Prep U Chapter 39: Alterations in Nutritional Status
An extremely obese client has been researching bariatric surgery after trying to lose weight for many years with dietary changes and exercise, without success. The client informs the nurse that he is interested in having the Roux-en-Y gastric bypass. Which statement by the client 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."
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 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 client is taking a thiazolidinedione type of antidiabetic drug for the treatment of diabetes and states that she has noticed a weight gain. What is the nurse's explanation to the client for the increase in weight?
"The drug stimulates the formation of new fat cells, causing increased glucose into the cells."
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%
The nurse is concerned about a pregnant client whose weight gain has not increased during the last weeks of the pregnancy. How many extra calories above her usual requirement should the client be consuming?
300 kcal/day
In order to prevent muscle wasting, what is the minimal range of carbohydrates that must be consumed per day?
50 to 100 grams
A client tells the nurse that she is going on a low carbohydrate diet in order to lose weight. In order to prevent tissue wasting and ketosis, the nurse should inform the client that the carbohydrate intake should be:
50-100 g/day
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 obese client would most likely be a poor candidate for bariatric surgery?
A morbidly obese client who does not wish to change his diet or perform exercise to lose weight
Which statement is true concerning energy requirements across the lifespan?
A newborn requires more kcal/kg of body weight than a 10-year-old.
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.
When educating a client recently diagnosed with the metabolic syndrome, the nurse begins by explaining how adipose tissue secretes which substance that regulates sensitivity to insulin?
Adiponectin
A 2-year-old child who has been neglected is admitted to the hospital. The child presents with systemic edema, flaky skin, oddly white-and-brown-colored hair, and extremely low body weight. The nurse should anticipate what intervention?
Administration of protein and calorie supplements.
The dietitian is teaching parents about eating disorders in children. Which eating disorder usually begins in adolescence?
Anorexia nervosa
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]
From this list of physical assessment results, which would be interpreted as the client having developed obesity?
Body mass index (BMI) of 40
The nurse is aware that psychological factors may be related to a client's problem with obesity. For this client, eating could be a response to:
Boredom Stress Anxiety
A nurse is assessing a client who is suspected of having anorexia nervosa (AN). Which characteristic does the nurse anticipate finding?
Bradycardia Constipation Amenorrhea
A child has been diagnosed with marasmus. Which clinical manifestations should the school nurse assess to confirm the diagnosis?
Bradycardia Stunted growth pattern
Which client has the greatest caloric needs?
Breast-feeding mother who delivered 1 month ago
How does the full-term newborn help to regulate its body temperature?
Brown fat
A client in high school is brought to the emergency department after fainting at school. Assessment findings reveal severe indigestion, tooth erosion, enlarged parotid gland, and an irregular heartbeat. What diagnosis should the nurse suspect, given this age population?
Bulimia nervosa
The nurse encourages a client with osteoporosis and intolerance to dairy products to consume calcium-containing foods. Which source of calcium does the nurse encourage?
Canned salmon with bones
A client asks the nurse what the body's primary source of immediate energy is. The best response would be:
Carbohydrates
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
Which condition does the school nurse know is of highest health concern for school-aged children?
Childhood obesity
A client with a body mass index of 32 would be classified as:
Class I obesity
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 nurse is teaching a client about the difference between saturated and unsaturated fats. The nurse should inform the client that the best source for unsaturated fats is:
Corn oil
A nurse is speaking at a weight loss meeting about the dangers to one's health from obesity. Which condition is directly attributed to being obese?
Coronary heart disease
The parish nurse is serving in a third-world country where protein calorie malnutrition is common. When assessing the children, which of these does the nurse anticipate will be present in the children with marasmus?
Diarrhea Infections Small stature
The health care provider will be assessing the nutrition status of a new client. Which assessment measures would they utilize? Select all that apply.
Dietary intake Height and weight Body mass index Skinfold thickness
A nurse is assisting a group of clients with a weight loss program and is to determine the obesity type that each client has. Which calculation would help the nurse determine the type of obesity?
Dividing the waist measurement by the hip circumference
Similarities between women with anorexia nervosa and bulimia nervosa include which clinical manifestation?
Electrolyte imbalances
Which response by the nurse best answers a client's question regarding the purpose of white fat?
Energy storage
While assessing a teenage girl suspected of having bulimia nervosa, the health care provider may find which clinical manifestation that would confirm the diagnosis?
Eroded tooth enamel leading to sensitive teeth Painless parotid gland enlargement Large number of teeth with dental caries
When nutritional requirements are needed for a specific group, what dietary requirements are used?
Estimated average requirement
A client diagnosed with a binge-eating disorder has made a goal to establish a regular, healthy eating pattern. Select the interventions the client should implement.
Exercising regularly Making a meal plan Keeping a daily food intake report Avoiding alcohol
Which measure 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
In order for a client to have effective cellular metabolism, which body fuels will be required?
Glucose Fats Amino acids
The nutritionist counsels a client to maintain a daily intake of alpha-linolenic acid to provide essential fatty acids. The client is encouraged to eat which food sources?
Green, leafy vegetables Soybeans Walnuts
For a client with a vitamin A deficiency, which item on the menu should the nurse encourage the client to choose for supper?
Grilled beef liver with carrots and canteloupe
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
Routine physical examination reveals a client has a new diagnosis of upper body obesity with central fat distribution. This diagnosis places the client at greater risk for developing which disease process?
Heart disease
An obese female informs the nurse that she is pregnant and is concerned about her baby's health because she realizes that she is obese. Which risk factor does the nurse understand may occur regarding the mother's obesity?
High birth weight leading to cesarean birth
Which characteristic distinguishes kwashiorkor from marasmus?
High intake of carbohydrates
A 20-year-old man who is addicted to methamphetamines has been admitted to the 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?
Incremental feeding combined with vitamin and mineral supplementation
A child asks about the purpose (function) of "white" fat. Which responses by the nurse are best? Select all that apply.
It stores energy for the body to use. It regulates temperature through insulation. It cushions vital organs of the body.
Adipose tissue is now known to be both an endocrine and a paracrine organ because of the factors it secretes. What are these factors?
Leptin Adipokines Adiponectin
After receiving laboratory results indicating that a client has elevated cholesterol levels, a nurse is to instruct the client about dietary restrictions. The nurse should tell the client that the daily cholesterol intake should be restricted to:
Less than 300 mg
Which individualized plan does the nurse understand will be included in the initial plan of treatment for the client who seeks treatment for obesity?
Lifestyle modification with behavioral therapy Reduced-calorie diet Increased physical activity
A client arrives at the clinic and informs the nurse that there is an "itchy rash" on his face. Which type of deficiency should the nurse suspect that may have caused dermatitis in this client?
Linolenic acid
A client is taking highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV). While the client is taking these medications, what should the client be carefully monitored for relative to the loss of fat cells?
Lipodystrophy
A client informs the nurse that he feels as though he has a kidney stone again. The client 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 diet does the nurse suspect the client may be on?
Low-carbohydrate/high protein
A nurse is caring for a client with bulimia nervosa who has been admitted to the hospital with weakness, hypotension, and abdominal discomfort. Which type of acid-base imbalance should the nurse assess the client for?
Metabolic acidosis
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?
Milk Eggs Chicken
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 observes a client moving restlessly in the hospital bed. Which type of energy expenditure can be affected by this activity?
Nonexercise activity thermogenesis (NEAT)
Malnutrition is not something that is considered common in the general population in the United States. However, certain populations are more prone to malnutrition than others. One of these populations is hospitalized clients. Why is this true?
Pain and medications can decrease appetite.
The nurse is caring for a client with chronic renal failure who must begin restricting potassium intake. Which food does the nurse emphasize should be avoided
Potatoes
The health care provider needs to assess a client for protein-calorie malnutrition. The best diagnostic measure would be:
Prealbumin
Which factor does the nurse recognize as being an independent predictor of risk factors and mortality for obese clients?
Presence of excess fat in the abdomen out of proportion to total body fat
A client presents to the clinic with severe edema. Which type of deficiency should be suspected in this client?
Protein
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 that 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
A client has a mineral deficiency that inhibits glucose absorption in the small intestine. Which mineral would the nurse assess for deficiency?
Sodium
A client is on a high-protein diet for weight loss. The nurse is aware that high-protein meals increase metabolic rate significantly. Which phenomenon does the nurse teach the client is the rationale for the weight loss?
Specific dynamic action of proteins
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 nurse assessing a female client obtains a waist circumference of 92 cm from the client. What does this finding indicate to the nurse?
The client may have increased health risks associated with this finding
A client is recovering from surgery and has been encouraged to increase his food intake to induce an anabolic state and promote healing. What phenomenon will occur while the client is experiencing anabolism?
The client will be expending energy to synthesize new cells.
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.
A chemotherapy client has been experiencing a lot of nausea and vomiting along with anorexia. Knowing how the body stores energy and breaks it down, which is the best way to explain this to a worried family?
The triglycerides in fat cells are broken down, therefore their fatty acids and glycerol are released as energy.
The nurse on the eating disorder unit is reviewing differences between anorexia nervosa and bulimia nervosa with a group of nursing students. Which statement made by the students leads the nurse to recognize the students understand these differences?
The weight of those with bulimia nervosa tends to be closer to normal.
An obese client is being seen in the clinic for treatment of a weight problem. The client states that he or she has been on multiple dietary regimens without success. In which situation is treatment indicated?
There is a body mass index (BMI) of 30 or higher There is a large waist circumference with a BMI of 25-29 There are two or more risk factors and BMI between 25-29
An older adult client informs the nurse that although he is eating the same foods as usual and walking daily, there has been a weight gain. What does the nurse understand is related to a progressive decline in the basal metabolic rate (BMR)?
There is a decrease in muscle mass and replacement with adipose tissue.
The nurse is teaching an extremely obese client scheduled for bariatric surgery about the benefits related to weight-loss surgery. What should the nurse include when discussing the priority benefit to the client?
There will be a resolution of comorbid disease states.
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
A nurse is explaining how the majority of body energy is stored in the body. Which explanation is considered most accurate?
Triglycerides
The health care provider reviews the waist-hip ratio of a male client. The ratio is 1.0. What 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 woman who is overweight has been sent to have her basal metabolic rate (BMR) measured by her physician. Which statement most accurately describes an aspect of the BMR?
Variations in body mass account for many differences in BMR between individuals.
The nurse is caring for a hospital client with chronic obstructive pulmonary disease with peripheral obesity. When performing an assessment of this client, what does the nurse anticipate finding?
Varicose veins
A client informs the nurse that he or she would like to begin a healthier dietary intake and would like to limit carbohydrate consumption. Understanding that the client must have carbohydrates to avoid tissue wasting and ketosis, which forms of carbohydrate should the nurse suggest? Select all that apply
Vegetables Fruits Whole grains
A client informs the nurse that he or she would like to begin a healthier dietary intake and would like to limit carbohydrate consumption. Understanding that the client must have carbohydrates to avoid tissue wasting and ketosis, which forms of carbohydrate should the nurse suggest? Select all that apply.
Vegetables Fruits Whole grains
A client is unable to absorb fats. Which vitamin deficiencies should the nurse assess the laboratory results for?
Vitamin A
A nurse is determining the type of obesity in a client prior to initiating a weight loss program. Which results would indicate that the male client has central obesity?
Waist-hip ratio greater than 1.0
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 to 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?" What should the nurse convey to the mother?
Water-soluble vitamins are excreted into the urine, making toxicity less likely
During a humanitarian trip to an underdeveloped country a senior nursing student is assessing a 6-year-old boy 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 95.1°F (35.1°C). The student should assess the child for:
a diet deficient in both protein and calories.
The nurse is assessing a client who has bulimia nervosa. The nurse would expect the assessment data to include that the client:
engages in binge eating.
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
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.
