Lab 5-Malnutrition and Life Cycle Nutrition

Readings: Dudek, Nutrition Essentials For Nursing Practice, Seventh Edition (chapters 1,14)

Please do the case study in Dudek, page 14

Malnutrition –over-nutrition- example-obesity

Over-nutrition is consuming one or more nutrients in amounts more than are required-results in being overweight or obese or facing toxicity

See pages 377-380 of Dudek and complete points raised in the overview and specifics below.

Overview1) develop specifics* for pre-onset management (prevention) of obesity in a 20

year old male or female- your choice - please see specifics below*2) diagnosis and management for pre-onset management is an assessment of

the potential for obesity to arise and how to prevent obesity3) develop specifics* for post-onset obesity management in a 20 year old male

or female- your choice –please see specifics below*4) diagnosis and management for post-onset management is an assessment of

the potential for obesity to decrease at least somewhat and how to implement a plan to decrease that obesity at least somewhat

5) you must do pre- and post-onset for obesity

*Specifics for nutritional care management plan-detail what you will do for each of the following

1) assessment – ABCD (Anthropometric, Biochemical, Clinical And Dietary data) plus medical –psychosocial history

2) nursing diagnosis3) planning-patient outcomes4) monitoring and evaluation5) conclusions-key points from specifics 1-4 immediately above-be sure to

show how these key points integrate with one another

Complete case study in Dudek, page 385

Please see http://www.obesitynetwork.ca/5As and note the video- video mentions nurses using the 5As tool.

Please also see powerpoint

Malnutrition-undernutrition-examples-Anorexia nervosa and bulimia nervosa

Undernutrition is not consuming enough of one or more nutrients and/or having an ingestion, digestion, absorption, transport, metabolism and or excretion issue that results in not getting one or more nutrients to where (W) they are needed, when (W) they are needed, in the form (F) they are needed and in the quantity (Q) they are needed

Life Cycle-Nutrition-NCLEX QUESTIONS

Page 585-Q 86- During a client’s first visit to a pre-natal, a nurse discusses a pregnancy diet. The client states that her mother told her she should restrict her salt intake. What is the nurse’s best response?a) “your mother is correct. You should use less salt to prevent swelling”b)” because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet”c) “salt is an essential nutrient that is naturally reduced by the body’s estrogen. There is no reason to restrict salt in your diet”d) “We no longer recommend that salt be as restricted as much as in the past. However, you shouldn’t add salt to your food”

a) “your mother is correct. You should use less salt to prevent swelling”-this could be detrimental to the client’s healthb) “because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet”- sodium is needed to maintain body water balance; sodium requirements increase slightly during pregnancy to accommodate the increased blood volume. A healthy pregnant woman should not limit her sodium intakec) “salt is an essential nutrient that is naturally reduced by the body’s estrogen. There is no reason to restrict salt in your diet”-this statement is not correctd) “We no longer recommend that salt be as restricted as much as in the past. However, you shouldn’t add salt to your food”-sodium intake should be as for the general population unless medically indicated otherwise

Page 585-Q 91- A pregnant women tells a nurse in a pre-natal clinic that she knows that folic acid is very important during pregnancy and she is taking a prescribed supplement. She also asks the nurse what foods contain folic acid (folate) so she can add them to her diet in its natural form. Which foods should the nurse recommend? Select all that apply.a) beef and fishb) milk and cheesec) chicken and turkeyd) black and pinto beanse) enriched bread and pasta

a) beef and fish-do not contain adequate amounts of folateb) milk and cheese- do not contain adequate amounts of folatec) chicken and turkey- do not contain adequate amounts of folated) black and pinto beans –rich in folatee) enriched bread and pasta-rich in folate

Page 585-Q 95-A client at 10 weeks gestation calls the clinic and tells a nurse that she has morning sickness and cannot control it. What should the nurse suggest to promote relief?a) eat dry crackers before risingb) increase fat intake before bedtimec) drink high carbohydrate fluids with mealsd) have two small meals a day with a snack at noon

a) eat dry crackers before rising-simple remedy that worksb) increase fat intake before bedtime-does not relieve nauseac) drink high carbohydrate fluids with meals—this is not helpful;separating fluids from solids at mealtime is more advisabled) have two small meals a day with a snack at noon- two small meals a day with a snack at noon does not meet the nutritional needs of a pregnant women nor will it relieve nausea. Some women find that eating five or six small meals daily instead of three large ones is helpful.

Page 585-Q 96- What should a nurse suggest to a pregnant client that might help overcome first trimester morning sickness?a) eat protein before bedtimeb) take an antacid before breakfastc) drink water until the nausea subsidesd) request a prescription for an anti-emetic

a) eat protein before bedtime-nausea and vomiting in early pregnancy can be relieved with a small snack of protein before bedtime to slow digestionb) take an antacid before breakfast-an antacid may affect electrolyte balance; also this will not help morning sicknessc) drink water until the nausea subsides-this is contraindicated because both mother and foetus need nourishmentd) request a prescription for an anti-emetic-medications in the first trimester are contraindicated because this is the period of organogenesis, and congenital abnormalities could resultPage 585-Q 97- What should a nurse include in nutritional planning for a newly pregnant woman of average height weighing 145 pounds?Note possible answers to question may read calories- this actually means kcala) a decrease of 100 kcal/day- b) a decrease of 200 kcal/day- c) an increase of 300 kcal/day-d) an increase of 500 kcal/day

a) a decrease of 100 kcal/day-this will not meet the metabolic demands of pregnancy and may harm the foetusb) a decrease of 200 kcal/day- this will not meet the metabolic demands of pregnancy and may harm the foetusc) an increase of 300 kcal/day-this will meet the increased metabolic demands of pregnancyd) an increase of 500 kcal/day-this is the recommendation for breast feeding mothers

Page 585-Q 102- What is the best advice a nurse can give to a pregnant women in her first trimester?a) cut down on drugs, alcohol and cigarettesb) avoid drugs, and refrain from smoking and ingesting alcoholc) avoid smoking, limit alcohol consumption and do not take aspirind) take only prescription drugs, especially in the second and third trimesters

a) cut down on drugs, alcohol and cigarettes-this is insufficient, all are teratogens and must be eliminatedb) avoid drugs, and refrain from smoking and ingesting alcohol-first trimester is when all major embryonic organs are forming; drugs, alcohol and tobacco may cause major defectsc) avoid smoking, limit alcohol consumption and do not take aspirin-any amount of alcohol is considered harmful, baby aspirin may be prescribed to some women who are considered at risk for pregnancy induced hypertension but not during the first trimesterd) take only prescription drugs, especially in the second and third trimesters-medications, unless absolutely necessary, should be avoided throughout pregnancy, but the first trimester is most significant.

Page 587-Q 105-A client who is 28 weeks into her second pregnancy is experiencing increasing edema in the lower extremities. The nurse advises rest with legs elevated and provides dietary instructions. What else should the nurse suggest?a) a preferred diet will include favourite foodsb) a nutritionist should be involved in planning a dietc) the foods selected do not need to have a low salt contentd) the client should be referred to the health care provider at the prenatal clinic

a) a preferred diet will include favourite foods-not all preferences can be included;the diet should contain normal sodium, high protein and sufficient caloriesb) a nutritionist should be involved in planning a diet-immediate planning based on the nurse’s knowledge of dietary needs is sufficientc) the foods selected do not need to have a low salt content-dependent oedema is common during the last trimester; there is no need to lower the salt content of the client’s diet. Teaching should be based on optimum nutrition as well as caloric content of the dietd) the client should be referred to the health care provider at the prenatal clinic –unless the nurse thought there was a need for medical intervention, the nurse may discuss care related to human responses

Page 587-Q 106-What recommendation should a nurse give to clients who have fluid retention during pregnancy?a) decrease fluid intakeb) maintain low-sodium dietc) elevate the lower extremitiesd) ask the healthcare provider for a diuretic

a) decrease fluid intake-fluid intake should be encouraged because adequate hydration maintains fluid and electrolyte balanceb) maintain low-sodium diet-sodium intake should not be restricted because it is needed to balance the increased fluid volume during pregnancyc) elevate the lower extremities-elevation of the lower extremities several times daily is recommended to decrease the dependent oedemad) ask the healthcare provider for a diuretic-diuretics can be harmful and are not used during a healthy pregnancy

Page 587-Q 113 During the post-partum period, a client tells a nurse she is having leg cramps. Which foods should the nurse encourage the clients to eat?a) liver and raisinsb) cheese and broccolic) eggs and lean meatsd) whole grain breads and cereals

a) liver and raisins- although these foods are recommended to maintain quality nutritional intake, they are inadequate sources of calciumb) cheese and broccoli-the leg cramps may be related to low calcium intake; cheese and broccoli both have high calcium intakec) eggs and lean meats- although these foods are recommended to maintain quality nutritional intake, they are inadequate sources of calciumd) whole grain breads and cereals- although these foods are recommended to maintain quality nutritional intake, they are inadequate sources of calcium

Page 599-Q 272- At the beginning of the first formula feeding a newborn begins to cough and choke, and the lips become cyanotic. What is the immediate nursing action?a) stimulate cryingb) suction and then oxygenatec) substitute the formula with sterile waterd) stop the feeding momentarily and then restart

a) stimulate crying-crying made add to the distressb) suction and then oxygenate-cyanosis, choking and coughing are signs of aspiration and hypoxia. Suctioning and oxygenation are neededc) substitute the formula with sterile water-the water may be aspirated and intensify the problemd) stop the feeding momentarily and then restart-this is unsafe;the newborn is showing signs of a blocked airway

Page 600-Q 279-A nurse teaches a group of post-partum clients that all their newborns that all their newborns will be screened for phenylketonuria (PKU) to:

a) assess protein metabolismb) reveal potential retardationc) detect chromosomal damaged) identify thyroid insufficiency

a) assess protein metabolism- PKU, is a rare inherited disorder that causes an amino acid called phenylalanine to build up in your body. PKU is caused by a defect in the gene that helps create the enzyme needed to break down phenylalanine.b) reveal potential retardation- PKU can cause retardation but the PKU test does not identify retardationc) detect chromosomal damage- PKU is due to a gene defect which is not due to chromosomal damaged) identify thyroid insufficiency-this is done at the same time as PKU testing, but thyroid deficiency is related to a hormone deficiency, not to PKU

Page 600-Q 280-When assessing a 9 pound neonate, 2 hours after birth, nurse identifies jitteriness, apneic episodes, tachycardia and temperature instability. What complication do these findings indicate to the nurse?a) hyponatremiab) hypoglycaemiac) cardiac defectd) immature CNS

a) hyponatremia-not a sign of this problemb) hypoglycaemia-hypoglycaemia causes CNS and sympathetic nervous system responsesc) cardiac defect- not a sign of this problemd) immature CNS- not a sign of this problemPage 600-Q 285-A client asks the nurse what advantage breastfeeding has over formula feeding. What group of substances in human milk are of special importance to the newborn and cannot be reproduced in a bottle formula?a) amino acidsb) gamma globulinsc) essential electrolytesd) complex carbohydrates

a) amino acids-these are present in commercial formulasb) gamma globulins-the antibodies in human milk provide the infant with immunity against all or most of the pathogens that the mother has encounteredc) essential electrolytes- these are present in commercial formulasd) complex carbohydrates-complex carbohydrates are not required by the infant

Page 600-Q 292-A nurse is teaching a group of new mothers about breast-feeding. Which factor that influences the availability of milk in the lactating women should the nurse include in the teaching?a) age of the woman at the time of birthb) distribution of erectile tissue in the nipplesc) amount of milk products consumed during pregnancyd) viewpoint of the woman’s family toward pregnancy

a) age of the woman at the time of birth-this has no influence on lactationb) distribution of erectile tissue in the nipples- this has no influence on lactationc) amount of milk products consumed during pregnancy-milk or milk product intake during pregnancy promotes relaxation and the let-down reflexd) viewpoint of the woman’s family toward pregnancy-if a women perceives a negative viewpoint about breastfeeding from significant others, she may be tense and the let-down reflex may not occur; a positive attitude from significant others toward breastfeeding promotes relaxation and the let down reflex

Page 600-Q 293-While teaching a prenatal class about infant feeding, the nurse is asked a question about the relationship between the size of breasts and breast feeding. How should the nurse respond?a) breast size is not related to milk productionb) movtivated women tend to breastfeed successfullyc) you seem to some concerns about breastfeedingd) glandular tissue in the breast determines the amount of milk produced

a) breast size is not related to milk production-the question should be answered directly in class. However the mother’s statement indicates some concerns about breast feedingb) motivated women tend to breastfeed successfully-this is false reassurance; successful breastfeeding requires mastery and some women have difficultyc) you seem to some concerns about breastfeeding-although the nurse perceives the clients conerns, the response is inappropriate in class with others presentd) glandular tissue in the breast determines the amount of milk produced-the infant’s suckling and emptying of breasts will determine the amount of milk produced.

Page 600-Q 294- A women learning about infant feedings asks a nurse how anyone who is breastfeeding gets anything done with a baby on demand feedings? Which is the best response by the nurse?a) most mothers find that feeding the baby whenever the baby cries works out fineb) perhaps a schedule might be better because the baby is already accustomed to the hospital routinec) babies on demand feedings eventually set a schedule, so there should be time for you to do other thingsd) most breastfeeding mothers find that their babies do better on demand because the amount of milk ingested may vary at each feeding

a) most mothers find that feeding the baby whenever the baby cries works out fine-some of the episodes of crying do not indicate that the infant is hungry; the mother will learn the differenceb) perhaps a schedule might be better because the baby is already accustomed to the hospital routine-it is best to allow the infant to set the schedulec) babies on demand feedings eventually set a schedule, so there should be time for you to do other things-most averaged sized infants regulate themselves to an approximate 3 to 4 hour schedule. However, variations do exist.d) most breastfeeding mothers find that their babies do better on demand because the amount of milk ingested may vary at each feeding-although this is true, this does not answer the mother’s question concerning when she will have free time

Page 600-Q 295- A nurse is caring for four clients who each have one of the following conditions. Which client should the nurse anticipate will be instructed not to breastfeed by the health care provider?a) mastitisb) inverted nipplesc) herpes genitalisd) human immunodeficiency virus

a) mastitis-breastfeeding by a mother with mastitis is not always contraindicated; during antibiotic treatment lactation can be maintained by pumping the breasts and discarding the milk. When the infection has resolved, breastfeeding can resume.b) inverted nipples-breastfeeding is not contraindicated with inverted nipples because a breast shield can provide mild suction to help evert a nipplec) herpes genitalis-breastfeeding is not contraindicated for a client with genital herpes. The infant may contract the virus during a vaginal birth but not via breast milk.d) human immunodeficiency virus-human breastfeeding by a mother with immunodeficiency virus (HIV) is contraindicated because breast milk can transmit the virus to the infant.

Page 600-Q 296-A nurse is teaching breast care to a client who is breastfeeding. Which client statement indicates that the teaching was effective? a) I should air dry my nipples after each feedingb) mild soap is appropriate for washing my breastsc) my breast pads should be lined with plastic shieldsd) I will remove my brassiere before going to bed at night

a) I should air dry my nipples after each feeding-air drying nipples after each feeding limits irritation and disruption of skin integrityb) mild soap is appropriate for washing my breasts-application of soap to breast tissue may result in drying and crackingc) my breast pads should be lined with plastic shields-plastic liners trap moisture against tissue and may cause skin breakdownd) I will remove my brassiere before going to bed at night-wearing a brassiere continuously, except for bathing, is recommended for two to three weeks to provide support for breast tissue structures.

Page 600-Q 297-A client who is breastfeeding is being discharged. The client tells the nurse that she is worried because her neighbour’s breasts “dried up: when she got home and she had to discontinue breastfeeding. What should the nurse reply?a) once lactation is established, this rarely happens.b) you have little to worry about because you already have a good milk supplyc) this can happen with the excitement of going home, but putting the baby to breast more often should re-establish lactationd) this commonly happens, so we will give you a bottle of formula to take home; then the baby will not go hungry until your milk supply returns

a) once lactation is established, this rarely happens-this is false reassurance. Many factors (stessors) inhibit lactation, and the client should be aware of this. b) you have little to worry about because you already have a good milk supply- this is false reassurance. The milk supply may diminish or stop under stress.c) this can happen with the excitement of going home, but putting the baby to breast more often should re-establish lactation-frequently the emotional excitement of going home will diminish the lactation and/or the let-down reflex. When the mother is aware that this may happen and knows how to cope with it, the problem is apt to be a minor one and easily overcome d) this commonly happens, so we will give you a bottle of formula to take home; then the baby will not go hungry until your milk supply returns-this is contraindicated. Lack of breast stimulation during formula feeding could diminish lactation.

Page 600-Q 298-A nurse is teaching breast feeding to a client. Which client statement indicates the need for further instructions?a) I will try to empty my breasts at each feedingb) I will start with an alternate breast at each feedingc) my breasts should be washed with soapy water before I breastfeedd) my baby’s cheek should be stroked gently when I am ready to breastfeed

a) I will try to empty my breasts at each feeding-the client should empty the breasts at each feeding to keep milk flowingb) I will start with an alternate breast at each feeding-this is a permissible and often used technique of breastfeedingc) my breasts should be washed with soapy water before I breastfeed-soap irritates, cracks and dries breasts and nipples, making it painful to the mother when the baby sucks; also it increases the risk for mastitisd) my baby’s cheek should be stroked gently when I am ready to breastfeed-this elicits the rooting reflex, causing the infant’s head to turn toward and touch the mother’s breast

Page 600-Q 299-What should be included in the plan of care to limit the development of hyperbilirubineamia to the breastfed neonate?a) encouraging more frequent breastfeeding during the first two daysb) instituting phototherapy every 30 minutes every 6 hours for 3 daysc) substituting breastfeeding with formula feeding on the second dayd) supplementing breast feeding with glucose-water during the first day

a) encouraging more frequent breastfeeding during the first two days-more frequent breastfeeding stimulates more frequent evacuation of meconium, thus preventing resorption of bilirubin into the circulatory systemb) instituting phototherapy every 30 minutes every 6 hours for 3 days-phototherapy is the treatment of bilirubinemia and it is maintained continuously; it does not prevent the development of hyperbilirubinemiac) substituting breastfeeding with formula feeding on the second day-it is not necessary to formula feed. Early breastfeeding tends to keep the bilirubin level low by stimulating GI activityd) supplementing breast feeding with glucose-water during the first day-increasing water intake does not prevent the development of bilirubinemia because only small amounts of bilirubin are excreted by the kidneys

Page 600-Q 300-Two days after being discharged a new mother calls the clinic stating that she is not sure if her baby is receiving enough breast milk. What information does the nurse need to determine if the infant is being fed adequately?a) voids 4 times before 2 pmb) sleeps 3 1/2-4 hours between feedingsc) has a least two or more bowel movements a dayd) nurses 5 minutes on the first breast and 10 on the second

a) voids 4 times before 2 pm-typically 6-8 wet diapers a day indicates adequate fluid intakeb) sleeps 3 1/2-4 hours between feedings-this may be a sign of inadequate nutritional intake. A breastfeeding infant usually sleeps 1 ½ to 2 ½ hours between feedings because breast milk digests rapidly.c) has a least two or more bowel movements a day-the number of bowel movements per day is not related to the amount of milk ingested, although breast feeding infants do defecate more frequently than formula-fed infantsd) nurses 5 minutes on the first breast and 10 minute on the second-the length of nursing time at each breast does not indicate the amount of milk being ingested

Page 600-Q 301-What client behaviour indicates to the nurse needs further teaching about breastfeeding her newborn?a) when she leans forward to put her breast into the infant’s mouthb) if she holds the infant level with her breast while in a side-lying positionc) if she touches her nipple to the infant’s cheek at the beginning of the feedingd) when she puts her finger in the infant’s mouth to break the suction after the feeding

a) when she leans forward to put her breast into the infant’s mouth-when the breast is pushed into the infant’s mouth, a typical response is for the mouth to close too soon, resulting in inadequate latching-onb) if she holds the infant level with her breast while in a side-lying position-this facilitates latching on and maintains the infant’s head in the correct alignment, which promotes sucking and swallowingc) if she touches her nipple to the infant’s cheek at the beginning of the feeding-this will stimulate the rooting reflex and promote latching-ond) when she puts her finger in the infant’s mouth to break the suction after the feeding-this prevents trauma to the nipple when removing the infant from the breast

Page 600-Q 302-A 2 day old infant who weighs 6 pounds (2722 g) is fed formula every 4 hours. Newborns need about 73 mL of fluid per pound (454 g) of body weight each day. Based on this information approximately how much formula should the infant receive at each feeding (1 oz = 29.6 ml)?a) 1 to 2 ozb) 2 to 3 ozc) 3 to 4 ozd) 4 to 5 oz

a) 1 to 2 oz -inadequate volume (see b)b) 2 to 3 oz-infants require about 73 ml of fluid per pound and 60 kcal/day per pound for growth. The infant’s weight of 6 pounds x 73 ml/pound = 438 mL. If fed every 4 hours will have 6 feedings per 24 hour cycle. 438/6 = 73 ml. 73 ml / 30 = 2.4 oz (1 fluid oz = 30 ml). Therefore the infant should receive 2- 3 oz /feedingc) 3 to 4 oz-this amount is excessive for this newborn (see b)d) 4 to 5 oz- this amount is excessive for this newborn (see b)

Page 600-Q 303-A client asks the difference between cow’s milk and breast milk. The nurse should respond that cow’s milk differs from human milk in that it contains:a) less protein, less calcium and more carbohydratesb) less protein, more calcium and more carbohydratesc) more protein, less calcium and fewer carbohydratesd) more protein, more calcium and fewer carbohydrates

a) less protein, less calcium and more carbohydrates-cow’s milk contains more calcium and more proteinb) less protein, more calcium and more carbohydrates- c) more protein, less calcium and fewer carbohydratesc) more protein, less calcium and fewer carbohydrates-cow’s milk contains more calcium d) more protein, more calcium and fewer carbohydrates-cow’s milk is more difficult to digest because it is meant to meet a calf’s, not an infant’s, nutritional needs. It is not recommended until after the infant is one year old. Formula is preferred if the mother is not breast feeding.

Page 720-Q 142- A parent tells a nurse at the clinic. “Each morning I offer my 24 month old child juice and all I hear is ‘No’. What should I do because I know my child needs fluid?” What strategy should the nurse suggest?a) offer the child the choice of two juicesb) distract the child with a favourite foodc) offer the child a glass in a firm mannerd) allow the child to see the parent getting angrya) offer the child the choice of two juices-children who are expressing negativism need to have a feeling of control. One way of achieving this within reasonable limits is for the parent or caregiver to offer a choice of two items, rather than force one on the childb) distract the child with a favourite food-this will not achieve the goal of giving fluidsc) offer the child a glass in a firm manner-this will probably not be successful with a toddlerd) allow the child to see the parent getting angry-this will complicate the situation and further inhibit the child’s willingness to take fluid

Page 721-Q 149-What foods should a nurse order for a 30 month old toddler for a 30 month old toddler on a regular diet?a) hamburger with bun and grapesb) chicken fingers and French friesc) hot dog with a bun and potato chipsd) macaroni and cheese and Cheerios

a) hamburger with bun and grapes-grapes are dangerous because toddlers may choke on the skins and shape of the grapeb) chicken fingers and French fries-the fried foods have a high fat content and if eaten regularly can lead to obesityc) hot dog with a bun and potato chips-the skin and the shape of a hot dog may cause choking, and potato chips are not nutritiousd) macaroni and cheese and Cheerios-these are foods that a toddler enjoys and can handle; in addition they are nutritious

Page 721-Q 152-Which healthy snack should the nurse teach the parents to give their 2 year old child who has the diagnosis of acute asthma. Select all that applya) grapesb) ice creamc) apple slicesd) oatmeal cookiese) cut up vegetablesf) cold glass of milk

a) grapes-this is unsafe because of the shape of the grape and its skinb) ice cream-cold food and fluids may precipitate bronchospasms and should be avoidedc) apple slices-apple slices are easy to handle and chew and provide excellent nutrition for a toddlerd) oatmeal cookies-cookies are high in fat and sugar and are not as healthy fruite) cut up vegetables-vegetables cut up into small pieces can be handled and chewed effectively by a 2 year old child; also, they are nutritious and prevent constipationf) cold glass of milk-cold fluid may cause bronchospasms

Page 730-Q 272-The school nurse is planning to teach a class about nutrition. Which age group will be most receptive to this information?a) 6 year old childrenb) 8 year old childrenc) 11 year old childrend) 15 year old children

a) 6 year old children-6 year old children are just beginning to experience the developmental goals of the school-age child. They are not ready to make choices based on what they have learned. b) 8 year old children- 8 year old children are beginning to achieve a sense of industry and accomplishment. They are in Piaget’s stage of concrete operations wherein they are able to use their thought processes to experience actions. Their growing independence enables them to make decisions based on what they have learned.c) 11 year old children-pre-adolescents are beginning to assert their independence and probably will rebel if taught what they should eatd) 15 year old children-adolescents need to conform to their peer group. What is learned in nutrition class will be ignored in favour of pre-established preferences

Page 730-Q 273-Obesity in children is an ever increasing problem. What should a nurse consider before confronting the problem with individual children?a) enjoyment of specific foods is inheritedb) childhood obesity is not usually a predictor of adult obesityc) children with obese parents and siblings are destined for obesityd) familial and cultural influences ae deciding factors in eating habits

a) enjoyment of specific foods is inherited-inheritance is not known to influence eating habits although it is believed that there may be hereditary factors associated with obesityb) childhood obesity is not usually a predictor of adult obesity-childhood obesity is a known predictor of adult obesityc) children with obese parents and siblings are destined for obesity-although there is a trend toward this, with intervention it can be preventedd) familial and cultural influences ae deciding factors in eating habits-studies have shown that culture and family eating habits have an impact on the child’s eating habits

Page 730-Q 274-An 11 year old child has gained weight. The mother tells a nurse that she is concerned that her child, who loves sports, may become obese. What is the nurse’s most appropriate response?a) Suggest an increase in activity

b) Encourage a decreased caloric intake

c) Explain that this is expected in pre-adolescence

d) Discuss the influence of genetics on weight gain

a) Suggest an increase in activity- before advising increased activity, the nurse should assess the child’s present level of activity

b) Encourage a decreased caloric intake-an adequate caloric intake is needed for the growth spurt that will occur during adolescence

c) Explain that this is expected in pre-adolescence-there may be a weight gain caused by the influence of hormones before the growth spurt. Most 10- to 12-year children can eat an adult-size meal without becoming obese, especially if they are active.

d) Discuss the influence of genetics on weight gain-family eating patterns appear to have more effect on weight that do genetics