Eliopoulos Chapter 11- Nutrition and Hydration

Origin: Chapter 14- Nutrition and Hydration, 1

Chapter: 14

Client Needs: D4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 1

Page and Header: 173, Quantity and Quality of Caloric Needs

Even though a nursing assistant notices that an older patient's oral intake has been poor since being admitted to the care area, the assistant is not concerned since "older people don't need to eat much anyway." How should the nurse respond to this assistant's comment?

A) "That's a myth actually; older adults have increased caloric and nutritional needs."

B) "Actually, older adults who are sick require more calories than younger people do during their recovery."

C) "You're right, but it's still important that we provide vitamin supplements especially when a patient is recovering from an illness."

D) "Even though it is true that older people don't need quite as many calories as younger people, they need as many nutrients as you or I."

Ans: D

Feedback:

While caloric need does decrease with age, nutrient requirements are relatively consistent across the life span. Older adults do not have increased caloric and nutritional needs. Older adults who are sick do not necessarily require more calories since the basal metabolic rate declines 2% for each decade of life. Vitamin and mineral supplements for older adults are undetermined.

Origin: Chapter 14- Nutrition and Hydration, 2

Chapter: 14

Client Needs: B

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 1

Page and Header: 173, Quantity and Quality of Caloric Needs

2. A health-conscious resident of an assisted living facility is promoting the value of fiber to a fellow resident. Which statement made by the resident about the benefits of fiber is accurate?

A) Improved bowel activity and increased metabolic rate

B) Improved bowel activity and decreased serum cholesterol

C) Improved gastric emptying and prevention of colon cancer

D) Increased nutrient absorption and decreased glucose tolerance

Ans: B

Feedback:

Fiber is noted to lower serum cholesterol and promote good bowel activity. It is not noted to improve nutrient absorption or gastric emptying or to increase overall metabolic rate.

Origin: Chapter 14- Nutrition and Hydration, 3

Chapter: 14

Client Needs: D2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 2

Page and Header: 175, Nutritional Supplements

3. During a home visit, the nurse is asked by an older couple if vitamin and nutritional supplements can compensate for poor food intake. What should the nurse respond to this question?

A) "Supplements can be useful but avoid those that contain calcium."

B) "The risks of excess dosages mean that supplements are best avoided entirely."

C) "Supplements should be thought of as supplements, not replacements, so it's best not use them."

D) "Vitamin and nutrient supplements can be a useful short-term nutritional measure, but only if they don't interact with prescribed medications."

Ans: D

Feedback:

There is a valid role for supplements in meeting the nutritional needs of older adults, but the risk of medication interactions must be taken into account. It would be unnecessary to recommend complete avoidance of all supplements or of those that contain calcium.

Origin: Chapter 14- Nutrition and Hydration, 4

Chapter: 14

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 3

Page and Header: 176, Special Needs of Women

4. An older woman asks what she can do to reduce the risk of developing osteoporosis. What should the nurse respond to this patient?

A) "The key to preventing osteoporosis is to remain physically active on a regular basis."

B) "For women who have complete menopause, vitamin D supplements are the best form of prevention."

C) "The best thing that you can do is to maximize your calcium intake by including dairy at most meals and taking supplements as well."

D) "You need to make sure you are getting the recommended daily dose of calcium, which may involve taking supplements at each meal."

Ans: D

Feedback:

Postmenopausal women need to ensure a daily intake of calcium of at least 1 g. Supplements may be required. It would be inaccurate to encourage the woman to consume as much calcium as possible given the risks associated with excess calcium intake. Neither vitamin D supplementation nor exercise is the primary preventative measure for the development of osteoporosis.

Origin: Chapter 14- Nutrition and Hydration, 5

Chapter: 14

Client Needs: D4

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 5

Page and Header: 177, Hydration Needs of Older Adults

5. An older patient with a history of renal failure is admitted with dehydration and hyponatremia. The nurse identifies which assessment findings as being consistent with the diagnosis of dehydration? (Select all that apply.)

A) Confusion

B) Shortness of breath

C) Decreased skin elasticity

D) Increased blood urea nitrogen (BUN)

E) Adventitious lung sounds on auscultation

Ans: A, C, D

Feedback:

Confusion, decreased skin elasticity, and increased BUN are all associated with dehydration. Adventitious lung sounds and shortness of breath are not associated with dehydration but rather with overhydration.

Origin: Chapter 14- Nutrition and Hydration, 6

Chapter: 14

Client Needs: D4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 4

Page and Header: 177, Hydration Needs of Older Adults

6. An older patient is demonstrating signs of dehydration. Which action should the nurse initiate first?

A) Minimize food intake and maximize fluid intake

B) Advocate for the initiation of intravenous rehydration

C) Initiate monitoring and recording of fluid intake and output

D) Ask that the physician order blood work to confirm or rule out dehydration

Ans: C

Feedback:

When dehydration is suspected, the nurse should monitor and record fluid intake and output. This would likely precede IV rehydration and blood work, and minimizing food intake would be an inappropriate action.

Origin: Chapter 14- Nutrition and Hydration, 7

Chapter: 14

Client Needs: D4

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 6

Page and Header: 178, Promotion of Oral Health

7. After receiving new dentures the nurse provides instruction to an older patient on the use and their care. Which patient statement indicates that teaching about the dentures has been effective?

A) "I do not have to brush and floss my teeth every day."

B) "I suppose that I'll have to get these resized and adjusted from time to time."

C) "I'll have to change my diet to include only soft and pureed foods now I suppose."

D) "I've had to go to the dentist so often over the last few years and it's a relief not to have to anymore."

Ans: B

Feedback:

It is important that older adults realize that dentures still necessitate maintenance and occasional readjustments. Brushing is still necessary, as is visiting the dentist. The diet of adults with dentures is not noted to be restricted to soft and pureed foods.

Origin: Chapter 14- Nutrition and Hydration, 8

Chapter: 14

Client Needs: D4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 7

Page and Header: 178, Indigestion and Food Intolerance

8. An older patient asks the nurse what he can about nausea that occurs after eating because of delayed gastric emptying. What advice should the nurse provide to the patient?

A) Changing to a vegetarian, organic diet

B) Limiting food intake and taking antacids regularly

C) Increasing the amount of soluble and insoluble fiber in his diet

D) Eating several small meals throughout the day rather than three larger ones

Ans: D

Feedback:

More frequent intake of smaller amounts of food is noted to be useful in the management of slow gastric emptying. A vegetarian diet and increasing fiber intake are not known to be effective management techniques for delayed gastric emptying. Limiting food and using antacids predisposes the patient to other risks.

Origin: Chapter 14- Nutrition and Hydration, 9

Chapter: 14

Client Needs: A2

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 7

Page and Header: 179, Dysphagia

9. The family of an older patient with dysphagia comes to the skilled nursing facility at mealtimes to feed the patient. Which of the family's feeding practices should the nurse follow up with teaching or correction?

A) The family makes sure that the patient does not talk while eating

B) The family checks for pocketing of food prior to introducing another bite

C) The family places the patient in high Fowler position during and after feeding

D) The family introduces large pieces of food to prevent accidental inhalation of small food particles

Ans: D

Feedback:

For patients with dysphagia, small pieces of food are preferable. The other actions by the family are appropriate when feeding a patient with dysphagia.

Origin: Chapter 14- Nutrition and Hydration, 10

Chapter: 14

Client Needs: D4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 7

Page and Header: 179, Constipation

10. The nurse is planning interventions for an older patient who is prone to developing constipation. Which intervention would be appropriate for the nurse to implement with this patient?

A) Increase fluids and encourage activity

B) Scheduled administration of oil-based laxatives

C) Provide normal saline enemas every 2 to 3 days

D) Reduce activity and provide senna each day before bed

Ans: A

Feedback:

Plenty of fluids and activity are advisable to prevent the onset of constipation. Laxatives and enemas would not be appropriate to prevent the onset of constipation. Reducing activity could contribute to the development of constipation.

Origin: Chapter 14- Nutrition and Hydration, 11

Chapter: 14

Client Needs: B

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Teaching/learning

Objective: 1

Page and Header: 173, Quantity and Quality of Caloric Needs

11. The nurse is providing a seminar for a group of seniors on changing nutritional needs. What should the nurse instruct the participants about the reduced need for calories?

A) "You should consume at least three servings of fruits and vegetables daily."

B) "You should limit your fat intake to less than 50% of total calories consumed."

C) "The consumption of a high-carbohydrate diet prevents the release of glucose."

D) "As you age, your basal metabolic rate declines, contributing to weight gain even when you consume the same amount of calories as when you were younger."

Ans: D

Feedback:

Basal metabolic rate declines with age, a fact that can contribute to weight gain. Carbohydrates stimulate the release of insulin while fat intake should be below 30% of calories and five servings of fruit and vegetables should be consumed daily.

Origin: Chapter 14- Nutrition and Hydration, 12

Chapter: 14

Client Needs: B

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 1

Page and Header: 173, Quantity and Quality of Caloric Needs

12. A confused but physically healthy older patient eats a diet very high in cereals and breads, with fruit only once per week and little protein. How does the patient's diet impact her current condition?

A) A lack of vitamin A can affect her night vision.

B) A high-calcium diet can lead to problems with kidney stones.

C) The lack of fruit in her diet can contribute to complaints of constipation.

D) A high-carbohydrate diet can stimulate abnormally high release of insulin, which can add to her confusion.

Ans: D

Feedback:

An abnormally high release of insulin can cause hypoglycemia, which first presents in the elderly as a confused state. The patient's high-carbohydrate diet could increase her confusion. There is not enough information to support that the patient is experiencing problems with night vision because of a lack of vitamin A. There is also not enough information to support that the patient is experiencing constipation or has a high intake of calcium.

Origin: Chapter 14- Nutrition and Hydration, 13

Chapter: 14

Client Needs: B

Cognitive Level: Analysis

Difficulty: Easy

Integrated Process: Nursing process

Objective: 3

Page and Header: 176, Special Needs of Women

13. After a nutritional assessment the nurse learns that a 70-year-old female patient routinely ingests a diet high in fat. The nurse realizes the patient is at an increased risk for developing which health problem?

A) Cancer

B) Arthritis

C) Osteoporosis

D) Heart disease

Ans: D

Feedback:

Heart disease, cancer, and osteoporosis are among the nutrition-related conditions to which older women are susceptible. From ages 64 to 74, the rate of heart disease equals that of men, and reduction of fat intake can be beneficial in reducing this risk.

Origin: Chapter 14- Nutrition and Hydration, 14

Chapter: 14

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 2

Page and Header: 175, Nutritional Supplements

14. An older patient reports a significant amount of cheese, milk, and calcium-fortified orange juice in her diet. She also takes a 750 mg calcium supplement at breakfast. What should the nurse instruct the patient about her calcium intake?

A) Keep the intake of calcium to 30% of kilocalories or less

B) Take calcium supplement doses totaling not more than 5,000 mg

C) Limit the intake of calcium to a total of 2,000 mg or less from all sources

D) Follow the RDA listed on the milk products' nutrition labels for calcium intake

Ans: C

Feedback:

If the patient has a daily calcium intake of greater than 2,000 mg, she may be at risk for kidney stones. Patients should check labels of food as well as supplements to ensure that the contents do not add up to excessive calcium consumption; however, the RDA listed on milk products' nutritional labels for calcium intake may be too great for the older patient. Calcium does not contribute to caloric intake. Calcium supplements totaling not more than 5,000 mg is too high an amount for most adults.

Origin: Chapter 14- Nutrition and Hydration, 15

Chapter: 14

Client Needs: D4

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing process

Objective: 7

Page and Header: 182, Assessment Guide 14-1

15. The nurse observes the skin of an older patient and then asks the patient questions about his nutritional status. How did inspection of the patient's skin guide the nurse to complete a nutritional assessment?

A) Purpura may indicate hyperglycemia

B) Fungus infections may indicate zinc deficiency

C) Poor skin turgor may be an indicator of overhydration

D) Persistent "goose bumps" may indicate a vitamin deficiency

Ans: D

Feedback:

Persistent "goose bumps" can be indicative of a deficiency in B vitamins. Purpura does not indicate hyperglycemia. Fungus infections do not indicate a zinc deficiency. Poor skin turgor may be an indication of dehydration and not overhydration.

Origin: Chapter 14- Nutrition and Hydration, 16

Chapter: 14

Client Needs: D2

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 4

Page and Header: 177, Hydration Needs of Older Adults

16. A 75-year-old patient and his 40-year-old daughter both have an intestinal virus with complaints of vomiting and diarrhea. Why is the nurse concerned about the patient being at risk for dehydration?

A) The patient is on a fixed income

B) The virus will make changes to the patient's gastrointestinal system

C) The vomiting and diarrhea will cause a reduction in intracellular fluids

D) The patient does not want to bother a health care professional for a common virus

Ans: C

Feedback:

The patient is at risk because of his age. With age, intracellular fluid is lost, resulting in decreased body fluids. Water makes up 50% or less of body weight in older adults, compared with 60% in younger adults. An increase in water loss could be life-threatening to an older person. The nurse's concern has nothing to do with the patient's income. The virus will not make changes to the patient's gastrointestinal system. There is not enough information to determine that the patient does not want to bother the nurse for a common virus.

Origin: Chapter 14- Nutrition and Hydration, 17

Chapter: 14

Client Needs: D2

Cognitive Level: Analysis

Difficulty: Easy

Integrated Process: Nursing process

Objective: 5

Page and Header: 177, Hydration Needs of Older Adults

17. An 80-year-old patient who has just spent 2 days at the beach with his family is demonstrating confusion, dry skin, a dry brown tongue, sunken cheeks, and concentrated urine. What health problem do the patient's symptoms most likely indicate?

A) Dehydration

B) Renal failure

C) Hyperthermia

D) Food poisoning

Ans: A

Feedback:

The nurse has identified the signs of dehydration in older adults. The manifestations of confusion, dry skin, dry brown tongue, sunken cheeks, and concentrated urine may or may not indicate renal failure, hyperthermia, or food poisoning.

Origin: Chapter 14- Nutrition and Hydration, 18

Chapter: 14

Client Needs: D3

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 5

Page and Header: 177, Hydration Needs of Older Adults

18. An 80-year-old patient is admitted to the hospital for dehydration related to flu symptoms and receives intravenous fluids. What is a major risk factor for the patient during this hospitalization?

A) Fluid restriction can lead to infection and constipation.

B) Fluid restriction can lead to serious electrolyte imbalance.

C) Dehydration can lead to decreased ability of the bladder to distend.

D) Overhydration can lead to problems when receiving intravenous fluids.

Ans: D

Feedback:

Older patients are more sensitive to overhydration which is a consideration if intravenous fluids are needed. The patient was admitted and treated with intravenous fluids for dehydration. At this point, overhydration would be a concern. The patient is not prescribed a fluid restriction so there is no risk for infection, constipation, or electrolyte imbalance. Dehydration does not lead to changes in the bladder's ability to distend.

Origin: Chapter 14- Nutrition and Hydration, 19

Chapter: 14

Client Needs: D4

Cognitive Level: Analysis

Difficulty: Easy

Integrated Process: Nursing process

Objective: 6

Page and Header: 178, Promotion of Oral Health

19. An older female patient will only eat oatmeal and has bad breath. A dental exam reveals that the patient has a few of her own teeth and uses a partial appliance. She also has red, swollen, painful gums, and some teeth are loose at the gumline. The nurse realizes the patient is experiencing which health problem?

A) Periodontal disease

B) Endodontic disease

C) Gastrointestinal disease

D) Lack of adequate nutrition

Ans: A

Feedback:

The patient's signs and symptoms are typical of periodontal disease. These signs and symptoms are consistent with endodontic disease, gastrointestinal disease, or a lack of adequate nutrition.

Origin: Chapter 14- Nutrition and Hydration, 20

Chapter: 14

Client Needs: D1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 6

Page and Header: 178, Promotion of Oral Health

20. An older patient has dentures and tells the nurse that she has not seen the dentist for years. What is the best advice the nurse should provide the patient?

A) Visit the dentist periodically to replace the dental appliance

B) Visit the dentist regularly if she wears his dentures everyday

C) Make an emergency dental visit if she notices a problem with the gums

D) Schedule regular visits with the dentist to monitor for lesions and fit of the dental appliance

Ans: D

Feedback:

Older adults commonly misunderstand their need for dental care once they have dental appliances. The nurse should correct this misconception and encourage the patient to have routine dental examinations. The dental appliance may or may not need to be replaced. The patient should see the dentist regularly whether or not the dentures are worn every day. If the patient visits the dentist regularly, a problem with the gums could be avoided.

Origin: Chapter 14- Nutrition and Hydration, 21

Chapter: 14

Client Needs: D3

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing process

Objective: 2

Page and Header: 175, Nutritional Supplements

21. During a home visit the nurse notes that an older patient has a tray of many types of vitamins, minerals, and herbal supplements on the kitchen counter. The patient was recently discharged from the hospital after having an acute myocardial infarction. What should the nurse instruct the patient about these supplements?

A) Continue taking the supplements but only with meals

B) Stop taking the vitamins and other supplements until further notice

C) Take the vitamins but do not exceed the recommended daily allowances for older adults

D) Check with the health care provider to identify any supplements that may produce adverse interactions with prescribed medication

Ans: D

Feedback:

Caution is necessary when using vitamins, minerals, and herbal supplements in older patients since some can cause adverse effects if taken in high doses and may interact with many medications. The patient should check with the health care provider before continuing to take the supplements with meals. Telling the patient to stop the supplements until further notice could frighten the patient since some of the supplements may be appropriate. It is most important that the patient check with the health care provider for adverse interactions between the supplements and prescribed medication.

Origin: Chapter 14- Nutrition and Hydration, 22

Chapter: 14

Client Needs: D4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 7

Page and Header: 179, Dysphagia

22. The nurse is instructing a nursing assistant on how to feed all patients with dysphagia. What information should the nurse include in this instruction?

A) Thicken liquids and cut solids into very small pieces

B) Use a spoon to transport even solid food to the patient's mouth

C) Listen for bowel sounds to make sure the food has reached the stomach

D) Make sure the patient is sitting upright whenever consuming food or fluid

Ans: D

Feedback:

One general measure for all persons with dysphagia is to have the patient sitting upright whenever food or fluid is being consumed. The other feeding measures may not be indicated for every person with dysphagia.

Origin: Chapter 14- Nutrition and Hydration, 23

Chapter: 14

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 1

Page and Header: 173, Quantity and Quality of Caloric Needs

23. The nurse is caring for an 85-year-old male patient who weighs 150 lb and is 6 feet 3 inches tall. If using the resting energy expenditure equation, how many calories must the patient consume each day to maintain his current body weight? (Be sure to round your answer to the nearest whole number.)

Ans: 1,378 calories

Feedback:

The equation for a male patient is 66 + [(6.23 × weight in pounds)] + [(12.7 × height in inches)] - (6.76 × age in years). For this patient, the equation would be:

66 + [(6.23 × 150 lb)] + [(12.7 ×75 inches)] - (6.76 × 85)

66 + 934.5 + 952.5 - 574.6 = 1378.4 calories

Origin: Chapter 14- Nutrition and Hydration, 24

Chapter: 14

Client Needs: D3

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 7

Page and Header: 180, Box 14-1; 180, Malnutrition

24. An older patient takes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for self-treatment of arthritis. For which nutritional health problems will the nurse include when assessing this patient? (Select all that apply.)

A) Thirst

B) Nausea

C) Diarrhea

D) Vomiting

E) Constipation

Ans: B, C, D, E

Feedback:

Nutritional health problem risks associated with taking NSAIDs include nausea, diarrhea, vomiting, and constipation. Thirst is not associated with taking NSAIDs.

Origin: Chapter 14- Nutrition and Hydration, 25

Chapter: 14

Client Needs: D4

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing process

Objective: 7

Page and Header: 180, Malnutrition

25. The nurse is concerned that an older patient with renal failure is developing malnutrition. What did the nurse assess in this patient? (Select all that apply.)

A) Hematocrit level 30%

B) Hemoglobin level 7 g/dL

C) Serum albumin level 2.5 g/100 mL

D) Blood glucose level 110 mg/dL

E) Weight loss of 6% over the last month

Ans: A, B, C, E

Feedback:

Clinical signs of malnutrition include a weight loss of greater than 5% over the last month, a serum albumin level lower than 3.5 g/100 mL, hemoglobin level below 12 g/dL, and hematocrit level below 35%. Blood glucose level is not used as a clinical indicator of malnutrition.

Origin: Chapter 14- Nutrition and Hydration, 26

Chapter: 14

Client Needs: D3

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/learning

Objective: 2

Page and Header: 175, Nutritional Supplements; 176, Table 14-5

26. An older patient is prescribed a thiazide diuretic as treatment for mild right heart failure. Which herbal supplements should the nurse instruct the patient to avoid while taking this medication? (Select all that apply.)

A) Green tea

B) Kava-kava

C) White willow

D) Cascara sagrada

E) Aloe barbadensis

Ans: D, E

Feedback:

Aloe barbadensis or cascara sagrada interacts with thiazide diuretics to cause an increased loss of potassium. Green tea can cause anorexia, diarrhea, insomnia, and vertigo. Kava-kava interacts with central nervous system depressants to cause increased sedation. White willow interacts with salicylates to cause increased antithrombotic effects.