LCCA EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS, Exams of Nursing

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LCCA EXAM 2024/2025 WITH 100% ACCURATE

SOLUTIONS

What would you do if a patient was losing weight - Answer liberalizing diet, encouraging dining room eating if possible, a select menu of foods that patient likes to eat, then resort to supplements if necessary. what nutrients you would focus on for a patient with a PU - Answer Juven 1 packet BID for 2 weeks (max 1 month) or zinc 220 mg and Vitamin C 500 mg x 14 days what interventions would you put into place for an elderly patient who is not eating - Answer how would you deal with a physician that didn't agree with your recommendations - Answer Questions? - Answer Will I be expected to have any dining services responsibilities (sanitation audits, kitchen staff trainings, etc) Average census and admission case load for sure What kind of training will I get?

Will I ever be working at other sites? How's the relationship with the dining team? With nursing? Expectations for your position vs the CDM Order writing privileges Who completes the MDS (Minimum Data Set) Assessments Who completes kitchen audits MDS coding and liberalized diets - Answer how do you feel about supplements - Answer how would you manage or what is your comfort level with residents with dementia - Answer state regulations - Answer MDS - Answer

Dialysis - Answer Tube feedings - Answer Hospice - Answer Memory Care (alzheimers/dementia) - Answer Wounds - Answer Weightloss - Answer Dehydration - Answer survey experience - Answer SLP and RD working together - Answer what's your food dating procedure - Answer Storing foods - Answer temps - Answer

portion sizes - Answer Review your state's regs in terms of assessments - Answer What Does MDS Mean? - Answer minimum data set (MDS) What is minimum data set (MDS)? - Answer a tool for implementing standardized assessment and for facilitating care management in long- term care facilities. By law, all residents in Medicare and/or Medicaid- certified nursing homes must be assessed according to this prescribed instrument. When are MDS assessments completed? - Answer The assessments are completed within 14 days of admission, and at quarterly and annual intervals unless there is a significant change in condition. What qualifies A "Significant Change" - Answer A decline or improvement in a resident's status that: Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions Impacts more than one area of the resident's health status

Requires interdisciplinary review and/or revision of the Care Plan Physician Prescribed Weight Loss Regimen: - Answer A weight reduction plan ordered by the resident's physician with the care plan goal of weight reduction. May employ a calorie-restricted diet or other weight loss diets and exercise. Also includes planned diuresis. Mechanically Altered Diet - Answer A diet specifically prepared to alter the texture or consistency of food to facilitate oral intake. Examples include soft solids, puréed foods, ground meat, and thickened liquids. Therapeutic Diet - Answer A therapeutic diet is a diet intervention ordered by a health care practitioner as part of the treatment for a disease or clinical condition manifesting an altered nutritional status, to eliminate, decrease, or increase certain substances in the diet (i.e. sodium, potassium). liberalized diet/meal plan - Answer diet prescriptions that are based on a dietetic professional and/or physician's assessment of the patient's dietary and medical needs, rights, and personal food preferences The Four Pillars of Medicare Charting Include: - Answer Inherent Complexity Observation and Assessment Management and Evaluation of a Care Plan Teaching and Training

What is PDPM? - Answer Patient Driven Payment Model what does clinically significant weight change looks like according to the MDS: - Answer > 5% Weight Gain/Loss in 30 Days

7.5% Weight Gain/Loss in 90 days 10% Weight Gain/Loss in 180 Days sarcopenia - Answer Skeletal muscle atrophy "Suitable and nourishing alternative meals and snacks" - Answer means that when an alternate meal or snack is provided, it is of similar nutritive value as the meal or snack offered at the normally scheduled time and consistent with the resident plan of care. Dietary supplements - Answer refers to herbal and alternative products that are not regulated by the Food and Drug Administration and their composition is not standardized. Dietary supplements must be labeled as such and must not be represented for use as a conventional food or as the sole item of a meal or the diet Nutritional Supplements - Answer refers to products that are used to complement a resident's dietary needs (e.g., calorie or nutrient dense drinks, total parenteral products, enteral products, and meal replacement products) "Artificial nutrition and hydration" - Answer are medical treatments and refer to nutrition that is provided through routes other than the usual oral

route, typically by placing a tube directly into the stomach, the intestine or a vein. Acceptable parameters of nutritional status - Answer refers to factors that reflect that an individual's nutritional status is adequate, relative to his/her overall condition and prognosis, such as weight, food/fluid intake, and pertinent laboratory values What is the goal of nutrition intervention for the older adults? - Answer maintenance of good health and well-being and reduction of the risk of chronic and debilitating diseases. What is Mini Nutritional Assessment - Answer he MNA is a validated screening and assessment tool that can identify older adults at risk for malnutrition. The MNA includes 15 questions and 4 anthropometric measures. What is Council on Nutrition Appetite Questionnaire (CNAQ)? - Answer a screening tool for predicting anorexia-related weight loss in long-term-care residents to be used upon admission or in other clinical settings. What is the Simplified Nutritional Appetite Questionnaire (SNAQ) - Answer a revision of CNAQ, is a short, simple appetite assessment tool that predicts anorexia-related weight loss in both community-dwelling adults and those in long-term-care facilities.

What is the subjective Global Assessment? - Answer Subjective Global Assessment (SGA) aids in the recognition of malnutrition by examining the medical history and using the physical examination. What is DETERMINE Check List? - Answer screen older adults. DETERMINE is an acronym for warning signs of poor nutritional health: disease, eating poorly, tooth loss/mouth pain, economic hardship, reduced social contact, multiple medicines, involuntary weight loss/gain, need for assistance with self-care, and elder years older than 80. What is Malnutrition Screening Tool (MST)? - Answer is a simple, quick, valid, and reliable tool for identifying patients at risk for malnutrition. The tool is composed of two questions related to weight. Malnutrition Universal Screening Tool (MUST) - Answer uses three independent criteria: current weight and height with determination of body mass index, unintentional weight loss using specific cutoff points, and acute disease effect on nutrition intake for more than 5 days What is dementia? - Answer Dementia is not a specific disease but an overall term that describes a wide range of symptoms. It may be defined as the loss of memory, cognitive reasoning, awareness of environment, judgment, and/or abstract thinking as well as loss of the ability to perform usual tasks associated with self-care and day-to-day function. Alzheimer's - Answer Alzheimer's disease is the most common type of dementia.

Parkinsons nutrition concerns - Answer Weight loss and feeding problems including dysphagia must be addressed in nutrition evaluations. Vitamins D and B Levodopa - Answer Antiparkinson (Dopamine pro drug) Dietary amino acids can compete with Levodopa for absorption in the GI tract, and, once absorbed, to cross the blood-brain barrier, thus exacerbating this problem For the subset of patients taking levadopa who experience the "on-off syndrome," a protein-modified nutrition therapy may be of benefit Huntingtons Disease - Answer Chorea, is a progressive genetic neurologic disorder characterized by uncontrollable dance-like physical movements (chorea), dystonia, impairment in gait and eye movement, cognitive impairment, and psychiatric symptoms including depression, apathy, irritability, obsessive-compulsive disorder, and psychosis nutrition and Huntingtons - Answer Dysphagia is a common complication of the movement disorder. Consequently, one of the most common causes of

death is aspiration. This, in addition to neuro-psychological problems, including memory impairment, makes feeding a prominent issue in the care of persons suffering from this disorder. Expected Nutrition-Related Outcomes due to Dementias - Answer Decreased or abnormal senses of smell and taste Loss of memory on how to appropriately use eating utensils Lost perception of hazards in the environment that may cause injury/harm Consumption of nonfood items Chewing and swallowing problems Forgetting to eat Significant changes in body weight Behavior changes including movement patterns What are some nutrition interventions you could implement with patients with Dementia? - Answer Provide texture as tolerated

Provide low-stress environment Develop a routine that can be sustained over time—person assisting, time, place Involve speech pathologist as needed for repetitive chewing, pocketing foods, and other signs of dysphagia Determine if small meals or one food at a time will improve intake Provide high-energy, nutrient-dense foods and fluids Prevent or correct dehydration Provide adaptive eating devices as needed If not meeting Dietary Reference Intakes, consider supplementing with multivitamin-mineral supplement Definition of metabolic syndrome - Answer 3 out of 5: -abdominal obesity -Impaired glucose tolerance -High triglycerides

-Low HDL -HTN Cardiovascular nutrition intervention - Answer Use a liberal approach to sodium for the older adult in health care communities Maintain weight if obese and long-term nursing home resident or slow weight reduction if able to exercise Encourage a general/healthful diet Encourage Dietary Approaches to Stop Hypertension (DASH) eating pattern or Mediterranean-type diet Reduce saturated fats, trans fats, and cholesterol Increase omega-3, polyunsaturated fatty acid intake and monounsaturated fatty acid intake Add plant stanol esters Add plant sterol esters Use soy protein if acceptable to patient/client

CKD nutrition intervention - Answer Work toward delaying dialysis as long as feasible Treat underlying conditions—hypertension, diabetes, dyslipidemia Maintain body weight Encourage physical activity Protect lean body mass by increasing the use of carbohydrate and fats to spare protein Prevent tissue catabolism Educate on the principles of the Dietary Approaches to Stop Hypertension, or DASH, diet (the DASH diet can be high in vitamin K and will need to be individualized for the patient) Provide supportive counseling about food choices that are appropriate for condition and patient/client goals Help patient/client identify low-sodium alternatives for foods noted during diet history

Work to ensure proper overall nutrition protein/kilocalorie level Work with interdisciplinary team to determine whether diuretic is needed Provide individualized suggestions for increasing kilocalories to meet total energy needs with preferred foods Recommend a water-soluble renal customized vitamin supplement Educate patient/client on modifications required with foods and beverages containing sodium, potassium, and phosphorus What factors may impair energy intake in those with COPD:? - Answer Shortness of breath while preparing or eating food Altered taste perceptions due to aerophagia, altered bicarbonate, and pH levels Early satiety caused by flattened diaphragm or aerophagia Gastrointestinal (GI) disturbances from lack of oxygen to the GI tract Anorexia and nausea due to medications

Depression due to chronic disease Medication side effects COPD nutrition intervention - Answer Focus on preventing weight loss Provide commercial beverages Provide soft foods, thus requiring less chewing Provide adequate fluids Provide small, concentrated feedings to minimize fatigue Encourage diet that meets Recommended Dietary Allowance for antioxidants (vitamins A, C, and E) Concentrate on higher protein levels Restrict gas-forming foods Encourage limiting high-sodium foods

management strategies in the older adult with constipation include the following: - Answer Increasing water intake each day so that urine is colorless and odorless (30 to 35 cc/kg) Increase fiber to 25 g with liberal use of whole grains, fruits, and vegetables, including legumes T/F: Prevention is better than the cure for constipation - Answer True! so it is recommended that older adults receive advice and education about hydration and a good diet with fiber sources: cereals, nuts and seeds, whole grain breads, raw and cooked vegetables, and fruits What should you screen older adults for to prevent constipation? - Answer history of medication use (especially polypharmacy and laxatives); cognitive status For people unable to walk or who are restricted to bed, what exercises can you advise for constipation? - Answer as low trunk rotation, pelvic tilt, and single leg lifts Constipation nutrition interventions - Answer Recommend and provide as ordered fiber-modified diet Recommend and provide as ordered fluid-modified diet

Consider the addition of medical food supplements Review medications for potential constipating effects Identify and provide favorite fluids Encourage physical activities that are enjoyed by client Increase fiber in diet slowly Encourage routine bathroom time T/F: Depression is a major factor in weight loss in nursing facilities and is potentially reversible - Answer TRUE Depression Nutrition Intervention - Answer Maintain adequate intake of amino acids, n-3 fatty acids, folic acid, and vitamins D-3 and B- Provide adequate nutritional intake Provide liquid supplements when meal preparation is overwhelming

Monitor for weight changes related to pharmacology and treatment options If overeating, provide low-kilocalorie food and fluid options Monitor for potential food and drug interactions as antidepressants may cause changes in weight Instruct on how to add moisture to foods for dry mouth syndrome often found with antidepressants Supplement with folate (400 mcg daily) Consider supplementing vitamin D-3 and calcium if not consuming adequate amounts Complications of Diabetes seen in Older Adults - Answer Malaise and weakness Osmotic diuresis with resulting nocturia Sleep disturbances Dehydration

Possible incontinence Impaired vision Cardiac problems such as angina or myocardial infarctions Frailty Impaired mobility, which may lead to falls/fractures Impaired driving ability Undiagnosed depression Difficult social issues (for example, doesn't want to take insulin in front of others; doesn't want to be "different" when going out to eat) Changes in cognitive function Microvascular and macrovascular complications Reduced food intake and continuing to take medication/insulin resulting in hypoglycemia

Poor wound healing Diabetic neuropathy with decreased sensation Impaired mobility due to neuropathy Nutrition intervention Diabetes Older adults - Answer Increase in physical activity where possible Weight maintenance for individuals in long-term-care facilities Follow nutrition recommendations and interventions of the American Diabetes Association Determine goals and interventions based on age and overall condition of client/patient Liberalize diets in long-term-care settings Consider use of large-print educational materials Carbohydrate-modified diet

Limit saturated and trans fats Test blood sugars Multivitamin-minerals to meet Dietary Reference Intakes Obesity Nutrition Intervention - Answer In older adults, ensure adequate protein sources and vitamins and minerals Assess cause of weight loss if it is indicative of a disease process Aim for weight reduction in healthy older adults living in the community Increase physical exercise Utilize behavior therapy Medications as needed For people in a care setting, work to prevent weight gain and only recommend slow weight loss over time if the older adult can participate in a supervised program that uses moderate restriction of energy intake combined with regular aerobic and resistance exercise.