21.2.20: Chapter 20

Unfolding Case Study

1. c. The Mini Nutritional Assessment is a nutritional screening tool for older clients.

2. a. The client will need education regarding foods rich in iron to consume at home.

3. b. Using Maslow’s hierarchy of needs framework, understanding the physical environment should be the first consideration. It is essential to understand if the client will be cooking or eating prepared meals before considering other options.

4. d. Eating smaller portions more frequently is a strategy that can overcome decreased food intake that occurs due to getting full quickly. Although hypertension and diabetes are not risk factors for worsening anemia, decreased taste is a physiological consequence of the change in density of taste buds that occurs with aging.

5. a. A holistic approach to client teaching includes spiritual influences, emotional influences, physical influences, and social determinants of health.

6. b. The client’s cognitive functioning will determine if a caregiver needs to be present for the educational session.

7. c. Ms. Foster is choosing food options and making plans for meals. She will be in the action stage of change once she begins modifying her diet.

8. a. The nurse should recognize that change is a cyclic process and that successes and failures are expected.

Review Questions

1. a. Vitamin K is a fat-soluble vitamin necessary for the synthesis and activation of coagulation factors II (prothrombin), VII, IX, and X.

2. c. Folate deficiency in pregnancy can lead to macrocytic anemia in mothers and neural tube defects in fetuses.

3. b. Long-term alcohol use can cause the malabsorption of Vitamin B₁₂.

4. c. These are all possible signs of scurvy, or vitamin C deficiency.

5. c. Iron is better absorbed when taken with vitamin C, found in orange juice, and on an empty stomach.

6. a. An older adult with anemia is likely to experience hypotension and/or lightheadedness, which is a significant risk for falls.

7. a. Animal meat, fish, eggs, and dairy are sources of vitamin B₁₂.

8. a. Health literacy is the only modifiable psychosocial factor listed.

9. a. Providing written material before determining the client’s preferred learning style, without assessing their preference and without giving time to ask questions, is not consistent with holistic nursing care.

10. a. The nurse should consider that a change in behavior typically takes 6 months to achieve.

Unfolding Case Study

1. c. Adequate intake of dairy products helps ensure that enough calcium is consumed, which is necessary to support musculoskeletal and integumentary growth and development in the fetus.

2. a. Adequate intake of calcium and vitamin D is essential for developing and maintaining healthy bones and teeth in both the pregnant client and the developing fetus.

3. a. Breastfed infants should continue vitamin D supplementation until they are taking in enough vitamin D–fortified solids or vitamin D–rich foods.

4. a. Breastfeeding does not provide an infant with enough vitamin D. To prevent musculoskeletal disorders and to promote healthy skeletal growth, experts recommend that all infants receive vitamin D supplementation.

5. b. The mother urgently needs to change this child’s diet so that they can achieve a healthy weight. Being overweight places additional strain on a child’s skeletal system putting them at increased risk for injury and may make them reluctant to participate in physical activity.

6. d. Leafy green vegetables are a good source of calcium, which promotes healthy bone development in the growing child.

7. a. Oral nutritional supplements with added protein and amino acids are recommended for clients with delayed wound healing due to malnutrition.

8. d. Based on the findings, the MNA classifies individuals as either well-nourished, at risk for malnutrition, or malnourished.

Review Questions

1. a. The FRAX does not diagnose osteoporosis, but it can estimate a person’s risk for a bone fracture within 10 years. This information can help the nurse and client plan care and implement strategies to help mitigate risks in the home and other environments.

2. d. Corticosteroids, as well as antacids, proton pump inhibitors, anticonvulsants, and loop diuretics, can affect bone health with long-term use.

3. c. Starting in infancy, parents should brush their children’s teeth at least twice a day with a fluoride toothpaste according to their dentist’s recommendations. The first dental visit should occur no later than the eruption of the first tooth, which happens well before 1 year of age in most children.

4. d. Pruritic urticarial papules and plaques of pregnancy (PUPPP) is characterized by itchy, red, raised bumps and hives that most commonly appear on the abdomen, thighs, buttocks, and arms.

5. c. Adolescent athletes have increased nutritional needs and should consume adequate amounts of complex carbohydrates, proteins, and fats while avoiding processed sugars.

6. c. Food, especially calcium-rich foods, can interfere with the absorption of bisphosphonates.

7. d. There is a correlation between low maternal vitamin D and osteopenia in newborns and decreased bone density in childhood. Consequently, it is important to monitor vitamin D levels in the pregnant client.

8. d. Weight-bearing exercise and maintenance of a healthy weight help prevent age-related osteoporotic changes in menopausal individuals.

9. b. Older adults with sarcopenia, or low muscle mass, should incorporate leucine-rich foods to stimulate muscle synthesis.

10. b. Osteopenia may be present in an infant born before 30 weeks’ gestation because the majority of calcium uptake occurs during the third trimester of fetal life.