By next visit, Mr. Johnston manifests a weight loss
of 2 pounds and has lower blood pressure and cho-
lesterol levels
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of nutrients and nutritional
requirements for patients across the life span.
Knowledge of hypertension and high cholesterol
and strategies for managing these conditions
through dietary restrictions
Interpersonal: special interpersonal competencies to
help the executive see the value in making lifestyle
changes necessary to improve his nutritional status
Ethical/Legal: ability to act as a trusted and effective
patient advocate
4.What resources might be helpful for Mr. Johnston?
Consultation with a nutritionist, printed materials
on hypertension and high cholesterol, exercise
programs
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Mr. Church, a 74-year-old white man, is being
admitted to the geriatric unit of the hospital for a
diagnostic workup. He was diagnosed with
Alzheimer’s disease 4 years ago,and 1 year ago, he
was admitted to a long-term care facility. His wife
of 49 years is extremely devoted and informs the
nurse taking the admission history that she
instigated his admission to the hospital because she
was alarmed by the amount of weight he was
losing.Assessment reveals a 6-foot, 1-inch tall,
emaciated man who weighs 149 pounds. His wife
reports he has lost 20 pounds in the past 2 months.
The staff at the long-term care facility report that he
was eating his meals and his wife validated that this
was the case.No one seems sure, however, of the
caloric content of his diet. Mrs. Church nods her
head vigorously when asked if her husband had
seemed more agitated and hyperactive recently.
Mr. Church has dull, sparse hair; pale, dry skin; and
dry mucous membranes.
2.Nursing Process Worksheet
Health Problem:Altered nutrition: less than body
requirements
Etiology:Imbalance between energy expenditure
and caloric intake
Signs and Symptoms: 6 feet tall, 149 lb; appears “emaci-
ated”; 20-lb weight loss over 2 months; is eating
meals; more hyperactive and agitated than usual; dull,
sparse hair; pale, dry skin; dry mucous membranes
Expected Outcome:In 1 month (1/20/11), patient
will demonstrate signs of ingesting enough caloriesto meet energy needs, as evidenced by a 5- to 10-lb
weight gain.
Nursing Interventions:
a.Do a 72-hour diet history to determine the aver-
age number of calories he ingests daily.
b.Provide whatever assistance he needs with feed-
ing. Add high-calorie snacks to his diet, increas-
ing calories progressively until the pattern of
weight loss is replaced by weight gain.
c. Until the desired weight is regained and
maintained, weigh the patient daily and keep an
accurate fluid I&O and calorie intake record.
d.Explore nursing strategies to reduce agitation
and hyperactivity, such as music, balance
between solitude and social interaction, rest peri-
ods, and so on.
Evaluative Statement:1/20/11: Expected outcome
met—patient gained 8 lb over past month and seems
to enjoy high-calorie snacks.—M. Bendyma, RN
3.Patient strengths: Patient has a very supportive
wife.
Personal strengths: Sound knowledge of nutrition
and Alzheimer’s disease; experienced in working
with persons with Alzheimer’s disease and their
families; experienced gerontologic nurse
4.Over the past month, the patient’s intake has
increased by 2,000 cal/day. He enjoys high-calorie
snacks of peanut butter and jelly sandwiches, milk-
shakes, dried fruit and nuts, pasta salads, and an
occasional Snickers bar. He has regained 8 of the 20
pounds he lost, and his wife is delighted. He
remains hyperactive, but scheduled walks have
decreased some of his agitation. Will continue to
monitor his nutritional needs.—M. Bendyma, RNCHAPTER 37
PRACTICING FOR NCLEX
MULTIPLE CHOICE QUESTIONS
1.a 2.b 3.d 4.a 5.c
6.d 7.a 8.b 9.c 10.a
11.d 12.d
ALTERNATE-FORMAT QUESTIONS
Multiple Response Questions
1.b, e, f
2.a, d, f
3.a, e
4.b, c, e, f
5.a, c, e, f
6.b, d, e
7.a, c, e
8.a, b, d, eCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:ANSWER KEY 397
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