Chapter 44: Nutrition

The nurse is concerned about pulmonary aspiration when providing her patient with tube feedings. The nurse should a. Verify tube placement before feeding. b. Lower the head of the bed to a supine po-sition. c. Add blue food coloring to the enteral formula. d. Run the formula over 12 hours to decrease volume.

ANS: A A major cause of pulmonary aspiration is regurgitation of formula. The nurse needs to verify tube placement and elevate the head of the bed 30 to 45 degrees during feedings and for 2 hours afterward. The addition of blue food coloring to enteral formula to assist with detection of aspi-rate is no longer used. Do not hang formula longer than 4 to 8 hours. Formula becomes a medium for bacterial growth after that length of time.

The patient has just started on enteral feedings but is complaining of abdominal cramping. The nurse should a. Slow the rate of tube feeding. b. Instill cold formula to "numb" the stom-ach. c. Place the patient in a supine position. d. Change the tube feeding to a high-fat formula.

ANS: A One possible cause of abdominal cramping is a rapid increase in rate or volume. Lowering the rate of delivery may increase tolerance. Another possible cause of abdominal cramping is use of cold formula. The nurse should warm the formula to room temperature. The nurse should maintain the head of the bed at least 30 degrees. High-fat formulas are also a cause of abdominal cramping.

In determining the nutritional status of a patient and developing a plan of care, it is important to evaluate the patient according to a. Published standards. b. Nursing professional standards. c. Absence of family input. d. Patient input only.

ANS: A Referring to professional standards for nutrition is especially important during this step because published standards are based on scientific findings. Nursing standards cannot be used alone. Other health care professionals must be consulted to adopt interventions that reflect the patient's needs. Family should be involved in evaluation and design of interventions. Although patient input is important, synthesis of patient information from multiple sources is necessary to devising an individualized approach to care that is relevant to the patient's needs.

The nurse is providing home care for a patient diagnosed with AIDS. In preparing meals for this patient, the nurse should a. Provide small, frequent nutrient-dense meals. b. Encourage intake of fatty foods to in-crease caloric intake. c. Prepare hot meals because they are more easily tolerated. d. Avoid salty foods and limit liquids to preserve electrolytes.

ANS: A Small, frequent, nutrient-dense meals that limit fatty foods and overly sweet foods are easier to tolerate. Patients benefit from eating cold foods and drier or saltier foods with fluid in between.

The energy needed to maintain life-sustaining activities for a specific period of time at rest is known as a. BMR. b. REE. c. Nutrients. d. Nutrient density.

ANS: A The basal metabolic rate (BMR) is the energy needed to maintain life-sustaining activities for a specific period of time at rest. The resting energy expenditure (REE), or resting metabolic rate, is the amount of energy an individual needs to consume over a 24-hour period for the body to maintain all of its internal working activities while at rest. Nutrients are the elements necessary for body processes and function. Nutrient density is the proportion of essential nutrients to the number of kilocalories. High-nutrient density foods provide a large number of nutrients in rela-tion to kilocalories.

Fats are composed of triglycerides and fatty acids. Triglycerides a. Are made up of three fatty acids. b. Can be saturated. c. Can be monounsaturated. d. Can be polyunsaturated.

ANS: A Triglycerides circulate in the blood and are made up of three fatty acids attached to a glycerol. Fatty acids (not triglycerides) can be saturated or unsaturated (monounsaturated or polyunsatu-rated).

When expected nutritional outcomes are not being met, the nurse should a. Revise the nurse measures or expected outcomes. b. Alter the outcomes based on nursing standards. c. Ensure that patient expectations are con-gruent with the nurse's expectations. d. Readjust the plan to exclude cultural be-liefs.

ANS: A When expected outcomes are not met, the nurse should revise the nursing measures or expected outcomes based on the patient's needs or preferences, not solely on the basis of nursing stand-ards. Expectations and health care values held by nurses frequently differ from those held by pa-tients. Working closely with patients enables the nurse to redefine expectations that are realisti-cally met within the limits of conditions and treatments and to identify their dietary preferences and cultural beliefs.

In providing diet education for a patient on a low-fat diet, it is important for the nurse to understand that with few exceptions a. Saturated fats are found mostly in vegeta-ble sources. b. Saturated fats are found mostly in animal sources. c. Unsaturated fats are found mostly in ani-mal sources. d. Linoleic acid is a saturated fatty acid.

ANS: B Most animal fats have high proportions of saturated fatty acids, whereas vegetable fats have higher amounts of unsaturated and polyunsaturated fatty acids. Linoleic acid, an unsaturated fatty acid, is the only essential fatty acid in humans.

When developing a plan of care for a patient with altered nutritional needs, the nurse must assess the patient for which of the following? (Select all that apply.) a. What is the condition now? b. Is the condition stable? c. Will the condition get worse? d. Will the disease process accelerate deteri-oration? e. Which single objective measure will pre-dict the course of action?

ANS: A, B, C, D Nutritional screening tools must gather data based on four main principles: What is the condition now? Is the condition stable? Will the condition get worse? And will the disease process acceler-ate nutritional deterioration? Using a single objective measure is ineffective in predicting risk of nutritional problems.

Dietary reference intakes (DRIs) present evidence-based criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age group. Components of DRIs include which of the following? (Select all that apply.) a. Estimated average requirement (EAR) b. Recommended dietary allowance (RDA) c. The Food Guide Pyramid d. Adequate intake (AI) e. The tolerable upper intake level (UL)

ANS: A, B, D, E Dietary reference intakes (DRIs) present evidence-based criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age group. DRIs have four components. The estimated average requirement (EAR) is the recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population based on age and gen-der. The recommended dietary allowance (RDA) indicates the average needs of 98% of the pop-ulation, not the exact needs of the individual. Adequate intake (AI) is the suggested intake for individuals based on observed or experimentally determined estimates of nutrient intakes and is used when evidence is insufficient to allow the RDA to be set. The tolerable upper intake level (UL) is the highest level that likely poses no risk of adverse health events. It is not a recom-mended level of intake. The food guide pyramid is not a component of the DRIs.

To create a new nutritional plan of care for a patient, the nurse needs to do which of the following? (Select all that apply.) a. Utilize the characteristics of a normal nu-tritional status. b. Evaluate previous patient responses to nursing interventions. c. Exclude established expected outcomes to evaluate patient responses. d. Design innovative interventions to meet the patient's needs. e. Follow through with evaluation and counseling.

ANS: A, B, D, E To create a new nutritional plan of care, the nurse must utilize characteristics of a normal nutri-tional status to gauge effectiveness of the plan. The nurse must be aware of previous patient re-sponses to nursing interventions for altered nutrition to determine the probability of success. The nurse must use established expected outcomes to evaluate the patient's response to care (e.g., patient's weight increases by 0.5 kg/week). The nurse must also be creative when designing in-novative nursing interventions to meet the patient's nutritional needs and must demonstrate re-sponsibility by following through with evaluation and counseling to successfully reach goals.

The patient is asking the nurse about the best way to stay healthy. The nurse explains to the patient that from a nutritional point of view, the patient should (Select all that apply.) a. Maintain body weight in a healthy range. b. Increase physical activity. c. Increase intake of meat and other high-protein foods. d. Keep total fat intake to 10% or less. e. Choose and prepare foods with little salt.

ANS: A, B, E According to the 2005 Dietary Guidelines for Americans, key recommendations include main-taining body weight in a healthy range; increasing physical activity and decreasing sedentary ac-tivities; increasing intake of fruits, vegetables, whole grain products, and fat-free or low-fat milk with less red meat; keeping fat intake between 30% and 35% of total calories, with most fats coming from polyunsaturated or monounsaturated fatty acids (most meats contain saturated fatty acids); and choosing prepared foods with little salt while at the same time eating potassium-rich foods.

Dysphagia refers to difficulty when swallowing. Of the following causes of dysphagia, which is considered neurogenic? a. Myasthenia gravis b. Stroke c. Candidiasis d. Muscular dystrophy

ANS: B Stroke is the only cause of dysphagia in this list that is considered neurogenic. Myasthenia gravis and muscular dystrophy are considered myogenic in origin, whereas candidiasis is considered obstructive.

The ChooseMyPlate program includes guidelines for a. Children younger than 2 years. b. Balancing calories. c. Increasing portion size. d. Decreasing water consumption.

ANS: B The ChooseMyPlate program includes guidelines for balancing calories; decreasing portion size; increasing healthy foods; increasing water consumption; and decreasing fats, sodium, and sugars. These guidelines have been put forth for Americans over the age of 2 years.

The patient with cardiovascular disease must be taught how to reduce the risk of cardiovascular disease by balancing calorie intake with exercise to maintain a healthy body weight. In addition to this, the nurse instructs the patient to a. Eat fish at least 5 times per week. b. Limit saturated fat to less than 7%. c. Limit cholesterol to less than 200 mg/day. d. Avoid high-fiber foods.

ANS: B AHA guidelines recommend limiting saturated fat to less than 7%, trans fat to less than 1%, and cholesterol to less than 300 mg/day. Diet therapy includes eating fish at least 2 times per week and eating whole grain high-fiber foods.

The patient is to receive multiple medications via the nasogastric tube. The nurse is concerned that the tube may become clogged. To prevent this, the nurse a. Irrigates the tube with 60 mL of water af-ter all medications are given. b. Checks with the pharmacy to find out if liquid forms of the medications are avail-able. c. Instills nonliquid medications without di-luting. d. Mixes all medications together to decrease the number of administrations.

ANS: B Avoid crushed medication if liquid is available. Irrigate with 30 mL of water before and after each medication per tube. Dilute crushed medications if not liquid. Read pharmacological infor-mation on compatibility of drugs and formula before mixing medications.

Before giving the patient an intermittent tube feeding, the nurse should a. Make sure that the tube is secured to the gown with a safety pin. b. Have the tube feeding at room tempera-ture. c. Inject air into the stomach via the tube and auscultate. d. Place the patient in a supine position.

ANS: B Cold formula causes gastric cramping and discomfort because the mouth and the esophagus do not warm the liquid. Do not use safety pins. Safety pins can become unfastened and may cause harm to the patient. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inadvertently placed in the lungs, pharynx, or esophagus transmits sound similar to that of air entering the stomach. Place the patient in high-Fowler's position, or elevate the head of the bed at least 30 degrees to help prevent aspiration.

When teaching a patient about current dietary guidelines for the general population, the nurse explains referenced daily intakes (RDIs) and daily reference values (DRVs), otherwise known as daily values. In providing this information, the nurse understands that daily values a. Have replaced recommended daily al-lowances (RDAs). b. Have provided a more understandable format of RDAs for the public. c. Are based on percentages of a diet con-sisting of 1200 kcal/day. d. Are not usually easy to find computer ex-perience is required.

ANS: B Daily values did not replace RDAs but provided a separate, more understandable format for the public. Daily values are based on percentages of a diet consisting of 2000 kcal/day; these values constitute the daily values used on food labels, which are easy for anyone to find. Computer ex-perience is not required.

In providing diabetic teaching for a patient with type 1 diabetes mellitus, the nurse instructs the patient that a. Insulin is the only consideration that must be taken into account. b. Saturated fat should be limited to less than 7% of total calories. c. Cholesterol intake should be greater than 200 mg/day. d. Nonnutritive sweeteners can be used without restriction.

ANS: B The diabetic patient should limit saturated fat to less than 7% of total calories and cholesterol intake to less than 200 mg/day. Type 1 diabetes requires both insulin and dietary restrictions for optimal control. Nonnutritive sweeteners can be eaten as long as the recommended daily intake levels are followed.

The nurse is assessing a patient for nutritional status. In doing so, the nurse must a. Choose a single objective tool that fits the patient's condition. b. Combine multiple objective measures with subjective measures. c. Forego the assessment in the presence of chronic disease. d. Use the Mini Nutritional Assessment for pediatric patients.

ANS: B Using a single objective measure is ineffective in predicting risk of nutritional problems. Combine multiple objective measures with subjective measures related to nutrition to adequately screen for nutritional problems. Chronic disease and increased metabolic requirements are risk factors for the development of nutritional problems; these patients may be in critical need of this assessment. The Mini Nutritional Assessment was developed to use for screening older adults in home care programs, nursing homes, and hospitals.

Knowing that protein is required for tissue growth, maintenance, and repair, the nurse must understand that for optimal tissue healing to occur, the patient must be in a. Negative nitrogen balance. b. Positive nitrogen balance. c. Total dependence on protein for kcal pro-duction. d. Neutral nitrogen balance.

ANS: B When intake of nitrogen is greater than output, the body is in positive nitrogen balance. Positive nitrogen balance is required for growth, normal pregnancy, maintenance of lean muscle mass and vital organs, and wound healing. Negative nitrogen balance occurs when the body loses more nitrogen than the body gains. Neutral nitrogen balance occurs when gain equals loss and is not optimal for tissue healing. Protein provides energy, but because of the essential role of protein in growth, maintenance, and repair, a diet needs to provide adequate kilocalories from nonprotein sources.

To counter obesity in adolescents, increasing physical activity is often more important than curbing intake. Sports and regular, moderate to intense exercise necessitate dietary modifications to meet increased energy needs for adolescents. The nurse understands that these modifications include a. Decreasing carbohydrates to 25% to 30% of total intake. b. Decreasing protein intake to .75 g/kg/day. c. Ingesting water before and after exercise. d. Providing vitamin and mineral supple-ments.

ANS: C Adequate hydration is very important for all athletes. They need to ingest water before and after exercise to prevent dehydration, especially in hot, humid environments. Carbohydrates, both simple and complex, are the main source of energy, providing 55% to 60% of total daily kilocal-ories. Protein needs increase to 1.0 to 1.5 g/kg/day. Vitamin and mineral supplements are not re-quired, but intake of iron-rich foods is required to prevent anemia.

At present, the most reliable method for verification of placement of small-bore feeding tubes is a. Auscultation. b. Aspiration of contents. c. X-ray. d. pH testing.

ANS: C At present, the most reliable method for verification of placement of small-bore feeding tubes is x-ray examination. Aspiration of contents and pH testing are not infallible. The nurse would need a more precise indicator to help differentiate the source of tube feeding aspirate. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inad-vertently placed in the lungs, pharynx, or esophagus transmits sound similar to that of air entering the stomach.

The patient has been diagnosed with cardiovascular disease and placed on a low-fat diet. The patient asks the nurse, "How much fat should I have? I guess the less fat, the better." The nurse needs to explain that a. Fats have no significance in health and the incidence of disease. b. All fats come from external sources so can be easily controlled. c. Deficiencies occur when fat intake falls below 10% of daily nutrition. d. Vegetable fats are the major source of saturated fats and should be avoided.

ANS: C Deficiency occurs when fat intake falls below 10% of daily nutrition. Various types of fatty acids have significance for health and for the incidence of disease and are referred to in dietary guidelines. Linoleic acid and arachidonic acid are important for metabolic processes but are manufactured by the body when linoleic acid is available. Most animal fats have high proportions of sat

The nurse is caring for a patient who will be receiving PN. To reduce the risk of developing sepsis, the nurse a. Takes down a running bag of TPN after 36 hours. b. Runs lipids for no longer than 24 hours. c. Wears a sterile mask when changing the CVC dressing. d. Wears clean gloves when changing the CVC dressing.

ANS: C During CVC dressing changes, always use a sterile mask and gloves, and assess insertion sites for signs and symptoms of infection. To avoid infection, change the TPN infusion tubing every 24 hours, and do not hang a single container of PN for longer than 24 hours or lipids longer than 12 hours.

To provide successful nutritional therapies to patients, the nurse must understand that a. Patients will have to change diet prefer-ences drastically to be successful. b. The patient will tell the nurse when to change the plan of care. c. Expectations of nurses frequently differ from those of the patient. d. Nurses should never alter the plan of care regardless of outcome.

ANS: C Expectations and health care values held by nurses frequently differ from those held by patients. Successful interventions and outcomes depend on recognition of this concept, in addition to nursing knowledge and skill. If ongoing nutritional therapies are not resulting in successful out-comes, patients expect nurses to recognize this fact and alter the plan of care accordingly. Work-ing closely with patients enables the nurse to redefine expectations that are realistically met within the limits of conditions and treatments and to identify their dietary preferences and cultural beliefs.

In providing prenatal care to a patient, the nurse teaches the expectant mother that a. Protein intake needs to decrease to pre-serve kidney function. b. Calcium intake is especially important in the first trimester. c. Folic acid is needed to help prevent birth defects and anemia. d. The mother should take in as many extra vitamins and minerals as possible.

ANS: C Folic acid intake is particularly important for DNA synthesis and growth of red blood cells. In-adequate intake may lead to fetal neural tube defects, anencephaly, or maternal megaloblastic anemia. Protein intake throughout pregnancy needs to increase to 60 g daily. Calcium intake is especially critical in the third trimester, when fetal bones are mineralized. Prenatal care usually includes vitamin and mineral supplementation to ensure daily intakes; however, pregnant women should not take additional supplements beyond prescribed amounts.

The patient has just been started on an enteral feeding and has developed diarrhea after being on the feeding for 2 hours. The most likely cause of the diarrhea would be a. Clostridium difficile. b. Antibiotic therapy. c. Formula intolerance. d. Bacterial contamination.

ANS: C Hyperosmolar formulas can cause diarrhea. If that is the case, the solution is to lower the rate, dilute the formula, or change to an isotonic formula. Antibiotics destroy normal intestinal flora and disturb the internal ecology, allowing for Clostridium difficile toxin buildup. However, this takes time, and no indication suggests that this patient was on antibiotics. Proximity to the start of the enteral feedings is more suspicious. Bacterial contamination of the feeding usually occurs when feedings are left hanging for longer than 8 hours.

In general, when energy requirements are completely met by kilocalorie (kcal) intake in food a. Weight increases. b. Weight decreases. c. Weight does not change. d. Kilocalories are not a factor.

ANS: C In general, when energy requirements are completely met by kilocalorie (kcal) intake in food, weight does not change. When kilocalories ingested exceed a person's energy demands, the indi-vidual gains weight. If kilocalories ingested fail to meet a person's energy requirement, the indi-vidual loses weight. Kilocalories are a factor.

In creating a plan of care to meet the nutritional needs of the patient, the nurse needs to explore the patient's feelings about weight and food. The nurse must do this to a. Determine which category of plan to use. b. Set realistic goals for the patient. c. Mutually plan goals with patient and team. d. Prevent the need for a dietitian consult.

ANS: C Mutually planned goals negotiated by patient, registered dietitian, and nurse ensure success. In-dividualized planning cannot be overemphasized. Preplanned and categorical care plans are not effective unless they are individualized to meet patient needs. It is important to explore patients' feelings about weight and food to help them set realistic and achievable goals. The nurse does not set goals for the patient. The plan should reflect the combined effort of patient, nurse, and dietitian, so a dietitian consult is required.

The patient is on PN and is lethargic. He has been complaining of thirst and headache and has had increased urination. Which of the following problems would cause these symptoms? a. Electrolyte imbalance b. Hypoglycemia c. Hyperglycemia d. Hypercapnia

ANS: C Signs and symptoms of hyperglycemia are thirst, headache, lethargy, and increased urination. Electrolyte imbalance is marked by changes in Na, Ca, K, Cl, PO4, Mg, and CO2 levels. These have to be monitored closely when patients are on PN. Hypercapnia increases oxygen consump-tion and increases CO2 levels. Ventilator-dependent patients are at greatest risk for this. Hypo-glycemia is characterized by diaphoresis, shakiness, confusion, and loss of consciousness.

The patient is having at least 75% of his nutritional needs met by enteral feeding, so the physician has ordered the PN to be discontinued. However, the nurse notices that the PN infusion has fallen behind. The nurse should a. Increase the rate to get the volume caught up before discon-tinuing. b. Stop the infusion and hang a normal saline drip in place. c. Taper the PN infusion gradually. d. Hang 5% dextrose if the PN runs out.

ANS: C Sudden discontinuation of PN can cause hypoglycemia. PN must be tapered off. Usually, 10% dextrose is infused when PN solution is suddenly discontinued. The same is true if the PN runs out. Too rapid administration of hypertonic dextrose (PN) can result in an osmotic diuresis and dehydration. If an infusion falls behind schedule, the nurse should not increase the rate in an at-tempt to catch up.

The nurse is providing nutrition teaching to a Korean patient. In doing so, the nurse must understand that the focus of the teaching should be on a. Changing the patient's diet to a more conventional American diet. b. Discouraging the patient's ethnic food choices. c. Food preferences of the patient, including racial and ethnic choices. d. Comparing the patient's ethnic preferences with American dietary choices.

ANS: C The nurse needs to make sure to consider the food preferences of different racial and ethnic groups, vegetarians, and others when planning diets. Initiation of a balanced diet is more im-portant than conversion to what may be considered an American diet. Ethnic food choices may be just as nutritious as "American" choices. Foods should be chosen for their nutritive value and should not be compared with the "American" diet.

The patient is an 80-year-old male who is visiting the clinic today for his routine physical examination. The patient's skin turgor is fair, but he has been complaining of fatigue and weak-ness. The skin is warm and dry, pulse rate is 126 beats per minute, and urinary sodium level is slightly elevated. After assessment, the nurse should recommend that the patient a. Decrease his intake of milk and dairy products to decrease the risk of osteopo-rosis. b. Drink more grapefruit juice to enhance vitamin C intake and medication absorp-tion. c. Drink more water to prevent further de-hydration. d. Eat more meat because meat is the only source of usable protein.

ANS: C Thirst sensation diminishes, leading to inadequate fluid intake or dehydration. Symptoms of de-hydration in older adults include confusion, weakness, hot dry skin, furrowed tongue, and high urinary sodium. Milk continues to be an important food for older woman and men, who need adequate calcium to protect against osteoporosis. After age 70, osteoporosis equally affects men and women. Caution older adults to avoid grapefruit and grapefruit juice because these will de-crease absorption of many drugs. Some older adults avoid meats because of cost, or because they are difficult to chew. Cream soups and meat-based vegetable soups are nutrient-dense sources of protein.

The patient has a calculated body mass index (BMI) of 34. This would classify the patient as a. Unclassifiable. b. Normal weight. c. Overweight. d. Obese.

ANS: D BMI greater than 30 is defined as obesity. BMI between 25 and 30 is classified as overweight. BMI less than 25 is considered normal or underweight. All patients can be classified by dividing their weight in kilograms by their height in meters squared.

In teaching mothers-to-be about infant nutrition, the nurse instructs patients to a. Give cow's milk during the first year of life. b. Supplement breast milk with corn syrup. c. Add honey to infant formulas for in-creased energy. d. Remember that breast milk or formula is sufficient for the first 4 to 6 months.

ANS: D Breast milk or formula provides sufficient nutrition for the first 4 to 6 months of life. Infants should not have regular cow's milk during the first year of life. Cow's milk causes gastrointesti-nal bleeding, is too concentrated for the infant's kidneys to manage, increases the risk of milk product allergies, and is a poor source of iron and vitamins C and E. Honey and corn syrup are potential sources of botulism toxin and should not be used in the infant diet.

Patients who are unable to digest or absorb enteral nutrition benefit from parenteral nutrition (PN). However, the goal to move toward use of the GI tract is constant because PN a. Can be given only in the hospital setting. b. Cannot be used in patients in highly stressed situations. c. Can be given only by way of a peripheral IV line. d. Can lead to villous atrophy and cell shrinkage.

ANS: D Disuse of the GI tract has been associated with villous atrophy and generalized cell shrinkage. Translocation of bacteria from the local gut to systemic regions has been noted in relation to GI cell shrinkage, resulting in gram-negative septicemia. PN is administered in a variety of settings, including the patient's home. Patients in highly stressed physiological states such as sepsis, head injury, or burns are candidates for PN therapy. Safe administration of this form of nutrition de-pends on meticulous management of a central venous catheter.

In determining kcal expenditure, the nurse knows that carbohydrates and proteins provide 4 kcal of energy per gram ingested. The nurse also knows that fats provide _____ kcal per gram. a. 3 b. 4 c. 6 d. 9

ANS: D Fats (lipids) are the most calorie-dense nutrient, providing 9 kcal per gram.

The patient is elderly and has been diagnosed with Imbalanced nutrition: less than body requirements. Her treatment regimen should include having the nurse a. Encourage weight gain as rapidly as pos-sible. b. Encourage large meals three times a day. c. Decrease fluid intake to prevent feeling full. d. Encourage fiber intake.

ANS: D Increasing fiber intake deters constipation and enhances appetite. Weight gain should be slow and progressive. Frequent small meals should be encouraged to increase dietary intake and to help offset anorexia. Older adults need eight 8-ounce glasses of fluid per day from beverage and food sources.

The nurse is preparing to insert a nasogastric tube in a patient who is semiconscious. To determine the length of the tube needed to be inserted, the nurse measures from the a. Tip of the nose to the xiphoid process of the sternum. b. Earlobe to the xiphoid process of the sternum. c. Tip of the nose to the earlobe. d. Tip of the nose to the earlobe to the xiph-oid process.

ANS: D Measure distance from the tip of the nose to the earlobe to the xiphoid process of the sternum. This approximates the distance from the nose to the stomach in 98% of patients. For duodenal or jejunal placement, an additional 20 to 30 centimeters is required.

The patient is admitted with facial trauma, including a broken nose, and has a history of esophageal reflux and of aspiration pneumonia. Given this information, which of the following tubes is appropriate for this patient? a. Nasogastric tube b. Percutaneous endoscopic gastrostomy (PEG) tube c. Nasointestinal tube d. Jejunostomy tube

ANS: D Patients with gastroparesis or esophageal reflux or with a history of aspiration pneumonia may require placement of tubes beyond the stomach into the intestine. The nasogastric tube and the PEG tube are placed in the stomach, and placement could lead to aspiration. The nasointestinal tube and the nasogastric tube may be contraindicated by facial trauma and the broken nose. The jejunostomy tube is the only tube in the list that is beyond the stomach and is not contraindicated by facial trauma.

The ChooseMyPlate program was developed to replace MyFoodPyramid as a basic guide for buying food and meal preparations. This system was developed by the a. Food and Drug Administration. b. 1990 Nutrition Labeling and Education Act. c. Referenced daily intakes (RDIs). d. U.S. Department of Agriculture.

ANS: D The ChooseMyPlate program was developed by the U.S. Department of Agriculture to replace the MyFoodPyramid program. ChooseMyPlate serves as a basic guide for making food choices for a healthy lifestyle. The Food and Drug Administration (FDA) created daily values for food labels in response to the 1990 Nutrition Labeling and Education Act (NLEA). The FDA first es-tablished two sets of reference values: referenced daily intakes (RDIs) and daily reference values (DRVs).

In measuring the effectiveness of nutritional interventions, the nurse should a. Expect results to occur rapidly. b. Not be concerned with physical measures such as weight. c. Expect to maintain a course of action re-gardless of changes in condition. d. Evaluate outcomes according to the pa-tient's expectations and goals.

ANS: D The nurse should measure the effectiveness of nutritional interventions by evaluating the pa-tient's expected outcomes and goals of care. Nutrition therapy does not always produce rapid results. Ongoing comparisons need to be made with baseline measures of weight, serum albumin or prealbumin, and protein and kilocalorie intake. Changes in condition may indicate a need to change the nutritional plan of care.

Some proteins are manufactured in the body, but others are not. Those that must be obtained through diet are known as a. Amino acids. b. Dispensable amino acids. c. Triglycerides. d. Indispensable amino acids.

ANS: D The simplest form of protein is the amino acid. The body does not synthesize indispensable amino acids, so these need to be provided in the diet. The body synthesizes dispensable amino acids. Triglycerides are made up of three fatty acids attached to a glycerol

The nurse is teaching the patient about dietary guidelines. In discussing the four components of dietary reference intakes (DRIs), it is important to understand that a. The estimated average requirement (EAR) is appropriate for 100% of the population. b. The recommended dietary allowance (RDA) meets the needs of the individual. c. Adequate intake (AI) determines the nu-trient requirements of the RDA. d. The tolerable upper intake level (UL) is not a recommended level of intake.

ANS: D The tolerable upper intake level (UL) is the highest level that likely poses no risk of adverse health events. It is not a recommended level of intake. The EAR is the recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population based on age and gender. The RDA reflects the average needs of 98% of the population, not the exact needs of the individual. AI is the suggested intake for individuals based on observed or experimentally determined estimates of nutrient intakes and is used when evidence is insufficient for setting of the RDA.