a 29-year-old woman weighs 156 pounds, and the nurse determines her ideal body weight to be 120 pounds, then how would the nurse classify the woman's weight?
a. Obese (Obesity, as a result of caloric excess, refers to weight more than 20% above ideal body weight. For this patient, 20% of her ideal body weight would be 24 pounds, and greater than 20% of her body weight would be over 144 pounds. Therefore, having a weight of 156 pounds would be considered obese.)
The nurse is performing a nutritional assessment on an 80-year-old patient. The nurse knows that physiologic changes can directly affect the nutritional status of the older adult and include:
a. Slowed gastrointestinal motility.
A patient tells the nurse that his food simply does not have any taste anymore. The nurse's best response would be:
b. "When did you first notice this change?"
A 21-year-old woman has been on a low-protein liquid diet for the past 2 months. She has had adequate intake of calories and appears well nourished. After further assessment, what would the nurse expect to find?
b. Decreased serum albumin (Kwashiorkor [protein malnutrition] is due to diets that may be high in calories but contain little or no protein [such as, low-protein liquid diets, fad diets, and long-term use of dextrose-containing intravenous fluids]. The serum albumin would be less than 3.5 g/dL.)
The nurse is assessing a patient who is obese for signs of metabolic syndrome. This condition is diagnosed when three or more certain risk factors are present. Which of these assessment findings are risk factors for metabolic syndrome? Select all that apply.
b. Fasting plasma glucose level greater than or equal to 110 mg/dL c. Blood pressure reading of 140/90 mm Hg (Metabolic syndrome is diagnosed when 3 or more of the following risk factors are present: 1-fasting plasma glucose level greater than or equal to 100 mg/dL 2-blood pressure greater than or equal to 130/85 mm Hg 3-waist circumference greater than or equal to 40 inches for men and 35 inches for women 4-high density lipoprotein cholesterol less than 40 in men and less than 50 in women 5-triglyceride levels greater than or equal to 150 mg/dL)
In performing an assessment on a 49-year-old woman who has imbalanced nutrition as a result of dysphagia, which data would the nurse expect to find?
b. Inadequate nutrient food intake
The nurse is reviewing the nutritional assessment of an 82-year-old patient. Which of these factors will most likely affect the nutritional status of an older adult?
b. Living alone on a fixed income (Socioeconomic conditions frequently affect the nutritional status of the aging adult; these factors should be closely evaluated. Physical limitations, income, and social isolation are frequent problems that interfere with the acquisition of a balanced diet. A decrease in taste and smell and decreased gastrointestinal motility and absorption occur with aging. Cardiovascular status is not a factor that affects an older adults nutritional status.)
During an assessment of a patient who has been homeless for several years, the nurse notices that his tongue is magenta in color, which is an indication of a deficiency in what mineral and/or vitamin?
b. Riboflavin (Magenta tongue is a sign of riboflavin deficiency. In contrast, a pale tongue is probably attributable to iron deficiency. Vitamin D and calcium deficiencies cause osteomalacia in adults, and a vitamin C deficiency causes scorbutic gums.)
How should the nurse perform a triceps skinfold assessment?
c. After applying the calipers, the nurse waits 3 seconds before taking a reading. After repeating the procedure three times, an average is recorded. (While holding the skinfold, the lever of the calipers is released. The nurse waits 3 seconds and then takes a reading. This procedure should be repeated three times, and an average of the three skinfold measurements is then recorded.)
Which of these interventions is most appropriate when the nurse is planning nutritional interventions for a healthy, active 74-year-old woman?
c. Decreasing the number of calories she is eating because of the decrease in energy requirements from the loss of lean body mass (Important nutritional features of the older years are a decrease in energy requirements as a result of loss of lean body mass, the most metabolically active tissue, and an increase in fat mass.)
Which of these conditions is due to an inadequate intake of both protein and calories?
c. Marasmus
The nurse is assessing a 30-year-old unemployed immigrant from an underdeveloped country who has been in the United States for 1 month. Which of these problems related to his nutritional status might the nurse expect to find?
c. Osteomalacia (softening of the bones) (General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia, scurvy, and dental caries are among the more common nutrition-related problems of new immigrants from developing countries.)
A 50-year-old woman with elevated total cholesterol and triglyceride levels is visiting the clinic to find out about her laboratory results. What would be important for the nurse to include in patient teaching in relation to these tests?
c. Provide information regarding a diet low in saturated fat.
A 50-year-old patient has been brought to the emergency department after a housemate found that the patient could not get out of bed alone. He has lived in a group home for years but for several months has not participated in the activities and has stayed in his room. The nurse assesses for signs of undernutrition, and an x-ray study reveals that he has osteomalacia, which is a deficiency of:
c. Vitamin D and calcium.
The nurse is preparing to measure fat and lean body mass and bone mineral density. Which tool is appropriate?
d. Dual-energy x-ray absorptiometry (DEXA)
A patient is asked to indicate on a form how many times he eats a specific food. This method describes which of these tools for obtaining dietary information?
d. Food-frequency questionnaire
For the first time, the nurse is seeing a patient who has no history of nutrition-related problems. The initial nutritional screening should include which activity?
d. Measurement of weight and weight history
When assessing a patient's nutritional status, the nurse recalls that the best definition of optimal nutritional status is sufficient nutrients that:
d. Provide for daily body requirements and support increased metabolic demands. (Optimal nutritional status is achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands resulting from growth, pregnancy, or illness.)
An older adult patient in a nursing home has been receiving tube feedings for several months. During an oral examination, the nurse notes that patient's gums are swollen, ulcerated, and bleeding in some areas. The nurse suspects that the patient has what condition?
d. Vitamin C deficiency (Vitamin C deficiency causes swollen, ulcerated, and bleeding gums, known as scorbutic gums. Rickets is a condition related to vitamin D and calcium deficiencies in infants and children. Linoleic-acid deficiency causes eczematous skin. Vitamin A deficiency causes Bitot spots and visual problems)
