Question 1

Which patient needs to be taught about how diet and exercise can lower lipids to reduce the risk for coronary artery disease?

Accepted Answer

The healthy range of LDL for men and women is <130 mg/dl. Patient A's HDL level is in the expected range. Patient B's HDL level is in the expected range. Patient C's LDL level is in the expected range.

Question 2

A patient who has anorexia nervosa reports a healthy diet and no protein calorie malnutrition. Which lab value best confirms this patient's report?

Accepted Answer

Prealbumin is a reflection of protein and calorie intake for the previous 2 to 3 days. Serum albumin measures circulating protein. Albumin can be affected by a number of factors, including fluid status, blood loss, liver function, and stress. Fluctuation of albumin levels occurs over 3 to 4 weeks. Blood glucose measures can be affected by many factors such as stress, which raises blood glucose levels, and is not a measure of protein calorie malnutrition. Serum cholesterol is part of the lipid profile, which provides data on fat metabolism only, and is not a measure of protein calorie malnutrition.

Question 3

A male patient weighs 205 lb and his desired body weight (DBW) is 190 lb. How should the nurse counsel this patient about his weight?

Accepted Answer

Ideally, the patient will fall between 90% and 110% of DBW, which for this patient is between 171 and 209 lb. A calculation is required to answer the question. Using the DBW scale, mild obesity is 20% to 40% above DBW. This patient is 9% above his DBW. Using the DBW scale, moderate obesity is 40% to 100% greater than DBW. This patient is 9% above his DBW. According to the DBW scale, the patient will ideally be between 90% and 110% of DBW; therefore, the nurse has enough information to make an interpretation.

Question 4

A nurse calculates a patient's body mass index (BMI) as 33. This measurement indicates which class of weight?

Accepted Answer

Obesity class I is a BMI of 30 to 34.9. Overweight is a BMI of 25 to 29.9. Obesity class II is a BMI of 35 to 39.9. Obesity class III is a BMI greater than 40.

Question 5

What is the desired body weight for a male who is 7 feet tall?

Accepted Answer

The patient is 84 inches tall. Use 106 lb for the first 5 feet (60 inches) and 6 lb/inch for the remaining 24 inches (84 inches - 60 inches = 24); thus, 106 + (24 × 6) = 250 lb. Students must perform a calculation to find the answer. The incorrect result mentioned in option A is obtained when 106 lb is used for the first 6 feet rather than 5 feet (84 inches - 72 inches = 12); thus, 106 + (12 × 6) = 178 lb. The incorrect result mentioned in option B is obtained when the scale for women is used rather than the scale for men (84 inches - 60 inches = 24); thus, 105 + (24 × 5) = 225. A result of 275 lb uses an incorrect calculation.

Question 6

During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema. Which nutritional deficiency might be present?

Accepted Answer

Dry and scaly skin is a manifestation of essential fatty acid deficiency. Vitamin C deficiency causes bleeding gums, arthralgia, and petechiae. Vitamin B deficiency is too large a category to consider. Specific categories of vitamin B deficiency have been identified, such as pyridoxine and thiamine. Protein deficiency causes decreased pigmentation and lackluster hair.

Question 7

A patient's current body weight is 304 lb and his desirable body weight is 190 lb. How does the nurse classify this patient's weight?

Accepted Answer

Moderate obesity is 40% to 100% above the DBW. This patient's weight of 304 is 60% above his DBW. A range of 90% to 110% of DBW is considered normal. This patient's weight of 304 is 60% above his DBW. Mildly obesity is 20% to 40% above DBW. This patient's weight of 304 is 60% above his DBW. Morbid obesity is 100% greater than DBW. This patient's weight of 304 is 60% above his DBW.

Question 8

During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema, and suspects a nutritional deficiency. What additional data should the nurse expect to find to confirm the suspicion?

Accepted Answer

Hair loss (alopecia) and hair that is easily removed from the scalp (easy pluck ability), such as dry, flaking skin, is caused by essential fatty acid deficiency. Inflammation of the tongue (glossitis) and fissured tongue are manifestations of a niacin deficiency. Inflammation of peripheral nerves (neuropathy) and numbness and tingling in extremities (paresthesia) are manifestations of a thiamine deficiency. Fissures of the mouth (cheilosis) and inflammation of the mouth (stomatitis) are manifestations of a pyridoxine deficiency.

Question 9

While assessing a patient's ability to consume food, the nurse recalls which types of foods are the easiest to chew and swallow?

Accepted Answer

Foods that are soft and highly viscous are most easily chewed and swallowed. Thin liquids and foods requiring forceful chewing (such as meat) may not be tolerated well.

Question 10

A nurse is asking questions about the present health status of a young woman who has lost weight recently. Which question is most appropriate when inquiring about present health status?

Accepted Answer

Asking the patient to describe recent changes in weight is an appropriate, open-ended question to begin data collection so that the patient can report her current health status related to weight. Question A implies the patient has or should have concerns about weight loss and is not focused on the present health status. Option B is not an appropriate question. More data are needed about this patient before anorexia can be suspected or determined. Question D is asked in the history rather than in the present health status part of the health history.

Question 11

A nurse is assessing an 80-year-old patient who is cared for at home by his 79-year-old wife. Which data indicate this patient has malnutrition? (Select all that apply.)

Accepted Answer

A BMI of 18.5 to 24.9 is the normal range, and this patient is below normal. Severe weight loss is a more than 2% weight change over 1 week. The expected hemoglobin for a man is 14 to 18 g/dl. These values may also indicate dehydration. Waist-to-hip ratio of 1.0 is an expected value for men. The expected level for prealbumin is 15 to 36 mg/dl. This hematocrit level is within normal limits.

Question 12

Which patient has the least risk for unhealthy fat distribution?

Accepted Answer

The woman's waist-to-hip ratio mentioned in option D is 0.789, which is below 0.8, the expected value for women. Triceps skinfold is an estimate for total body fat, rather than risk. The expected value is near the 50th percentile. Triceps skinfold is an estimate for total body fat, rather than risk. The expected value is near the 50th percentile. The man's waist-to-hip ratio mentioned in option C is 1.15, which is higher than the 1.0 or less expected value for a man.

Question 13

A patient is put on an 1800-calorie a day diet plan. During discharge teaching, the nurse explains to this patient how to use nutrition labels to determine the amount of carbohydrates in the product. The nurse explains, however, that the label is based on 2000 calories. Which is the appropriate formula to teach this patient of the maximum grams of carbohydrates she can eat on her prescribed diet?

Accepted Answer

Carbohydrates should account for 55% to 60% of total calories. Carbohydrates should account for a maximum of 60% of total calories rather than 45%. Each gram of carbohydrates yields 4 calories rather than 9. Carbohydrates should account for a maximum of 60% of total calories, rather than 50%.

Question 14

A patient tells the nurse that she tries to keep her fat intake at less than 15% of her total caloric intake per day. What is the nurse's most appropriate response to this patient's comment?

Accepted Answer

The recommended amount of fat is 25% to 30% of total calories. The patient's fat intake is too low.

Question 15

A man who is 6 feet 9 inches tall is told by his provider to lose weight so that he is closer to his desired body weight. He asks the nurse, How can I find out what my desired body weight should be? The nurse responds, Let me show you how to calculate it. Your desired body weight (DBW) should be ______ lb.

Accepted Answer

The answer of A man who is 6 feet 9...

Question 16

Which tool is the best choice for a nurse to use as a quick screening tool to assess a patient's dietary intake?

Accepted Answer

Twenty-four-hour recall is useful as a quick screening tool to assess dietary intake. A food diary provides detailed information, but is not convenient and requires a follow-up visit. A calorie count requires several days to collect data and requires a trained dietitian to analyze the results. A comprehensive diet history may provide more accurate reflection of nutrient intake, but is time-consuming to acquire and requires a trained/skilled dietary interviewer.

Question 17

A patient who keeps his fat consumption at 10% of his total caloric intake is at risk for deficiency of which nutrient(s)?

Accepted Answer

Vitamins A, D, and K are fat-soluble vitamins. If the patient does not have enough fat intake, adequate amounts of these vitamins cannot be absorbed. Fat-soluble vitamins should be linked to a lack of body fat. Iron absorption is not affected by low fat intake. Zinc absorption is not affected by low fat intake. Vitamins B and C are water-soluble vitamins and their absorption is not affected by low fat intake.

Question 18

Which patient may require additional nutritional assessment?

Accepted Answer

The expected hemoglobin level for a pregnant patient is 12 to 16 g/dl. Patient A's glucose level is within normal limits. Patient C's prealbumin level is within normal limits. Patient D's triglyceride level is within normal limits.

Question 19

A patient with mild renal disease has been put on a 2200-calorie per day diet plan with the lowest recommended amount of protein. During discharge teaching, the nurse explains to this patient how to use nutrition labels to determine the amount of protein in the product. The nurse explains, however, that the label is based on 2000 calories. Which is the appropriate formula to teach this patient the least amount of protein he can eat on his prescribed diet?

Accepted Answer

Proteins should account for 12% to 20% of total calories. Each gram of protein yields 4 calories. Twelve percent is the least recommended percentage for proteins, rather than 10%.

Question 20

Nurses use which measurement as the most highly correlated with risk of morbidity and mortality?

Accepted Answer

The BMI considers both weight and height in the calculation. The U.S. Preventive Services Task Force advocates the BMI assessment as reliable and valid for identifying adults at risk of morbidity and mortality because of being overweight or obese. For this reason, calculating BMI is recommended for all individuals on a periodic basis. The waist-to-hip ratio is an indication of the risk of unhealthy fat distribution. A ratio that exceeds the desired ratio is indicative of upper body obesity. This increases the risk of developing health problems related to obesity (e.g., diabetes, hypertension, coronary artery disease, gallbladder disease, osteoarthritis, and sleep apnea). Triceps skinfold measurement provides an estimate of total body fat, which is only one measure of risk for obesity, and not, by itself, the most reliable and valid measurement to determine risk. Calculating desirable body weight and comparing it to actual body weight does not consider height in the assessment of obesity.

Quiz 8: Nutritional Assessment