CNA Certification (Written Exam)Basic Nursing SkillsHard
A nurse aide weighs a resident weekly as part of routine monitoring. This week the resident weighs 142 pounds, compared to 148 pounds one week ago. What should the nurse aide do?
- AAdjust the resident's diet independently to address the weight loss
- BWait until next week's weigh-in to see if the trend continues before reporting
- CConsider this a normal weekly fluctuation and take no action
- DReport the weight change to the nurse, since it is more than a 2-pound difference in one week
Show answer & explanationAnswer & explanation
Correct answer: D. Report the weight change to the nurse, since it is more than a 2-pound difference in one week
A change of 6 pounds in one week is significant and should be reported to the nurse immediately. Generally, unplanned weight changes of more than 2 pounds in a week (or 5% in a month) are considered significant and warrant prompt reporting for further assessment.
Why the other options are wrong
- A. Nurse aides do not have the authority to independently change a resident's diet or care plan.
- B. Waiting delays identification of a potentially serious problem such as illness or dehydration.
- C. A 6-pound weekly change is significant, not a normal fluctuation.
Significant Weight Change
An unplanned weight change of more than 2 pounds in one week, or 5% of body weight in a month, is significant and must be reported to the nurse.
- More than 2 lb change in a week = report
- 5% change in a month is also significant
- Unplanned weight loss can indicate illness, dehydration, or poor nutrition
Memory trick: '2 pounds a week? Time to speak!'