Exam 2: Chapter 14 Flashcards
An older adult who is within a normal weight range asks a nurse, “I have heard that it is important to limit the amount of fats in my diet, but I don’t know how much I should be taking in daily. Can you help me?” The best response by the nurse is:
a. “Someone of your age needs to limit fats.”
b. “Since you are at your ideal weight, you should limit your daily fat grams to half your weight.”
c. “Fat intake will depend on the presence of any cardiac issues.”
d. “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.
A nursing student asks the instructor, “Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn’t obesity bad for everyone?” The best response by the instructor is:
a. “While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults.”
b. “Obesity is usually not a concern in older adults, as most older people tend to weigh less than they did when they were younger.”
c. “Obesity is a concern in all age groups; however, over the past decade obesity in older adults has decreased.”
d. “Obesity in older adults is less of a concern than we once thought; individuals over age 65 with a higher BMI have a lower mortality rate.”
ANS: A
There is evidence that obesity in younger people contributes to a decreased life expectancy. However, in older adults, it is not clear whether obesity is a predictor of mortality. Recent evidence demonstrated that for people who have survived to 70 years of age, mortality risk is lowest in those with a BMI classified as overweight. Persons who increased or decreased BMI have a greater mortality risk than those who have a stable BMI, particularly in those aged 70-79. Obesity is prevalent in older adults. The proportion of older adults who are obese has doubled in the past 30 years. More than one-third of individuals 65 years and older are obese with a higher prevalence in those 65-74 years than in those 75 years and older.
A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following:
a. “Since I am an older person, I need more calories because my metabolic rate is slower”
b. “Since I am an older person, I need fewer calories since my metabolic rate is slower”
c. “Even though I am an older person, I still need the same amount of nutrients in order to be healthy”
d. “Even though I am an older person, I still need to pay attention to my diet and activity levels”
ANS: A
Generally, older adults need fewer calories because they may not be as active and metabolic rates slow down. Older adults generally require the same amount of nutrients for optimal health outcomes. Older adults need to pay attention to meeting nutritional requirements and obtaining adequate physical activity for optimal health.
An older adult asks a nurse, “I hear a lot about limiting the amount of fat in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?” The nurse bases a response on which of the following?
a. 10-15% of total calories should be from fat, 30-40% from carbohydrates, and 35-75% from protein
b. 20-35% of total calories should be from fat, 45-65% from carbohydrates, and
10-35% from protein
c. 45-65% of total calories should be from fat, 20-35% from carbohydrates, and 10-35% from protein
d. 20-35% of total calories should be from fat, 10-25% from carbohydrates, and 50-75% from protein
ANS: B
Recommendations for older adults are that 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein.
A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is:
a. an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization.
b. an injury may cause malabsorption of nutrients.
c. most hospitalized older patients do not consume adequate amounts of micro- and macronutrients.
d. most hospitalized patients do not have accurate weights recorded upon admission.
ANS: A
One trajectory for malnutrition is inflammation-related malnutrition; in this situation, malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that contribute to an increased metabolic rate and impaired nutrient utilization. An injury does not necessarily cause malabsorption of nutrients. There is no evidence that most hospitalized patients do not consume adequate diets, and there is also no evidence that accurate weights are not recorded for most hospitalized patients.
An older adult’s nutritional status is screened by a nurse using the Mini Nutritional Assessment (MNA). The older adult scores a score of “10” on the screening portion of the tool. The best action by the nurse is to:
a. refer the patient to a dietician.
b. complete the assessment portion of the tool.
c. conduct a 72-hour calorie count.
d. initiate nutritional supplements between meals.
ANS: B
The MNA is both a screening tool and a detailed assessment. It is validated for use in individuals over age 65 and intended for use by professionals. If an individual scores less than a 12 on the screening portion of the tool, then the assessment portion must be completed. The assessment portion needs to be completed before any interventions or referrals are taken, as the information that is obtained in the assessment will guide the choice of interventions.
A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (Select all that apply.)
a. Sit the patient upright in a chair at 90 degrees.
b. Allow the patient to sit upright for 15 minutes after the meal is completed. c. Feed the patient only liquids to make swallowing easier.
d. Place the solid food in the left side of the mouth.
e. Have the patient swallow twice for every mouthful of food given.
ANS: A, E
When feeding a patient with dysphagia, it is important to have the patient sit upright at 90 degrees and to remain upright for an hour following the meal. Other important techniques include having the patient swallow twice for every mouthful of food given. This patient has a history of a right CVA, which would mean that the patient has left-sided weakness. The food needs to be placed in the nonimpaired side of the mouth, which in this case would be the right side. Since the patient has a CVA, the intake of “thin liquids” can increase risk for aspiration.
Many older adults have a vitamin B12 deficiency. Reasons for this include which of the following? (Select all that apply.)
a. Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient
b. The major source of vitamin B12 is sunlight, and older adults are less likely to be outdoors and absorb vitamin B12 in this manner
c. Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food
d. Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B12
e. Certain antibiotics and anticonvulsant medication increase the risk of vitamin B12 deficiency
ANS: A, C, E
A normal age-related change in the stomach is the production of less gastric acid, which makes vitamin B12 absorption less efficient. For most older adults, intake of vitamin B12 is usually adequate. Use of proton pump inhibitors and H2 receptor blockers for more than a year can lead to lower serum vitamin B12 levels by impairing absorption of the vitamin from food. Certain antibiotics and anticonvulsants can also increase the risk of vitamin B12 deficiency. While it is true that older adults may be outdoors less, the major source of vitamin B12 is not sunlight. While it is also true that older adults may not consume five servings of fruits and vegetables daily, fruit and vegetables are the major sources of vitamins A, C, and E and potassium.
Symptoms of gastroesophageal reflux disease (GERD) in older adults include: (Select all that apply.)
a. heartburn.
b. regurgitation.
c. abdominal pain within one hour of eating.
d. vomiting.
e. fever and elevated white blood cell count.
ANS: A, B, C
Symptoms of GERD include heartburn, regurgitation, persistent cough, exacerbation of asthma, laryngitis, and intermittent chest pain. In addition, abdominal pain within one hour of eating and worsening of symptoms upon lying down are common. Vomiting is not associated with GERD and neither is fever and elevated white blood cell count.
A nurse is developing a care plan for an older adult in a long-term care facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (Select all that apply.)
a. Assign a nursing aide to feed the resident to ensure adequate consumption of meals b. Supervise the resident during meals
c. Provide a pleasant eating environment
d. Provide nutritional supplements for the resident
e. Assess the resident for ability to feed himself/herself
ANS: B, C, D, E
Nurses hold an important role in ensuring adequate nutrition. Interventions that support this goal include supervision of eating, modification of the environment to be pleasing for eating, and assessing the individual for issues related to performance at mealtimes. Feeding a resident is not indicated unless it is known that the resident cannot feed himself/herself. It is important to promote independence as much as possible.
Which combination is suitable for the daily diet of older adults?
a. Vitamin B12, 2.4 mcg; and fiber, 15 g
b. Three 8-oz glasses of fluid; and 1600 calories
c. Vitamin B12, 1.1 mcg; and 40% of daily calories from fat
d. Calcium, 1200 mg; and vitamin D, 600 to 800 units
D
Which is a common age-related physical change that may affect digestion and food intake?
a. Loss of the majority of taste buds
b. Decreased motility in the esophagus
c. Decreased cholecystokinin secretion
d. Loss of smell
B
Which of the following is a true statement about nutrition for older adults?
a. The older person should be encouraged to practice strict controls on cholesterol intake to ensure protection against heart disease.
b. Transportation can be a critical factor in nutritional insufficiency in older adults.
c. Soul food is a concern primarily for the African-American culture.
d. No government programs promote congregate dining among older adults.
B
Which of the following is a true statement about dental health in older adults?
a. Most people can expect to lose most of their teeth by old age.
b. Excessive saliva production is a common problem among older adults.
c. Dentures should be cleaned once a day by brushing and soaking in a cleaning solution.
d. A little blood on the toothbrush is normal.
C
Which intervention should the nurse use to decrease the risk of burns during mealtime in patients with mental and physical impairments?
a. Wait until the drink has cooled.
b. Assist patients with warm drinks.
c. Use plastic mugs instead of ceramic.
d. Serve only cold beverages to patients at risk.
B
