The nurse recognizes that which of these persons is at greatest risk for undernutrition?
5-month-old infant
Vulnerable groups for undernutrition are infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults.
The nurse is assessing a 30-year-old unemployed immigrant from an underdeveloped country who has been in the United States for 1 month. Which of these problems related to his nutritional status might the nurse expect to find?
Osteomalacia
General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries are among the more common nutrition-related problems of new immigrants from developing countries.
After completing a diet assessment on a 30-year-old woman, the nurse suspects that she may be deficient in iron. Laboratory studies to obtain to verify this condition would be:
hemoglobin and hematocrit.
The hemoglobin determination is used to detect iron-deficiency anemia. Hematocrit, a measure of cell volume, is also an indicator of iron status. Cholesterol and triglyceride levels test for hyperlipidemia; serum albumin measure
The nurse is performing a nutritional assessment on an 80-year-old patient. The nurse knows that physiological changes that directly affect the nutritional status of the elderly include:
slowed gastrointestinal motility.
Normal physiological changes in aging adults that affect nutritional status include slowed gastrointestinal motility, decreased gastrointestinal absorption, diminished olfactory and taste sensitivity, decreased saliva pro
A 16-year-old girl is being seen at the clinic for gastrointestinal complaints and weight loss. The nurse determines that many of her complaints may be related to erratic eating patterns, eating predominantly fast foods, and high caffeine intake. In this
Have the patient complete a food diary for 3 days, including 2 weekdays and 1 weekend day.
Food diaries require the individual to write down everything consumed for a certain time period. Because of the erratic eating patterns of this individual, assessin
The nurse is aware that one change that may occur in the gastrointestinal system of an aging adult is:
decreased gastric acid secretion.
Gastric acid secretion decreases with aging. As one ages, salivation decreases, esophageal emptying is delayed, and liver size decreases.
While examining a patient, the nurse observes abdominal pulsations between the xiphoid and umbilicus. The nurse would suspect that these are:
normal abdominal aortic pulsations.
Normally, one may see the pulsations from the aorta beneath the skin in the epigastric area, particularly in thin persons with good muscle wall relaxation.
The nurse is watching a new graduate nurse perform auscultation of a patient's abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?
It prevents distortion of bowel sounds that might occur after percussion and palpation."
Auscultation is performed first (after inspection) because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds
During an abdominal assessment, the nurse would consider which of these findings as normal?
A tympanic percussion note in the umbilical region
Tympany should predominate in all four quadrants of the abdomen because air in the intestines rises to the surface when the person is supine. Vascular bruits are not usually present. Normally the spleen i
The nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include:
tympany, hyperresonance, and dullness.
Percussion notes normally heard during the abdominal assessment may include tympany, which should predominate because air in the intestines rises to the surface when the person is supine; hyperresonance, which may be