A visiting nurse is in the home of an older adult and notes a 7-pound weight loss since last month's visit. What actions should the nurse perform first? (Select all that apply)

Choice A reason: Calling Adult Protective Services assumes neglect without evidence. Weight loss in older adults can result from medical, psychological, or social factors, such as malabsorption, depression, or poor appetite. Investigating physiological causes first is critical to identify underlying issues before attributing weight loss to neglect. Choice B reason: Assessing oral health and denture fit is essential, as poor oral function impairs chewing and swallowing, reducing food intake. In older adults, ill-fitting dentures or dental issues like tooth loss can lead to malnutrition, contributing to weight loss. This assessment helps identify reversible causes of inadequate nutrition. Choice C reason: Encouraging continuation of an exercise plan is inappropriate without assessing the cause of weight loss. Increased physical activity could exacerbate malnutrition if caloric intake is insufficient. In older adults, unintentional weight loss often indicates underlying issues like malabsorption or disease, requiring investigation before promoting exercise. Choice D reason: Assessing nutritional status is critical to determine if weight loss results from inadequate caloric intake, malabsorption, or metabolic disorders. This involves evaluating dietary patterns, appetite, and medical conditions like diabetes or hyperthyroidism, which can increase metabolism, leading to unintentional weight loss in older adults.