Nutritional Assessment

Every question here, with the answer

1. A nurse is beginning a nutritional assessment for a newly admitted patient. Which action should the nurse take first to support an individualized plan of care?

   1. Collect subjective data about lifestyle behaviors, medical history, and access to food before developing interventions.
   2. Begin teaching the patient a standard healthy eating plan used for all patients on the unit.
   3. Wait for diagnostic testing results before asking the patient about diet or current concerns.
   4. Focus only on height, weight, and BMI because these are the most reliable indicators of nutrition.

   Answer: Collect subjective data about lifestyle behaviors, medical history, and access to food before developing interventions.

   The section emphasizes that nutritional assessment begins with subjective data, including lifestyle behaviors and underlying medical conditions. Objective measures and tests are also important, but they are combined with subjective cues before the nurse develops an individualized plan.

2. A nurse is collecting subjective data during a nutritional assessment. Which information should the nurse include? Select all that apply.

   1. Food access or food insecurity and use of food assistance programs
   2. Skin turgor, pallor, cyanosis, bruising, and edema
   3. Religious preference, ethnicity and culture, educational level, occupation, and geographic location
   4. Unintentional weight loss, change in appetite, difficulty chewing or swallowing, nausea, vomiting, stool changes, and abdominal pain
   5. Smoking history and use of alcohol or illicit drugs

   Answer: Food access or food insecurity and use of food assistance programs, Religious preference, ethnicity and culture, educational level, occupation, and geographic location, Unintentional weight loss, change in appetite, difficulty chewing or swallowing, nausea, vomiting, stool changes, and abdominal pain, Smoking history and use of alcohol or illicit drugs

   Subjective data include sociocultural factors, dietary patterns, lifestyle behaviors, and current health concerns. Skin findings are objective physical assessment data, not subjective history.

3. A patient with a newly placed NG tube is scheduled to begin enteral feeding. Which nursing action is most appropriate before feeding is started?

   1. Request a DEXA scan to evaluate bone strength.
   2. Measure waist circumference and compare it with previous documentation.
   3. Review and record the x-ray result that verifies tube placement.
   4. Ask the patient to complete a three-day food tracker.

   Answer: Review and record the x-ray result that verifies tube placement.

   The section states that routine x-rays are used to verify placement of NG and PEG tubes. A food tracker, waist circumference, and DEXA scan may relate to nutritional assessment, but they do not address tube placement safety before feeding.

4. A patient reports coughing when eating and says, “Food feels like it gets stuck when I swallow.” Which diagnostic test should the nurse anticipate to evaluate swallowing safety?

   1. Computed tomography scan
   2. Twenty-four-hour urine creatinine collection
   3. Dual-energy x-ray absorptiometry scan
   4. Modified barium swallow study

   Answer: Modified barium swallow study

   A modified barium swallow study evaluates swallowing function and safety in real time. The other options assess anatomical anomalies, bone density, or catabolism rather than swallowing physiology and safety.

5. A nurse is reviewing laboratory results for a patient at risk for malnutrition. Which interpretations are consistent with the section? Select all that apply.

   1. Low WBCs can place the patient at risk for infection.
   2. Low albumin can indicate prolonged protein deficiency intake over several weeks.
   3. Prealbumin reflects protein intake over the previous few weeks and may be used to monitor PN therapy effectiveness.
   4. Transferrin levels always decrease during iron deficiency anemia.
   5. Albumin and prealbumin levels confirm malnutrition without considering other patient data.

   Answer: Low WBCs can place the patient at risk for infection., Low albumin can indicate prolonged protein deficiency intake over several weeks., Prealbumin reflects protein intake over the previous few weeks and may be used to monitor PN therapy effectiveness.

   The section links albumin with prolonged protein deficiency and prealbumin with more recent protein intake, including monitoring PN therapy. It also states low WBCs increase infection risk; however, albumin/prealbumin can be affected by other medical conditions, and transferrin increases during iron deficiency anemia.

6. A nurse is planning care for a patient with a chronic inflammatory disease and unintentional weight loss. Which nutrition-related effects should the nurse anticipate? Select all that apply.

   1. Catabolic metabolism of muscle tissue
   2. Decreased appetite and decreased dietary intake
   3. Improved nutrient absorption
   4. Reduced insulin sensitivity of body cells
   5. Poor quality of life associated with decreased muscle mass

   Answer: Catabolic metabolism of muscle tissue, Decreased appetite and decreased dietary intake, Reduced insulin sensitivity of body cells, Poor quality of life associated with decreased muscle mass

   The section describes inflammation as a driving force for malnutrition that can reduce intake, promote catabolism, reduce insulin sensitivity, and impair absorption. It also connects low-grade inflammation with unintentional weight loss, decreased muscle mass, and poor quality of life.