The nurse is assessing an older female adult client’s nutritional status. Which finding indicates that the client has a nutritional deficiency?

Reference Ranges: Hemoglobin [12 to 16 g/dL (120 to 160 g/L)] Hematocrit [37% to 47% (0.37 to 0.47 volume fraction)] Albumin [3.5 to 5.0 g/dL (35 to 50 g/L)] Serum transferrin [250 to 380 mg/dL (2.5 to 3.80 g/L)]

Low weight as determined from a height/weight comparison chart.

Hemoglobin (Hgb) of 11.8 g/dL (118 g/L) and hematocrit (Hct) of 34% (0.34).

Decreased lean body mass compared to results of 10 years ago.

Serum albumin of 3 g/dL (30 g/L) and serum transferrin of 180 mg/dL (18 g/L).

Answer and Explanation

The Correct Answer is D

A. Low weight as determined from a height/weight comparison chart can indicate malnutrition, but it is not as specific as biochemical markers. Weight alone does not provide a complete picture of nutritional status, as it can be influenced by various factors such as fluid retention or loss of muscle mass.

B. Hemoglobin (Hgb) of 11.8 g/dL (118 g/L) and hematocrit (Hct) of 34% (0.34) are below the normal reference ranges, indicating anemia. Anemia can result from various nutritional deficiencies, including iron, vitamin B12, or folate deficiencies. However, it does not provide a comprehensive assessment of overall nutritional status.

C. Decreased lean body mass compared to results of 10 years ago suggests muscle wasting, which can be a sign of malnutrition. However, it is not as specific as biochemical markers like serum albumin and transferrin levels, which provide more direct evidence of protein-energy malnutrition.

D. Serum albumin of 3 g/dL (30 g/L) and serum transferrin of 180 mg/dL (18 g/L) are below the normal reference ranges, indicating protein-energy malnutrition. Low levels of these proteins are strong indicators of poor nutritional status and are commonly used to assess malnutrition in clinical settings.

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Correct Answer is B

Explanation

Choice A reason:

Emphasizing the need to reduce caloric intake, rather than increasing it, is not appropriate for a client with hyperthyroidism. Hyperthyroidism increases the body’s metabolic rate, leading to higher energy expenditure. Reducing caloric intake could result in weight loss and muscle wasting, which are already concerns for individuals with hyperthyroidism.

Choice B reason:

Encouraging the client to continue these changes in a dietary plan is appropriate. Increasing protein and calorie intake helps meet the higher metabolic demands associated with hyperthyroidism. Adequate protein supports muscle maintenance and repair, while increased calories help prevent unintentional weight loss. This approach ensures that the client meets their nutritional needs and maintains a healthy weight.

Choice C reason:

Advising the client to include aerobic exercise along with dietary changes can be beneficial for overall health, but it should be tailored to the individual’s energy levels and physical condition. While exercise is important, the primary focus should be on meeting the increased nutritional needs caused by hyperthyroidism.

Choice D reason:

Instructing the client to also increase the daily intake of dietary fiber is beneficial for overall health, but it is not the primary concern for managing hyperthyroidism. The focus should be on ensuring adequate protein and calorie intake to meet the increased metabolic demands.

A. Clam chowder. B. Turkey sandwich. C. Bacon, lettuce, and tomato sandwich. D. Macaroni and cheese.

Correct Answer is B

Explanation

A. Clam chowder is typically high in sodium due to the use of canned clams and broth, making it an unsuitable choice for a low-sodium diet. The high sodium content can exacerbate hypertension and other cardiovascular issues, which is why it is not recommended for someone recovering from a myocardial infarction.

B. Turkey sandwich is a better option for a low-sodium diet, especially if the turkey is fresh and not processed. Fresh turkey contains significantly less sodium compared to processed meats. Additionally, using whole grain bread and adding vegetables like lettuce and tomato can enhance the nutritional value without adding excessive sodium.

C. Bacon, lettuce, and tomato sandwich is not suitable for a low-sodium diet because bacon is high in sodium. Even though the lettuce and tomato are healthy, the bacon’s high sodium content makes this choice inappropriate for someone who needs to limit their sodium intake.

D. Macaroni and cheese is generally high in sodium, especially if it is made from a boxed mix or contains processed cheese. The high sodium content can be detrimental to someone on a low-sodium diet, making it an unsuitable choice for lunch.

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In reviewing the dietary teaching for a young adult client with hyperthyroidism, the nurse learns that the client has increased the intake of protein and calories. Which action should the nurse take?

Correct Answer is B

Explanation

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Correct Answer is B

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