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Hesi Rn Nutrition Wgu Proctored Exam
Total Questions : 54
Showing 10 questions, Sign in for moreThe healthcare provider prescribes a 2,000 mg sodium diet for an older adult client with heart failure (HF). Which meal choice indicates that the client understands the prescribed sodium restricted diet?
A high protein diet is prescribed for an adolescent client who is anemic. Which lunch is best for this client?
The client is a 64-year-old male who is visiting the shelter clinic for chest congestion and diarrhea. He reports he has been homeless for the past 6 years after he was injured and unable to work. He stays in shelters occasionally and does odd jobs for money.
Client has a productive cough with white, thin mucous. He is currently afebrile. He also reports that he is incredibly tired even though he has been sleeping well in the shelter. He has a dark, scaly dermatitis on his arms and face. The rest of his skin appears pink and healthy. He reports that he has had diarrhea for the past few days with about 4 to 6 loose stools per day.
Patient data
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 two parameters the nurse should monitor to assess the client's progress.
Explanation
Rationale for correct choices
• Vitamin B3 deficiency: The client presents with the classic triad of pellagra: dermatitis, diarrhea, and fatigue. The dark, scaly lesions on sun-exposed areas such as the face and arms are characteristic. Chronic malnutrition related to homelessness increases risk for niacin deficiency. The combination of skin and gastrointestinal symptoms strongly supports vitamin B3 deficiency.
• Provide a niacin supplement: Niacin replacement directly treats the underlying deficiency and leads to resolution of symptoms such as dermatitis and diarrhea. Early supplementation prevents progression to neurological complications like confusion or dementia. Addressing the deficiency is the priority intervention. Clinical improvement is often rapid once supplementation begins.
• Draw blood for an electrolyte panel: The client has ongoing diarrhea, which can lead to electrolyte imbalances such as hypokalemia and dehydration. Monitoring electrolyte levels helps guide fluid and electrolyte replacement therapy. Identifying imbalances early prevents complications like cardiac dysrhythmias.
• Level of consciousness: Niacin deficiency can progress to neurological manifestations including confusion and altered mental status. Monitoring level of consciousness helps detect worsening or improvement of central nervous system involvement. Changes may indicate progression to severe deficiency or response to treatment. This parameter reflects neurological recovery.
• Fluid balance: Frequent loose stools increase the risk of dehydration and fluid loss. Monitoring intake and output helps assess hydration status and effectiveness of interventions. Maintaining fluid balance is essential to prevent complications such as hypotension or kidney injury. Improvement indicates stabilization of the client’s condition.
Rationale for incorrect choices
• Folate deficiency: Folate deficiency typically presents with megaloblastic anemia, fatigue, and possibly glossitis rather than dermatitis and diarrhea. The skin findings in this client are more consistent with pellagra. There is no evidence of anemia-related symptoms such as pallor or shortness of breath.
• Iron deficiency: Iron deficiency usually manifests with anemia, fatigue, pallor, and sometimes brittle nails or pica. It does not cause the characteristic dermatitis or diarrhea seen in this client. The client’s presentation points toward a vitamin deficiency affecting skin and gastrointestinal systems.
• Vitamin C deficiency: Vitamin C deficiency is associated with bleeding gums, petechiae, bruising, and poor wound healing. The client does not exhibit bleeding or oral manifestations. The dermatitis described is scaly and pigmented rather than hemorrhagic. These features are inconsistent with vitamin C deficiency.
• Clean the areas of the skin where the dermatitis is located: Skin cleansing may provide comfort but does not treat the underlying nutritional deficiency causing the dermatitis. Without correcting niacin deficiency, the lesions will persist. This intervention does not address the root cause.
• Send blood to the laboratory for a hemoglobin level: A hemoglobin level helps assess anemia but is not directly related to diagnosing or managing niacin deficiency. The client’s symptoms are not primarily indicative of anemia. While it may provide additional information, it is not a priority compared to electrolyte monitoring. Management should focus on the presenting symptoms.
• Recommend increased consumption of leafy greens: Dietary improvement is beneficial long-term but does not provide immediate correction of niacin deficiency. The client requires direct supplementation to reverse symptoms quickly. Nutritional counseling can follow stabilization. Therefore it is not a priority acute intervention.
• Excessive bleeding: Excessive bleeding is associated with clotting disorders or deficiencies such as vitamin C or K deficiency. The client shows no signs of bleeding tendencies. Pellagra does not typically involve bleeding complications.
• Weight: Weight changes occur gradually and are not specific indicators of improvement in niacin deficiency. While useful for long-term nutritional assessment, it does not reflect acute changes. Monitoring hydration and neurological status is more clinically relevant.
• Tooth decay or loss: Tooth decay is more commonly linked to poor oral hygiene or vitamin C deficiency. The client’s condition does not involve oral health issues. Pellagra primarily affects the skin, gastrointestinal tract, and nervous system. Therefore this parameter is not relevant for monitoring progress.
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?
When conducting diet teaching for a client diagnosed with hypokalemia, which foods should the nurse encourage the client to eat?
The nurse has determined that a client with periodontitis is not consuming an adequate intake to meet nutritional requirements. Which etiology should the nurse identify for this problem?
An adult female client arrives at the clinic for an annual physical exam expressing an interest in becoming pregnant and requests information about preventing neural tube defects during pregnancy. Which food should the nurse encourage the client to include in her diet?
The nurse is providing dietary education to a client newly diagnosed with type 2 diabetes mellitus. Which information should the nurse provide?
A young adult male client tells the nurse that about half of his diet comes from eating meat and eggs. Which instruction should the nurse provide?
A client with coronary heart disease is informed by the healthcare provider (HCP) that the client's cholesterol levels are significantly elevated and there needs to be changes to diet and lifestyle. The client is unwilling to change eating habits. Which action should the nurse implement in response to the client's unwillingness to comply with the recommendations?
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