Question 1

A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is:

A) an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization.
B) an injury may cause malabsorption of nutrients.
C) most hospitalized older patients do not consume adequate amounts of micro- and macronutrients.
D) most hospitalized patients do not have accurate weights recorded upon admission.

Accepted Answer

One trajectory for malnutrition is inflammation-related malnutrition; in this situation, malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that contribute to an increased metabolic rate and impaired nutrient utilization. An injury does not necessarily cause malabsorption of nutrients. There is no evidence that most hospitalized patients do not consume adequate diets, and there is also no evidence that accurate weights are not recorded for most hospitalized patients.

Question 2

A nursing student asks the instructor, &#34;Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn't obesity bad for everyone?&#34; The best response by the instructor is:&#10;A) &#34;While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults.&#34;&#10;B) &#34;Obesity is usually not a concern in older adults, as most older people tend to weigh less than they did when they were younger.&#34;&#10;C) &#34;Obesity is a concern in all age groups; however, over the past decade obesity in older adults has decreased.&#34;&#10;D) &#34;Obesity in older adults is less of a concern than we once thought; individuals over age 65 with a higher BMI have a lower mortality rate.&#34;

Accepted Answer

There is evidence that obesity in younger people contributes to a decreased life expectancy. However, in older adults, it is not clear whether obesity is a predictor of mortality. Recent evidence demonstrated that for people who have survived to 70 years of age, mortality risk is lowest in those with a BMI classified as overweight. Persons who increased or decreased BMI have a greater mortality risk than those who have a stable BMI, particularly in those aged 70-79. Obesity is prevalent in older adults. The proportion of older adults who are obese has doubled in the past 30 years. More than one-third of individuals 65 years and older are obese with a higher prevalence in those 65-74 years than in those 75 years and older.

Question 3

An older adult who is within a normal weight range asks a nurse, "I have heard that it is important to limit the amount of fats in my diet, but I don't know how much I should be taking in daily. Can you help me?" The best response by the nurse is:

A) "Someone of your age needs to limit fats."
B) "Since you are at your ideal weight, you should limit your daily fat grams to half your weight."
C) "Fat intake will depend on the presence of any cardiac issues."
D) "Read food labels well and focus your diet on low-fat foods."

"Since you are at your ideal weight, you should limit your daily fat grams to half your weight."

Accepted Answer

A simple technique to determine how much fat a person should consume is to divide the ideal weight in half and allowing that number of grams of fat. The remaining options don't address the issue of how much fat should be eaten daily.

Question 4

Many older adults have a vitamin B₁₂ deficiency. Reasons for this include which of the following? (Select all that apply.) A) Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B₁₂ absorption less efficient B) The major source of vitamin B₁₂ is sunlight, and older adults are less likely to be outdoors and absorb vitamin B₁₂ in this manner C) Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B₁₂ from food D) Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B₁₂ E) Certain antibiotics and anticonvulsant medication increase the risk of vitamin B₁₂ deficiency

Accepted Answer

A normal age-related change in the stomach is the production of less gastric acid, which makes vitamin B₁₂ absorption less efficient. For most older adults, intake of vitamin B₁₂ is usually adequate. Use of proton pump inhibitors and H? receptor blockers for more than a year can lead to lower serum vitamin B₁₂ levels by impairing absorption of the vitamin from food. Certain antibiotics and anticonvulsants can also increase the risk of vitamin B₁₂ deficiency. While it is true that older adults may be outdoors less, the major source of vitamin B₁₂ is not sunlight. While it is also true that older adults may not consume five servings of fruits and vegetables daily, fruit and vegetables are the major sources of vitamins A, C, and E and potassium.

Question 5

An older adult's nutritional status is screened by a nurse using the Mini Nutritional Assessment (MNA). The older adult scores a score of "10" on the screening portion of the tool. The best action by the nurse is to:

A) refer the patient to a dietician.
B) complete the assessment portion of the tool.
C) conduct a 72-hour calorie count.
D) initiate nutritional supplements between meals.

Accepted Answer

The MNA is both a screening tool and a detailed assessment. It is validated for use in individuals over age 65 and intended for use by professionals. If an individual scores less than a 12 on the screening portion of the tool, then the assessment portion must be completed. The assessment portion needs to be completed before any interventions or referrals are taken, as the information that is obtained in the assessment will guide the choice of interventions.

Question 6

A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (Select all that apply.)

A) Sit the patient upright in a chair at 90 degrees.
B) Allow the patient to sit upright for 15 minutes after the meal is completed.
C) Feed the patient only liquids to make swallowing easier.
D) Place the solid food in the left side of the mouth.
E) Have the patient swallow twice for every mouthful of food given.

Accepted Answer

When feeding a patient with dysphagia, it is important to have the patient sit upright at 90 degrees and to remain upright for an hour following the meal. Other important techniques include having the patient swallow twice for every mouthful of food given. This patient has a history of a right CVA, which would mean that the patient has left-sided weakness. The food needs to be placed in the nonimpaired side of the mouth, which in this case would be the right side. Since the patient has a CVA, the intake of "thin liquids" can increase risk for aspiration.

Question 7

A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following:&#10;A) &#34;Since I am an older person, I need more calories because my metabolic rate is slower&#34;&#10;B) &#34;Since I am an older person, I need fewer calories since my metabolic rate is slower&#34;&#10;C) &#34;Even though I am an older person, I still need the same amount of nutrients in order to be healthy&#34;&#10;D) &#34;Even though I am an older person, I still need to pay attention to my diet and activity levels&#34;

Accepted Answer

Generally, older adults need fewer calories because they may not be as active and metabolic rates slow down. Older adults generally require the same amount of nutrients for optimal health outcomes. Older adults need to pay attention to meeting nutritional requirements and obtaining adequate physical activity for optimal health.

Question 8

Symptoms of gastroesophageal reflux disease (GERD) in older adults include: (Select all that apply.)&#10;A) heartburn.&#10;B) regurgitation.&#10;C) abdominal pain within one hour of eating.&#10;D) vomiting.&#10;E) fever and elevated white blood cell count.

Accepted Answer

Symptoms of GERD include heartburn, regurgitation, persistent cough, exacerbation of asthma, laryngitis, and intermittent chest pain. In addition, abdominal pain within one hour of eating and worsening of symptoms upon lying down are common. Vomiting is not associated with GERD and neither is fever and elevated white blood cell count.

Question 9

A nurse is developing a care plan for an older adult in a long-term care facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (Select all that apply.)

A) Assign a nursing aide to feed the resident to ensure adequate consumption of meals
B) Supervise the resident during meals
C) Provide a pleasant eating environment
D) Provide nutritional supplements for the resident
E) Assess the resident for ability to feed himself/herself

Accepted Answer

Nurses hold an important role in ensuring adequate nutrition. Interventions that support this goal include supervision of eating, modification of the environment to be pleasing for eating, and assessing the individual for issues related to performance at mealtimes. Feeding a resident is not indicated unless it is known that the resident cannot feed himself/herself. It is important to promote independence as much as possible.

Question 10

An older adult asks a nurse, &#34;I hear a lot about limiting the amount of fat in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?&#34; The nurse bases a response on which of the following?&#10;A) 10-15% of total calories should be from fat, 30-40% from carbohydrates, and 35-75% from protein&#10;B) 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein&#10;C) 45-65% of total calories should be from fat, 20-35% from carbohydrates, and 10-35% from protein&#10;D) 20-35% of total calories should be from fat, 10-25% from carbohydrates, and 50-75% from protein

Accepted Answer

Recommendations for older adults are that 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein.

Deck 14: Nutrition