Chapter 30 Oral Nutrition

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Chapter 30  Oral Nutrition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. The nurse is admitting a person to the unit and is assessing the patient’s nutritional status. In assessing the patient’s nutritional status, the nurse realizes that:
a.
body mass index (BMI) is the main indicator of obesity.
b.
ideal body is the standard gauge for nutritional status.
c.
clinical judgment is required, along with other indicators.
d.
the amount of weight change is the main nutritional indicator.

ANS: C
Use clinical judgment when evaluating muscular patients or patients with large amounts of edema or ascites, because these physiological states will lead to false overestimation of the degree of fatness. BMI alone is not a perfect predictor of overweight or obesity. You gather weight information in several ways, including usual body weight (UBW), ideal body weight (IBW), actual body weight (ABW), and BMI. A thorough nutritional assessment usually requires the collection of all of these weight measures. The magnitude and direction of weight change are more meaningful than standardized weight references when one is dealing with sick or debilitated patients.

DIF: Cognitive Level: Application REF: Text reference: p. 761
OBJ: Perform accurate nutritional screening.
TOP: Anthropometrics/Body Weight KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. The nurse is assessing the patient for nutritional status. Which laboratory value may indicate compromised protein status?
a.
Serum albumin level of 4.0 g/dL
b.
Prealbumin level of 12 g/dL
c.
Total lymphocyte count of 1600 cells/mm3
d.
Prealbumin level of 35 g/dL

ANS: B
Prealbumin normally ranges from 20 to 50 mg/dL. This test is useful for monitoring short-term changes in visceral protein (Grodner et al, 2004). It has a short half-life of 2 days. A patient has compromised protein status when levels are between 10 and 15 g/dL. Normal serum albumin values are between 3.5 and 5.0 g/dL. For nutritional analysis, values between 2.8 and 3.5 g/dL indicate compromised protein status. Total lymphocyte count (TLC) is a useful measure of immune function. A normal TLC is greater than 1500 cells/mm3. You must assess a measure of TLC along with other diagnostic indicators. A count of less than 1500/mm3 indicates possible immunocompromise associated with protein-energy malnutrition.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 762
OBJ: Perform accurate nutritional screening. TOP: Prealbumin
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. The nurse is caring for a patient diagnosed with severe dehydration. She notes that the patient’s albumin level is 4.0. What may this indicate?
a.
The patient is in a compromised protein state.
b.
The level may be falsely high.
c.
An acute nutritional deficiency.
d.
A long-term nutritional deficiency.

ANS: B
In patients who are dehydrated or who have received infusions of albumin, fresh frozen plasma, or whole blood, serum albumin levels will appear normal. Normal serum albumin values are between 3.5 and 5.0 g/dL. Albumin is a useful test for monitoring long-term nutrition changes because normal values still may be found among patients who are malnourished. For nutritional analysis, values between 2.8 and 3.5 g/dL indicate compromised protein status. Normal serum albumin values are between 3.5 and 5.0 g/dL.

DIF: Cognitive Level: Analysis REF: Text reference: p. 762
OBJ: Perform accurate nutritional screening. TOP: Albumin
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. The nurse is caring for a patient who requires assistance with eating. The patient repeatedly apologizes to the nurse, saying, “I’m so sorry. I’m like a baby. I’m such a burden since I can’t even feed myself.” What is the most appropriate strategy for the nurse to use?
a.
Feed all of the solid foods first, and then offer liquids.
b.
Feed the patient quickly so as not to make the patient feel like it is taking a great deal of time out of the nurse’s day.
c.
Minimize conversation so that the patient can eat faster.
d.
Appear unhurried, sit at the bedside, and encourage the patient to feed himself/herself as much as possible.

ANS: D
Meals should be a pleasant event for the patient. Conversation promotes socialization. Adults who need help to eat need compassion and understanding. Given the importance of nutrition in the healing process the nurse should use common sense to provide a socially meaningful mealtime. Feeding the patient quickly is likely to accentuate his belief that he is a burden. It is best to offer fluids after every 3 or 4 bites of solid food, or whenever the patient requests a drink.

DIF: Cognitive Level: Application REF: Text reference: p. 764 |Text reference: p. 767
OBJ: Verbalize the steps used in assisting an adult to eat.
TOP: Assisting the Patient with Oral Nutrition
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity

5. What must the nurse do before assisting the patient with feeding?
a.
Assess the patient’s gag reflex.
b.
Make sure that the consistency of the food is thin.
c.
Remove the patient’s dentures to prevent gagging.
d.
Prepare the patient to be fed by a staff member.

ANS: A
Assess the patient’s ability to swallow and the patient’s gag reflex. Some patients (those who have neurological diseases or who are handicapped) have a reduced gag reflex and/or dysphagia, increasing the risk for aspiration. Changes in the consistency of the diet (thickened liquids, pureed, soft), swallow training, or alternative means of nutrition are often necessary and require a speech therapist or a registered dietitian. If the patient wears dentures, check to ensure that they fit well and are clean. This ensures that the patient is able to chew food and swallow more normally. Patients with any level of independence should not be totally fed by hospital staff. A thorough understanding of the patient’s physical and cognitive limitations alerts the nurse to the type of assistance the patient needs.

DIF: Cognitive Level: Application REF: Text reference: p. 765
OBJ: Perform accurate nutritional screening.
TOP: Assisting the Patient with Oral Nutrition
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

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