Question

A nurse in the emergency department (ED) is caring for a client. Click to highlight the findings that indicate the client is malnourished. A. Cachectic, with flaccid muscle tone.

B. Skin dry and scaly with bruises on extremities.
C. Oriented x 3, able to move all extremities.
D. Pulse rate 118/min.
E. Respiratory rate 18/min.
F. Abdomen distended.
G. Temperature 39.2 degrees C (102.6 degrees F).
H. BMI 17.

Answer 1

Cachectic appearance, flaccid muscle tone, and a BMI of 17 are indicative of malnutrition in a client. Normal respiratory rate and fever do not specifically point to malnutrition.

Step-by-step explanation:

The findings that indicate the client is malnourished include being cachectic, having flaccid muscle tone, and a BMI of 17. These signs are classic indicators of malnutrition. Cachexia is a condition that denotes severe weight loss and muscle wasting, and is often seen in chronic illnesses or malnutrition. Flaccid muscle tone indicates a lack of muscle strength and can be due to inadequate prāāotein and caloric intake. A BMI under 18.5 is considered underweight in adults, suggesting that a BMI of 17 falls within the category of malnutrition.

Regarding the other findings, a respiratory rate of 18/min is within the normal range and does not specifically indicate malnutrition. Similarly, a temperature of 39.2 degrees C indicates a fever, which could be related to an infection or other conditions, but is not a specific marker of malnutrition.