Chapter 12, Nutrition Assessment: Patient History: Nutrition-Sherpath

Question 1 of 15

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Match the nutrition assessment with the element of the nutritional history in which it is included.

• History of present illness
• Medical history
• Family history
• Personal and social history

Question 2 of 15

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Match the energy requirements to the portion of total energy expended daily.

• Largest proportion of total energy expenditure
• Second largest proportion of total energy expenditure
• Smallest (7%) proportion of total energy expenditure

Question 3 of 15

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Which factors related to nutritional health should the nurse explore further with a patient of lower socioeconomic status?

• • History of diabetesA history of diabetes is a risk factor for nutritional concerns, but may not be influenced by economic status.
• • Eating alone at homeEating alone at home is a risk factor for nutritional concerns resulting from the social isolation and feelings of loneliness may affect nutritional intake. However, this is a risk discussed as part of the social history and is not related to the socioeconomic status of the patient.
• Correct
  • Limited or fixed incomeA limited or fixed income will make it challenging for the patient to afford healthy foods (fresh fruits/vegetables and fresh fish/meats) on a regular basis. Eating processed foods and fast food increases the patient’s risk for nutritional problems.
• • Family history of eating disordersA family history of eating disorders does increase the patient’s risk for nutritional problems; however, the risk is not influenced by economic status.

Question 4 of 15

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Which statements describe aspects of resting energy expenditure (REE)?

• • REE accounts for energy expenditure during physical activity.REE accounts for energy expenditure during rest, not during physical activity.
• Correct
  • REE is the largest proportion of total daily energy expenditure.REE does account for the largest proportion of total daily energy expenditure.
• Correct
  • REE and basal metabolic rate (BMR) are interchangeable.REE and BMR are used interchangeably. Specifically, the BMR is the REE measured after awakening in the morning.
• • REE accounts for energy expenditure immediately after eating.Thermogenesis, not REE, accounts for the energy expended after eating.
• Correct
  • An individual’s REE is influenced by age, weight, and gender.An individual’s REE is influenced by age, weight, and gender. It is not influenced by height.

Question 5 of 15

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Which patient-related factors affect daily energy requirements?

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  • AgeAge influences daily energy requirements. Energy requirements decrease with age.
• Correct
  • GenderGender influences daily energy requirements. Men tend have higher daily energy requirements than women due to increased muscle.
• Correct
  • GeneticsGenetics influences daily energy requirements. Metabolic rate is inherited in part and determines the number of calories that the body needs to function.
• • Ethnic backgroundEthnic background does not affect daily energy requirements.
• • Socioeconomic statusSocioeconomic status does not affect daily energy requirements.

Question 6 of 15

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What role does thermogenesis play in daily energy expenditure?

• • It is energy expended at rest.Resting energy expenditure, not thermogenesis, is the energy expended at rest.
• Correct
  • It is energy expended after eating.After eating, the metabolic rate increases. The energy expended to accommodate this increase in metabolism is thermogenesis.
• • It is total energy expended in one day.Thermogenesis is not the total energy expended in one day.
• • It is energy expended with physical activity.Physical activity energy expenditure, not thermogenesis, is the energy expended with physical activity.

Question 7 of 15

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Which elements of the patient’s history should the nurse ask about to gain more information related to the present illness?

• • “Are your immunizations up to date?”A question about the patient’s immunizations is part of the medical and surgical history, not the history of present illness.
• Correct
  • “Do you take any medications?”The nurse should ask the patient about medications taken as part of the history of present illness because many medications can affect nutritional status.
• • “What are your exercise habits?”Exercise is an important component of the personal and social assessment, but it is not part of the history of present illness.
• • “Do you have a family history of obesity?”A family history of obesity is important information to obtain during the family history part of the assessment, but it is not part of the history of present illness.

Question 8 of 15

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A 45-year-old patient with a history of alcohol abuse reports “significant” weight loss since the last appointment. Which nutrition assessment questions related to present health status should the nurse ask?

• • “Do you use illicit drugs?”Although appropriate to ask in a comprehensive nutritional assessment, illicit drug use is included in the personal and social history, not in the history of present illness.
• • “Who do you live with?”Although appropriate to ask in a comprehensive nutritional assessment, living environment is included in the personal and social history, not in the history of present illness.
• • “Do you have a history of diabetes?”Although appropriate to ask in a comprehensive nutritional assessment, chronic illnesses are included in the medical history, not in the history of present illness.
• Correct
  • “How many pounds have you lost?”A question about the amount of weight lost is related to present nutritional health status. A significant amount of weight loss requires further evaluation and can have an impact on nutritional status.
• Correct
  • “When did you start losing weight?”A question about when weight loss started is related to present nutritional health status. Rapid weight loss requires further evaluation and can affect nutritional status.

Question 9 of 15

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Which nutrition assessment questions regarding present health status should the nurse ask a 20-year-old patient who follows a different fad diet every month?

• • “Do you drink alcohol?”Alcohol intake is important to assess but is covered in the personal and social history, not the history of present illness.
• • “What is your exercise pattern?”Exercise plays an important role in nutritional health but is assessed in the personal and social history, not the history of present illness.
• • “Do you have a family history of obesity?”A family history of obesity puts an individual at higher risk for excessive weight. This is assessed as part of the family history, not the history of present illness.
• Correct
  • “Do you take any vitamins or dietary supplements?”A question about use of vitamins and dietary supplements is appropriate to include in the history of present illness. Many people use vitamins or nutritional supplements; dietary supplements are not intended to serve as food substitutes. A patient on a fad diet may be using vitamins or supplements to provide nutrients not provided in the special diet.

Question 10 of 15

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Which surgical procedure in a patient’s medical record suggests concern about the patient’s nutritional status?

• • Peripheral venous graftBecause vascular surgery does not affect the digestive tract, it will not raise concern about the patient’s nutritional status.
• • Total hip replacementA total hip replacement does not have an impact on the digestive tract and therefore will not raise concern about the patient’s nutritional status.
• • Surgical removal of the breastSurgical removal of the breast does not affect the digestive tract and therefore will not raise concern about the patient’s nutritional status.
• Correct
  • Surgical resection of the bowelSurgical removal of portions of the gastrointestinal tract may affect the patient’s nutritional status.

Question 11 of 15

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A patient reports many problems with weight changes periodically through the years. Which follow-up questions should the nurse ask regarding the patient’s medical history?

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  • “What was your minimum body weight as an adult?”A follow-up question about minimum body weight is related to the patient’s medical history. It is important to know the patient’s minimum adult body weight to assess weight loss of gain over time.
• Correct
  • “What was your maximum body weight?”A follow-up question about maximum body weight is related to the patient’s medical history. It is important to know the patient’s maximum body weight to assess weight loss or gain over time.
• • “Do you have a family history of obesity?”A question about family history of obesity is important but does not address the patient’s medical history. Family history will be assessed separately.
• • “Do you have a family history of eating disorders?”A question about family history of eating disorders is important but does not address the patient’s medical history. Family history will be assessed separately.
• Correct
  • “How much did you weigh when you were 21 years old?”A follow-up question about weight at the age of 21 is related to the patient’s the medical history. Information about the patient’s weight at 21 is important to assess weight loss or gain over time.

Question 12 of 15

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The patient reports a history “full of medical problems.” Which medical conditions may influence the patient’s nutritional status?

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  • Liver diseaseLiver disease is a chronic illness that can influence nutritional status. In liver disease, proteins are not properly processed.
• Correct
  • DiabetesDiabetes is a chronic illness that can influence nutritional status. In diabetes, carbohydrates need to be monitored and managed because of lack of insulin production.
• Correct
  • HyperthyroidismHyperthyroidism is a chronic illness that can influence nutritional status. In hyperthyroidism, metabolism is increased and weight loss is common.
• • High blood pressureHigh blood pressure does not have a significant impact on the nutritional status of a patient.
• Correct
  • Chronic infectionChronic infection is a condition that can influence nutritional status. In chronic infection, daily energy requirements increase to fight the infection. More calories are needed daily.

Question 13 of 15

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Which personal or social history question should the nurse ask regarding diet during the nutrition assessment of a patient who is an immigrant from the Middle East?

• • “What medications do you take?”A question about medication use is part of a nutrition assessment addressed in the history of present illness, not the personal and social history.
• • “Have you noticed any unexplained changes in your weight in the last 6 months?”A question about unexplained changes in the patient’s weight is part of a nutrition assessment addressed in the history of present illness, not the personal and social history.
• • “Do you have a family history of eating disorders?”A question about a family history of eating disorders is part of a nutrition assessment addressed in the family history, not the personal and social history.
• Correct
  • “Do you follow any specific diet or have any dietary restrictions?”A question about a specific diet or dietary restrictions is part of a nutritional assessment addressed in the personal and social history. A patient may follow a specific diet for religious or cultural reasons. This patient is an immigrant from the Middle East and may have special dietary considerations.

Question 14 of 15

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An elderly patient has ill-fitting dentures. Which nutrition assessment question should the nurse ask regarding dentition?

• • “Who obtains and prepares your food?”Although a very important question to ask, information about who prepares a patient’s food does not address the poorly fitting dentures.
• Correct
  • “Do you have any problems eating certain foods?”Poorly fitting dentures can make it difficult for the patient to chew and swallow food, which can affect nutritional status.
• • “Do you have any chronic illnesses?”Although a very important question to ask, information about chronic illnesses does not address the poorly fitting dentures.
• • “Do you take any medications?”Although a very important question to ask, information about patient medications does not address the poorly fitting dentures.

Question 15 of 15

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Which nutrition assessment questions should the nurse ask a patient with quadriplegia regarding functional abilities related to food?

• • “Do you drink alcohol?”Although a question about alcohol intake is very important, it does not address the patient’s functional abilities regarding food.
• • “Have you noticed any weight changes in the last 6 months?”Although a question about weight changes is important, it does not address the patient’s functional abilities regarding food.
• Correct
  • “Who shops for your food and prepares your meals?”A patient with quadriplegia will need assistance obtaining and preparing meals. Shopping and food preparation are components of the functional assessment and can have an impact on nutritional status.
• • “What types of food do you enjoy eating?”Although it is important to obtain information on diet, a question about the food the patient enjoys will not address the patient’s functional abilities regarding food.
• Correct
  • “Who feeds you your food?”A patient with quadriplegia will need assistance eating meals. Feeding is an activity of daily living addressed during the functional assessment and can affect nutritional status.