Nutritional Foundations And Clinical Applications- A Nursing Approach- 6th Edition By Michele Grodner – Test Bank

Chapter 11: Nutrition Assessment and Patient Care
MULTIPLE CHOICE

1. The situation in which it would be most important for the nurse to contact the registered dietitian (RD) is if a
a. patient complains of constipation during his or her hospital stay.
b. patient’s family complains about the quality of the food in the hospital.
c. patient reports losing 10 lb in the past year without trying.
d. patient has been receiving intravenous glucose and saline but no oral intake for 36 hours.

ANS: D
It would be most important for the nurse to contact the RD to conduct a nutrition assessment if the patient has received only intravenous fluids with no nutrient intake for more than 24 hours. Constipation may warrant a nutrition assessment if it is ongoing, but in the short term, it is probably related to surgery, medical procedures, inactivity, or medications. Loss of 10 lb in a year is not considered severe and would warrant nutrition assessment only if other nutrition risk factors are present. Family complaints should be treated with respect but would warrant nutrition assessment only if the patient’s oral intake is significantly compromised; stressed family members often complain about food because it is unfamiliar and they believe it is the one thing in the hospital that should be familiar.

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2. An example of a common cause of iatrogenic malnutrition is
a. scheduling of frequent daily tests that prevents the patient from eating meals.
b. food from home brought in by family members and friends of a patient.
c. small portion sizes of hospital food and absence of snacks.
d. errors in ordering and delivery of meals for hospitalized patients.

ANS: A
A common cause of iatrogenic malnutrition is the scheduling of frequent tests that require patients to fast beforehand, possibly through the next meal time. It is not uncommon for patients to miss breakfast because they need to fast, to miss lunch because they are having a test, and to be too tired to eat very much at dinner. Bringing food from home may help prevent malnutrition. Hospital portion sizes are usually appropriate, and extra food and snacks can be ordered if needed. Errors in ordering and delivering patient meals are rare.

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3. If a patient is 6 feet tall and his or her waist measures 42 inches, the patient would be considered to have _____ fat levels consistent with _____ risk for chronic disease.
a. essential; low
b. essential; high
c. abdominal; low
d. abdominal; high

ANS: D
Waist-to-height ratio (WHtR) indicates abdominal fat levels, which can be predictive of risk for diabetes, hypertension, and cardiovascular disease. This patient has a WHtR ratio of 42:72, or 0.58. A WHtR ratio exceeding 0.5 is consistent with high risk for chronic disease.

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4. The best way to estimate height for a patient with both legs amputated below the knee is to use
a. demi-span (distance from the sternal notch to the middle finger).
b. knee height (with the use of calipers to measure heel-to-thigh distance).
c. recumbent bed height measured while the patient is lying down.
d. the patient’s stated pre-amputation height.

ANS: A
The most reliable method for a double leg amputee would be to use a formula based on measured demi-span. Knee height and recumbent bed height would not be measurable with lower limbs missing. Stated height is not necessarily accurate.

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5. If a male patient weighs 140 pounds when he is admitted to a long-term care facility and weighs 147 pounds 2 months later, his percent weight change during his hospital stay is
a. 3.5%.
b. 5%.
c. 7%.
d. 14%.

ANS: B
Percent weight change = [(147 – 140) ÷ 140]  100 = (7 ÷ 140)  100 = 5%.

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6. If a patient weighed 150 lb 1 month ago and now weighs 140 lb, the weight loss would be considered
a. insignificant.
b. mild.
c. moderate.
d. severe.

ANS: D
Percent weight loss = [(150 – 140) ÷ 150]  100 = (10 ÷ 150)  100 = 6.67%. Loss of more than 5% of body weight in 1 month is considered severe.

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7. An elderly patient who has been living alone and has gradually been losing weight has had a stroke and is transferred to a long-term care facility. It is unlikely that he will be able to achieve adequate oral intake during recovery, and so a percutaneous endoscopic gastrostomy (PEG) tube is inserted to begin tube feedings into his stomach. If the patient gains 8 lb in the first week of tube feeding, it is likely that
a. he is retaining fluid weight.
b. the tube feeding is well tolerated.
c. he is constipated.
d. the feedings are replenishing muscle and fat stores.

ANS: A
Weight gains exceeding 1 pound in a day are probably caused by excess fluid. The body cannot accumulate lean body mass or body fat this quickly, and accumulation of this amount of feces is highly unlikely.

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8. Body mass index (BMI) would be most useful for evaluating the weight status of a(n)
a. middle-aged, moderately active woman.
b. elderly, mostly sedentary man.
c. high-school football player.
d. young woman undergoing chemotherapy.

ANS: A
BMI measurement would be most useful for a healthy, moderately active woman. It may yield an underestimate of body fat in older adults, an overestimate of body fat in muscular individuals such as football players, and invalid results in patients who are acutely ill or who have lost muscle mass, as may be the case for a patient undergoing chemotherapy.

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9. An example of a patient considered to be at high nutrition risk is a(n)
a. 72-year-old man who has been vomiting for 12 hours.
b. 38-year-old overweight man who has had a heart attack.
c. 18-month-old child with weight in the third percentile for height.
d. woman with a broken leg and a serum albumin level of 3.8 g/dL.

ANS: C
A child with weight below the fifth percentile for height has high nutrition risk. A man between 65 and 75 years of age has moderate nutrition risk; vomiting for 12 hours does not necessarily increase nutrition risk. An overweight man who has had a heart attack may benefit from long-term interventions to decrease weight and saturated fat intake, but he is not at immediate nutrition risk. Broken bones may represent moderate nutrition risk, but a serum albumin level greater than 3.5 is not of immediate concern.

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10. Measurement of serum albumin level would be most useful for predicting visceral protein status in a(n)
a. patient with congestive heart failure who has very little appetite.
b. elderly patient who has been living alone and is scheduled for nonemergency surgery.
c. patient with liver failure related to chronic alcohol abuse.
d. patient who was in a serious car accident and is recovering from multiple fractures.

ANS: B
Serum albumin level is a good index of visceral protein status for patients who are otherwise healthy, such as an older adult scheduling nonemergency surgery. Congestive heart failure, hepatic insufficiency, and trauma may cause abnormally low values.

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