Chapter 10: Nutrition My Nursing Test Banks

Chapter 10: Nutrition

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. A 73-year-old patient is concerned about staying healthy for as long as possible. When asked what lifestyle changes the patient should consider, the nurse suggests:

a.

As your metabolism slows, you will need to increase your intake of fat.

b.

If you are having difficulty sleeping, a mild sedative will help you sleep.

c.

Regular exercise will help you preserve function and reduce your risk for disease.

d.

Minimize stress by being willing to ask your family for help when you need it.

ANS: C

For the healthy aging person, research is showing that exercise (along with the resulting maintenance of muscle mass) is one of the greatest determinants of maintaining vitality and health.

DIF: Understanding (Comprehension) REF: Page 184 OBJ: 10-2

TOP: Teaching-Learning MSC: Health Promotion

2. The nurse caring for older adult patients best minimizes the patients risk of developing dehydration by:

a.

identifying the patients oral fluid preferences and offering them regularly.

b.

carefully monitoring the effects of daily diuretics via blood sodium levels.

c.

minimizing the patients reliance on laxatives by increasing dietary fiber intake.

d.

carefully monitoring of the rate of infusion of all intravenous fluids prescribed.

ANS: A

Physiologically, the decreased intake can be related to altered thirst; older adults may not feel thirsty even when hypovolemic. The other actions may be appropriate for selected patients.

DIF: Applying (Application) REF: N/A OBJ: 10-1

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

3. A patient is newly widowed and lives alone. Which suggestion by the nurse will help the adult children maximize the patients nutritional status?

a.

Help identify possible barriers to their mother achieving good nutritional health.

b.

Ensure that the patient has an adequate supply of healthy, easily prepared foods available.

c.

Contact a food delivery service to provide one nutritiously sound meal a day.

d.

Arrange a schedule that allows someone to have dinner with her each evening.

ANS: D

The lack of companionship during mealtime that can lead to depression or social isolation often causes the patient to eat poorly and thus develop a nutritional deficiency. The patient who is newly widowed may not have adjusted to this change in status. The other actions are also helpful, but they are not as important for this patient.

DIF: Applying (Application) REF: N/A OBJ: 10-1

TOP: Communication and Documentation MSC: Psychosocial Integrity

4. The nurse is caring for four postsurgical patients who have experienced similar abdominal procedures and are all 68 years of age. The nurse anticipates that the patient with the greatest risk for complications resulting in an extended hospitalization has:

a.

a history of Crohn disease.

b.

developed mild confusion.

c.

an allergy to latex.

d.

severe postoperative nausea and vomiting.

ANS: A

Malnourished hospitalized patients such as those with chronic digestive disorders like Crohn disease have a greater risk of developing infections and other complications after surgery, which can significantly increase the length and costs of hospitalization and care.

DIF: Remembering (Knowledge) REF: Page 188 OBJ: 10-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. The nurse conducting a food recall assessment on an older adult patient shows an understanding of the requirements of the process when:

a.

having the patient identify any existing food allergies.

b.

asking the family to verify the patients statements.

c.

asking how the food being discussed was prepared.

d.

correlating diet information with signs of malnutrition.

ANS: C

For accuracy and relevancy, the food recall must include specific information about the type of food ingested, the preparation method, and an accurate estimate of the amount.

DIF: Applying (Application) REF: N/A OBJ: 10-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

6. An older adult patient has been prescribed a specialized enteral formula after an extensive surgical procedure. The nurse anticipates and addresses a concern of many patients in this age cohort when assuring the patient that:

a.

her family can easily manage the formula after she is discharged.

b.

Medicare will cover the expense of the treatment.

c.

the treatment will be discontinued as soon as she is able to eat sufficiently.

d.

this is the most effective form of nutrition for her at this time.

ANS: B

Specialized enteral formulas are considerably more expensive than standard formulas and should be used only when clearly indicated. The cost of such a treatment would be of great concern to this cohort. The special feeding will be discontinued as soon as possible, this is the best way to give this patient nutrition at this time, and the family can manage the feedings, but the bigger concern is cost.

DIF: Understanding (Comprehension) REF: N/A OBJ: 10-6

TOP: Communication and Documentation MSC: Physiologic Integrity

7. During a nutritional assessment, a 79-year-old patient responds, My weight is fine. I weigh the same as I did 15 years ago. The nurse responds based on the understanding that older patients:

a.

generally guess their weight rather than weigh themselves.

b.

often rely on how their clothes fit to determine whether their weight has changed.

c.

sometimes experience altered metabolic problems that hide weight change.

d.

often exchange lean muscle mass for body fat so weight stays the same.

ANS: D

With age there is a loss of lean body mass and an increase of body fat; therefore, body weight alone can be misleading.

DIF: Remembering (Knowledge) REF: Page 191 OBJ: 10-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

8. An older adult patient has experienced severe nausea and vomiting for 2 days since undergoing abdominal surgery. A prealbumin serum blood test is ordered. The nurse explains the rationale for the test to the patients family by saying:

a.

The provider is interested in whether there is enough available protein in the blood.

b.

This test is designed to determine how the body is meeting current demands for protein.

c.

The test will tell us if the vomiting has created a problem with protein metabolism.

d.

Healing from such a surgery requires protein, and this test measures protein.

ANS: B

This test is sensitive to sudden demands on protein synthesis and is often used in the acute care setting. Healing from surgery does require sufficient protein stores, and this test can help the nurse, dietician, and provider determine if the patient needs extra nutritional support.

DIF: Understanding (Comprehension) REF: Page 191 OBJ: 10-4

TOP: Teaching-Learning MSC: Physiologic Integrity

9. Based on recent surveys identifying nutritional information concerning the daily diet of older adults in America, the nurse suggests:

a.

substituting carbohydrates with lean protein sources.

b.

adding calories through the addition of fruits and vegetables.

c.

introducing a protein at each meal.

d.

relying on foods that are both easy to chew and easy to digest.

ANS: B

Government-sponsored surveys have indicated that the average diet of the older adult lacks in calories, especially in the form of fruits and vegetables. The recommendations do not include substituting protein for carbohydrates, adding protein at each meal, and relying solely on foods that are easy to chew and digest, although these suggestions might be appropriate for individual patients.

DIF: Understanding (Comprehension) REF: Page 192 OBJ: 10-5

TOP: Teaching-Learning MSC: Health Promotion

10. An older adult patient with a history of a myocardial infarction tells the nurse that he takes his daily dose of prescribed aspirin with breakfast each morning. The nurses response is:

a.

Food interferes with the drugs absorption, so take it between meals.

b.

Taking aspirin with food increases your likelihood of stomach upset.

c.

Taking the drug with food is likely to alter the taste of the food.

d.

Eating as you take the aspirin is likely to result in constipation.

ANS: A

The absorption of aspirin occurs in the stomach and so is greatly altered by the presence of food.

The other statements are incorrect.

DIF: Understanding (Comprehension) REF: Page 197 OBJ: 10-1

TOP: Teaching-Learning MSC: Physiologic Integrity

11. The nurse notes a patients prealbumin is 2 mg/dL. What action by the nurse is best?

a.

Tell the patient to add more protein to the diet.

b.

Conduct a nutritional screening with a standard tool.

c.

Refer the patient to a registered dietician.

d.

Instruct the patient to maintain good nutritional habits.

ANS: C

Normal albumin levels are above 15 mg/dl. Values below 5 mg/dL are considered a marker for severe protein deficiency. The nurse should enlist the services of a registered dietician to help manage this patient. Adding more protein to the diet and conducting a nutritional screening are not the best answers because the nurse already knows the patient is severely malnourished. Instructing the patient to maintain his or her good nutritional habits is incorrect.

DIF: Applying (Application) REF: N/A OBJ: 10-4

TOP: Communication and Documentation MSC: Physiologic Integrity

12. A nurse works with a patient who is malnourished. What lab value does the nurse assess for the most up-to-date information on the patients status?

a.

Albumin

b.

Prealbumin

c.

Transferrin

d.

Total iron

ANS: B

Prealbumin has a half-life of 2 to 3 days, so it is the most accurate measure of the patients current status. Albumins half-life is 21 days; transferrins half-life is 8 to10 days. Total iron does not indicate current nutritional status as accurately as the others.

DIF: Remembering (Knowledge) REF: Page 191 OBJ: 10-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

13. The nurse has conducted a nutrition screen on a patient using the Nutrition Screening Initiative tool. The patient scored a 4. What action by the nurse is most appropriate?

a.

Refer the patient to a dietician for a nutritional assessment.

b.

Encourage the patient to add more protein items to the diet.

c.

Reinforce the patients good eating habits and nutrition.

d.

Consult the provider about adding an iron supplement.

ANS: A

A score of 3 or higher indicates moderate to severe nutritional risk. The nurse consults a dietician for a more in-depth nutritional assessment. Adding more protein items to the diet is probably a good idea, but this is not the most comprehensive answer. The nurse can reinforce the good eating habits the patient does have, but the patient needs more intervention. The patient may or may not need an iron supplement.

DIF: Applying (Application) REF: N/A OBJ: 10-4

TOP: Communication and Documentation

MSC: Safe Effective Care Environment

14. A nurse is caring for an observant Hindu patient who has a protein deficiency. What menu items does the nurse select for the patient?

a.

Lean beef

b.

Chicken

c.

Beans

d.

Pork

ANS: C

Hindus do not eat any meat, so to get a food high in protein, the nurse selects beans.

DIF: Remembering (Knowledge) REF: Page 196

TOP: Nursing Process: Implementation | Cultural Awareness Box

MSC: Psychosocial Integrity

15. A nurse is caring for four patients. On which patient should the nurse plan to conduct a further nutritional assessment?

a.

The patient who has lost 10% of body weight in 1 month

b.

The patient who has lost 5 pounds with exercise in 1 month

c.

The patient who gained 3 pounds while on vacation

d.

The patient who weighs 12% over ideal body weight

ANS: A

Loss or gain of 5% of body weight in 1 month puts a patient at nutritional risk. The other patients are not at nutritional risk.

DIF: Remembering (Knowledge) REF: Page 190 OBJ: 10-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

16. A patient wants to know what no sugar added on a food label means. What explanation is best?

a.

The food has no calories.

b.

No sugar was added during processing.

c.

The food naturally has no sugar.

d.

The food has 23% less sugar than normal.

ANS: B

No sugar added means that no sugar is added during processing (or packaging) and no ingredients are added that contain sugar. It does not mean that the food has no calories or that the food itself does not naturally contain sugar. A product with 23% less sugar than the original counterpart is labeled low sugar.

DIF: Understanding (Comprehension) REF: Page 196 OBJ: 10-7

TOP: Teaching-Learning MSC: Health Promotion

17. The nurse teaches older adults to reduce sodium in their diets. What is the daily recommended limit for sodium in this population?

a.

1000 mg

b.

1500 mg

c.

2000 mg

d.

2500 mg

ANS: B

The current recommendations for sodium intake in the older population limits ingestion to 1500 mg/day.

DIF: Understanding (Comprehension) REF: Page 193 OBJ: 10-7

TOP: Teaching-Learning MSC: Health Promotion

18. An older adult is worried about potassium intake. What does the nurse teach this patient?

a.

Unless you take a diuretic, dont worry about potassium.

b.

You should take a daily potassium supplement.

c.

You should try to get all your potassium through food.

d.

Potassium is not a nutrient people generally worry about.

ANS: C

The guidelines for nutrition and older individuals state that potassium intake (4700 mg/day) should be ingested through food. Some people do need a supplement, for instance, those on potassium-wasting diuretics. Potassium is a vital nutrient, important in electrical conduction and muscle function.

DIF: Understanding (Comprehension) REF: Page 193 OBJ: 10-7

TOP: Teaching-Learning MSC: Health Promotion

19. An older patient asks why he needs a multivitamin supplement. The patient has always been healthy, has excellent nutrition, and has never needed vitamins. What explanation by the nurse is best?

a.

Older people tend to eat fewer calories, so its harder to get nutrients.

b.

You need to have extra nutritional reserves in case of sudden illness.

c.

Its recommended in all the nutritional guidelines for older adults.

d.

Now that you are older, your good nutritional habits are not enough.

ANS: A

Older people do tend to eat fewer calories, making it more difficult to get all the needed nutrients. Stating that old habits are no longer good enough is not quite accurate. Extra nutritional reserves are a good idea, but the patient may not feel vulnerable to illness. Stating that it is in the nutritional recommendations does not give the patient useful information.

DIF: Understanding (Comprehension) REF: Page 193 OBJ: 10-3

TOP: Teaching-Learning MSC: Health Promotion

20. A diabetic is struggling with the carbohydrate-controlled diet as a result of having a large extended family with many get-togethers. What action by the nurse is best?

a.

Remind the patient of the consequences of poor control of diabetes.

b.

Tell the patient that once a month he or she can eat as desired.

c.

Help the patient make priorities so some favorite foods can be eaten.

d.

Tell the patient to increase the insulin dose on get-together days.

ANS: C

Nurses working with patients who have dietary issues need to understand the social, emotional, cultural, and religious ties their patients have to food, or the interventions will not be successful. While normally maintaining a diabetic diet the patient can be assisted to prioritize foods that are must haves and determine how to work them into the diet.

DIF: Applying (Application) REF: N/A OBJ: 10-1

TOP: Teaching-Learning MSC: Health Promotion

21. An older woman asks the nurse why she suddenly has a deficiency in B vitamins as her eating and cooking habits have not changed. What response by the nurse is best?

a.

Something has to be different now.

b.

You cant absorb B vitamins like before.

c.

Your need for B vitamins has increased.

d.

The guidelines have been increased.

ANS: B

Age-related gastrointestinal changes include a decrease in intestinal pH, which lowers the ability of the gastrointestinal tract to absorb B vitamins.

DIF: Understanding (Comprehension) REF: Page 185 OBJ: 10-2

TOP: Teaching-Learning MSC: Physiologic Integrity

MULTIPLE RESPONSE

1. A patient is being discharged on total parenteral nutrition (TPN). What topics do the patient and family need to be taught? (Select all that apply.)

a.

How to work the enteral feeding pump

b.

Care of a central venous catheter

c.

How to crush and give medications

d.

Proper use of an intravenous (IV) pump

e.

Actions to take if the IV becomes occluded

ANS: B, D, E

TPN is administered via a large central IV line using an IV pump. The family needs to know how to use the pump, how to care for the catheter, and what to do if the IV line becomes occluded. An enteral pump is not used. Meds are not crushed and given through the TPN line.

DIF: Applying (Application) REF: N/A OBJ: 10-6

TOP: Teaching-Learning MSC: Physiologic Integrity

2. The student learning about gerontologic nursing knows that which features are commonly associated with geriatric failure to thrive? (Select all that apply.)

a.

Impaired physical function

b.

Depression

c.

Malnutrition

d.

Cognitive decline

e.

Poor dentition

ANS: A, B, C, D

According to one description of failure to thrive, components include impaired physical function, depression, malnutrition, and cognitive decline. Poor dentition is not specifically mentioned.

DIF: Remembering (Knowledge) REF: Page 198 OBJ: 10-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

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