Deck 11: Nutritional Assessment

Question 1

The nurse recognizes which of these persons is at greatest risk for undernutrition?

A)5-month-old infant
B)50-year-old woman
C)20-year-old college student
D)30-year-old hospital administrator

Answer 1

5-month-old infant

Question 2

A patient tells the nurse that his food simply does not have any taste anymore.The nurse's best response would be:

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."

Answer 2

"When did you first notice this change?"

Question 3

The nurse is providing care for a 68-year-old woman who is complaining of constipation.What concern exists regarding her nutritional status?

A)Absorption of nutrients may be impaired.
B)Constipation may represent a food allergy.
C)The patient may need emergency surgery to correct the problem.
D)Gastrointestinal problems will increase her caloric demand.

Answer 3

Absorption of nutrients may be impaired.

Question 4

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 child in this age group.
B)The recommended dietary allowances for an infant are the same as for an adolescent.
C)The baby's growth is minimal at this age; therefore, caloric requirements are decreased.
D)The baby should be placed on skim milk to decrease the risk of coronary artery disease when he or she grows older.

Question 5

A pregnant woman is interested in breastfeeding her baby and asks several questions about the topic.Which information is appropriate for the nurse to share with her?

A)Breastfeeding is best when also supplemented with bottle feedings.
B)Babies who are breastfed often require supplemental vitamins.
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 immunity.

Question 6

The nurse is discussing appropriate foods with the mother of a 3-year-old child.Which of these foods are recommended?

A)Foods that the child will eat, no matter what they are
B)Foods easy to hold such as hot dogs, nuts, and grapes
C)Any foods, as long as the rest of the family is also eating them
D)Finger foods and nutritious snacks that cannot cause choking

Question 7

A mother and her 13-year-old daughter express their concern related to 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.

Question 8

When assessing a patient's nutritional status,the nurse recalls that the best definition of optimal nutritional status is sufficient nutrients that:

A)Are in excess of daily body requirements.
B)Provide for the minimum body needs.
C)Provide for daily body requirements but do not support increased metabolic demands.
D)Provide for daily body requirements and support increased metabolic demands.

Question 9

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?

A)Obese
B)Mildly overweight
C)Suffering from malnutrition
D)Within appropriate range of ideal weight

Question 10

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.The nurse's appropriate response would be:

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."

Question 11

When considering a nutritional assessment,the nurse is aware that the most common anthropometric measurements include:

A)Height and weight.
B)Leg circumference.
C)Skinfold thickness of the biceps.
D)Hip and waist measurements.

Question 12

A 50-year-old woman with elevated total cholesterol and triglyceride levels is visiting the clinic to find out about her laboratory results.What would be important for the nurse to include in 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; she can do nothing to change the levels.

Question 13

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 24 hours.

Question 14

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

Question 15

In teaching a patient how to determine total body fat at home,the nurse includes instructions to obtain measurements of:

A)Height and weight.
B)Frame size and weight.
C)Waist and hip circumferences.
D)Mid-upper arm circumference and arm span.

Question 16

For the first time,the nurse is seeing a patient who has no history of nutrition-related problems.The initial nutritional screening should include which activity?

A)Calorie count of nutrients
B)Anthropometric measures
C)Complete physical examination
D)Measurement of weight and weight history

Question 17

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

Question 18

The nurse is reviewing the nutritional assessment of an 82-year-old patient.Which of these factors will most likely affect the nutritional status of an older adult?

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

Question 19

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 related to his nutritional status might the nurse expect to find?

A)Obesity
B)Hypotension
C)Osteomalacia (softening of the bones)
D)Coronary artery disease

Question 20

How should the nurse perform a triceps skinfold assessment?

A)After pinching the skin and fat, the calipers are vertically applied to the fat fold.
B)The skin and fat on the front of the patient's arm are gently pinched, and then the calipers are applied.
C)After applying the calipers, the nurse waits 3 seconds before taking a reading. After repeating the procedure three times, an average is recorded.
D)The patient is instructed to stand with his or her back to the examiner and arms folded across the chest. The skin on the forearm is pinched.

Question 21

The nurse is preparing to measure fat and lean body mass and bone mineral density.Which tool is appropriate?

A)Measuring tape
B)Skinfold calipers
C)Bioelectrical impedance analysis (BIA)
D)Dual-energy x-ray absorptiometry (DEXA)

Question 22

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 percentage? To calculate recent weight change percentage,use this formula:
Usual weight - current weight ´ 100
usual weight

Question 23

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.The nurse calculates the patient's ideal body weight and concludes that the patient is:

A)Experiencing mild malnutrition.
B)Experiencing moderate malnutrition.
C)Experiencing severe malnutrition.
D)Still within expected parameters with her current weight.

Question 24

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?

A)Iron
B)Riboflavin
C)Vitamin D and calcium
D)Vitamin C

Question 25

The nurse is performing a nutritional assessment on an 80-year-old patient.The nurse knows that physiologic changes can directly affect the nutritional status of the older adult and include:

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.

Question 26

Which of these conditions is due to an inadequate intake of both protein and calories?

A)Obesity
B)Bulimia
C)Marasmus
D)Kwashiorkor

Question 27

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 condition?

A)Rickets
B)Vitamin A deficiency
C)Linoleic-acid deficiency
D)Vitamin C deficiency

Question 28

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

Question 29

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)Fasting plasma glucose level less than 100 mg/dL
B)Fasting plasma glucose level greater than or equal to 110 mg/dL
C)Blood pressure reading of 140/90 mm Hg
D)Blood pressure reading of 110/80 mm Hg
E)Triglyceride level of 120 mg/dL

Question 30

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,which is a deficiency of:

A)Iron.
B)Riboflavin.
C)Vitamin D and calcium.
D)Vitamin C.

Question 31

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 related to 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 weekend day
D)Using the food frequency questionnaire to identify the amount of intake of specific foods

Question 32

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)Inadequate nutrient food intake
C)Weight 10% to 20% over ideal
D)Sore, inflamed buccal cavity

Question 33

Which of these interventions is most appropriate when the nurse is planning nutritional interventions for a healthy,active 74-year-old woman?

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 reverse osteoporosis
C)Decreasing the number of calories she is eating because of the decrease in energy requirements from the loss of lean body mass
D)Increasing the number of calories she is eating because of the increased energy needs of the older adult