The nurse recognizes which of these people is at greatest risk for undernutrition?
a. 30-year-old man
b. 50-year-old woman
c. 5-month-old infant
d. 20-year-old college student
Vulnerable groups for undernutrition are infants, children, pregnant women, recent immigrants, people with low incomes,
hospitalized people, and aging adults
When assessing a patient’s nutritional status, what does the nurse need to recognize that sufficient nutrients need to do for optimal
a. Provide for the minimum body needs.
b. Provide an excess of daily body requirements.
c. Provide for daily body requirements but do not support increased metabolic
d. Provide for daily body requirements and support increased metabolic demands.
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 these statements represents accurate
information for this age group?
a. Maintaining adequate fat and caloric intake is important for a 1-year-old child.
b. The recommended dietary allowances for an infant are the same as for an
c. The baby’s growth is minimal at this age; therefore, caloric requirements are
d. The baby should be placed on skim milk to decrease the risk for coronary artery
disease when he or she grows older.
Because of rapid growth, especially of the brain, both infants and children younger than 2 years of age should not drink skim or
low-fat milk or be placed on low-fat diets. Fats (calories and essential fatty acids) are required for proper growth and central
nervous system development. The recommended dietary allowances for infants and adolescents are not the same. There is a great
deal of growth in the first 4 years of life both in length/height and in the brain. So, the correct answer is that maintaining adequate
fat and caloric intake is important for a 1-year-old child.
A pregnant woman is interested in breastfeeding her baby and asks several questions about the topic. Which statement by the nurse
a. “Babies who are breastfed often require supplemental vitamins.”
b. “Breastfeeding is best when also supplemented with bottle-feedings.”
c. “Breastfeeding is recommended for infants for the first 2 years of life.”
d. “Breast milk provides the nutrients necessary for growth, as well as natural
Breastfeeding 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, as well as natural immunity. The other statements are not correct. Babies who are breastfed
do not normally require supplemental vitamins or bottle-feedings. Breastfeeding is recommended for the first year, not two, of life
for full-term infants because breast milk is ideally formulated to promote normal infant growth and development, as well as natural
A mother and her 13-year-old daughter express their concern r/t the daughter’s recent weight gain and her increase in appetite.
Which of these statements represents information the nurse should discuss with them?
a. Dieting and exercising are necessary at this age.
b. Snacks should be high in protein, iron, and calcium.
c. Teenagers who have a weight problem should not be allowed to snack.
d. A low-calorie diet is important to prevent the accumulation of fat.
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 these problems r/t his nutritional status might the nurse expect to find?
d. Coronary artery disease
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. Obesity, hypotension, and coronary
artery disease are not nutritionally related problems commonly found in those newly immigrated to the United States from
developing countries. Instead, general undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia, scurvy, and dental
caries are among the more common nutrition-related problems of new immigrants from developing countries.
For the first time, the nurse is seeing a patient who has no history of nutrition-related problems. Which activity should the initial
nutritional screening include?
a. Anthropometric measures
b. Calorie count of nutrients
c. Complete physical examination
d. Measurement of weight and weight history
Parameters used for nutrition screening typically include weight and height history, conditions associated with increased nutritional
risk, diet information, and routine laboratory data. The other responses reflect a more in-depth assessment rather than a screening.
Anthropometric measures, calorie count of nutrients, and a complete physical examination are all a part of a more in-depth
nutritional assessment than an initial nutrition screening. 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 method describes which of these tools for obtaining dietary information? a. Food diary b. Calorie count c. 24-hour recall d. Food-frequency questionnaire
With a food-frequency questionnaire, information is collected on how many times per day, week, or month the individual eats
particular foods, which provides an estimate of usual intake. A food diary asks individuals to write down everything consumed for
a certain period of time. A calorie count involves calculating the calories of all foods consumed for a period of time and is often
performed for hospitalized patients. A 24-hour recall is either an interview or a questionnaire that asks a person to recall everything
eaten with the last 24 hours. To assess how many times a person eats a specific food, a food-frequency questionnaire should be
During a nutritional assessment, why is it important for the nurse to ask a patient what medications he or she is taking?
a. Certain drugs can affect the metabolism of nutrients.
b. The nurse needs to assess the patient for allergic reactions.
c. Medications need to be documented in the record for the physician’s review.
d. Medications can affect one’s memory and ability to identify food eaten in the last
Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives, antineoplastic drugs, steroids, and oral contraceptives are
drugs that can interact with nutrients, impairing their digestion, absorption, metabolism, or use. The other responses are not correct.
In conducting a nutritional assessment, the nurse does not ask about patient medications to assess for allergic reactions, to
document for physician review, or to identify potential influence on the patient’s food recall. Instead, the nurse asks about
medications during a nutritional assessment to assess for potential interactions with foods or nutrients.
A patient tells the nurse that his food simply does not have any taste anymore. What is the best response by the nurse?
a. “That must be really frustrating.”
b. “When did you first notice this change?”
c. “My food doesn’t always have a lot of taste either.”
d. “Sometimes that happens, but your taste will come back.”
With changes in appetite, taste, smell, or chewing or swallowing, the examiner should ask about the type of change and when the
change occurred. These problems interfere with adequate nutrient intake. The other responses are not correct. Saying that
something must be frustrating, that your food doesn’t always have taste, or that sometimes that happens but their taste will come
back are not addressing the patient’s concern or gathering more data on the problem
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. What is an appropriate response by the nurse?
a. “How much do you think you should weigh?”
b. “Don’t worry about it; you’re not that overweight.”
c. “The best thing for you would be to go on a diet.”
d. “I used to always think I was fat when I was your age.”
Telling the adolescent not to worry, to go on a diet, or share your own experiences at that age is belittling the adolescent’s feelings,
providing unsolicited advice, or agreeing with her. Adolescents’ increased body awareness and self-consciousness may cause
eating disorders such as anorexia nervosa or bulimia, conditions in which the real or perceived body image does not favorably
compare with an ideal image. The nurse should not belittle the adolescent’s feelings, provide unsolicited advice, or agree with her.
The nurse is discussing appropriate foods with the mother of a 3-year-old child. Which of these foods are recommended?
a. Foods easy to hold such as hot dogs, nuts, and grapes
b. Foods that the child will eat, no matter what the food
c. Any food, as long as the rest of the family is eating it, too
d. Finger foods and nutritious snacks that cannot cause choking
Small portions, finger foods, simple meals, and nutritious snacks help improve the dietary intake of young children. Foods likely to
be aspirated should be avoided (e.g., hot dogs, nuts, grapes, round candies, popcorn).
The nurse is reviewing the nutritional assessment of an 82-year-old widowed patient. Which of these factors will most likely affect
the nutritional status of this patient?
a. Increase in taste and smell.
b. Living alone on a fixed income.
c. Change in cardiovascular status.
d. Increase in gastrointestinal motility and absorption
Socioeconomic conditions frequently affect the nutritional status of the aging adult; these factors should be closely evaluated.
Physical limitations, income, and social isolation are frequent problems that interfere with the acquisition of a balanced diet. A
decrease in taste and smell and decreased gastrointestinal motility and absorption occur with aging. Cardiovascular status is not a
factor that affects an older adult’s nutritional status. Older adults normally experience decrease in taste, smell, and gastrointestinal
motility and absorption, not an increase in them. Changes in cardiovascular status do not normally affect nutritional status.
When considering a nutritional assessment, what should the nurse be aware is/are one of the most common anthropometric measurements? a. Height and weight b. Leg circumference c. Chest and waist measurements d. Skinfold thickness of the biceps
The most commonly used anthropometric measures are height, weight, body mass index, waist-to-hip ratio, and arm span or total
If a 29-year-old woman weighs 156 pounds, and the nurse determines her ideal body weight to be 120 pounds, then how would the
nurse classify the woman’s weight?
b. Mildly overweight
c. Suffering from malnutrition
d. Within appropriate range of ideal weight
Obesity, as a result of caloric excess, refers to weight more than 20% above ideal body weight. For this patient, 20% of her ideal
body weight would be 24 pounds, and greater than 20% of her body weight would be over 144 pounds. Therefore, having a weight
of 156 pounds would be considered obese.
In teaching a patient how to determine total body fat at home, what should the nurse instruct the patient to measure?
a. Height and weight
b. Frame size and weight
c. Waist and hip circumferences
d. Mid-upper arm circumference and arm span
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 other options are not correct. Frame size and weight, waist and hip circumferences, and mid-upper arm
circumference and arm span are not measurements used to determine total body fat.
The nurse is evaluating patients for obesity-related diseases by calculating the waist-to-hip ratios. Which one of these patients
would be at increased risk?
a. 29-year-old woman whose waist measures 33 inches and hips measure 36 inches
b. 32-year-old man whose waist measures 34 inches and hips measure 36 inches
c. 38-year-old man whose waist measures 35 inches and hips measure 38 inches
d. 46-year-old woman whose waist measures 30 inches and hips measure 38 inches
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 29-year-old woman has a waist-to-hip ratio of 0.92, which is greater than 0.8. The 32-year-old man has a waist-to-hip
ratio of 0.94; the 38-year-old man has a waist-to-hip ratio of 0.92; the 46-year-old woman has a waist-to-hip ratio of 0.78. The
patient with a waist-to-hip of concern is the 29-year-old woman. This woman has a waist-to-hip ratio of 0.92, which is greater than
A 50-year-old woman with an elevated total cholesterol level is visiting the clinic to find out about her laboratory results. What
would be important for the nurse to include in the patient teaching in relation to these tests?
a. The risks of undernutrition should be included.
b. Offer methods to reduce the stress in her life.
c. Provide information regarding a diet low in saturated fat.
d. This condition is hereditary; there is little she can do to change the levels.
The patient with elevated cholesterol level should be taught about eating a healthy diet that limits the intake of foods high in
saturated fats. Reducing dietary fats is part of the treatment for this condition. The other responses are not pertinent to her
condition. There is nothing in the question to indicate there is a risk for undernutrition or stress. Although there may be some
hereditary component to elevated cholesterol, maintaining a diet low in saturated fats can lower cholesterol levels. Therefore, this
patient should be taught about eating a healthy diet that limits the intake of foods high in saturated fats.
In performing an assessment on a 49-year-old woman who has imbalanced nutrition as a result of dysphagia, which data would the nurse expect to find? a. Increase in hair growth b. Weight 10% to 20% over ideal c. Sore, inflamed buccal cavity d. Inadequate nutrient or food intake
Dysphagia, or impaired swallowing, interferes with adequate nutrient or food intake. Since dysphagia, or impaired swallowing,
interferes with adequate nutrient intake, the nurse would not expect increased hair growth or being overweight. Sore, inflamed
buccal cavity is also not an expected finding for a patient with dysphagia. The correct answer is inadequate nutrient or food intake
as difficulty swallowing would make it difficult to get adequate oral nutrition.
A 21-year-old woman has been on a low-protein liquid diet for the past 2 months. She has had adequate intake of calories and
appears well nourished. After further assessment, what would the nurse expect to find?
a. Poor skin turgor
b. Decreased serum albumin
c. Increased lymphocyte count
d. Triceps skinfold less than standard
Poor skin turgor is typically found in a person who is dehydrated, not on a low-protein diet. An increased lymphocyte count is
typically found when an infection is present, not due to a low-protein diet. A low triceps skinfold would typically be found in an
undernourished person. 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). The serum albumin
would be less than 3.5 g/dL
The nurse is performing a nutritional assessment on an 80-year-old patient. What is one of the many physiologic changes that can
directly affect the nutritional status of the older adult?
a. Slowed gastrointestinal motility
b. Hyperstimulation of the salivary glands
c. Increased sensitivity to spicy and aromatic foods
d. Decreased gastrointestinal absorption causing esophageal reflux
Normal physiologic 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
Which of these interventions is most appropriate when the nurse is planning nutritional interventions for a healthy, active
a. Decreasing the amount of carbohydrates to prevent lean muscle catabolism
b. Increasing the amount of soy and tofu in her diet to promote bone growth and
c. Increasing the number of calories she is eating because of the increased energy
needs of the older adult
d. Decreasing the number of calories she is eating because of the decrease in energy
requirements from the loss of lean body mass
Important nutritional features of the older years are a decrease in energy requirements as a result of loss of lean body mass, the
most metabolically active tissue, and an increase in fat mass.
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 r/t erratic eating patterns, eating predominantly fast foods, and high caffeine intake. In this situation, which is
most appropriate when collecting current dietary intake information?
a. Scheduling a time for direct observation of the adolescent during meals
b. Asking the patient for a 24-hour diet recall, and assuming it to be reflective of a
typical day for her
c. Having the patient complete a food diary for 3 days, including 2 weekdays and 1
d. Using the food frequency questionnaire to identify the amount of intake of
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 these conditions is due to an inadequate intake of both protein and calories?
Marasmus, protein-calorie malnutrition, is due to an inadequate intake of protein and calories or prolonged starvation. Obesity is
due to caloric excess; bulimia is an eating disorder. Kwashiorkor is protein malnutrition. Bulimia is an eating disorder characterized
by binge eating followed by self-induced vomiting. Obesity is caused by excess calories resulting in a body weight greater than
20% the ideal body weight for height. Kwashiorkor is caused by diets high in calories but with little or no protein. The disorder that
is caused by inadequate intake of both protein and calories, or starvation, is marasmus.
During an assessment of a patient who has been homeless for several years, the nurse notices that his tongue is magenta in color,
which is an indication of a deficiency in what mineral and/or vitamin?
c. Vitamin C
d. Vitamin D and calcium
Magenta tongue is a sign of riboflavin deficiency. In contrast, a pale tongue is probably attributable to iron deficiency. Vitamin D
and calcium deficiencies cause osteomalacia in adults, and a vitamin C deficiency causes scorbutic gums. A deficiency in iron
would cause a pale tongue, not magenta colored
A 50-year-old patient has been brought to the emergency department after a housemate found that the patient could not get out of
bed alone. He has lived in a group home for years but for several months has not participated in the activities and has stayed in his
room. The nurse assesses for signs of undernutrition, and an x-ray study reveals that he has osteomalacia. What deficiency is likely
b. Vitamin C
d. Vitamin D and calcium
Osteomalacia results from a deficiency of vitamin D and calcium in adults. Iron deficiency would result in anemia, vitamin C
deficiency would result in scurvy, and riboflavin deficiency would result in a magenta tongue.
An older adult patient in a nursing home has been receiving tube feedings for several months. During an oral examination, the
nurse notes that patient’s gums are swollen, ulcerated, and bleeding in some areas. The nurse suspects that the patient has what
b. Vitamin A deficiency
c. Linoleic-acid deficiency
d. Vitamin C deficiency
Vitamin C deficiency causes swollen, ulcerated, and bleeding gums, known as scorbutic gums. Rickets is a condition r/t vitamin D
and calcium deficiencies in infants and children. Vitamin A deficiency causes Bitot spots and visual problems. Linoleic-acid
deficiency causes eczematous skin.
The nurse is assessing the body weight as a percentage of ideal body weight on an adolescent patient who was admitted for
suspected anorexia nervosa. The patient’s usual weight was 125 pounds, but today she weighs 98 pounds. After calculating the
patient’s ideal body weight, what should the nurse conclude?
a. The patient is experiencing mild malnutrition.
b. The patient is experiencing moderate malnutrition.
c. The patient is experiencing severe malnutrition.
d. The patient is still within expected parameters with her current weight
By dividing her current weight by her usual weight and then multiplying by 100, a percentage of 78.4% is obtained, which means
that her current weight is 78.4% of her ideal body weight. A current weight of 80% to 90% of ideal weight suggests mild
malnutrition; a current weight of 70% to 80% of ideal weight suggests moderate malnutrition; a current weight of less than 70% of
ideal weight suggests severe malnutrition.
The nurse is assessing a patient who is obese for signs of metabolic syndrome. This condition is diagnosed when three or more
certain risk factors are present. Which of these assessment findings are risk factors for metabolic syndrome? (Select all that apply.)
a. Triglyceride level of 120 mg/dL
b. Blood pressure reading of 110/80 mm Hg
c. Blood pressure reading of 140/90 mm Hg
d. Fasting plasma glucose level less than 100 mg/dL
e. Fasting plasma glucose level greater than or equal to 110 mg/dL
ANS: C, E
Metabolic syndrome is diagnosed when three or more of the following risk factors are present: (1) fasting plasma glucose level
greater than or equal to 100 mg/dL; (2) blood pressure greater than or equal to 130/85 mm Hg; (3) waist circumference greater than
or equal to 40 inches for men and 35 inches for women; (4) high-density lipoprotein cholesterol less than 40 in men and less than
50 in women; and (5) triglyceride levels greater than or equal to 150 mg/dL.
A patient has been unable to eat solid food for 2 weeks and is in the clinic today complaining of weakness, tiredness, and hair loss.
The patient states that her usual weight is 175 pounds, but today she weighs 161 pounds. What is her recent weight change
To calculate recent weight change percentage, use this formula:
Usual weight – Current weight/Usual weight × 100
175 – 161 = 14 pounds
14 ÷ 175 = 0.080.08 × 100 = 8%
After completing a diet assessment on a 30-year-old woman, the nurse suspects that she may be deficient in iron. The nurse can verify by using laboratory values of:
a. Hemoglobin and hematocrit.
b. Cholesterol and triglycerides.
d. Serum albumin.
The hemoglobin determination is used to detect iron-deficiency anemia. Hematocrit, a measure of cell volume, is also an indicator of iron status. Cholesterol and triglyceride levels are tested for hyperlipidemia, and serum albumin levels indicate visceral protein status. Urinalysis is a measure of renal function and does not reflect iron-deficiency anemia
During assessment of a 78-year-old patient taking multiple medications for various chronic conditions, the nurse is concerned that the patient is experiencing:
a. Increase in hair growth.
b. Inadequate nutrient food intake.
c. Extreme weight gain.
d. Increase in abdominal fat.
Older adults are prescribed multiple medications that may interact with nutrients, vitamin supplements, and other prescription medications.
A 21-year-old woman with extensive weight gain over the past 12 months, has a BMI of 38, indicating obesity. The nurse is concerned that she is at increased risk for:
c. Optimal nutrition.
d. Low mortality
Excess body weight is associated with numerous chronic conditions, including type 2 diabetes, hypertension, cardiovascular disease, gallbladder disease, and certain types of cancer
The nurse in a family practice clinic is reviewing the patients scheduled for appointments. Which of these statements is true regarding routine laboratory testing in the following individuals?
a. In pregnancy, no laboratory testing is needed unless problems with the pregnancy are suspected.
b. In the older adult, laboratory values regarding cholesterol and triglyceride levels are the most important because of the risk for disease.
c. Routine laboratory testing is not necessary during adolescence.
d. Laboratory tests for infants with suspected undernutrition.
In infancy and childhood, laboratory tests are performed only when undernutrition is suspected or if the child has an illness. During adolescence, laboratory evaluation of hemoglobin and hematocrit values and urinalysis are performed. Many laboratory values are monitored during pregnancy, and older adults should be monitored for signs of renal insufficiency and overhydration or underhydration
The nurse is reviewing the laboratory results for a 52-year-old male patient: fasting plasma glucose (FPG) 7.2 mmol/L; high-density lipoprotein cholesterol (HDL-C) 0.9 mmol/L; triglycerides 2 mmol/L. During assessment the patient’s blood pressure (BP) is read as 145/88 mm Hg. His waist circumference is 110 cm, and the hip circumference is 98 cm. The nurse recognizes that the patient is at risk for:
a. Red man syndrome.
b. Sjogren’s syndrome.
c. Short bowel syndrome.
d. Metabolic syndrome
Metabolic syndrome is diagnosed when three or more of the risk determinants—BP, FPG, HDL-C—show high levels. (See Table 12-2.) Metabolic syndrome is a highly prevalent, multifaceted condition characterized by a distinctive collection of abnormalities, including abdominal obesity, hypertension, dyslipidemia, insulin resistance, and dysglycemia.
A 22-year-old patient presents with chronic diarrhea, weight loss, fatigue, bloating, and cramps. Her hemoglobin laboratory results indicate anemia. The nurse suspects:
b. Cardiovascular disease.
c. Celiac disease.
d. Metabolic syndrome.
Celiac disease is a medical condition in which the absorptive surface of the small intestine is damaged by gluten. This results in an inability of the body to absorb nutrients: protein, fat, carbohydrates, vitamins, and minerals. It is estimated that 1 in 133 persons in Canada are affected by celiac disease. Common symptoms are anemia, chronic diarrhea, weight loss, fatigue, cramps and bloating, and irritability
The nurse is working with a number of patients with liver disease from excessive alcohol consumption. The nurse recognizes that these patients are at risk for:
a. Weight loss from alcohol consumption replacing caloric food intake.
b. Undernutrition from consuming alcohol in place of nutritious foods.
c. Obesity from a fatty liver.
d. Overnutrition with the increased calories from alcohol consumption
Tobacco, alcohol, and illicit drug use are agents often substituted for nutritious foods and increase requirements for some nutrients. Individual is at risk for undernutrition with poor intake of necessary nutrients.
The nurse recognizes which of these persons as being at risk for undernutrition? (Select all that apply.)
a. A 28-year-old living in his car
b. A 50-year-old female bank manager
c. A 27-year-old university graduate student
d. A 30-year-old hospital administrator
e. A 5-month-old infant
f. A 12-year-old recently relocated from Syria
ANS: A, E, F
Vulnerable groups for undernutrition are infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults
The nurse is reviewing a patient’s laboratory tests. Which of the following are indicators of nutritional status? (Select all that apply.)
a. Serum alkaline phosphatase
c. Serum albumin
d. Creatinine kinase
ANS: B, C, E, F
Laboratory indicators of nutritional status include hemoglobin, hematocrit, ferritin, cholesterol, triglycerides, total lymphocyte count, and serum albumin measurements.
The nurse is working with some of the city’s homeless population. When assessing the 2-day-old surgical wound of one of the patients, the nurse is most concerned about:
a. Undernutrition leading to delayed wound healing.
b. Excess weight gain from overconsumption of nutrients.
c. Adequate nutritional intake for athletic performance.
d. Lowered resistance to infection resulting from overnutrition
Vulnerable groups for undernutrition are infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults. Undernutrition increases the risk for impaired growth and development, lowered resistance to infection and disease, delayed wound healing, longer hospital stays, and higher health-related expenses