NEWEST EXAM CURRENTLY TESTING
COMPLETE 500 QUESTIONS WITH
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A nurse has just received a client's laboratory results and is
reviewing them. Which finding should the nurse recognize
as an indication of malnutrition or malabsorption? -
....ANSWER...1. Creatinine 1.9 mg/dL (168 μmol/L)
2. Hemoglobin (Hgb) 11.3 g/dL (113 g/L)
3. Hematocrit (Hct) 56% (0.56)
4. Serum albumin 2.8 g/dL (28 g/L)
ANSWER: Serum albumin 2.8 g/dL (28 g/L)
,Normal serum albumin is 3.3 to 5 g/dL (33 to 50 g/L).
Decreased albumin indicates malnutrition or
malabsorption. Decreased Hgb indicates anemia.
Increased creatinine indicates dehydration. Increased Hct
indicates dehydration.
A nurse is caring for a client who has been prescribed a
clear liquid diet. Which liquid can be included in the
client's diet? - ....ANSWER...Cranberry juice
Composed only of clear fluids or foods that become fluid at
body temperature and includes clear broth, coffee, tea,
clear fruit juices (apple, cranberry, grape), gelatin,
popsicles, commercially prepared clear liquid supplements.
A clear liquid diet requires minimal digestion and leaves
minimal residue.
Low-fat milk, fruit juices or soup, and juices with fruit
pulp (orange and grapefruit) are considered full-liquid diet.
A client with dysphagia prepares to eat dinner. How does
the nurse best help this client? - ....ANSWER...Ensure the
head of the bed is high-Fowler.
,The nurse must ensure that the client is sitting up well
enough to safely eat, whether that is high-Fowler or in the
chair. The nurse may assist in setting up the meal tray or
play something the client enjoys for background noise.
The client with dysphagia should have minimal
conversation while eating due to the increased risk of
failure to correctly swallow.
The nurse is caring for a client who has dysphagia and is
unable to eat independently. The nurse is preparing to
assist the client in eating a meal. Which action is
appropriate? - ....ANSWER...Speak to the client but limit
the need for the client to respond verbally while chewing
and swallowing.
Talking during eating increases the risk of aspiration for a
client who has dysphagia. Arranging food on the plate in a
clock face pattern is a strategy appropriate for a client
who is visually impaired. Clients who have dysphagia need
to eat slowly and be continually observed for signs of
aspiration. Allow enough time for the client to adequately
chew and swallow the food. The client may need to rest for
short periods during eating.
, A nurse delivers a tray of food to an older client and sets it
on the overbed table. The client shows no interest in the
food, however. Which actions should the nurse take?
Select all that apply. - ....ANSWER...- Assess the client for
signs of depression.,
- Consult a dietician if the problem persists.,
- Ask why the client does not want to eat anything on the
tray.
The nurse should explore with the client the reason why he
does not want to eat anything on the tray. The nurse
should assess for psychological factors that impact
nutrition. Malnutrition is sometimes found with depression
in the older adult population. The nurse and client should
mutually develop a plan to address the lack of nutritional
intake and consult the dietitian as needed. The nurse
should not remove the tray until the reason for the client's
not eating is explored. Crackers and ginger ale may be
offered and an antiemetic administered if nausea is the
reason for the lack of eating, but this is not established.