Chapter 5

What food items should the nurse teach an older patient to ingest to increase the dietary intake of vitamin D? 1. Eat liver at least once a week. 2. Plan to eat salmon at least twice a week. 3. Eat three servings of yogurt or cheese each day. 4. Red meat should be consumed every other day.

Correct Answer: 1 Rationale 1: Food sources of vitamin D include liver, fish liver oils, and fortified milk.

Which assessment data indicates to the nurse that an older patient is experiencing undernutrition? 1. Body mass index (BMI) of 20 2. Unintentional 3% weight loss over a month 3. Denial of taking a multiple vitamin supplement 4. Serum albumin slightly below normal, prealbumin and transferrin within normal limits

Correct Answer: 1 Rationale 1: A body mass index (BMI) less than 22 in the older person is predictive of undernutrition.

Which observation made by the nurse suggests that a patient is having difficulty swallowing? 1. Drooling 2. Cheilosis 3. Long furrowed tongue 4. Unintentional weight loss

Correct Answer: 1 Rationale 1: Drooling suggests difficulty swallowing because the patient is unable to swallow the saliva produced in the mouth

The nurse instructed an older patient on the importance of maintaining adequate hydration. Which statement by the patient indicates that additional teaching is needed? 1. Ill drink water and unsweetened beverages whenever I feel thirsty. 2. I can add an extra cup of decaffeinated coffee with breakfast and dinner. 3. I will set up a schedule to drink a glass of water every 2 hours throughout the day. 4. If I drink a lot of fluids, Ill have to go to the bathroom more often, but Ill get more exercise.

Correct Answer: 1 Rationale 1: The patient needs additional instructions regarding adequate fluid intake. Because the thirst mechanism becomes blunted with age, the patient cannot rely on feeling thirsty as a signal to meet hydration requirements.

What should the nurse instruct an older patient to do to support healthy eating habits? Standard Text: Select all that apply. 1. Increase fiber intake. 2. Reduce sodium intake. 3. Look for hidden sugar. 4. Enjoy olive oil and walnuts. 5. Complete a meal in 10 minutes.

Correct Answer: 1,2,3,4 Rationale 1: Increasing fiber intake is a healthy eating tip. Rationale 2: Reduce sodium intake is a healthy eating tip. Rationale 3: Looking for hidden sugar is a healthy eating tip. Rationale 4: Enjoying good fats such as olive oil and walnuts is a healthy eating tip.

The nurse is using the DETERMINE nutrition screening tool when assessing the nutritional status of an older patient. Which criteria are included in this screening tool? Standard Text: Select all that apply. 1. Disease 2. Above the age of 80 3. Reduced social contact 4. Eats fruits and vegetables 5. Needs assistance in self-care

Correct Answer: 1,2,3,5 Rationale 1: Disease is a category in the DETERMINE nutrition screening tool. Reference: Page 111 Rationale 2: Above the age of 80 is a category in the DETERMINE nutrition screening tool. Reference: Page 111 Rationale 3: Reduced social contact is a category in the DETERMINE nutrition screening tool. Rationale 5: Needs assistance in self-care is a category in the DETERMINE nutrition screening tool. Reference: Page 111

The nurse is concerned that an older patient is experiencing dehydration. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. Confusion 2. Headache 3. Weight gain 4. Long tongue furrows 5. Forearm tenting of the skin

Correct Answer: 1,2,4 Rationale 1: Confusion is a symptom of dehydration in the older adult. Reference: Page 98 Rationale 2: Headache is a symptom of dehydration in the older adult. Reference: Page 98 Rationale 4: Long tongue furrows are symptoms of dehydration in the older adult. Reference: Page 98

A patient prescribed medications for gastroesophageal reflux disease (GERD) is at risk for altered absorption of which nutrients? Standard Text: Select all that apply. 1. Iron 2. Calcium 3. Folic acid 4. Vitamin D 5. Vitamin B12

Correct Answer: 1,2,5 Rationale 1: Medications that alter gastric pH may also alter iron absorption because of the alkalinizing effects of these medications. Reference: Page 98 Rationale 2: Medications that alter gastric pH may also alter calcium absorption because of the alkalinizing effects of these medications. Rationale 5: Medications that alter gastric pH may also alter vitamin B12 absorption because of the alkalinizing effects of these medications. Reference: Page 98

When planning care, for which older patients should the nurse identify as being at risk for malnutrition as a result of hypermetabolism? Standard Text: Select all that apply. 1. Patient with a fever 2. Patient with dysphagia 3. Patient with osteoporosis 4. Patient who is a vegetarian 5. Patient with chronic lung disease

Correct Answer: 1,5 Rationale 1: The patient with a fever is at risk for malnutrition as a result of hypermetabolism. Rationale 5: The patient with chronic obstructive pulmonary disease often is malnourished because of the increased caloric need associated with breathing efforts. Reference: Page 113

The nurse has instructed an older patient on the modified My Plate and caloric intake. Which patent response indicates that instruction has been effective? 1. If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 2,000 calories. 2. If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 1,600 calories. 3. If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 2,200 calories. 4. If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 2,400 calories.

Correct Answer: 2 Rationale 2: Following the lowest recommended values for all the food groups will result in approximately 1,600 calories of energy. Reference: Page 102

An older patient has an unintentional weight loss of 20 pounds in the last 3 months. What should the nurse teach the patients family to prevent further loss of weight? 1. Provide liquid nutritional supplements with meals. 2. Add nonfat milk powder to scrambled eggs to add more protein. 3. Encourage the patient to resume smoking to increase the appetite. 4. There is nothing to change as weight loss is a normal part of aging.

Correct Answer: 2 Rationale 2: Interventions for patients with undernutrition issues include adding nonfat milk to soups, puddings, scrambled eggs, and other recipes. Reference: Page 117

An older patient receiving enteral feedings is experiencing abdominal cramps and liquid stools. Which ingredient in the patients tube feeding would cause these manifestations? 1. Maltose 2. Lactose 3. Fructose 4. Sucrose

Correct Answer: 2 Rationale 2: Lactose is implicated in the formation of diarrhea in the patient receiving enteral feedings. A lactose-free supplement should be used for this patient. Reference: Page 120

An older patient without any major health problems is experiencing decreased strength and endurance while performing some activities. What should the nurse explain as the reason for the change in strength and endurance? 1. Depression 2. Decrease in lean muscle mass 3. Lowered absorption of vitamin D 4. Increase in cholecystokinin production

Correct Answer: 2 Rationale 2: Lean muscle mass diminishes with aging. This can lead to a loss of type II muscle fibers that affect strength and endurance. Reference: Page 97

Which older patient is at greatest risk for vitamin D deficiency? 1. The patient with macrocytic anemia 2. The patient who does not drink milk 3. The patient who works outdoors daily and does not wear sunscreen 4. The patient who is taking isoniazid (INH) after a positive tuberculin skin test

Correct Answer: 2 Rationale 2: Older adults at risk for poor vitamin D status include those who do not consume milk. Reference: Page 102

An older patient is receiving feedings through a permanent feeding tube. Which nursing intervention will decrease this patients risk of aspiration? 1. Administer formulas that contain fiber. 2. Keep the head of the bed elevated at a 30 to 45 degree angle. 3. The risk of aspiration no longer exists after a permanent feeding tube has been placed. 4. Flush the tube with water before and after each medication administered through the tube.

Correct Answer: 2 Rationale 2: The head of the bed of patients receiving tube feedings should be elevated at a 30 to 45 degree angle to decrease the risk of aspiration. Reference: Page 119

During an assessment, the nurse determines that an older patient is taking several supplements that affect blood clotting. Which supplements did the nurse assess that this patient is taking? Standard Text: Select all that apply. 1. Zinc 2. Garlic 3. Fish oil 4. Ginseng 5. Vitamin E

Correct Answer: 2,3,4,5 Rationale 2: A supplement with an antiplatelet effect includes garlic. Reference: Page 106 Rationale 3: A supplement with an antiplatelet effect includes fish oil. Reference: Page 106 Rationale 4: A supplement with an antiplatelet effect includes ginseng. Reference: Page 106 Rationale 5: A supplement with an antiplatelet effect includes vitamin E.

The nurse is caring for an older patient who is receiving phenytoin. Which nutritional issues is this patient at risk for developing? Standard Text: Select all that apply. 1. Altered swallowing 2. Reduced oral intake 3. Affected folate levels 4. Altered taste and smell 5. Affected vitamin D levels

Correct Answer: 2,3,4,5 Rationale 2: Phenytoin causes patients to experience reduced oral intake. Reference: Page 100 Rationale 3: Phenytoin affects folate levels in the body. Reference: Page 100 Rationale 4: Phenytoin alters a patients taste and smell. Reference: Page 100 Rationale 5: Phenytoin affects vitamin D levels in the body.

The nurse is instructing an older patient on the use of My Plate to ensure an adequate nutritional intake. Which food items would the nurse teach the patient to fill on one-half of the plate? Standard Text: Select all that apply. 1. Oils 2. Fruits 3. Grains 4. Proteins 5. Vegetables

Correct Answer: 2,5 Rationale 2: Fruits should be included for one-half of the plate. Reference: Page 101 Rationale 5: Vegetables should be included for one-half of the plate. Reference: Page 101

The nurse is planning interventions to reduce an older patients risk of dehydration. Which intervention would support the onset of dehydration in the patient? 1. Ensuring fresh water is available to the patient 2. Providing the prescribed diuretic with breakfast 3. Administering the prescribed diuretic with the evening meal 4. Offering a drink of water every time the patients room is entered

Correct Answer: 3 Rationale 3: Administering prescribed diuretics with the evening meal will encourage nocturia and voluntary restriction of fluids by the patient. This will lead to dehydration. Reference: Page 98

Which statement about food insecurity would the nurse include in a presentation regarding nutritional issues in the older patient? 1. Food insecurity is when a person hoards food. 2. White older persons are at a higher risk for food insecurity than African Americans. 3. African American older persons are at a higher risk for food insecurity than Caucasian Americans. 4. Food insecurity is when a person is concerned that he or she is eating foods that might be harmful to his or her health.

Correct Answer: 3 Rationale 3: African Americans and Hispanic older persons are at a disproportionate risk of food insecurity compared with other households.

What should the nurse instruct a caregiver to do to assist a cognitively impaired older patient to self-feed? 1. Offer the patient a variety of favorite foods. 2. Provide diversional stimuli, such as a television show, so the patient can eat without thinking about it. 3. Serve each food separately with the proper utensil and cue the patient to use the utensil to eat that particular food. 4. Place the food types in the same arrangement on the plate and relate the location to the face of a clock to assist the patient in locating the food on the plate.

Correct Answer: 3 Rationale 3: Limiting the patient to one task and food, and cueing the patient to use the utensil to eat the specific food can be effective in promoting self-feeding. Reference: Page 116

The nurse is discussing proper nutrition with older community members at a senior citizen center. What should the nurse teach as general guidelines for healthy older individuals? Standard Text: Select all that apply. 1. Calcium intake should be 1,000 mg for those over the age of 51 years. 2. Older individuals need to take supplements of vitamins A, C, E, and K. 3. Vitamin D intake should be 600 IU up to age 70 and 800 IU if older than 70. 4. Ingest at least 0.8 grams of protein for each kilogram of body weight each day 5. Fluid intake each day should be at least 13 cups for men and 9 cups for women.

Correct Answer: 3,4,5 Rationale 3: Vitamin D intake should be 600 IU up to age 70 and 800 IU if older than 70. Reference: Page 102 Rationale 4: Protein intake for older individuals should be 0.8 grams per kilogram of body weight. Reference: Page 102 Rationale 5: Fluid intake each day should be at least 13 cups for men and 9 cups for women.

A resident in the nursing home is diagnosed with undernutrition and is unable to take in adequate food despite efforts by the multidisciplinary team and family members. Prior to insertion of a permanent feeding tube, which issue needs to be considered? 1. Equipment, care, and time needed to administer the feedings 2. The extent of the surgical intervention, cost and insurance coverage 3. The patients nutritional needs and tolerance of the formula feedings 4. The patients advanced directive and evaluation of risks, benefits, and ethical considerations

Correct Answer: 4 Rationale 4: Prior to placement of a permanent feeding tube, it is important to evaluate the individual patients wishes and review the advanced directive. The patient and family need accurate information regarding risks, benefits, and ethical considerations associated with placement of the feeding tube. Reference: Page 116

An older patient is prescribed diet supplementation to combat unintentional weight loss. How should the nurse provide these supplements to the patient? 1. Serve at room temperature. 2. Provide with the next meal. 3. Provide separate from medications. 4. Provide more than an hour before the next meal.

Correct Answer: 4 Rationale 4: Supplements should be given more than 1 hour before meals to minimize satiety and enable the patient to still eat at mealtime. Liquid supplements are digested more quickly than solids, thus decreasing the feeling of fullness. Reference: Page 116

Which older patient would the nurse identify as being at the highest risk of dehydration from receiving nutrition through a feeding tube? 1. Receiving bolus feedings 2. Receiving 50 ml free water at 4-hour intervals 3. Receiving feedings through a jejunostomy tube 4. Receiving feedings with a formula that is 1.5 calories per ml

Correct Answer: 4 Rationale 4: Tube feeding formulas that are denser than 1 calorie per milliliter are hypertonic and predispose the patient to dehydration unless the patient also receives free water. Reference: Page 119