The nurse is visiting an older adult client who is homebound. Which finding about the client's nutritional status requires additional follow- up?

Continues to take a prescribed vitamin D supplement.

Usually eats an additional serving of protein rich foods daily.

Takes 1200 mg of an over-the-counter calcium supplement daily.

Ate approximately 1,200 calories daily for the past two weeks.

Answer and Explanation

The Correct Answer is D

A. Continues to take a prescribed vitamin D supplement. Vitamin D supplementation is recommended for older adults to support bone health and calcium absorption. This does not require additional follow-up.
B. Usually eats an additional serving of protein-rich foods daily. Adequate protein intake is essential for muscle maintenance and overall health in older adults. This is a positive nutritional habit and does not indicate a concern.
C. Takes 1200 mg of an over-the-counter calcium supplement daily. This is within the recommended daily intake for older adults (1,000-1,200 mg/day) to maintain bone health. Excess calcium intake should be monitored, but this amount alone does not require urgent follow-up.
D. Ate approximately 1,200 calories daily for the past two weeks. Older adults typically need at least 1,500-2,000 calories per day, depending on activity level and health conditions. A prolonged intake of only 1,200 calories per day may indicate malnutrition, unintentional weight loss, or inadequate nutrient intake, requiring further evaluation.

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Correct Answer is ["C","D","F","G"]

Explanation

Heart rate 88 beats/minute: This is within the normal range (60-100 bpm) and does not require immediate intervention.

Blood pressure 122/72 mm Hg: This is within a normal range and does not indicate an urgent issue.

Temperature 100.5°F (38°C): An elevated temperature suggests a possible infection, such as cellulitis or deep vein thrombosis (DVT), which requires further evaluation.

Reports of pain with ambulation: Pain with walking, especially in a client with peripheral vascular disease and diabetes, may indicate worsening circulation, infection, or DVT.

Respirations 20 breaths/minute: This is within the normal range (12-20 breaths/minute) and does not require immediate intervention.

Left lower leg with erythema, warm, and swollen: These are signs of inflammation or infection, such as cellulitis or a possible DVT, both of which require urgent medical attention.

Blood glucose 252 mg/dL (13.9 mmol/L): Elevated blood glucose can impair wound healing, increase the risk of infection, and contribute to further complications in a client with diabetes.

Correct Answer is []

Explanation

Potential Condition:
Diabetic neuropathy – The client has a history of type 1 diabetes, and her elevated Hemoglobin A1C (8.2%) suggests poor blood glucose control, which increases the risk of diabetic neuropathy.

Actions to Take:
Perform a sensory test on both feet – Diabetic neuropathy can cause loss of sensation in the feet. A sensory test helps assess nerve function and detect early signs of neuropathy.
Instruct the client to change to clean, dry socks – Proper foot care is crucial for preventing infections and complications in clients with diabetes. Keeping feet dry reduces the risk of skin breakdown and infections.

Parameters to Monitor:
Pedal pulses – Poor circulation is a common complication of diabetes and neuropathy. Monitoring pedal pulses helps assess blood flow to the feet.
Blood glucose – Tight glucose control is essential for preventing the progression of diabetic neuropathy. Monitoring blood glucose levels helps guide management and treatment adjustments.

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The nurse is visiting an older adult client who is homebound. Which finding about the client's nutritional status requires additional follow- up?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["C","D","F","G"]

Explanation

Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and to parameters the nurse should monitor to assess the client's progress.

Correct Answer is []

Explanation

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