Chapter 28. Nutrition

Which food provides the body with no usable glucose? 1)Wheat germ 2)Apple 3)White bread 4)White rice

ANS: 1 Dietary fiber, such as wheat germ, contains no usable glucose. Apples, white bread, and white rice all contain carbohydrates, which provide usable glucose. PTS: 1 DIF: Easy REF: p. 902; does not specify wheat germ, just indicates that fiber provides no glucose.

A patient who was prescribed furosemide (Lasix) is deficient in potassium. Which of the following is an appropriate goal for this patient? The patient will increase his consumption of: 1)Bananas, peaches, molasses, and potatoes. 2)Eggs, baking soda, and baking powder. 3)Wheat bran, chocolate, eggs, and sardines. 4)Egg yolks, nuts, and sardines.

ANS: 1 Foods rich in potassium include bananas, peaches, molasses, meats, avocados, milk, shellfish, dates, figs, and potatoes. Eggs, baking soda, and baking powder have high sodium content. Dairy products, beef, pork, beans, sardines, eggs, chicken, wheat bran, and chocolate are rich in phosphorus. Egg yolks, nuts, sardines, dairy products, broccoli, and legumes are rich in calcium.

The nurse notices that a patient has spoon-shaped, brittle nails. This suggests that the patient is experiencing Imbalanced Nutrition: Less Than Body Requirements related to deficiency of which of the following nutrients? 1)Iron 2)Vitamin A 3)Protein 4)Vitamin C

ANS: 1 Patients with iron deficiency may have spoon-shaped, brittle nails. Other abnormal nail findings include dull nails with transverse ridge (protein deficiency); pale, poor blanching, or mottled nails (vitamin A or C deficiency); splinter hemorrhages (vitamin C deficiency); and bruising or bleeding beneath nails (protein or caloric deficiency).

A patient is brought to the emergency department experiencing leg cramps. He is irritable, his temperature is elevated, and his mucous membranes are dry. Based on these findings, the patient most likely has excess levels of which mineral? 1)Sodium 2)Potassium 3)Phosphorus 4)Magnesium

ANS: 1 Signs and symptoms associated with sodium excess include thirst, fever, dry and sticky tongue and mucous membranes, restlessness, irritability, and seizures. Findings associated with potassium excess include cardiac arrhythmias, weakness, abdominal cramps, diarrhea, anxiety, and paresthesia. Phosphorus excess leads to tetany and seizures. Magnesium excess causes weakness, nausea, and malaise.

The nurse is providing nutrition counseling for a patient planning pregnancy. The nurse should emphasize the importance of consuming which nutrient to prevent neural tube defects? 1)Folic acid 2)Calcium 3)Protein 4)Vitamin D

ANS: 1 The nurse should emphasize the importance of consuming folic acid even before conception to prevent neural tube defects from developing. Calcium and protein needs also increase during pregnancy; however, their consumption does not prevent neural tube defects. Vitamin D consumption does not prevent neural tube defects.

A mother brings her 4-month-old infant for a well-baby checkup. The mother tells the nurse that she would like to start bottle feeding her baby because she cannot keep up with the demands of breastfeeding since returning to work. Which response by the nurse is appropriate? 1)"Make sure you give your baby an iron-fortified formula to supplement any stored breast milk you have." 2)"You really need to continue breastfeeding your baby." 3)"Give your baby formula until he is 6 months old; then you can introduce whole milk." 4)"Your baby weighs 14 pounds, so he will require about 36 ounces of formula a day."

ANS: 1 The nurse should not make the mother feel guilty about her decision to stop breastfeeding. Instead, she should provide the mother with instruction about bottle feeding. She can give it to supplement any stored breast milk she might have in supply. She should emphasize the importance of giving the baby iron-fortified formula because fetal iron stores become depleted by 4 to 6 months of age. Infants younger than 1 year of age should not receive regular cow's milk because it may place a strain on the immature kidneys. Because the baby weighs 14 pounds, he will require about 21 ounces of formula a day (not 36 ounces), based on the nutritional recommendations that infants require 80 to 100 mL of formula or breast milk per kilogram of body weight per day.

Which portion of a nutritional assessment must the registered nurse complete? 1)Analyzing the data 2)Obtaining intake and output 3)Weighing the patient 4)Obtaining the history

ANS: 1 The registered nurse should review and interpret (analyze) the data collected as part of a nutritional assessment. The registered nurse can delegate height, weight, and intake and output to nursing assistive personnel. History taking can be safely delegated to the licensed practical nurse.

A 52-year-old man has a triceps skinfold thickness of 18 mm, and his weight exceeds the ideal body weight for his height by 23%. Which nursing diagnosis should the nurse identify for this patient? 1)Imbalanced Nutrition: More Than Body Requirements 2)Risk for Imbalanced Nutrition: More Than Body Requirements 3)Imbalanced Nutrition: Less Than Body Requirements 4)Readiness for Enhanced Nutrition

ANS: 1 This patient has defining characteristics for the nursing diagnosis Imbalanced Nutrition: More Than Body Requirements: triceps skinfold thickness more than 15 mm in men and weight that is 20% over ideal for height and frame. The patient does not have defining characteristics for the other nursing diagnoses.

To promote wound healing, the nurse is teaching a patient about choosing foods containing protein. The nurse will evaluate that learning has occurred if the patient recognizes which food(s) as an incomplete protein that should be consumed with a complementary protein? Choose all that apply. 1)Whole grain bread 2)Peanut butter 3)Chicken 4)Eggs

ANS: 1, 2 Incomplete protein foods do not provide all of the essential amino acids necessary for protein synthesis. Therefore, the nurse should inform the patient that whole grain bread and peanut butter should be consumed with a complementary protein. For example, they could be eaten together as a peanut butter sandwich.

The nurse is teaching a patient about the importance of reducing saturated fats in his diet. The nurse will recognize that learning has occurred if, upon questioning, the patient replies that he should read product labels to eliminate the intake of which saturated fat(s)? Choose all that apply. 1)Palm oil 2)Coconut oil 3)Canola oil 4)Peanut oil

ANS: 1, 2 Palm and coconut oils are sources of saturated fat that are contained in many processed foods. The patient should be encouraged to read product labels to eliminate them from his diet. Olive, canola, and peanut oils are unsaturated fats and should be substituted for saturated fats in the diet.

Which instruction(s) should the nurse give to the patient complaining of constipation? Choose all that apply. 1)Drink at least eight glasses of water or non-caffeinated fluid per day. 2)Include a minimum of four servings of meat per day. 3)Consume a high-fiber diet. 4)Exercise as you feel necessary.

ANS: 1, 3 To prevent constipation, the nurse should instruct the patient to consume a high-fiber diet, drink at least eight glasses of water or non-caffeinated fluid per day, exercise regularly, and eat meals on a regular schedule. Caffeine can aggravate constipation.

For a patient with Risk for Imbalanced Nutrition: Less Than Body Requirements related to Impaired Swallowing, which nursing interventions are appropriate? Choose all that apply. 1)Check inside the mouth for pocketing of food after eating. 2)Provide a full liquid diet that is easy to swallow. 3)Remind the patient to raise the chin slightly to prepare for swallowing. 4)Keep the head of the bed elevated for 30 to 45 minutes after feeding.

ANS: 1, 4 The nurse should check for pocketing of food that the patient has not been able to swallow, and should keep the head of the bed elevated for 30 to 45 minutes after feeding. Liquids should be avoided unless thickeners are added. The patient should flex the head forward (tuck the chin) in preparation for swallowing.

Which patient is most likely experiencing positive nitrogen balance? A patient admitted: 1)With third-degree burns of his legs. 2)In the sixth month of a healthy pregnancy. 3)From a nursing home who has been refusing to eat. 4)With acute pancreatitis.

ANS: 2 A positive nitrogen balance typically exists during pregnancy when new tissues are being formed. Patients with burns, malnutrition, and serious illness commonly experience negative nitrogen balance because tissues are lost.

A patient with trigeminal neuralgia is prescribed a mechanical soft diet. This diet places the patient at risk for which complication? 1)Dehydration 2)Constipation 3)Hyperglycemia 4)Diarrhea

ANS: 2 Because of its lack of fiber, a mechanical soft diet places the patient at risk for constipation. It does not place the patient at risk for dehydration, hyperglycemia, or diarrhea.

A middle-aged patient with a history of alcohol abuse is admitted with acute pancreatitis. This patient will most likely be deficient in which nutrients? 1)Iron 2)B vitamins 3)Calcium 4)Phosphorus

ANS: 2 Patients who regularly abuse alcohol may be deficient in many nutrients; however, they are commonly deficient in the B vitamins and folic acid. Vitamin A deficiency can be associated with night blindness in heavy drinkers; vitamin D deficiency leads to softening of the bones. Because some alcoholics are deficient in vitamins A, C, D, E, and K and the B vitamins, they experience delayed wound healing. In particular, because vitamin K, the vitamin needed for blood clotting, is commonly deficient in those who regularly abuse alcohol, those patients can have delayed clotting, resulting in excess bleeding. Deficiencies of other vitamins involved in brain function can cause severe neurological damage.

Which laboratory test result most accurately reflects a patient's nutritional status? 1)Albumin 2)Prealbumin 3)Transferrin 4)Hemoglobin

ANS: 2 Prealbumin levels fluctuate daily and give the best indication of the patient's immediate nutritional status. Albumin level is not as accurate because the half-life of albumin is 18 to 21 days, causing a delay in detection of nutritional problems. Transferrin, a protein that binds to iron, has a half-life of 8 to 9 days; therefore, it allows for faster detection of protein deficiency than does albumin. However, transferrin is not as fast as prealbumin. Hemoglobin level reflects iron intake or blood loss.

Patients may be deficient in which vitamin during the winter months? 1)A 2)D 3)E 4)K

ANS: 2 The body can synthesize vitamin D from a cholesterol compound in the skin when exposed to adequate sunlight. People at risk for vitamin D deficiency are those who spend little time outdoors, older people, and people who live in an institution (e.g., a nursing home). The deficiency can also occur in the winter at northern and southern latitudes, in people who keep their bodies covered (e.g., traditional Muslim women), and in those who use sunscreen. Also, because breast milk contains only small amounts of vitamin D, breastfed infants who are not exposed to enough sunlight are at risk of the deficiency and rickets. There is no seasonal tie to deficiencies in the other fat-soluble vitamins, A, E, and K.

Where in the body is glucose stored? Choose all that apply. 1)Brain 2)Liver 3)Skeletal muscles 4)Smooth muscles

ANS: 2, 3 Human beings store glucose in liver and skeletal muscle tissue as glycogen. Glycogen is converted back into glucose to meet energy needs.

A patient who underwent surgery 24 hours ago is prescribed a clear liquid diet. The patient asks for something to drink. Which item may the nurse provide for the patient? 1)Tea with cream 2)Orange juice 3)Gelatin 4)Skim milk

ANS: 3 A clear liquid diet consists of water; tea (without cream); coffee; broth; clear juices, such as apple, grape, or cranberry; popsicles; carbonated beverages; and gelatin. Skim milk, tea with cream, and orange juice are included in a full liquid diet.

During the day shift, a patient's temperature measures 97°F (36.1°C) orally. At 2000, the patient's temperature measures 102°F (38.9°C). What effect does this rise in temperature have on the patient's basal metabolic rate? 1)Increases the rate by 7% 2)Decreases the rate by 14% 3)Increases the rate by 35% 4)Decreases the rate by 28%

ANS: 3 Basal metabolic rate increases 7% for each degree Fahrenheit (0.56°C); therefore, this patient's temperature rise is an increase of 35%.

A patient's 2:1 parenteral nutrition container infuses before the pharmacy prepares the next container. This places the patient at risk for which complication? 1)Sepsis 2)Pneumothorax 3)Hypoglycemia 4)Thrombophlebitis

ANS: 3 Because of the high glucose content of 2:1 parenteral nutrition, any interruption in therapy places the patient at risk for hypoglycemia. A PN of this type should not be discontinued abruptly, but rather over several (as many as 48) hours to prevent a sudden drop in blood sugar. Hypoglycemia is unlikely to occur with a 3:1 solution (containing lipids), as the final concentration of glucose is less than 10%. Sepsis is a complication that can occur if a break in aseptic technique occurs during therapy. Pneumothorax can occur as a result of central venous catheter insertion. Central venous catheters are typically employed for parenteral nutrition. Thrombophlebitis is a complication of central venous catheter use.

Which polysaccharide is stored in the liver? 1)Insulin 2)Ketones 3)Glycogen 4)Glucose

ANS: 3 Humans store glucose in the liver as polysaccharides, known as glycogen. Glycogen can then be converted back into glucose to meet energy needs through a process known as glycogenolysis. If fats must be used for energy, they are converted directly into ketones. Insulin is a pancreatic hormone that promotes the movement of glucose into cells.

Which nutritional goal is appropriate for a patient newly diagnosed with hypertension? The patient will: 1)Limit his intake of protein. 2)Avoid foods containing gluten. 3)Restrict his use of sodium. 4)Limit his intake of potassium-rich foods.

ANS: 3 Patients with hypertension should limit their intake of sodium. Those with liver disease should control their protein intake. Patients with renal disease must limit their intake of potassium-rich foods. Patients with celiac disease should avoid foods containing gluten.

While addressing a community group, the nurse explains the importance of replacing saturated fats in the diet with mono- and polyunsaturated fats. She emphasizes that doing so greatly reduces the risk of which complication? 1)Kidney failure 2)Liver failure 3)Stroke 4)Lung cancer

ANS: 3 Replacing saturated fats in the diet with mono- and polyunsaturated fats reduces the risk of heart disease, atherosclerosis, and stroke, not kidney failure, liver failure, or lung cancer.

A patient with type 1 diabetes mellitus is admitted with hyperglycemia and associated acidosis. The presence of which alternative fuel in the body is responsible for the acidosis? 1)Glycogen 2)Insulin 3)Ketones 4)Proteins

ANS: 3 When fats are converted to ketones for use as alternative fuel, as in diabetic ketoacidosis when glucose cannot by used by the cells, the acidity of the blood rises, leading to the acidosis. Glycogen is converted to glucose to meet energy needs. Insulin, a pancreatic hormone, promotes the movement of glucose into cells for use. Proteins would not be used for fuel as long as fats were available.

Which of the following interventions would help to prevent or relieve persistent nausea? 1)Assess for signs of dehydration. 2)Provide dietary supplements. 3)Have the patient sit in an upright position for 30 minutes after eating. 4)Immediately remove any food that the patient cannot eat

ANS: 4 Dehydration can occur as a result of continued nausea and vomiting, so the nurse should assess for it. However, this intervention does not prevent nausea. Dietary supplements might help to prevent malnutrition. However, they do not prevent nausea; in fact, they often cause nausea. Having the patient sit upright helps to prevent respiratory aspiration should the patient vomit; it does not prevent or relieve nausea. Odors (even pleasant ones) and even the sight of food can cause nausea, so any uneaten food should be removed immediately from the room.

A patient has anemia. An appropriate goal for that the patient would be for him to increase his intake of which nutrient? 1)Calcium 2)Magnesium 3)Potassium 4)Iron

ANS: 4 Iron deficiency causes anemia; therefore, the nurse should encourage the patient with anemia to increase his intake of iron. Increasing calcium intake helps prevent osteoporosis. Magnesium supplementation may decrease the risk of hypertension and coronary artery disease in women. Potassium is essential for muscle contraction, acid-base balance, and blood pressure control.

After instructing a mother about nutrition for a preschool-age child, which statement by the mother would indicate correct understanding of the topic? 1)"I usually use dessert only as a reward for eating other foods." 2)"I will hide vegetables in casseroles and stews to get my child to eat them." 3)"I do not give my child snacks; they simply spoil his appetite for meals." 4)"I know that lifelong food habits are developed during this stage of life."

ANS: 4 Lifelong food habits are developed during the preschool stage of life. Therefore, the mother should widen the variety of foods she introduces to her child. Desserts should not be used as rewards for eating other foods. This practice can shape an attitude about food that can lead to eating disorders later in life. Preschool-age children often refuse combined foods such as casseroles and stews. Because they are active, preschoolers require nutritious between-meal snacks.

Which organ relies almost exclusively on glucose for energy? 1)Liver 2)Heart 3)Pancreas 4)Brain

ANS: 4 The brain relies almost exclusively on glucose for energy. The heart and liver do not. The pancreas produces insulin for glucose utilization but does not use glucose. REF: p. 902; ESG, Chapter 28, Supplemental Materials, Dietary Reference Intake: Macronutrients