Deck 11: Nutrition Assessment and Patient Care

Question 1

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.

Answer 1

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.

Question 2

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.

Answer 2

B
If staff are concerned about the adequacy of a patient's 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.

Question 3

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.

Answer 3

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.

Question 4

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.

Question 5

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.

Question 6

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%.

Question 7

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) patient's 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.

Question 8

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 patient's stated pre-amputation height.

Question 9

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)

Question 10

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.

Question 11

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.

Question 12

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.

Question 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.

Question 14

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

A) at the same time as assessing the patient's 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.

Question 15

A situation that may be associated with moderate nutrition risk is

A) use of analgesic medications to manage a patient's 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.

Question 16

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.

Question 17

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

Question 18

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.

Question 19

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 patient's position or turn the patient several times a day.
C) conduct a calorie count to make sure the patient's food intake is adequate.
D) change sheets and blankets during each shift.

Question 20

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.

Question 21

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.

Question 22

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.

Question 23

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.

Question 24

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 patient's pain.

Question 25

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.

Question 26

A BMI of 18 would reflect

A) underweight.
B) normal weight.
C) overweight.
D) severe overweight.

Question 27

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.

Question 28

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.

Question 29

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 patient's immune function,the physician may decide to test the patient's serum _____ levels.

A) iron
B) vitamin D
C) prealbumin
D) creatinine

Question 30

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.