Module 7 Exam

A client with cirrhosis has an increased ammonia level. Which diet does the nurse anticipate will be of benefit to the client? a. One low in protein b. One high in protein c. One with a moderate amount of fat d. One high in carbohydrates

a Rationale: A low-protein diet would be prescribed for the client with cirrhosis who has an increased ammonia level. Protein in the diet is transported to the liver by the portal vein after digestion and absorption. The liver breaks down protein, resulting in the formation of ammonia. Therefore the client would benefit from a low-protein diet.

A client who experienced a brain attack (stroke) is experiencing residual dysphagia. Which food item would the nurse remove from the client's meal tray? a. Peas b. Scrambled eggs c. Cheese casserole d. Mashed potatoes

a Rationale: In general, flavorful, warm, or well-chilled foods with texture stimulate the swallow reflex. Moist pastas, casseroles, egg dishes, and potatoes are usually well tolerated. Raw vegetables; chunky vegetables, such as diced beets; stringy vegetables; and those with skin, such as corn and peas are foods commonly excluded from the diet of a client with dysphagia.

A nurse provides dietary instructions to a client with cholecystitis. Which menu selection by the client indicates to the nurse that the client understands the instructions? a. Roast turkey with a baked potato b. Fruit plate with fresh whipped cream c. Fried chicken with macaroni and cheese d. Barbecued spare ribs with buttered noodles

a Rationale: The client with cholecystitis should reduce intake of fat. Foods that should generally be avoided to achieve this end include sauces and gravies, fatty meats, fried foods, products made with cream, and heavy desserts. Therefore the correct answer is roast turkey with a baked potato, which is a meal low in fat.

The nurse provides instructions to a client who is beginning therapy with theophylline. The nurse recognizes that the client understands the instructions when the client states that he will be sure to limit consumption of which items? a. Coffee, cola, and chocolate b. Oysters, lobster, and shrimp c. Apples, oranges, and pineapple d. Cottage cheese, cream cheese, and dairy creamers

a Rationale: Theophylline is a methylxanthine bronchodilator, and the nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, tea, cola, and chocolate.

A client with a genitourinary tract infection has been prescribed metronidazole (Flagyl) and fluid therapy. The nurse concludes that the client understands the dietary regimen to be followed while taking the medication when the client states that she must avoid which item? a. Alcohol b. Diet cola c. Bran flakes d. Chicken livers

a Rationale: A disulfiram-type reaction may result when someone taking metronidazole ingests alcohol. This syndrome includes flushing, palpitations, shortness of breath, severe headache, and nausea. To help prevent this reaction, the nurse must warn the client not to drink alcohol while taking this medication. The items presented in the remaining options are acceptable for consumption by the client while taking this medication.

The nurse teaches a client who has begun taking phenelzine, a monoamine oxidase inhibitor (MAOI), about the medication. Which foods are allowed in the diet of the client taking phenelzine? Select all that apply. a. Peas b. Broccoli c. Potatoes d. Red wine e. Avocados f. Cereal with raisins

a, b, c Rationale: Because phenelzine is an MAOI, the client should avoid foods that are high in tyramine, which could trigger a potentially fatal hypertensive crisis. Foods to avoid include aged cheeses, smoked or processed meats, red wines, beer, and certain fruits, including avocados, raisins, and figs. Vegetables, with the exception of broad-bean pods, are generally acceptable.

The nurse is instructing a client with hypertension about foods that are low in sodium. Which menu selections by the client indicate to the nurse that the client understands what has been taught? Select all that apply. a. Spaghetti with fresh tomatoes b. Boiled lobster with baked potato c. Grilled chicken with turnip greens d. Instant hot cereal with bacon e. Tomato soup with a ham sandwich

a, c Rationale: Foods that are lower in sodium include fruits and vegetables, which do not contain physiologic saline. Fresh poultry and pastas are also low in sodium. Highly processed and refined foods and luncheon meats are high in sodium unless they are specifically labeled "low sodium." Saltwater fish and shellfish are higher in sodium

A client with atrial fibrillation has been placed on warfarin sodium. As part of the instructions for the medication, which foods does the nurse tell the client to avoid? Select all that apply. a. Spinach b. Cherries c. Broccoli d. Cabbage e. Potatoes f. Spaghetti

a, c, d Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables such as broccoli, spinach, Brussels sprouts, cabbage, and turnip greens. The other options are foods that are low in vitamin K.

A nurse is teaching a client with cholecystitis about a low-fat diet. Which foods should the nurse tell the client to avoid? Select all that apply. a. Avocados b. Baked tuna c. Green olives d. Baked potato e. Fresh cherries f. Cream cheese

a, c, f Rationale: Fruits and vegetables tend to be lower in fat because they do not come from animal sources; however, olives, although technically a fruit, are high in fat (as are avocados), and fish is also naturally lower in fat. Meats and dairy products (e.g., cream cheese) are higher in fat, although modifications can be made to these foods to reduce their fat content.

Calcitriol is prescribed for a client with hypocalcemia. Which foods does the nurse, knowing that they may interfere with calcium absorption, instruct the client to limit in the diet? Select all that apply. a. Bran Correct b. Milk c. Clams d. Spinach e. Orange juice

a, d Rationale: The client taking a medication to treat hypocalcemia should be instructed to avoid excessive consumption of spinach, rhubarb, bran, and whole-grain cereals, all of which may limit calcium absorption. Good dietary sources of calcium include milk products, dark-green leafy vegetables, clams, oysters, sardines, and orange juice fortified with calcium.

Triamterene has been prescribed for a client with a history of hypertension. Which fruits should the nurse tell the client to avoid while taking this medication? Select all that apply. a. Prunes b. Apples c. Peaches d. Avocados e, Nectarines f.. Cranberries

a, d, e Rationale: Triamterene is a potassium-sparing diuretic, so the client should avoid foods high in potassium. Fruits that are naturally high in potassium include dried prunes, avocado, bananas, fresh oranges and mangoes, nectarines, and papayas.

A client with renal calculi is instructed to follow an alkaline ash diet. Which menu choice by the client indicates to the nurse that the client understands the prescribed regimen? a. Chicken, potatoes, and cranberries b. Spinach salad, milk, and a banana c. Peanut butter sandwich, milk, and prunes d. Linguini with shrimp, tossed salad, and a plum

b Rationale: In an alkaline ash diet, all fruits are allowed except cranberries, prunes, and plums. The incorrect options represent components of an acid ash diet.

For which vitamin deficiency should the nurse monitor the client who is on a vegan diet? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E

b Rationale: The client on a vegan diet does not consume animal products and is therefore at risk for vitamin B12 deficiency. Fruits and vegetables, which are acceptable to the client on a vegan diet, contain vitamins A, C, and E.

Diverticulitis has been diagnosed in a client who has been experiencing episodes of gastrointestinal cramping. The nurse should tell the client to maintain, during the asymptomatic period, a soft diet that has which modification? a. Low in fat b. High in fiber c. Low in residue d. High in carbohydrates

b Rationale: When a client's diverticulitis is asymptomatic, a soft high-fiber diet containing fruits, vegetables, and whole grains is recommended. The client is also instructed to consume a small amount of bran daily and to take bulk-forming laxatives, if prescribed, to increase stool mass and softness. Increasing fluid intake to 2500 to 3000 mL daily (unless contraindicated) is also important. A low-fat diet may be healthy but is not specific to this disorder. A high-carbohydrate diet is not helpful for the client with this condition.

A clear liquid diet has been prescribed for client who has just undergone surgery. Which foods should the nurse offer to the client? Select all that apply. a. Custard b. Apple juice c. Orange juice d. Chicken broth e. Orange gelatin f. Vanilla ice cream

b, d, e Rationale: A clear liquid diet consists of foods that are relatively transparent, such as apple juice, chicken broth, and gelatin. Custard, orange juice, and vanilla ice cream are components of a full liquid diet.

A client recovering from acute renal failure is being discharged home. The nurse knows that the client understands the therapeutic dietary regimen when the client states that he will plan to eat foods that are low in which nutrient? a. Fats b. Vitamins c. Potassium d. Carbohydrates

c

Which food should the nurse offer to a client who has been prescribed a full liquid diet? a. Toast b. Plain bagel c. Cooked custard

c Rationale: A full liquid diet consists of liquid foods that are clear or opaque liquid foods, including those that are liquid at room temperature. Cooked custard is allowed on a full liquid diet. Toast and a bagel are allowed on a regular diet (a diet with no restrictions). Scrambled eggs are allowed on a soft diet.

A client who has sustained multiple fractures of the left leg is in skeletal traction. The nurse has obtained an overhead trapeze to improve the client's bed mobility. To which high-risk areas must the nurse pay particular attention during skin inspection for indications of pressure and skin breakdown? a. Left heel b. Scapulae c. Right heel d. Back of head

c Rationale: Certain areas are under pressure and at risk for breakdown in the client who is in skeletal traction. These areas include the elbows (if they are used for repositioning instead of a trapeze) and the heel of the unaffected leg, which is used as a brace when the client pushes up from the bed. Other such pressure points include the ischial tuberosity, popliteal space, and Achilles tendon.

A client with heart failure and hypertension who has been admitted to the hospital is unable to make her own selections from the menu. Which meals does the nurse select for the client's supper on the day of admission? a. Smoked ham, fresh carrots, boiled potato b. Hot dog in a bun, sauerkraut, baked beans c. Turkey, baked potato, salad with oil and vinegar d. Shrimp, baked potato, salad with blue cheese dressing

c Rationale: Foods that are high in sodium should be limited in the diet of the client with hypertension and heart failure. Foods in the meat group that are higher in sodium include bacon, luncheon meat, chipped or corned beef, ham, hot dogs, kosher meat, smoked or salted meat or fish, and a variety of shellfish. These foods should be avoided or strictly limited for hypertensive clients.

A regular diet has been prescribed for a client with a leg fracture who has been placed in skeletal traction. Which foods that will promote wound healing does the nurse encourage the client to select from the hospital menu? a. Spare ribs, rice, gelatin, tea b. Pasta, garlic bread, ginger ale c. Chicken breast, broccoli, strawberries, milk

c Rationale: Protein and vitamin C are necessary for wound healing. Poultry and milk are good sources of protein. Broccoli and strawberries are good sources of vitamin C. Peanut butter is a source of niacin. Gelatin, jelly, tea, and ginger ale have no nutritional value. Pasta, rice, and bread deliver complex carbohydrates. Spare ribs may contain some protein but are high in fat.

A client with a urinary tract infection has been started on nitrofurantoin, a urinary antiseptic medication, and is taught about the foods that will maintain the urinary pH in the acid range. Which food does the nurse tell the client to avoid while taking this medication? a. Prunes b. Oranges c. Rhubarb d. Cranberries

c Rationale: When a client is taking nitrofurantoin, the urinary pH must be maintained in the acid range, so the client needs to be instructed to consume an acid ash diet. Rhubarb reduces the acidity of the urine and should be avoided when acidic urine is required. Prunes, oranges, and cranberries are acceptable foods.

A client is resuming eating after undergoing partial gastrectomy. What does the nurse tell the client to avoid doing as a means of minimizing the risk of complications? a. Lying down after eating b. Eating high-protein foods c. Drinking liquids with meals d. Eating six small meals per day

c The client who has undergone partial gastrectomy is at risk for dumping syndrome. This client should be prescribed a diet that is high in protein, moderate in fat, and low in carbohydrates. The client should lie down after meals and avoid drinking liquids with meals. Frequent small meals are encouraged. The client should avoid concentrated sweets.

A nurse has provided dietary instructions to a client with a new diagnosis of gout. Which menu suggestions by the client indicate to the nurse that the client needs additional instruction? Select all that apply. a. Carrots b. Tapioca c. Scallops d. Broccoli e. Chicken liver

c, e Rationale: Organ meats such as liver, as well as certain sea foods, including scallops, sardines, and herring, should be omitted from the diet of the client who with gout because of the high purine content. The foods identified in the other options contain negligible amounts of purines and may be consumed freely by the client with gout.