A nurse is assessing an older adult's nutritional status. The nurse understands that which of the following is the most important indicator for a potential nutritional deficit?
Decreased serum albumin levels
Decreased vitamin D levels
Unintentional weight loss,
Anorexia lasting more than 24 hours
The Correct Answer is C
A. Decreased serum albumin levels.
Explanation: Decreased serum albumin levels can be an indicator of poor nutritional status, but they are not as immediate or easily observed as unintentional weight loss.
B. Decreased vitamin D levels.
Explanation: Decreased vitamin D levels may indicate a specific nutrient deficiency but may not capture the overall nutritional status comprehensively.
C. Unintentional weight loss.
Explanation: Unintentional weight loss is a significant indicator of potential nutritional deficits and can be associated with underlying health issues. It can lead to deficiencies in essential nutrients, negatively impacting an individual's overall health and well-being. Weight loss should prompt further assessment and intervention to identify the underlying causes and address nutritional needs
D. Anorexia lasting more than 24 hours.
Explanation: Anorexia (loss of appetite) lasting more than 24 hours may contribute to inadequate nutrient intake, but it is not as direct an indicator as unintentional weight loss, which reflects changes in body composition and overall nutritional status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
A. Two servings of deep-colored fruit.
While fruits are recommended, the "deep-colored" specification is not a specific focus in the MyPlate for Older Adults.
B. Six or more servings of fortified, enriched, or whole grain foods.
Correct. Whole grains are an important source of fiber, vitamins, and minerals.
C. Three or more servings of low-fat or nonfat dairy products.
Correct. Dairy products provide calcium and vitamin D, important for bone health.
D. Three 8-ounce glasses of water.
Correct. Staying hydrated is crucial for overall health, especially for older adults.
E. Four or more servings of high-quality protein.
Correct. Protein is essential for muscle maintenance and repair. Sources of high-quality protein include lean meats, poultry, fish, eggs, dairy, and plant-based protein sources.
F. One or two servings of brightly colored vegetables.
While vegetables are recommended, the "brightly colored" specification is not a specific focus in the MyPlate for Older Adults.
Correct Answer is D
Explanation
A. "As the health care proxy, you are the one who makes the decisions. Let's call your mom's doctor."
Explanation: This response inaccurately suggests that the health care proxy has the authority to make decisions even when the client has decision-making capacity. The focus should be on the client's autonomy.
B. "I understand why you are so upset. I don't think she is doing the right thing either. Let us think together how we can change her mind."
Explanation: This response is inappropriate as it involves the nurse expressing a personal opinion and attempting to influence the client's decision. The nurse's role is to support the client's autonomy and facilitate communication between the client and their family.
C. "You will need to go to court and be declared a guardian."
Explanation: Involving the court and seeking guardianship is not warranted when the client has decision-making capacity. This option is not aligned with the principles of respecting the client's autonomy and decision-making capacity.
D. "Health care proxies only come into play when the individual can no longer make their own decisions. Your mother is able to make her own decisions. I suggest you talk with her."
Explanation: In this scenario, the client is cognitively intact and has decision-making capacity. As long as the older adult is able to make their own decisions, the health care proxy's role is not activated. The nurse appropriately advises the daughter to communicate directly with her mother about her concerns and decisions. This respects the autonomy of the client, who has the right to make decisions about their own healthcare as long as they have the capacity to do so.
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