Chapter 44 Nutrition Questions

A woman is considering becoming pregnant. The nurse practitioner recommends that the client begin to consume which of the following before attempting pregnancy to prevent neural tube defects in the fetus? A. Calcium B. Folic acid C. Vitamin C D. Riboflavin

B. Folic acid The importance of consuming folic acid to prevent neural tube deficits has been proven. The other vitamins and minerals are important but not essential.

Which statement made by an adult patient demonstrates understanding of healthy nutrition teaching? A) I need to stop eating red meat. B) I will increase the servings of fruit juice to four a day. C) I will make sure that I eat a balanced diet and exercise regularly. D) I will not eat so many dark green vegetables and eat more yellow vegetables.

C Obesity is an epidemic in the United States. Proposed contributing factors are sedentary lifestyle and poor meal choices. Healthy eating and participation in exercise or other activities of healthy living promote good health.

The nurse is teaching a program on healthy nutrition at the senior community center. Which points should be included in the program for older adults? (Select all that apply.) A) Avoid grapefruit and grapefruit juice, which impair drug absorption. B) Increase the amount of carbohydrates for energy. C) Take a multivitamin that includes vitamin D for bone health. D) Cheese and eggs are good sources of protein. E) Limit fluids to decrease the risk of edema.

A, C, D Caution older adults to avoid grapefruit and grapefruit juice because these impair absorption of many drugs. Thirst sensation diminishes, leading to inadequate fluid intake or dehydration; thus older adults should be encouraged to ingest adequate fluids. 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. Cheese, eggs, and peanut butter are also useful high-protein alternatives. Milk continues to be an important food for older women and men who need adequate calcium to protect against osteoporosis (a decrease of bone mass density). Screening and treatment are necessary for both older men and women. Vitamin D supplements are important for improving strength and balance, strengthening bone health, and preventing bone fractures.

The nurse is caring for a client experiencing dysphagia. Which interventions will help decrease the risk of aspiration during feeding? (Select all that apply.) A. Have the client sit upright in a chair. B. Give liquids at the end of the meal. C. Place food in the strong side of the mouth. D. Provide thin foods to make it easier to swallow. E. Feed the client slowly, allowing time for the client to chew and swallow. F. Encourage the client to lie down to rest for 30 minutes after eating.

A, C, E The nurse should have the client sit upright or in high-Fowler's position and then feed the client slowly, allowing the client time to chew and swallow. Thin foods should be thickened to the consistency of mashed potatoes to make swallowing easier, and the food should be placed in the strong side of the mouth. Liquids should be thickened, but the client should be allowed to have them as desired. The client should sit upright for 30 minutes after eating to ensure digestion and prevent reflux of the food.

The nurse is caring for a patient experiencing dysphagia. Which interventions help decrease the risk of aspiration during feeding? (Select all that apply.) A) Sit the patient upright in a chair. B) Give liquids at the end of the meal. C) Place food in the strong side of the mouth. D) Provide thin foods to make it easier to swallow. E) Feed the patient slowly, allowing time to chew and swallow. F) Encourage patient to lie down to rest for 30 minutes after eating.

A, C, E Patients with dysphagia are at risk for aspiration and need more assistance with feeding and swallowing. Feed the patient with dysphagia slowly, providing smaller-size bites, and allow the patient to chew thoroughly and swallow the bite before taking another. Position the patient in an upright, seated position in a chair or raise the head of the bed to 90 degrees. If the patient has unilateral weakness, teach him or her and caregiver to place food in the stronger side of the mouth. Additional interventions include providing a 30-minute rest period before eating. Have the patient slightly flex the head to a chin-down position to help prevent aspiration. Determine the viscosity of foods that the patient tolerates best through the use of trials of different consistencies of foods and fluids. Thicker fluids are generally easier to swallow. More frequent chewing and swallowing assessments throughout the meal are necessary. Allow the patient time to empty the mouth after each spoonful, matching the speed of feeding to the patient's readiness. If the patient begins to cough or choke, remove the food immediately.

Which action should the nurse take initially to verify correct positioning of a newly placed small-bore feeding tube? A. Place an order for a radiograph to check position. B. Confirm the distal mark on the feeding tube after taping. C. Test the pH of the gastric contents and observe the color. D. Auscultate over the gastric area as air is injected into the tube.

A. Place an order for a radiograph to check position. Radiography will confirm placement more reliably than other methods of checking placement.

The nurse teaches a patient who has had surgery to increase which nutrient to help with tissue repair? A) Fat B) Protein C) Vitamin D) Carbohydrate

B Proteins provide a source of energy (4 kcal/g), and they are essential for synthesis (building) of body tissue in growth, maintenance, and repair. Collagen, hormones, enzymes, immune cells, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA) are all made of protein.

The home health nurse is seeing the following clients. Which client is at greatest risk for experiencing inadequate nutrition? A. A 55-year-old obese man recently diagnosed with diabetes mellitus B. A recently widowed 76-year-old woman recovering from a mild stroke C. A 22-year-old mother with a 3-year-old toddler who underwent tonsillectomy D. A 46-year-old man recovering at home following coronary artery bypass surgery

B. A recently widowed 76-year-old woman recovering from a mild stroke The 76-year-old woman has multiple issues confronting her that put her at a higher risk for inadequate nutrition, including the recent death of her spouse and her recent stroke. The other clients do have some risk of inadequate nutrition, but not as great a risk as the older widow.

The nurse wants to begin feeding a client through a small-bore feeding tube that was recently placed. Before initiating feedings through this tube, the nurse confirms tube placement by: A. Aspirating fluid contents from the stomach B. Requesting confirmation of placement via radiographic examination C. Measuring the pH of the fluid aspirated through the small-bore tube D. Injecting air through the feeding tube while auscultating for air in the stomach

B. Requesting confirmation of placement via radiographic examination The most reliable method for verifying the placement of a small-bore feeling tube is radiographic examination. None of the other methods is as reliable.

The nurse is teaching a client about healthy nutrition. The nurse recognizes that the client understands the teaching when the client makes which of the following statements? A. "I need to stop eating red meat." B. "I will increase the servings of fruit juice to four a day." C. "I will make sure that I eat a balanced diet and exercise regularly." D. "I will not eat so many dark green vegetables and eat more yellow vegetables."

C. "I will make sure that I eat a balanced diet and exercise regularly." The client should adopt a balanced eating pattern that includes a variety of nutrient-dense foods and beverages among the basic food groups. The nurse should encourage the client to consume fruits, vegetables, whole-grain products, and fat-free or low-fat milk while staying within energy needs. Total fat intake should be kept between 20% and 35% of total calories with most fats coming from polyunsaturated or monounsaturated fatty acids. The client should choose and prepare foods and beverages with little added sugars or sweeteners and foods with little salt while at the same time eating potassium-rich foods.

The nurse is assessing a patient receiving enteral feedings via a small-bore nasogastric tube. Which assessment findings need further intervention? A) Gastric pH of 4.0 during placement check B) Weight gain of 1 pound over the course of a week C) Active bowel sounds in the four abdominal quadrants D) Gastric residual aspirate of 350 mL for the second consecutive time

D Delayed gastric emptying is a concern if 250 mL or more remains in the patient's stomach on each of two consecutive assessments. The North American Summit on Aspiration in the Critically Ill Patient made the following recommendations regarding gastric residual volumes (GRVs): (1) stop feedings immediately if aspiration occurs; (2) withhold feedings and reassess patient tolerance to feedings if GRV is over 500 mL for two successive measurements; and (3) routinely evaluate the patient for aspiration and use nursing measures to reduce the risk of aspiration if GRV is between 250 and 500 mL.

The nurse is assessing a client receiving enteral feedings via a small-bore nasointestinal tube. Which assessment finding needs further intervention? A. Gastric pH of 3.0 during placement check B. Weight gain of 1 lb over the course of a week C. Active bowel sounds in the four abdominal quadrants D. Gastric residual aspirate of 300 mL for the second consecutive time

D. Gastric residual aspirate of 300 mL for the second consecutive time Gastric residual aspirate of 300 mL indicates that the client is not digesting the food. Active bowel sounds in all four quadrants is a positive sign. Weight gain of 1 lb in a week is an appropriate weight variance. A gastric pH of 3.0 is expected.

Based on knowledge of peptic ulcer disease (PUD), the nurse anticipates the presence of which bacteria when reviewing the laboratory data for a client suspected of having PUD? A. Micrococcus B. Staphylococcus C. Corynebacteria D. Helicobacter pylori

D. Helicobacter pylori H. pylori is a bacterium that causes peptic ulcers, and its presence can be confirmed by laboratory tests. It is treated with antibiotics that control the bacterial infection. The other bacteria listed are not associated with PUD.

The nurse evaluates laboratory findings for a client hospitalized because of chronic obstructive pulmonary disease. Which finding is consistent with poor nutrition? A. Nitrogen balance of 3 g B. Transferrin level of 370 mg/dl C. Hemoglobin level of 13.8 g/dl D. Serum albumin level of 2.5 g/dl Factors that affect serum albumin levels include hydration; hemorrhage; renal or hepatic disease; large amounts of drainage from wounds, drains, burns, or the gastrointestinal tract; steroid administration; exogenous albumin infusions; age; and trauma, burns, stress, or surgery. A normal serum albumin level is 4.0 g/dl. The other options are incorrect.

D. Serum albumin level of 2.5 g/dl Factors that affect serum albumin levels include hydration; hemorrhage; renal or hepatic disease; large amounts of drainage from wounds, drains, burns, or the gastrointestinal tract; steroid administration; exogenous albumin infusions; age; and trauma, burns, stress, or surgery. A normal serum albumin level is 4.0 g/dl. The other options are incorrect.

A client has gained 2 lb of weight in the past day. The nurse calculates this weight gain to be __________ ml of fluid.

The correct response is "1000"

When evaluating the history of a client who has gastrointestinal (GI) upset, the nurse is sure to assess the client for routine ingestion of which of the following? (Select all that apply.) A. Beer B. Aspirin C. Acetaminophen D. High-fiber foods

A, B Alcohol and aspirin are two substances directly absorbed through the lining of the stomach. This can contribute to GI upset. High-fiber foods should reduce GI symptoms because they stimulate peristalsis. Acetaminophen does not commonly cause GI symptoms. It is more likely to cause problems with the liver.

The nurse is measuring the pH of fluid from a jejunostomy tube and suspects that the tube has migrated into the stomach when the pH reading is: A. 3.0 B. 4.0 C. 5.0 D. 6.0

A. 3.0 The pH of gastric contents is low and acidic (3 or less), whereas the pH of the small intestine is higher because of the bicarbonate released.

The nurse suspects that the patient receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What action does the nurse need to take first? A) Raise head of bed to 90 degrees B) Turn patient to left lateral decubitus position C) Notify health care provider immediately D) Have patient perform the Valsalva maneuver

B An air embolus possibly occurs during insertion of the catheter or when changing the tubing or cap. Have the patient assume a left lateral decubitus position first. Then have the patient perform a Valsalva maneuver (holding the breath and "bearing down"). The increased venous pressure created by the maneuver prevents air from entering the bloodstream during catheter insertion. Maintaining integrity of the closed intravenous system also helps prevent air embolus.

The home care nurse is seeing the following patients. Which patient is at greatest risk for experiencing inadequate nutrition? A) A 55-year-old obese man recently diagnosed with diabetes mellitus B) A recently widowed 76-year-old woman recovering from a mild stroke C) A 22-year-old mother with a 3-year-old toddler who had tonsillectomy surgery D) A 46-year-old man recovering at home following coronary artery bypass surgery

B Older adults who are homebound and have a chronic illness have additional nutritional risks. Frequently this group lives alone with few or no social or financial resources to assist in obtaining or preparing nutritionally sound meals. This contributes to a risk for food insecurity caused by low income and poverty. In addition, the mild stroke might cause dysphagia.

Based on knowledge of peptic ulcer disease (PUD), the nurse anticipates the presence of which bacteria when reviewing the laboratory data for a patient suspected of having PUD? A) Micrococcus B) Staphylococcus C) Corynebacterium D) Helicobacter pylori

D Marshall and Warren first identified Helicobacter pylori in 1984. It is a bacteria that causes up to 85% of peptic ulcers and is confirmed by laboratory tests. It is treated with antibiotics that control the bacterial infection.

Which action is initially taken by the nurse to verify correct position of a newly placed small-bore feeding tube? A) Placing an order for x-ray film examination to check position B) Confirming the distal mark on the feeding tube after taping C) Testing the pH of the gastric contents and observing the color D) Auscultating over the gastric area as air is injected into the tube

A At present the most reliable method for verification of placement of small-bore feeding tubes is x-ray film examination. The measurement of the pH of gastric secretions withdrawn from the feeding tube helps to determine the location of the tube. Auscultation has repeatedly been shown to be ineffective in detecting tubes accidentally placed in the lung. Further, it is not effective in distinguishing between gastric and intestinal placement for feeding tubes.

The patient receiving total parenteral nutrition (TPN) asks the nurse why his blood glucose is being checked since he does not have diabetes. What is the best response by the nurse? A) TPN can cause hyperglycemia, and it is important to keep your blood glucose level in an acceptable range. B) The high concentration of dextrose in the TPN can give you diabetes; thus you need to be monitored closely. C) Monitoring your blood glucose level helps to determine the dose of insulin that you need to absorb the TPN. D) Checking your blood glucose level regularly helps to determine if the TPN is effective as a nutrition intervention.

A The TPN formula is a combination of crystalline amino acids, hypertonic dextrose, electrolytes, vitamins, and trace elements. Administration of concentrated glucose is accompanied by increases in endogenous insulin production, which causes cations (potassium, magnesium, and phosphorus) to move intracellularly. Blood glucose levels should be monitored every 6 hours to assess for hyperglycemia. Maintaining blood glucose within acceptable limits helps prevent complications from the TPN.

The nurse sees the nursing assistive personnel (NAP) perform the following for a patient receiving continuous enteral feedings. What intervention does the nurse need to address immediately with the NAP? The NAP: A) Fastens the tube to the gown with tape. B) Places the patient supine while giving a bath. C) Performs oral care for the patient. D) Elevates the head of the bed 45 degrees.

B Patients receiving enteral feedings should have the head of the bed elevated a minimum of 30 degrees, preferably 45 degrees, unless medically contraindicated. Laying the patient supine increases the risk of aspiration of the feeding and should be avoided. This needs to be addressed to maintain patient safety.

Which of the following statements about water-soluble vitamins is true? (Select all that apply.) A. They cannot be stored. B. They often cause toxicity. C. They must be consumed daily. D. Supplements must be taken to reach the recommended daily allowance of these vitamins.

A, C Water-soluble vitamins are eliminated daily; they are not stored. Thus they must be consumed daily. Although toxicity may occur with megavitamin intake, the possibility of toxicity is low. A healthy diet should provide the necessary amount of water-soluble vitamins without the need for supplementation.

The nurse teaches a client who has had surgery to increase intake of which nutrient to help with tissue repair? A. Fat B. Protein C. Vitamins D. Carbohydrate

B. Protein Proteins provide a source of energy and are essential for synthesis (building) of body tissue in growth, maintenance, and repair. Proteins are also required for blood clotting, fluid regulation, and acid-base balance. Fats are important for metabolic processes. Vitamins are chemicals used as catalysts in biochemical reactions. They are essential to normal metabolism and are present in small amounts in foods. Carbohydrates are used for energy.

Which statement made by a patient of a 2-month-old infant requires further education? A) I'll continue to use formula for the baby until he is a least a year old. B) I'll make sure that I purchase iron-fortified formula. C) I'll start feeding the baby cereal at 4 months. D) I'm going to alternate formula with whole milk starting next month.

D Infants should not have regular cow's milk during the first year of life. It causes gastrointestinal 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. Breast milk or formula provides sufficient nutrition for the first 4 to 6 months of life. The development of fine-motor skills of the hand and fingers parallels the infant's interest in food and self-feeding. Iron-fortified cereals are typically the first semisolid food to be introduced. For infants 4 to 11 months, cereals are the most important nonmilk source of protein.