Description

Ebersole and Hess Toward Healthy Aging 8th Edition Touhy Jett Test Bank

ISBN-13: 978-0323073165

ISBN-10: 0323073166

 

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Touhy: Ebersole & Hess’ Toward Healthy Aging, 8th Edition

 

Chapter 14: Nutrition and Hydration

 

Test Bank

 

MULTIPLE CHOICE

 

1. The nurse provides a client with education regarding the use of My Pyramid. What is the primary advantage of the United States Department of Agriculture’s (USDA) My Pyramid to the older adult client?
   1. It’s an easy method for identifying and correcting nutritional deficiencies in one’s diet.
   2. The USDA authored the system based on extensive nutritional research.
   3. The method is easily adapted to the most commonly prescribed therapeutic diets.
   4. When tested, it was readily accepted by numerous older adult clients.

 

ANS:   A

With proper instruction, the Modified MyPyramid is an easy and systematic way for a person to evaluate his/her own nutritional intake and independently make corrective adjustments. While the other options may be true, they do not directly address the known advantage of the tool.

 

DIF:    Cognitive level: Application   TOP:    Integrated Process: Learning and Teaching

MSC:   Health Promotion and Maintenance

 

2. A person weighs 180 pounds. Which explanation concerning how to determine the amount of fat this person should consume each day is correct?
   1. Someone your weight needs to limit fats so you can lose weight.
   2. If you are at your ideal weight you should limit your daily fat grams to 1/2 your weight.
   3. Fat intake will depend on the presence of any cardiac issues.
   4. Read food labels well and focus your diet on low fat foods.

 

ANS:   B

A simple technique to determine how much fat a person should consume is to divide the ideal weight in half and allowing that number of grams of fat. The remaining options don’t address the issue of how much fat should be eaten daily.

 

DIF:    Cognitive level: Application   TOP:    Integrated Process: Learning and Teaching

MSC:   Health Promotion and Maintenance

 

3. Which intervention is most likely to minimize weight loss and assure adequate nutritional intake in a mildly impaired, older adult client admitted to a rehabilitation facility following a stroke that has resulted in right side weakness and dysphagia?
   1. Asking the family to identify foods the client enjoyed prior to the stroke
   2. Regular discussion of the client’s nutritional status by a multidisciplinary team
   3. Providing appropriate assistance with eating at all meals
   4. Strict adherence to the protocol for feeding a client with impaired swallowing

 

ANS:   B

A multidisciplinary approach is key to appropriate assessment and intervention for proper management of this client’s nutritional issues and should involve medicine, nursing, dietary, physical, occupational, and speech therapy, and social work. The remaining options are focused on encouraging the client to eat and considering the client’s risk for injury related to choking, not on the holistic issue of adequate nutrition for this client.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Implementation

MSC:   Health Promotion and Maintenance

 

4. Which indicator should receive priority concern when monitoring an older adult for possible malnutrition?
   1. The client’s stated goal to ‘lose 10 pounds in 6 weeks’.
   2. The client’s weight loss of 3 pounds in the last 2 weeks.
   3. The client’s weight, when compared to a weight chart, is below normal.
   4. The client’s statement that, “I could save some money by cutting back on my food bills.”

 

ANS:   B

Weight loss is a key indicator of malnutrition, even in overweight older adults. While the remaining options reflect possible reasons for a weight loss, they are not an objective sign of possible malnutrition.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Assessment

MSC:   Health Promotion and Maintenance

 

5. What information will be included in client education for a client who needs to manage their calcium levels?
   1. A peanut butter and jelly sandwich and a glass of milk is an excellent way to get calcium
   2. Calcium citrate and Calcium carbonate are equally effective forms of supplemental calcium
   3. Take your 1200–1500 mgs of daily calcium spread out between your meals and snacks
   4. Sodium keeps the calcium from being lost through the excretion of urine

 

ANS:   C

Calcium should be spread out over the day so that a total intake of 1200 to 1500 mg is achieved, with 500 mg or less being consumed at each meal to optimize absorption. Calcium citrate is better absorbed than calcium carbonate and does not need to be taken with food. Calcium is a difficult mineral to absorb, and some foods inhibit calcium absorption (spinach, green beans, peanuts, summer squash). High levels of protein, sodium, or caffeine also cause more calcium to be excreted in the urine and should be avoided.

 

DIF:    Cognitive level: Application   TOP:    Integrated Process: Learning and Teaching

MSC:   Health Promotion and Maintenance

 

6. A 76-year-old is moderately obese but otherwise healthy. When asking whether weight loss is important at this point in life, the nurse respond based on the rationale that:
   1. The “obesity paradox” research shows that weight is not a great mortality risk for this client
   2. Ideal weight is a goal that is appropriate for all age groups
   3. The client needs to discuss these issues with a registered nutritionist
   4. In order to maintain wellness, the client needs to lose weight in a controlled, healthy manner

 

ANS:   A

It remains unclear whether overweight and obesity are predictors of mortality in older adults and concerns have been raised about encouraging apparently overweight older people to lose weight. In what has been termed the “obesity paradox” for people who have survived to age 70, mortality risk is lowest in those with a BMI classified as overweight. Overweight older people are not at greater mortality risk, and there is little evidence that dieting in this age group confers any benefit. Ideal weight and weight loss are issues that do not appear to have the same degree of importance for the older adult as they do for the rest of the population. The nurse is capable of discussing such issues with the client and needs to refer to a nutritionist only when more specific information is needed.

 

DIF:    Cognitive level: Application   TOP:    Integrated Process: Learning and Teaching

MSC:   Health Promotion and Maintenance

 

7. What evidence-based practice information should the nurse base decisions on regarding assigning ancillary staff to long-term care clients requiring feeding assistance?
   1. The staff should be allowed at least 20 minutes per patient to provide feeding assistance.
   2. 50% of long-term care residents require some degree of assistance with eating.
   3. Long-term care clients eat better when fed in a community environment like a dining room.
   4. Poor nutrition and hydration is primarily affected by the client’s physical condition.

 

ANS:   A

Having one staff person for every two or three residents who need feeding assistance would allow the resident 20 to 30 minutes with the staff and such an intervention creates a marked improvement in the individual client’s nutritional status. It is true that the incidence of eating disability in long-term care is high with estimates that 50% of all residents cannot eat independently, but this option does not provide the focused information needed to determine an appropriate intervention. While eating in a community setting may have an impact on socialization and minimize social isolation, there is not proof to confirm it has a positive effect on nutrition. Research has shown that inadequate staffing in long-term care facilities is associated with poor nutrition and hydration with 50% of residents significantly increasing their oral food and fluid intake during mealtime when they received one-on-one feeding assistance.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Planning

MSC:   Health Promotion and Maintenance

 

8. The caregiver for an older adult with cognitive impairment is concerned about the individual’s seeming disinterest in eating. Which suggestion does the nurse offer based upon a known effect of dementia on a client’s nutrition?
   1. Focus menu choices on the individual’s known favorite foods and beverages.
   2. Provide the individual with easily managed finger foods whenever possible.
   3. Serve food in several small meals each day instead of the traditional 3 big meals.
   4. Establish a routine of when and where the individual will have their meals.

 

ANS:   D

A major factor predisposing older people with dementia to nutritional inadequacy is the lack of awareness of the need to eat. One of the best strategies for managing poor intake is establishing a routine so the older person does not have to remember times and places for eating. While the other options represent appropriate interventions, they are not based on a known effect of dementia.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Implementation

MSC:   Health Promotion and Maintenance

 

9. A 78-year-old is admitted to the long-term care facility after a hospitalization for pneumonia. The client has a history of a right cerebrovascular accident and dysphagia. When preparing the room for this patient, what equipment is most important in the care of this patient?
   1. A room located within sight of the nursing station
   2. An adjustable height bed that goes low to the floor
   3. A suction machine
   4. Oxygen at bedside

 

ANS:   C

Aspiration is the most profound and dangerous problem for patients with dysphagia. A suction machine is essential to have at the bedside or in the dining room. Although it is wise to place a new patient who potentially has mobility issues close to the nursing station where there is closer observation, this is not mandatory. An important intervention is to reduce injuries from falls, which might be a concern with this patient, but there is no indication in the scenario that falls are a problem for this patient. There is no evidence that oxygen is necessary for this patient.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Planning

MSC:   Health Promotion and Maintenance

 

10. A 75-year old resident in the nursing home has end stage dementia and experiences a 10-pound weight loss over the course of 2 months. The resident has become increasingly difficult to feed and often spits out food, pockets food, and frequently drools. The family is concerned about the resident’s nutritional status. What is the initial action of the nurse?
    1. Recommend to the physician that a gastric feeding tube be placed.
    2. Recommend to the physician that a swallowing evaluation be done.
    3. Amend the care plan to include vigorous feeding by the nursing assistants.
    4. Assure the family that feeding issues are often a characteristic of end-stage dementia.

 

ANS:   B

It is important to do a careful assessment for swallowing disorders and other factors that influence intake before considering severe dietary restrictions or feeding tubes, especially in patients with dementia. Feeding tubes are not the first line of action; a complete assessment is done to identify the problem. The word vigorous implies force-feeding, which is never recommended. It would be especially contraindicated in this patient because there is evidence of a swallowing problem (spitting out food, pocketing food, and excessive drooling). While feeding issues are common at this stage of dementia, this option does not address the family’s concern.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Implementation

MSC:   Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

1. Which diagnostic laboratory test should the nurse anticipate being ordered for the purpose of evaluating an individual’s acute, unexplained weight loss? Select all that apply.
   1. A complete blood count (CBC)
   2. Urinalysis
   3. Fecal Occult Blood
   4. Serum Potassium
   5. Serum Electrolytes

 

ANS:   A, B, C

A complete blood count helps assess the presence of diseases known to affect weight loss or cause loss of appetite. Urinalysis to rule out infection, as well as a stool sample for fecal occult blood, should be included to rule out bleeding from ulcers or cancer. The remaining options are unlikely to provide information regarding the client’s weight loss.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Planning

MSC:   Health Promotion and Maintenance

 

2. Which intervention would be included when developing a care plan to deduce the risk for injury for a patient with dysphagia who requires feeding assistance? Select all that apply.
   1. Elevate bed to 90 degrees when feeding either solids or liquids
   2. If facial weakness is present, place food on the non-impaired side of the mouth
   3. Provide fluids when feeding of solids is complete
   4. Monitor the individual’s temperature frequently
   5. If feeding causes agitation, introduce food after sedative medication is administered

 

ANS:   A, B, D

The correct options reflect appropriate care to facilitate swallowing and monitor for possible aspiration pneumonia. The introduction of solids and liquids should be alternated during the feeding and feeding should not occur when the client is experiencing medication-induced sedation since the cough reflex and swallowing abilities are impaired by the medication.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Implementation

MSC:   Health Promotion and Maintenance

 

3. Which assessment data would be of particular concern when attempting to manage an older adult’s risk for dehydration? Select all that apply.
   1. African-American ethnicity
   2. Diuretic medication therapy
   3. Chronic constipation
   4. Diagnosed dysphagia
   5. A large draining wound on the left leg.

 

ANS:   A, B, D, E

Old age and black race have both been associated with an increased risk of dehydration. Other risk factors for dehydration include medications, particularly those that directly affect renal function and fluid balance, such as diuretics, and functional deficits including dysphagia and delayed wound healing have all been noted as risk factors for dehydration in this population. Diarrhea rather than constipation would be a recognized risk factor.

 

DIF:    Cognitive level: Application   TOP:    Nursing Process: Assessment

MSC:   Health Promotion and Maintenance