Toward Healthy Aging, 11th Edition Chapter 15: Nutritional Health Advanced Test

1. 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 saturated fats in my diet, but I don't know how much I should be taking in daily. Can you help me?" What is the nurse's best response? a. "Someone of your age needs to limit saturated fats." b. "Less than 10% of calories per day should come from saturated fats." c. "Saturated fat intake will depend on the presence of any cardiac issues." d. "Read food labels well and focus your diet on saturated-free, low-fat foods." - ANSWERSANS: B Similar to other age groups, older adults should limit intake of saturated fat and trans fatty acids. High-fat diets cause obesity and increase the risk of heart disease and cancer. Less than 10% of calories per day should come from saturated fats. The remaining options don't address the issue of how much fat should be eaten daily. 2. 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 presented in which statement? - ANSWERSa. "While there is evidence that obesity in younger people lessens life expectancy, overweight and obese adults do not have the same risk of morbidity and mortality. 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." Part 2 ANS: A Although there is strong evidence that obesity in younger people decreases life expectancy and has a negative effect on functionality and morbidity, less is known about the benefits and risks of obesity in older adults compared to children and adults. Older overweight and obese adults do not have the same risk of morbidity and mortality as younger individuals, particularly if obesity develops late in life. Some research has found 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 - ANSWERS 3. A nurse identifies that an older adult needs more education on nutritional needs when the older adult makes which statement? 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." - ANSWERSANS: 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. 4. An older adult asks a nurse, "I hear a lot about getting enough fruits and vegetables 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. Daily intake should consist of 25% fruits and vegetables; 25% grains; and 50% protein-rich foods. b. Daily intake should consist of 50% fruits and vegetables; 25% grains; and 25% protein-rich foods. c. Daily intake should consist of 33% fruits and vegetables; 33% grains; and 33% protein-rich foods. d. Daily intake should consist of 40% fruits and vegetables; 30% grains; and 30% protein-rich foods. - ANSWERSANS: B The USDA Human Nutrition Research Center on Aging at Tufts University provides a MyPlate for Older Adults emphasizing the nutritional needs of older adults in a framework on the Dietary Guidelines for Americans. The MyPlate for Older Adults depicts a colorful plate composed of approximately 50% fruits and vegetables; 25% grains, many of which are whole-grains; and 25% protein-rich foods such as nuts, beans, fish, lean meat, poultry, and fat-free and low-fat dairy products such as milk, cheeses, and yogurts. 5. A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming provided meal trays and snacks. What is one reason that this might be occurring? 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. - ANSWERSANS: 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. 6. An older adult's nutritional status is screened by a nurse using the Mini Nutritional Assessment Short Form (MNA-SF). The older adult scores a "7" on the screening portion of the tool. What is the nurse's best action? a. Offer low calorie meals. b. Perform a comprehensive nutritional assessment. c. Provide the adult and caregivers with nutritional educational information. d. No action is required. - ANSWERSANS: B Nutrition risk screening using a validated tool such as the (Mini-Nutritional Assessment Short-Form [MNA-SF]) should be performed routinely and can be incorporated into annual health checks for those aged 75 years and older. A score of "7" would indicate a risk for malnutrition) There is a risk of malnutrition, so intervention is needed. The client is not in need of calorie reduction. Nutritional education is appropriate after the comprehensive assessment is complete. 1. 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. - ANSWERSAns,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. 2. 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, impair 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. Vegetarian diets increase the risk of vitamin B12 deficiency. - ANSWERSANS: 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. Individuals consuming a vegetarian diet and those with some form of weight-loss surgery are also more likely to be low in the vitamin. 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. 3. What are the symptoms of gastroesophageal reflux disease (GERD) in older adults ? (Select all that apply.) a. Heartburn. b. Regurgitation. c. Abdominal pain within 1 hour of eating. d. Vomiting. e. Fever and elevated white blood cell count. - ANSWERSAns, A,B,C Symptoms of GERD include heartburn, regurgitation, persistent cough, exacerbation of asthma, laryngitis, and intermittent chest pain. In addition, abdominal pain within 1 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. 4. A nurse is developing a care plan for an older adult in a long-term care facility that has a nutritional problem. Which 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 or herself. - ANSWERSANS: 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 or herself. It is important to promote independence as much as possible.