Chapter 8: Nutritional Assessment Nursing School Test Banks

Chapter 8: Nutritional Assessment
Test Bank

MULTIPLE CHOICE

1. A patient with mild renal disease has been put on a 2200-calorie per day diet plan with the lowest recommended amount of protein. During discharge teaching, the nurse explains to this patient how to use nutrition labels to determine the amount of protein in the product. The nurse explains, however, that the label is based on 2000 calories. Which is the appropriate formula to teach this patient the least amount of protein he can eat on his prescribed diet?
a. 2200 calories 0.15 = 330/9 calories/gram = 36.6 g
b. 2200 calories 0.10 = 220/4 calories/gram = 55 g
c. 2200 calories 0.20 = 440/9 calories/gram = 48.8 g
d. 2200 calories 0.12 = 264/4 calories/gram = 66 g
ANS: D

Feedback
A Each gram of protein yields 4 calories rather than 9.
B Twelve percent is the least recommended percentage for proteins, rather than 10%.
C Twelve percent is the least recommended percentage for proteins. Each gram of protein yields 4 calories rather than 9.
D Proteins should account for 12% to 20% of total calories. Each gram of protein yields 4 calories.
DIF: Cognitive Level: Apply REF: 81
TOP: Nursing Process: Implementation
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

2. A patient is put on an 1800-calorie a day diet plan. During discharge teaching, the nurse explains to this patient how to use nutrition labels to determine the amount of carbohydrates in the product. The nurse explains, however, that the label is based on 2000 calories. Which is the appropriate formula to teach this patient of the maximum grams of carbohydrates she can eat on her prescribed diet?
a. 1800 calories 0.45 = 810/4 calories/gram = 202.5 g
b. 1800 calories 0.60 = 1080/4 calories/gram = 270 g
c. 1800 calories 0.55 = 990/9 calories/gram = 110 g
d. 1800 calories 0.50 = 900/9 calories/gram = 100 g
ANS: B

Feedback
A Carbohydrates should account for a maximum of 60% of total calories rather than 45%.
B Carbohydrates should account for 55% to 60% of total calories. Each gram of carbohydrates yields 4 calories.
C Each gram of carbohydrates yields 4 calories rather than 9.
D Carbohydrates should account for a maximum of 60% of total calories, rather than 50%. Each gram of carbohydrates yields 4 calories rather than 9.
DIF: Cognitive Level: Apply REF: 81
TOP: Nursing Process: Implementation
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

3. A patient tells the nurse that she tries to keep her fat intake at less than 15% of her total caloric intake per day. What is the nurses most appropriate response to this patients comment?
a. That is admirable; how do you accomplish fat intake that low on a daily basis?
b. Eating fat is essential for good health, and you should consume about 40% of your fats as monounsaturated fat.
c. Limiting fat prevents some diseases, but your fat intake is much lower than the 25% recommended.
d. If you want to bring your fat intake down further, you might want to eliminate eating fast foods.
ANS: C

Feedback
A The patients fat intake is too low. The recommended amount of fat is 25% to 30% of total calories.
B The recommended amount of fat is 25% to 30% of total calories.
C The recommended amount of fat is 25% to 30% of total calories.
D The patients fat intake is already too low. The recommended amount of fat is 25% to 30% of total calories.
DIF: Cognitive Level: Apply REF: 81
TOP: Nursing Process: Implementation
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Lifestyle Choices

4. A patient who keeps his fat consumption at 10% of his total caloric intake is at risk for deficiency of which nutrient(s)?
a. Iron
b. Vitamins A, D, and K
c. Zinc
d. B and C vitamins
ANS: B

Feedback
A Iron absorption is not affected by low fat intake.
B Vitamins A, D, and K are fat soluble vitamins. If the patient does not have enough fat intake, adequate amounts of these vitamins cannot be absorbed. Fat soluble vitamins should be linked to a lack of body fat.
C Zinc absorption is not affected by low fat intake.
D Vitamins B and C are water soluble vitamins and their absorption is not affected by low fat intake.
DIF: Cognitive Level: Apply REF: 81
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

5. A nurse is asking questions about the present health status of a young woman who has lost weight recently. Which question is most appropriate when inquiring about present health status?
a. What concerns have you had in the past regarding your weight?
b. Do you have anorexia?
c. Describe the recent changes in your weight.
d. Do you have a family history of eating disorders?
ANS: C

Feedback
A This question implies the patient has or should have concerns about weight loss and is not focused on the present health status.
B This is not an appropriate question. More data are needed about this patient before anorexia can be suspected or determined.
C Asking the patient to describe recent changes in weight is an appropriate, open-ended question to begin data collection so that the patient can report her current health status related to weight.
D This question is asked in the history rather than in the present health status part of the health history.
DIF: Cognitive Level: Apply REF: 83
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

6. While assessing a patients ability to consume food, the nurse recalls which types of foods are the easiest to chew and swallow?
a. Thin liquids
b. Soft foods
c. Dry foods
d. Chewy foods
ANS: B

Feedback
A Thin liquids and foods requiring forceful chewing (such as meat) may not be tolerated well.
B Foods that are soft and highly viscous are most easily chewed and swallowed.
C Foods that are soft and highly viscous are most easily chewed and swallowed.
D Thin liquids and foods requiring forceful chewing (such as meat) may not be tolerated well.
DIF: Cognitive Level: Understand REF: 84
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

7. Which tool is the best choice for a nurse to use as a quick screening tool to assess a patients dietary intake?
a. Food diary
b. Calorie count
c. Comprehensive diet history
d. 24-hour recall
ANS: D

Feedback
A A food diary provides detailed information, but is not convenient and requires a follow-up visit.
B A calorie count requires several days to collect data and requires a trained dietitian to analyze the results.
C A comprehensive diet history may provide more accurate reflection of nutrient intake, but is time-consuming to acquire and requires a trained/skilled dietary interviewer.
D Twenty-four-hour recall is useful as a quick screening tool to assess dietary intake.
DIF: Cognitive Level: Understand REF: 84
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

8. A nurse calculates a patients body mass index (BMI) as 33. This measurement indicates which class of weight?
a. Overweight
b. Obesity class I
c. Obesity class II
d. Obesity class III
ANS: B

Feedback
A Overweight is a BMI of 25 to 29.9.
B Obesity class I is a BMI of 30 to 34.9.
C Obesity class II is a BMI of 35 to 39.9.
D Obesity class III is a BMI greater than 40.
DIF: Cognitive Level: Understand REF: 86-87
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

9. Nurses use which measurement as the most highly correlated with risk of morbidity and mortality?
a. Waist-to-hip ratio
b. Triceps skinfold measure
c. Desirable body weight
d. Body mass index (BMI)
ANS: D

Feedback
A The waist-to-hip ratio is an indication of the risk of unhealthy fat distribution. A ratio that exceeds the desired ratio is indicative of upper body obesity. This increases the risk of developing health problems related to obesity (e.g., diabetes, hypertension, coronary artery disease, gallbladder disease, osteoarthritis, and sleep apnea).
B Triceps skinfold measurement provides an estimate of total body fat, which is only one measure of risk for obesity, and not, by itself, the most reliable and valid measurement to determine risk.
C Calculating desirable body weight and comparing it to actual body weight does not consider height in the assessment of obesity.
D The BMI considers both weight and height in the calculation. The U.S. Preventive Services Task Force advocates the BMI assessment as reliable and valid for identifying adults at risk of morbidity and mortality because of being overweight or obese. For this reason, calculating BMI is recommended for all individuals on a periodic basis.
DIF: Cognitive Level: Understand REF: 86-87
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

10. What is the desired body weight for a male who is 7 feet tall?
a. 178 lb
b. 225 lb
c. 250 lb
d. 275 lb
ANS: C

Feedback
A This incorrect result is obtained when 106 lb is used for the first 6 feet rather than 5 feet (84 inches 72 inches = 12); thus, 106 + (12 6) = 178 lb.
B This incorrect result is obtained when the scale for women is used rather than the scale for men (84 inches 60 inches = 24); thus, 105 + (24 5) = 225.
C The patient is 84 inches tall. Use 106 lb for the first 5 feet (60 inches) and 6 lb/ inch for the remaining 24 inches (84 inches 60 inches = 24); thus, 106 + (24 6) = 250 lb. Students must perform a calculation to find the answer.
D A result of 275 lb uses an incorrect calculation.
DIF: Cognitive Level: Apply REF: 90
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Lifestyle Choices

11. During a physical examination, the nurse notes that the patients skin is dry and flaking, with patches of eczema. Which nutritional deficiency might be present?
a. Vitamin C
b. Vitamin B
c. Essential fatty acid
d. Protein
ANS: C

Feedback
A Vitamin C deficiency causes bleeding gums, arthralgia, and petechiae.
B Vitamin B deficiency is too large a category to consider. Specific categories of vitamin B deficiency have been identified, such as pyridoxine and thiamine.
C Dry and scaly skin is a manifestation of essential fatty acid deficiency.
D Protein deficiency causes decreased pigmentation and lackluster hair.
DIF: Cognitive Level: Understand REF: 86
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

12. Which patient needs to be taught about how diet and exercise can lower lipids to reduce the risk for coronary artery disease?
a. A woman with a high-density lipoprotein (HDL) level of 53 mg/dl
b. A man with an HDL level of 43 mg/dl
c. A woman with a low-density lipoprotein (LDL) level of 125 mg/dl
d. A man with an LDL level of 200 mg/dl
ANS: D

Feedback
A This patients HDL level is in the expected range.
B This patients HDL level is in the expected range.
C This patients LDL level is in the expected range.
D The healthy range of LDL for men and women is <130 mg/dl.
DIF: Cognitive Level: Apply REF: 91| 93
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Lifestyle Choices

13. Which patient may require additional nutritional assessment?
a. A male patient with a blood glucose level of 100 mg/dl
b. A pregnant patient with a hemoglobin level of 10.5 g/dl
c. A female patient with a prealbumin level of 25 mg/dl
d. A male patient with a serum triglyceride level of 100 mg/dl
ANS: B

Feedback
A This patients glucose level is within normal limits.
B The expected hemoglobin level for a pregnant patient is 12 to 16 g/dl.
C This patients prealbumin level is within normal limits.
D This patients triglyceride level is within normal limits.
DIF: Cognitive Level: Analyze REF: 91| 93
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

14. During a physical examination, the nurse notes that the patients skin is dry and flaking, with patches of eczema, and suspects a nutritional deficiency. What additional data should the nurse expect to find to confirm the suspicion?
a. Hair loss and hair that is easily removed from the scalp
b. Inflammation of the tongue and fissured tongue
c. Inflammation of peripheral nerves, and numbness and tingling in extremities
d. Fissures and inflammation of the mouth
ANS: A

Feedback
A Hair loss (alopecia) and hair that is easily removed from the scalp (easy pluck ability), such as dry, flaking skin, is caused by essential fatty acid deficiency.
B Inflammation of the tongue (glossitis) and fissured tongue are manifestations of a niacin deficiency.
C Inflammation of peripheral nerves (neuropathy) and numbness and tingling in extremities (paresthesia) are manifestations of a thiamine deficiency.
D Fissures of the mouth (cheilosis) and inflammation of the mouth (stomatitis) are manifestations of a pyridoxine deficiency.
DIF: Cognitive Level: Analyze REF: 88
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

15. A male patient weighs 205 lb and his desired body weight (DBW) is 190 lb. How should the nurse counsel this patient about his weight?
a. He has mild obesity and needs to increase exercise and assess his diet for nutrients and calories.
b. He has moderate obesity and needs to consult a health care provider about weight loss therapy.
c. He is within normal limits and need not be concerned at this time.
d. Further data are needed before an interpretation can be determined.
ANS: C

Feedback
A Using the DBW scale, mild obesity is 20% to 40% above DBW. This patient is 9% above his DBW.
B Using the DBW scale, moderate obesity is 40% to 100% greater than DBW. This patient is 9% above his DBW.
C Ideally, the patient will fall between 90% and 110% of DBW, which for this patient is between 171 lb and 209 lb. A calculation is required to answer the question.
D According to the DBW scale, the patient will ideally be between 90% and 110% of DBW; therefore, the nurse has enough information to make an interpretation.
DIF: Cognitive Level: Apply REF: 90
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Lifestyle Choices

16. A patients current body weight (304 lb) and his desirable body weight of 190 lb. How does the nurse classify this patients weight?
a. Within expected range
b. Mildly obesity
c. Moderate obesity
d. Morbid obesity
ANS: C

Feedback
A A range of 90% to 110% of DBW is considered normal. This patients weight of 304 is 60% above his DBW.
B Mildly obesity is 20% to 40% above DBW. This patients weight of 304 is 60% above his DBW.
C Moderate obesity is 40% to 100% above the DBW. This patients weight of 304 is 60% above his DBW.
D Morbid obesity is 100% greater than DBW. This patients weight of 304 is 60% above his DBW.
DIF: Cognitive Level: Apply REF: 90
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Lifestyle Choices

17. Which patient has the least risk for unhealthy fat distribution?
a. The man whose triceps skinfold is at the 25th percentile
b. The woman whose triceps skinfold is at the 72nd percentile
c. The man whose waist circumference is 46 inches and hip circumference is 40 inches
d. The woman whose waist circumference is 30 inches and hip circumference is 38 inches
ANS: D

Feedback
A Triceps skinfold is an estimate for total body fat, rather than risk. The expected value is near the 50th percentile.
B Triceps skinfold is an estimate for total body fat, rather than risk. The expected value is near the 50th percentile.
C This mans waist-to-hip ratio is 1.15, which is higher than the 1.0 or less expected value for a man.
D This womans waist-to-hip ratio is 0.789, which is below 0.8, the expected value for women.
DIF: Cognitive Level: Apply REF: 91
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Lifestyle Choices

18. A patient who has anorexia nervosa reports a healthy diet and no protein calorie malnutrition. Which lab value best confirms this patients report?
a. Prealbumin
b. Serum albumin
c. Blood glucose
d. Serum cholesterol
ANS: A

Feedback
A Prealbumin is a reflection of protein and calorie intake for the previous 2 to 3 days.
B Serum albumin measures circulating protein. Albumin can be affected by a number of factors, including fluid status, blood loss, liver function, and stress. Fluctuation of albumin levels occurs over 3 to 4 weeks.
C Blood glucose measures can be affected by many factors such as stress, which raises blood glucose levels, and is not a measure of protein calorie malnutrition.
D Serum cholesterol is part of the lipid profile, which provides data on fat metabolism only, and is not a measure of protein calorie malnutrition.
DIF: Cognitive Level: Understand REF: 93
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

MULTIPLE RESPONSE

1. A nurse is assessing an 80-year-old patient who is cared for at home by his 79-year-old wife. Which data indicate this patient has malnutrition? Select all that apply.
a. Body mass index (BMI) of 17
b. Waist-to-hip ratio of 1.0
c. Weight loss of 6% since last months visit
d. Prealbumin level of 16 mg/dl
e. Hematocrit level of 50%
f. Hemoglobin level of 20 g/dl
ANS: A, C, F
Correct: A BMI of 18.5 to 24.9 is the normal range, and this patient is below normal. Severe weight loss is a more than 2% weight change over 1 week. The expected hemoglobin for a man is 14 to 18 g/dl. These values may also indicate dehydration.
Incorrect: Waist-to-hip ratio of 1.0 is an expected value for men. The expected level for prealbumin is 15 to 36 mg/dl. This hematocrit level is within normal limits.

DIF: Cognitive Level: Analyze REF: 86-87| 90| 93
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

COMPLETION

1. A man who is 6 feet 9 inches tall is told by his provider to lose weight so that he is closer to his desired body weight. He asks the nurse, How can I find out what my desired body weight should be? The nurse responds, Let me show you how to calculate it. Your desired body weight (DBW) should be _____ lb.

ANS:
232
6 feet 9 inches = 81 inches. DBW = 106 lb for the first 60 inches + 6 lb for every other inch, which for this man equals 21 inches (81 60 = 21). 21 6 = 126 +106 = 232 lb.

DIF: Cognitive Level: Apply REF: 90
TOP: Nursing Process: Implementation
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

2. A woman who is 4 feet 11 inches tall is told by her provider to lose weight so that she is closer to her desired body weight. She asks the nurse, How can I find out what my desired body weight should be? The nurse responds, Let me show you how to calculate it. Your desired body weight (DBW) should be _____ lb.

ANS:
103.25
4 feet 11 inches = 59 inches. DBW = 105 lb for the 60 inches + 5 lb for every other inch. However this woman is under 5 feet in height. Thus 105 lb/60 inches = 1.75 lb/inch. 1.75 59 inches = 103.25 lb.

DIF: Cognitive Level: Apply REF: 90
TOP: Nursing Process: Implementation
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

3. A womans waist circumference is 32 inches and her hip circumference is 29 inches. Her waist-to-hip ratio is _____.

ANS:
1.10
Calculate waist-to-hip by dividing waist measurement by the hip measurement, 32 inches/29 = 1.10.

DIF: Cognitive Level: Apply REF: 91
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Basic Care and Comfort: Nutrition and Hydration

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