# Situation: A public health nurse works with the barangay nutrition scholars (BNS) and barangay health workers (BHWs) of an upland barangay on its nutrition program, including the yearly Operation Timbang Plus (OPT Plus). During OPT Plus, a 30-month-old boy has these results on the WHO Child Growth Standards: Weight-for-age: −1.6 z Height-for-age: −2.4 z Weight-for-height: −0.6 z How should the nurse classify his nutritional status?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627252  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A public health nurse works with the barangay nutrition scholars (BNS) and barangay health workers (BHWs) of an upland barangay on its nutrition program, including the yearly Operation Timbang Plus (OPT Plus).

During OPT Plus, a 30-month-old boy has these results on the WHO Child Growth Standards:
Weight-for-age: −1.6 z
Height-for-age: −2.4 z
Weight-for-height: −0.6 z
How should the nurse classify his nutritional status?

## 보기

1. Wasted
2. Stunted **✔ 정답**
3. Stunted and underweight
4. Underweight

**정답: 2**

## 해설

Each indicator is read against its own cutoff of −2 z. Height-for-age below −2 z means stunting, a sign of chronic undernutrition. His weight-for-height is within the normal range, so he is not wasted, and his weight-for-age is above −2 z, so he is not underweight.

## 심화 해설

Reading each indicator against its own cutoff
The WHO Child Growth Standards use three main indicators for young children, each interpreted with a z-score. A z-score below −2 on an indicator marks undernutrition on that indicator. Height-for-age below −2 z means stunting, weight-for-height below −2 z means wasting, and weight-for-age below −2 z means underweight. This boy's results are: weight-for-age −1.6 z, height-for-age −2.4 z, and weight-for-height −0.6 z. Only height-for-age is below −2 z. He is stunted, and not wasted or underweight.

What each indicator tells the nurse
Stunting reflects chronic undernutrition: long-term inadequate nutrition, repeated infections, or poor conditions since early life, which slow linear growth. Wasting reflects acute undernutrition, recent weight loss or failure to gain weight, and carries a high risk of death. Underweight is a composite indicator that can reflect either or both. A child can be stunted with a normal weight for his height, as here, because his weight is appropriate for his short stature even though his height is low for his age.

| Indicator | His z-score | Cutoff | Classification |
| --- | --- | --- | --- |
| Height-for-age | −2.4 | Below −2 | Stunted |
| Weight-for-height | −0.6 | Below −2 | Not wasted |
| Weight-for-age | −1.6 | Below −2 | Not underweight |

Why the other classifications are wrong
Wasted would require weight-for-height below −2 z, but his is −0.6 z. Underweight would require weight-for-age below −2 z, but −1.6 z is above the cutoff. Stunted and underweight adds an underweight label that his weight-for-age does not support. Watch out! A weight-for-age between −1 and −2 z may look low, but it does not meet the underweight cutoff, so do not add a second classification.

Action after OPT Plus
A stunted child needs attention to long-term feeding and health, and the window for preventing stunting is the first 1,000 days. At 30 months, the nurse counsels the family on adequate, diverse complementary foods and continued breastfeeding if still practiced, checks his immunization and deworming status, gives micronutrient supplementation according to program guidelines, and monitors his growth regularly. The barangay nutrition scholar includes him in the barangay nutrition action plan, and the family is linked to feeding programs where available.

## 임상 시나리오

Classifying Nutritional StatusWHO z-scores from OPT Plus
Each indicator uses a cutoff of −2 z. Height-for-age below −2 z = stunted; weight-for-height below −2 z = wasted; weight-for-age below −2 z = underweight.

This boy: height-for-age −2.4 z (stunted), weight-for-height −0.6 z (not wasted), weight-for-age −1.6 z (not underweight).

Stunting reflects chronic undernutrition; counsel on feeding, check immunization and deworming, and monitor growth.

CautionDo not add underweight when weight-for-age is above −2 z.

## 핵심 개념

- **Stunting** — Low height-for-age, below −2 z, reflecting chronic undernutrition.
- **Wasting** — Low weight-for-height, below −2 z, reflecting acute undernutrition.
- **Underweight** — Low weight-for-age, below −2 z, which may reflect stunting, wasting, or both.
- **OPT Plus** — Operation Timbang Plus, the yearly weighing and measuring of preschool children to identify malnutrition.

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