Chapter 12: Nutrition Assessment in Medicine - Flashcards

The nurse recognizes that which of the following persons is at greatest risk for undernutrition?

1.A 5-month-old infant

2.A 50-year-old woman

3.A 20-year-old college student

4.A 30-year-old hospital administrator

ANS: 1

Vulnerable groups are infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults.

When assessing a patient's nutritional status, the nurse recalls that the best definition of optimal nutritional status is:

1.nutrients in excess of daily body requirements.

2.sufficient nutrients to provide for the minimum body needs.

3.sufficient nutrients for daily body requirements but not for increased metabolic demands.

4.sufficient nutrients to provide for daily body requirements and for increased metabolic demands.

ANS: 4

Optimal nutritional status is achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands resulting from growth, pregnancy, or illness.

The nurse is providing nutrition information to the mother of a 1-year-old child. Which of the following statements represents accurate information for this age group?

1.It is important to maintain adequate fat and caloric intake.

2.The recommended dietary allowances for an infant are the same as for an adolescent.

3.At this age the baby's growth is minimal so caloric requirements are decreased.

4.The baby should be placed on skim milk to decrease the risk of coronary artery disease when older.

ANS: 1

Because of rapid growth, especially of the brain, infants and children younger than 2 years should not drink skim or low-fat milk or be placed on low-fat diets—fat (calories and essential fatty acids) is required for proper growth and central nervous system development.

A pregnant woman is interested in breast-feeding her baby, and asks several questions about the topic. Which information is appropriate for the nurse to share with her?

1.Breast-feeding is best when also supplemented with bottle feedings.

2.Babies who are breastfed often require supplemental vitamins.

3.Breast-feeding is recommended for infants for the first 2 years of life.

4.Breast milk provides the nutrients necessary for growth as well as natural immunity.

ANS: 4

Breast-feeding is recommended for full-term infants for the first year of life because breast milk is ideally formulated to promote normal infant growth and development and natural immunity.

A mother and her 13-year-old daughter express their concern related to the daughter's recent weight gain and increase in appetite. Which of the following represents information the nurse should discuss with them?

1.The necessity of exercise and dieting at this age

2.Suggestions for snacks high in protein, iron, and calcium

3.Teenagers who have a weight problem should not be allowed to snack

4.The importance of a low-calorie diet to prevent the accumulation of fat

ANS: 2

After a period of slow growth in late childhood, adolescence is characterized by rapid physical growth and endocrine and hormonal changes. Caloric and protein requirements increase to meet this demand. Because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase.

The nurse is assessing a 30-year-old unemployed immigrant from an underdeveloped country who has been in the United States for 1 month. Which of the following problems related to his nutritional status might the nurse expect to find?

1.Obesity

2.Hypotension

3.Osteomalacia

4.Coronary artery disease

ANS: 3

General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries are among the more common nutrition- related problems of new immigrants from developing countries.

During a nutritional assessment of a 22-year-old male refugee, the nurse must remember to:

1.obtain a 24-hour dietary recall.

2.clarify what is meant by the term "food."

3.provide him with a standard dietary handbook.

4.assume that his diet is consistent with other refugees from the same country.

ANS: 2

Although one may assume that the term "food" is a universal concept, the person should clarify what is meant by the term.

Which of the following statements is true concerning the nutritional assessment?

1.It is only useful in patients who are overweight.

2.It identifies patients who are at risk of malnutrition.

3.This assessment can only be thoroughly done by a dietician.

4.It provides the nurse with physical findings related to all the systems.

ANS: 2

The purposes of the nutritional assessment are to (1) identify individuals who are malnourished or are at risk for development of malnutrition, (2) provide data for designing a plan of care that will prevent or minimize the development of malnutri- tion, and (3) establish baseline data for evaluating the efficacy of nutritional care.

The nurse is seeing a patient for the first time who has no history of nutrition-related problems. The initial nutritional screening should include which of the following?

1.Calorie count of nutrients

2.Anthropometric measures

3.Complete physical examination

4.Measurement of weight and weight history

ANS: 4

Parameters used for nutrition screening typically include weight and weight history, conditions associated with increased nutritional risk, diet information, and routine laboratory data.

A patient is asked to indicate on a form how many times he eats a specific food. This would describe which of the following methods for obtaining dietary information?

1.Food diary

2.Calorie count

3.24-hour recall

4.Food frequency questionnaire

ANS: 4

With this tool, information is collected on how many times per day, week, or month the individual eats particular foods.

The nurse is providing care for a 68-year-old woman who is complaining of constipation. What concern exists regarding her nutritional status?

1.The absorption of nutrients may be impaired.

2.The constipation may represent a food allergy.

3.She may need emergency surgery for the problem.

4.The gastrointestinal problem will increase her caloric demand.

ANS: 1

Gastrointestinal symptoms such as vomiting, diarrhea, or constipation may interfere with nutrient intake or absorption.

During a nutritional assessment, why is it important for the nurse to ask a patient what medications he or she is taking?

1.Certain drugs can affect the metabolism of nutrients.

2.The nurse needs to assess the patient for allergic reactions.

3.Medications need to be documented on the record for the physician's review.

4.Medications can affect one's memory and ability to identify food eaten in the last 24 hours.

ANS: 1

Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives, antineoplastic drugs, steroids, and oral contraceptives are among the drugs that can interact with nutrients, impairing their digestion, absorption, metabolism, or use.

A patient tells the nurse that his food just doesn't have any taste anymore. The nurse's best response would be:

1."That must be really frustrating."

2."When did you first notice this change?"

3."My food doesn't always have a lot of taste either."

4."Sometimes that happens but your taste will come back."

ANS: 2

With changes in appetite, taste, smell, or chewing or swallowing, the examiner asks about the type of change and when the change occurred.

The nurse is performing a nutritional assessment on a 15-year-old girl, who tells the nurse that she is "so fat." Assessment reveals that she is 5 feet 4 inches and weighs 110 pounds. The nurse's appropriate response would be:

1."How much do you think you should weigh?"

2."Don't worry about it, you're not that overweight."

3."The best thing for you would be to go on a diet."

4."I used to always think I was fat when I was your age."

ANS: 1

Because of adolescents' increased body awareness and self-consciousness, they are prone to develop eating disorders such as anorexia nervosa or bulimia, conditions in which the real or perceived body image does not compare favorably to an ideal image.

The nurse is discussing appropriate foods with the mother of a 3-year-old child. Which of the following foods are recommended?

1.Foods that the child will eat, no matter what they are

2.Foods easy to hold such as hot dogs, nuts, and grapes

3.Any foods as long as the rest of the family is eating them

4.Finger foods and nutritious snacks that can't cause choking.

ANS: 4

Use of small portions, finger foods, simple meals, and nutritious snacks are strategies to improve dietary intake. Foods likely to be aspirated should be avoided (e.g., hot dogs, nuts, grapes, round candies, popcorn).

Which of the following factors is most likely to affect the nutritional status of an 82-year-old person?

1.Increase in taste and smell

2.Living alone on a fixed income

3.Change in cardiovascular status

4.Increase in gastrointestinal motility and absorption

ANS: 2

Socioeconomic conditions frequently have the greatest effect on the nutritional status of the aging adult; these factors should be closely evaluated. Physical limitations, income, and social isolation are frequent problems and can obviously interfere with the acquisition of a balanced diet.

When considering a nutritional assessment, the nurse is aware that the most common anthropometric measurements include:

1.height and weight.

2.leg circumference.

3.biceps skinfold thickness.

4.hip and waist measurement.

ANS: 1

The most commonly used anthropometric measures are height, weight, triceps skinfold thickness, elbow breadth, and arm and head circumferences.

If a 29-year-old woman weighs 146 pounds and the nurse determines her ideal body weight to be 120 pounds, how would the nurse classify the woman's weight?

1.Obese

2.Mildly overweight

3.Suffering from malnutrition

4.Within appropriate range of ideal weight

ANS: 1

Obesity is defined as greater than 120% of ideal body weight. For this patient, 120% of her ideal body weight, 120 pounds, is 144 pounds. Her current weight of 146 pounds is greater than 120% of ideal body weight.

To perform a triceps skinfold assessment, the examiner would do which of the following?

1.After pinching the skin and fat, apply the calipers vertically to the fat fold.

2.Gently pinch the skin and fat on the anterior aspect of the patient's arm and then apply calipers.

3.After applying the calipers, wait 3 seconds before taking a reading. Repeat the procedure three times.

4.Instruct the patient to stand with the back to the examiner and arms folded across the chest and pinch the skin on the forearm.

ANS: 3

Release the lever of the calipers while holding the skinfold. Wait 3 seconds and then take a reading. Repeat three times and average the three skinfold measurements.

When assessing muscle mass and fat stores on a 40-year-old woman, the nurse would use:

1.triceps skinfold.

2.mid arm muscle area.

3.percent ideal body weight.

4.mid upper arm circumference.

ANS: 4

Mid upper arm circumference estimates skeletal muscle mass and fat stores.

When the mid upper arm circumference and triceps skinfold of an 82-year- old man are evaluated, it is important to remember that:

1.these measurements are no longer necessary for the elderly.

2.derived weight measures may be difficult to interpret because of wide ranges of normal.

3.these measurements may not be accurate because of changes in skin and fat distribution.

4.measurements may be difficult to obtain if the patient is unable to flex his elbow to at least 90 degrees.

ANS: 3

Remember that accurate mid upper arm circumference and triceps skinfold measurements are difficult to obtain and interpret in older adults because of sagging skin, changes in fat distribution, and declining muscle mass.

The nurse is concerned about the skeletal protein reserves of a patient who has been hospitalized frequently for chronic lung disease. Which of the following measurements would be necessary to include in the assessment?

1.Body mass index

2.Weight and height

3.Mid arm muscle area

4.Ideal body weight and frame size

ANS: 3

Mid arm muscle area is a good indicator of lean body mass and skeletal protein reserves. These reserves are important in growing children and are especially valuable in evaluating persons who may be malnourished because of chronic illness, multiple surgeries, or inadequate dietary intake. The equation for calculating mid arm muscle area includes mid upper arm circumference and mid-upper arm muscle circumference.

Which of the following best describes the technique for measuring frame size?

1.With the patient standing, measure the distance from the top of the head to the back of the heel.

2.With the patient in a sitting position, measure the distance from the condyle of the humerus to the clavicle.

3.With the patient's right arm extended forward and the elbow extended, measure the distance from fingertips to the condyle of the humerus.

4.With the right arm extended forward and the elbow bent, use the calipers to measure the distance between the condyles of the humerus.

ANS: 4

Instruct the person to extend the right arm forward, perpendicular to the body. Bend the elbow to a 90-degree angle with the palm of the hand turned laterally. Facing the person, place the calipers on the condyles of the humerus. Read the distance between the condyles.

In teaching a patient how to determine total body fat at home, the nurse includes instructions to obtain measurements of:

1.height and weight.

2.frame size and weight.

3.waist and hip circumferences.

4.mid upper arm circumference and arm span.

ANS: 1

Body mass index, calculated by using height and weight measurements, is a practical marker of optimal weight for height and an indicator of obesity.

The nurse is evaluating patients for obesity-related diseases. Which one of the following would be at increased risk?

1.A 29-year-old woman whose percent ideal body weight is 125%, waist is 33 inches, and hips 36 inches

2.A 32-year-old man whose percent ideal body weight is 115%, waist is 34 inches, and hips 36 inches

3.A 38-year-old man whose percent ideal body weight is 120%, waist is 35 inches, and hips 38 inches

4.A 46-year old woman whose percent ideal body weight is 130%, waist is 30 inches, and hips 38 inches

ANS: 1

The waist-to-hip ratio assesses body fat distribution as an indicator of health risk. A waist-to-hip ratio of 1.0 or greater in men or 0.8 or greater in women is indicative of android (upper body obesity) and increasing risk for obesity-related disease and early death.

The mother of an 8-year-old boy is concerned about the amount of weight her son has gained. To determine whether this is a problem, the nurse will measure:1.

1.arm span.

2.waist-to-hip ratio.

3.skinfold thickness.

4.mid upper arm circumference.

ANS: 3

Determination of skinfold thickness or body mass index may be useful in evaluating childhood and teenage overnutrition.

The nurse needs to determine the body mass index of an 80-year-old man who is confined to a wheelchair. Which of the following is true in this situation?

1.Changes in fat distribution will affect the waist-to-hip ratio.

2.Height measurements may not be accurate because of changes in bone.

3.Declining muscle mass will affect the triceps skinfold measure.

4.Mid arm circumference is difficult to obtain because of loss of skin elasticity.

ANS: 2

Height measures may not be accurate in individuals confined to a bed or wheelchair or those over 60 years of age (because of osteoporotic changes).

After completing a diet assessment on a 30-year-old woman, the nurse suspects that she may be deficient in iron. Laboratory studies to obtain to verify this condition would be:

1.hemoglobin and hematocrit.

2.cholesterol and triglycerides.

3.creatinine and serum protein.

4.serum albumin and urinary urea nitrogen.

ANS: 1

The hemoglobin determination is used to detect iron-deficiency anemia. Hematocrit, a measure of cell volume, is also an indicator of iron status.

A 50-year-old woman with elevated serum, total cholesterol, and triglyceride levels is visiting the clinic today to find out about her laboratory results. What would be important for the nurse to include in patient teaching in relation to these tests?

1.The risks of undernutrition

2.Methods to reduce stress in her life

3.Information regarding a low saturated fat diet

4.The fact that this is hereditary and there is nothing she can do to change the levels

ANS:3

Total cholesterol is measured to evaluate fat metabolism and to assess the risk of cardiovascular disease. Serum triglycerides are used to screen for hyperlipidemia and to determine the risk of coronary artery disease.

A 40-year-old man has had a recent weight loss of 20 pounds because of a quick loss diet and stress. He tells the nurse that he keeps getting "colds and the flu." In addition to assessing his nutrition status, the nurse would also want to obtain which laboratory report?

1.Serum albumin

2.Cholesterol level

3.Serum transferrin

4.Total lymphocyte count

ANS: 4

Loss of immunocompetence is strongly correlated with malnutrition in stressed and starving patients. The most commonly used tests of immune function are total lymphocyte count and skin testing, also called delayed cutaneous hypersensitivity.

To obtain an accurate nitrogen balance and creatinine-height index, the nurse must ensure that:

1.the patient's height and weight have been determined.

2.the laboratory draws the blood specimen in the early morning.

3.an accurate 24-hour urine specimen has been collected.

4.the patient has not had anything by mouth for 8 hours before the test.

ANS: 3

The validities of creatinine-height index and nitrogen balance studies are dependent on the accuracy of the 24-hour urine collection.

When evaluating the results of laboratory tests, the nurse knows that which of the following statements is true?

1.Normal values do not vary according to age.

2.Variations based on biocultural differences may exist.

3.It is not necessary to repeat laboratory tests once malnutrition has been determined.

4.Lab tests are more sensitive than other parts of the assessment and should take priority.

ANS: 2

Biocultural variations occur with some laboratory tests, such as hemoglobin/ hematocrit, serum cholesterol, and serum transferrin.

In performing an assessment on a 49-year-old woman who has imbalanced nutrition as a result of dysphagia, which of the following data would the nurse expect to find?

1.An increase in hair growth

2.Inadequate food intake

3.Weight 10% to 20% over ideal

4.Sore, inflamed buccal cavity

ANS: 2

Imbalanced nutrition, less than body requirements, would result from inadequate food intake.

A 21-year-old woman has been on a low-protein liquid diet for the past 2 months. She has had adequate calories and appears well nourished. In further assessing her, what would the nurse expect to find?

1.Poor skin turgor

2.Decreased serum albumin

3.Increased lymphocyte count

4.Triceps skinfold less than standard

ANS: 2

Kwashiorkor (protein malnutrition) is due to diets that may be high in calories but contain little or no protein (e.g., low-protein liquid diets, fad diets, and long-term use of dextrose-containing intravenous fluids). Serum albumin <3.5 g/dl.

The nurse is performing a nutritional assessment on an 80-year-old patient. The nurse knows that physiologic changes that directly affect the nutritional status of the elderly include:

1.slowed gastrointestinal motility.

2.hyperstimulation of the salivary glands.

3.an increased sensitivity to spicy and aromatic foods.

4.decreased gastrointestinal absorption causing esophageal reflux.

ANS: 1

Normal physiological changes in aging adults that affect nutritional status include slowed gastrointestinal motility, decreased gastrointestinal absorption, diminished olfactory and taste sensitivity, decreased saliva production, decreased visual acuity, and poor dentition.

Which of the following interventions is most appropriate when the nurse is planning nutritional interventions for a healthy, active 74-year-old woman?

1.Decrease the amount of carbohydrates to prevent lean muscle catabolism.

2.Increase the amount of soy and tofu in her diet to promote bone growth and reverse osteoporosis.

3.Decrease the number of calories she is eating because of the decrease in energy requirements from loss of lean body mass.

4.Increase the number of calories she is eating because of the increased energy needs of the elderly.

ANS: 3

Important nutritional features of the older years are a decrease in energy require- ments as a result of loss of lean body mass, the most metabolically active tissue, and an increase in fat mass.

Which of the following statements is true regarding routine laboratory testing in the following individuals

1.In pregnancy, no laboratory testing is needed unless problems with the pregnancy are suspected.

2.In the elderly, laboratory values regarding cholesterol and triglycerides are the most important because of the risk of disease.

3.During adolescence, unless disease is suspected, laboratory evaluation of hemoglobin and hematocrit levels and urinalysis for glucose and protein are adequate.

4.In infancy and childhood, laboratory tests should be performed at each well-child check-up, regardless of whether the child is exhibiting signs of illness that affect nutritional status.

ANS: 3

Unless disease is suspected, evaluation of hemoglobin and hematocrit levels and urinalysis for glucose and protein levels are adequate in adolescents. In infancy, laboratory tests are performed only if nutritional problems are suspected or illnesses affect nutritional status. Many laboratory values are monitored during pregnancy and older adulthood.

A 16-year-old girl is being seen at the clinic for gastrointestinal complaints and weight loss. The nurse determines that many of her complaints may be related to erratic eating patterns, eating predominantly fast foods, and high caffeine intake. In this situation, which of the following is most appropriate when collecting current dietary intake information?

1.Schedule a time for direct observation of the adolescent during meals.

2.Ask the patient for a 24-hour diet recall and assume this is reflective of a typical day for her.

3.Have the patient complete a food diary for 3 days—2 weekdays and 1 weekend day.

4.Use the food frequency questionnaire to identify the amount of intake of specific foods.

ANS: 3

Food diaries require the individual to write down everything consumed for a certain time period. Because of the erratic eating patterns of this individual, assessing dietary intake over a few days would produce more accurate information regarding eating patterns. Direct observation is best used with young children or older adults.

Which of the following individuals is most likely to have an anergic response when assessing skin test antigens?

1.An 8-year-old child

2.An obese individual

3.A healthy 80-year-old female

4.An individual with malnutrition

ANS: 4

Adequate immunity can be assessed by a positive reaction to multiple skin test antigens. Antigens are injected and the response is noted at 24 and 48 hours. Anergy occurs with malnutrition, hepatic failure, infection, and immunosuppressive drugs.

Which body composition-measuring tool measures fat and lean body mass and bone mineral density?

1.Waist-to-hip ratio

2.Body mass index

3.Bioelectrical impedance analysis

4.Dual-energy x-ray absorptiometry

ANS: 4

Dual-energy x-ray absorptiometry measures bone mineral density and fat and lean body mass.

Which of the following measurements is an early indicator of protein malnutrition?

1.Serum albumin

2.Serum creatinine

3.Nitrogen balance

4.Serum transferrin

ANS: 4

Serum transferrin, with a half-life of 8 to 10 days, may be a more sensitive indicator of visceral protein status than albumin. Serum albumin has a relatively long half-life of 17 to 20 days.

42. A 65-year-old man is brought to the emergency department after he was found dazed and incoherent, alone in his apartment. He has an enlarged liver and is moderately dehydrated. When evaluating his serum albumin level, the nurse must keep in mind that:

1.serum albumin levels will increase as liver function decreases.

2.serum albumin levels are a sensitive measure of early protein malnutrition.

3.low serum albumin levels may be caused by reasons other than protein-calorie malnutrition.

4.the results of the serum albumin measurement along with the patient's hemoglobin level should be considered.

ANS: 3

Low serum albumin levels may be caused by reasons other than protein-calorie malnutrition, such as an altered hydration status and decreased liver function.

Which of the following conditions is due to an inadequate intake of both protein and calories?

1.Obesity

2.Bulimia

3.Marasmus

4.Kwashiorkor

ANS: 3

Marasmus, protein-calorie malnutrition, is due to an inadequate intake of protein and calories or prolonged starvation.

A pregnant woman who is human immunodeficiency virus (HIV) positive is asking the nurse about breast-feeding her baby. Which of the following statement is true?

1.There is not enough information to know whether it would be safe for her to breast-feed.

2.It is safe for women who are HIV positive to breast-feed.

3.Women who are HIV positive should not breast-feed because HIV can be transmitted through breast milk.

4.She can breastfeed as long as she uses pumped breast milk.

ANS: 3

Although relatively few contraindications to breast-feeding exist, women who are HIV positive should not breast-feed because HIV can be transmitted through breast milk.

During an assessment of a patient who has been homeless for several years, the nurse notices that his tongue is magenta in color. This is an indication of:

1.iron deficiency.

2.riboflavin deficiency.

3.vitamin D and calcium deficiency.

4.vitamin C deficiency.

ANS: 2

"Magenta tongue" is a sign of riboflavin deficiency. In contrast, a pale tongue is probably attributable to iron deficiency. Vitamin D and calcium deficiency causes osteomalacia in adults, and vitamin C deficiency causes scorbutic gums.

The nurse is assessing an obese patient for signs of metabolic syndrome. This condition is diagnosed when three or more certain risk factors are present. Which of the following are risk factors for metabolic syndrome? Select all that apply.

1.Fasting plasma glucose level less than 110 mg/dl

2.Fasting plasma glucose level greater than or equal to 110 mg/dl

3.Blood pressure reading of 140/90 mm/Hg

4.Blood pressure reading of 110/80 mm/Hg

5.Triglyceride level of 120 mg/dl

ANS: 2, 3

Metabolic syndrome is diagnosed when three or more of the following risk factors are present: (1) fasting plasma glucose level ≥110 mg/dl; (2) blood pressure ≥130/85 mm Hg; (3) waist circumference ≥40 inches for men and 35 inches for women; (4) high-density lipoprotein cholesterol <40 in men and <50 in women; and (5) triglyc- eride levels ≥150 mg/dl (ATP III, 2001).