ch 16 Flashcards
The home care nurse is assessing an older patient diagnosed with mild cognitive impairment (MCI) in the home setting. Which information is of concern?
a. The patient’s son uses a marked pillbox to set up the patient’s medications
weekly.
b. The patient has lost 10 pounds (4.5 kg) during the last month.
c. The patient is cared for by a daughter during the day and stays with a son at night.
d. The patient tells the nurse that a close friend recently died.
ANS: B
A 10-pound weight loss in 1 month could indicate cancer or may be an indication of further progression of memory loss. Depression is also another common cause of weight loss. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this patient. It is not unusual that an older patient would have friends who have died.
The nurse is assisting a 79-year-old patient with information about diet and weight loss. The patient has a body mass index (BMI) of 31. How should the nurse instruct this patient?
a. “Your weight is within normal limits. Continue maintaining with current lifestyle
choices.”
b. “You are a little overweight. Cut down on calories and increase your activity, and
you should be fine.”
c. “You are morbidly obese, and we would like to schedule you an appointment to
speak with a bariatric specialist about surgery.”
d. “You are considered obese and will need to consult with your doctor about a plan
that includes exercises, not diet, to decrease weight.”
ANS: D
This patient is at an increased risk for sarcopenia and should be instructed to increase activity that includes strength training to prevent muscle loss. Diet is not indicated. A BMI of 31 is considered obese; however, this patient does not qualify for surgical intervention until BMI reaches over 35.
The nurse is completing a nutritional assessment on a patient with hypertension. What foods would be recommended for this patient?
a. Regular diet
b. Low sodium diet
c. Pureed diet
d. Low sugar diet
ANS: B
A low sodium diet will prevent water retention which could increase blood pressure. Patients with hypertension would not be on a regular diet due to sodium content. A pureed diet is indicated for stroke patients who may have impaired swallowing. A low sugar diet is indicated for patients with diabetes.
During a nutritional assessment, the nurse calculates that a female patient’s BMI is 27. The nurse would advise the patient to follow which of these recommendations?
a. This measurement indicates that the patient is overweight and should follow a
plan of diet and exercise to lose weight.
b. This measurement indicates that the patient is underweight and will need to take
measures to gain weight.
c. This measurement indicates that the patient is morbidly obese and may be a
candidate for bariatric surgery.
d. This measurement indicates that the patient is of normal weight and should
continue with current lifestyle.
ANS: A
A BMI of 25–29.9 is in the overweight range. A BMI of <18.5 is in the underweight range. A BMI of 30–34.9 is obesity class I, a BMI of 35–39.9 is obesity class II, and a BMI of >40 is obesity class III (morbid obesity). A BMI of 19–24 is in the normal range.
During an interview, the nurse is discussing dietary habits with a patient. Which tool would be the best choice to use as a quick screening tool to assess dietary intake?
a. Food diary
b. Calorie count
c. Comprehensive diet history
d. 24-hour recall
ANS: D
A 24-hour recall is useful as a quick screening tool to assess dietary intake. A food diary provides detailed information, but it is not convenient and requires a follow-up visit. A calorie count requires several days to collect data and requires a trained dietician to analyze the results. A comprehensive diet history may provide more accurate reflection of nutrient intake, but it is time-consuming to acquire and requires a trained/skilled dietary interviewer.
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?
a. Vitamin C
b. Vitamin B
c. Essential fatty acid
d. Protein
ANS: C
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.
During a physical examination, the nurse notes that the patient’s skin is dry and flaking. What additional data would the nurse expect to find to confirm the suspicion of a nutritional deficiency?
a. Hair loss and hair that is easily removed from the scalp
b. Inflammation of the tongue and fissured tongue
c. Inflammation of peripheral nerves and numbness and tingling in extremities
d. Fissures and inflammation of the mouth
ANS: A
Hair loss (alopecia) and hair that is easily removed from the scalp (easy pluckability), like 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 thiamin deficiency. Fissures of the mouth (cheilosis) and inflammation of the mouth (stomatitis) are manifestations of a pyridoxine deficiency.
An African American is at an increased risk for which of the following? (Select all that apply.)
a. Vitamin D deficiency
b. Type 1 diabetes
c. Celiac disease
d. Type 2 diabetes
e. Hypertension
f. Metabolic syndrome
ANS: A, D, E, F
Type 1 diabetes and celiac disease are more common in Northern European heritage.
