Chapter 11: Nutrition Assessment and Patient Care My Nursing Test Banks

Chapter 11: Nutrition Assessment and Patient Care

Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition

MULTIPLE CHOICE

1. The situation in which it would be most important for the nurse to contact the registered dietitian (RD) is if a

a.

patient complains of constipation during his or her hospital stay.

b.

patients family complains about the quality of the food in the hospital.

c.

patient reports losing 10 lb in the past year without trying.

d.

patient has been receiving intravenous glucose and saline but no oral intake for 36 hours.

ANS: D

It would be most important for the nurse to contact the RD to conduct a nutrition assessment if the patient has received only intravenous fluids with no nutrient intake for more than 24 hours. Constipation may warrant a nutrition assessment if it is ongoing, but in the short term, it is probably related to surgery, medical procedures, inactivity, or medications. Loss of 10 lb in a year is not considered severe and would warrant nutrition assessment only if other nutrition risk factors are present. Family complaints should be treated with respect but would warrant nutrition assessment only if the patients oral intake is significantly compromised; stressed family members often complain about food because it is unfamiliar and they believe it is the one thing in the hospital that should be familiar.

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2. An example of a common cause of iatrogenic malnutrition is

a.

scheduling of frequent daily tests that prevents the patient from eating meals.

b.

food from home brought in by family members and friends of a patient.

c.

small portion sizes of hospital food and absence of snacks.

d.

errors in ordering and delivery of meals for hospitalized patients.

ANS: A

A common cause of iatrogenic malnutrition is the scheduling of frequent tests that require patients to fast beforehand, possibly through the next meal time. It is not uncommon for patients to miss breakfast because they need to fast, to miss lunch because they are having a test, and to be too tired to eat very much at dinner. Bringing food from home may help prevent malnutrition. Hospital portion sizes are usually appropriate, and extra food and snacks can be ordered if needed. Errors in ordering and delivering patient meals are rare.

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3. If a patient is 6 feet tall and his or her waist measures 42 inches, the patient would be considered to have _____ fat levels consistent with _____ risk for chronic disease.

a.

essential; low

b.

essential; high

c.

abdominal; low

d.

abdominal; high

ANS: D

Waist-to-height ratio (WHtR) indicates abdominal fat levels, which can be predictive of risk for diabetes, hypertension, and cardiovascular disease. This patient has a WHtR ratio of 42:72, or 0.58. A WHtR ratio exceeding 0.5 is consistent with high risk for chronic disease.

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4. The best way to estimate height for a patient with both legs amputated below the knee is to use

a.

demi-span (distance from the sternal notch to the middle finger).

b.

knee height (with the use of calipers to measure heel-to-thigh distance).

c.

recumbent bed height measured while the patient is lying down.

d.

the patients stated pre-amputation height.

ANS: A

The most reliable method for a double leg amputee would be to use a formula based on measured demi-span. Knee height and recumbent bed height would not be measurable with lower limbs missing. Stated height is not necessarily accurate.

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5. If a male patient weighs 140 pounds when he is admitted to a long-term care facility and weighs 147 pounds 2 months later, his percent weight change during his hospital stay is

a.

3.5%.

b.

5%.

c.

7%.

d.

14%.

ANS: B

Percent weight change = [(147 140) 140] 100 = (7 140) 100 = 5%.

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6. If a patient weighed 150 lb 1 month ago and now weighs 140 lb, the weight loss would be considered

a.

insignificant.

b.

mild.

c.

moderate.

d.

severe.

ANS: D

Percent weight loss = [(150 140) 150] 100 = (10 150) 100 = 6.67%. Loss of more than 5% of body weight in 1 month is considered severe.

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7. An elderly patient who has been living alone and has gradually been losing weight has had a stroke and is transferred to a long-term care facility. It is unlikely that he will be able to achieve adequate oral intake during recovery, and so a percutaneous endoscopic gastrostomy (PEG) tube is inserted to begin tube feedings into his stomach. If the patient gains 8 lb in the first week of tube feeding, it is likely that

a.

he is retaining fluid weight.

b.

the tube feeding is well tolerated.

c.

he is constipated.

d.

the feedings are replenishing muscle and fat stores.

ANS: A

Weight gains exceeding 1 pound in a day are probably caused by excess fluid. The body cannot accumulate lean body mass or body fat this quickly, and accumulation of this amount of feces is highly unlikely.

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8. Body mass index (BMI) would be most useful for evaluating the weight status of a(n)

a.

middle-aged, moderately active woman.

b.

elderly, mostly sedentary man.

c.

high-school football player.

d.

young woman undergoing chemotherapy.

ANS: A

BMI measurement would be most useful for a healthy, moderately active woman. It may yield an underestimate of body fat in older adults, an overestimate of body fat in muscular individuals such as football players, and invalid results in patients who are acutely ill or who have lost muscle mass, as may be the case for a patient undergoing chemotherapy.

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9. An example of a patient considered to be at high nutrition risk is a(n)

a.

72-year-old man who has been vomiting for 12 hours.

b.

38-year-old overweight man who has had a heart attack.

c.

18-month-old child with weight in the third percentile for height.

d.

woman with a broken leg and a serum albumin level of 3.8 g/dL.

ANS: C

A child with weight below the fifth percentile for height has high nutrition risk. A man between 65 and 75 years of age has moderate nutrition risk; vomiting for 12 hours does not necessarily increase nutrition risk. An overweight man who has had a heart attack may benefit from long-term interventions to decrease weight and saturated fat intake, but he is not at immediate nutrition risk. Broken bones may represent moderate nutrition risk, but a serum albumin level greater than 3.5 is not of immediate concern.

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10. Measurement of serum albumin level would be most useful for predicting visceral protein status in a(n)

a.

patient with congestive heart failure who has very little appetite.

b.

elderly patient who has been living alone and is scheduled for nonemergency surgery.

c.

patient with liver failure related to chronic alcohol abuse.

d.

patient who was in a serious car accident and is recovering from multiple fractures.

ANS: B

Serum albumin level is a good index of visceral protein status for patients who are otherwise healthy, such as an older adult scheduling nonemergency surgery. Congestive heart failure, hepatic insufficiency, and trauma may cause abnormally low values.

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11. If a patient complains of fatigue and has spoon-shaped nails, a test that may be ordered is _____ measurement.

a.

total bilirubin

b.

blood hemoglobin

c.

plasma glucose

d.

blood urea nitrogen (BUN)

ANS: B

Fatigue and spoon-shaped nails may indicate iron deficiency anemia, and so assessment of hemoglobin level would be appropriate. Bilirubin level reflects liver function, and BUN level reflects renal function; problems with either may cause fatigue, but not spoon-shaped nails. Plasma glucose level may be used to monitor diabetes control.

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12. If a hospitalized patient is not recovering well and seems to have a poor appetite, it would be appropriate to request a

a.

tube feeding.

b.

calorie count.

c.

food record.

d.

menu analysis.

ANS: B

If staff are concerned about the adequacy of a patients diet in an acute-care or long-term care facility, they may conduct a calorie count to determine what the patient is actually eating. Food records are usually kept by patients themselves when they are not in a hospital setting. Menu analysis shows what is available to the patient but does not measure what the patient actually ate. A tube feeding is not appropriate unless the patient is incapable of achieving adequate oral intake.

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13. If nutrition screening identifies a patient as being at high nutrition risk, the next step in their care would be nutrition

a.

intervention by a registered dietitian.

b.

assessment by a registered dietitian.

c.

diagnosis by the physician.

d.

monitoring and evaluation by the nurse.

ANS: B

Someone identified as being at high nutrition risk should first receive a comprehensive nutrition assessment, preferably by a RD. This would be followed by nutrition diagnosis by the RD, nutrition intervention by the RD and nursing staff, and nutrition monitoring and evaluation by the RD, nurse, and physician.

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14. If a patient is immobilized for several days and cannot get out of bed, the most important thing for the nurse to do is

a.

compare fluid intake and output and check for edema.

b.

change the patients position or turn the patient several times a day.

c.

conduct a calorie count to make sure the patients food intake is adequate.

d.

change sheets and blankets during each shift.

ANS: B

It is especially important for nurses to turn and reposition immobilized patients frequently to reduce their risk of skin breakdown and shifts in body fluids. Changing the sheets every shift is not necessary and may be too disruptive. Encouraging the patient to maintain adequate oral intake would be helpful, but a calorie count is not needed unless there are specific concerns about inadequate intake. Checking for edema is helpful, but keeping track of fluid intake and output is unnecessary unless specific problems with fluid balance are identified.

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15. The best way to evaluate the weight of a hospitalized patient is

a.

at the same time as assessing the patients vital signs.

b.

no more than once a week, to avoid measuring fluid shifts rather than true weight.

c.

by using a bed scale.

d.

while the patient is wearing a hospital gown, at the same time each day, and after voiding.

ANS: D

For consistent and comparable results, patients weights should be measured daily, at the same time each day, after voiding, and while the patient is wearing a hospital gown. It is helpful to measure weight daily rather than just weekly because it may be important to measure fluid gains or losses. Measuring weight at the same time as assessing vital signs would be too frequent. A bed scale is necessary only for patients who are unable to stand; most patients can stand on a regular beam or electronic scale.

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16. When a nurse is recording food intake for a calorie count, the best way to describe food intake is to

a.

list the percentage of each food served that was actually eaten.

b.

describe intake in qualitative terms, such as fair, adequate, and good.

c.

weigh each food before and after the patient eats and list the weight of food eaten.

d.

visit the patient each day and obtain a 24-hour diet recall.

ANS: A

It is important to provide objective measurements of food intake for calorie counts such as percentage of food served that is actually eaten or amount eaten in terms of household measurements. Weighing food is impractical in a hospital setting. A 24-hour diet recall is unlikely to be accurate because it relies on the patients memory and is not quantitative. Qualitative descriptions of the amount of food eaten cannot be accurately translated into calorie and protein intake.

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17. If a patient reports feeling lethargic and having a headache, and you notice that his or her hair is thin and the skin is dry, it would be important to ask the patient whether he or she

a.

has access to and is able to afford enough food.

b.

follows a vegan eating pattern or restricts intake of animal foods.

c.

uses any herbal or botanical remedies on a regular basis.

d.

takes high-dose vitamin supplements that contain vitamin A.

ANS: D

Lethargy, headache, dry skin, and hair loss are all symptoms of vitamin A excess, which is usually caused by use of high-dose supplements rather than food. Asking about food security is appropriate if the patient has general symptoms of malnutrition. Herbal or botanical remedies are not necessarily associated with these specific symptoms. A vegan eating pattern may cause vitamin B12 deficiency, which may manifest as confusion, depression, ataxia, weakness, and paresthesias.

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18. A patient with diabetes is recovering at home after foot surgery. He takes antidepressant and antihypertensive medications, as well as an oral hypoglycemia agent. When the nurse visits at noon to change his dressing, his or her greatest concern would be

a.

the open bottle of vodka on the table next to his recliner.

b.

the fact that he has not yet eaten lunch.

c.

his reliance mainly on canned and prepackaged food in the house.

d.

his complaints that his family does not come and help him.

ANS: A

For a patient taking several medications, especially including one for depression, the open bottle of vodka may signify alcohol dependency and may cause serious interactions with his medications. It is not uncommon for patients to each lunch after noon. Convenience food is higher in sodium than fresh food, but it is less of a concern than potentially high alcohol intake. His complaints about his lack of help may or not be a concern, depending on other help that is available to him.

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19. A situation that may be associated with moderate nutrition risk is

a.

use of analgesic medications to manage a patients pain.

b.

being tube fed for several weeks and transitioning to oral intake.

c.

food brought in by family members for a hospitalized patient.

d.

following a low-fat, high-fiber, low-sodium diet.

ANS: B

Transitioning from tube feeding to oral intake is associated with moderate nutrition risk because oral intake may not be adequate initially. Managing a patients pain may decrease nutritional risk because pain-free patients usually have a better appetite. Food brought in by family members for a patient may also improve food intake and nutritional status, if they do not need to follow a restrictive or modified diet. Following a low-fat, high-fiber, low-sodium diet is likely to improve nutritional health.

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20. Overall, the greatest concern in screening patients for risk of malnutrition is

a.

edema.

b.

muscle wasting.

c.

unintended weight gain.

d.

unintended weight loss.

ANS: D

Unintended weight loss is the greatest predictor of nutritional risk. Muscle wasting may indicate loss of somatic protein, and edema may indicate loss of visceral protein, but these conditions are more likely to be caused by nonnutrition-related factors. Unintended weight gain is associated with risk of chronic disease, but not with nutrition risk.

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21. Rapid weight gain (>1 pound in a day) is probably caused by accumulation of

a.

fluid.

b.

feces.

c.

body fat.

d.

lean body mass.

ANS: A

Weight gains exceeding 1 pound in a day are probably caused by excess fluid. The body cannot accumulate lean body mass or body fat this quickly, and accumulation of this amount of feces is highly unlikely.

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22. A BMI of 18 would reflect

a.

underweight.

b.

normal weight.

c.

overweight.

d.

severe overweight.

ANS: A

A BMI less than 18.5 is classified as underweight. A BMI between 18.5 and 24.9 is considered normal weight, 25 to 29.9 is considered overweight, and 30 or greater is considered obese.

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23. An elderly patient falls at home and lies on the floor for 24 hours without anything to eat or drink for 24 hours before being found and admitted to the hospital. What would be an important thing for the nurse to do before collecting blood to evaluate nutritional status?

a.

Weigh the patient.

b.

Assess food and beverage intake before the fall.

c.

Rehydrate the patient.

d.

Manage the patients pain.

ANS: C

It is important to rehydrate patients who have not had any fluids for some time. If they are not rehydrated before blood is collected, test results will be falsely elevated. Weighing the patient will be useful only after the patient is rehydrated. Managing the patients pain is important, but is not directly related to evaluation of nutritional status. Assessing food and beverage intake before the fall may be part of a complete nutrition assessment, but it is not necessary before collection of blood samples.

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24. A patient who is scheduled for knee surgery mentions not having eaten much in the past few weeks because it has been difficult to shop and prepare food. To evaluate the patients immune function, the physician may decide to test the patients serum _____ levels.

a.

iron

b.

vitamin D

c.

prealbumin

d.

creatinine

ANS: B

Low serum vitamin D levels are related to poor immune function. Low serum iron levels may be associated with anemia. Serum prealbumin levels are positively related to visceral protein status. High serum creatinine levels indicate renal function and loss of muscle tissue.

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25. A meal rich in nutrients that promote wound healing is

a.

a bean burrito with salsa and guacamole.

b.

a roast beef sandwich on whole grain bread with strawberries.

c.

a grilled cheese sandwich and carrot sticks.

d.

tuna salad on a bed of lettuce with crackers.

ANS: B

Nutrients that promote wound healing include protein, zinc, and vitamin C. Roast beef is an excellent source of protein and zinc, the whole grain bread is also a good source of zinc, and strawberries are an excellent source of vitamin C. The beans in the burrito provide some protein, but the meal has relatively low amounts of zinc and vitamin C. Cheese also provides protein, but carrot sticks provide more vitamin A than vitamin C and, unless the bread is whole grain, the zinc content is low. Tuna salad also provides protein but relatively little zinc; lettuce provides relatively little vitamin C.

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26. If a patient is taking a monoamine oxidase inhibitor (MAOI) for depression, a meal that may result in unpleasant side effects and dangerous hypertension is

a.

salad with bacon and blue cheese.

b.

peanut butter sandwich and grapefruit juice.

c.

fresh fruit salad with nuts and honey.

d.

cream of mushroom soup with crackers.

ANS: A

MAOIs inhibit the enzyme monoamine oxidase, which inactivates tyramine found in foods such as Chianti wine, aged cheese (such as blue cheese) and some fermented foods. Grapefruit juice should be avoided by people taking certain other drugs, but not MAOIs.

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27. A patient may be at high nutritional risk if he or she

a.

is receiving a soft diet.

b.

has a serum albumin level of 2.5 g/dL.

c.

has been receiving a tube feeding for 1 week.

d.

has gained 5 pounds during the previous month.

ANS: B

Serum albumin levels of 3 g/dL or lower indicate high nutritional risk; serum albumin levels between 2.4 and 2.9 mg/dL indicate moderate malnutrition. Soft diets are altered in texture but are still nutritionally adequate. Tube feedings are also nutritionally adequate if administered correctly. Gradual weight gain does not necessarily indicate nutritional risk.

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28. If a patient is prescribed long-term treatment with steroids, he or she will need to be advised to

a.

avoid foods that contain tyramine.

b.

avoid grapefruit juice.

c.

try to eat more than they want, to avoid weight loss.

d.

limit intake of high-calorie foods, to avoid weight gain.

ANS: D

Steroids are appetite stimulants, so it would be helpful to counsel patients to limit food intake to avoid weight gain. Grapefruit juice and tyramine do not affect the action of steroids.

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29. If a hospitalized patient is taking warfarin (Coumadin) to reduce risk of blood clots, you would be concerned if a family member brought them lunch consisting of

a.

a fruit smoothie containing grapefruit juice.

b.

a peanut butter sandwich and chocolate milk.

c.

spicy rice and beans with tomatoes.

d.

spinach salad with chopped egg and nuts.

ANS: D

Foods high in vitamin K, such as spinach, may reduce the efficacy of warfarin. Grapefruit juice affects the action of several drugs, but not warfarin. Dairy products may affect the action of some antibiotics.

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30. If a patient who received four prescription medications is going to begin enteral tube feedings, the best thing for the nurse to do is to

a.

use liquid medications and flush the tube before and after administration.

b.

crush each medication and dissolve it in water before administration.

c.

crush the medications and mix them with the tube feeding.

d.

contact the pharmacy to determine the best route of administration.

ANS: D

The nurse should contact the pharmacy to determine the best route of administration for each drug. Some drugs are available in liquid form and can be administered via the feeding tube. Some medications can be crushed and dissolved in water in order to administer them. Medications should never be mixed with enteral formulas because they may alter the consistency of the feeding and cause the tube to become clogged.

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