Nutrition, Giddens 1e
What should the nurse teach parents is the most important influence on the eating habits of early school-age children? Smell and appearance of food Availability of food selections Food preferences of the peer group Example of parents and siblings at mealtimes
Example of parents and siblings at mealtimes The early school-age child has become a cooperative member of the family and will mimic parents' attitudes and food habits readily. Smell and appearance of food does not have a major influence on eating habits. Availability of food selections certainly has some influence, though not major, on eating habits. The peer group does not become influential until later school age and during adolescence.
A client eats a meal that contains 13 g of fat, 31 g of carbohydrates, and 5 g of protein. What is this client's total caloric intake for this meal? Record your answer using a whole number. _____________kilocalories
Fat contains 9 kilocalories per gram; carbohydrates and proteins contain 4 kilocalories per gram; therefore, 117 + 124 + 20 = 261 kilocalories.
A nurse provides a list of suggested food choices to a client who has peptic ulcer disease. What foods should be included on the list? Orange juice, fried eggs, and sausage Applesauce, cream of wheat, and milk Tomato juice, raisin bran cereal, and tea Sliced oranges, pancakes with syrup, and coffee
Applesauce, cream of wheat, and milk Applesauce, cream of wheat, and milk are bland foods that do not irritate the gastric mucosa. Orange juice, fried eggs, sausage, tomato juice, raisin bran cereal, tea, sliced oranges, pancakes with syrup, and coffee are not bland; they may be irritating to the mucosal lining.
A 24-year-old client who has had type 1 diabetes for 6 years is concerned about how her pregnancy will affect her diet and insulin needs. How should the nurse respond? "Insulin needs will decrease; the excess glucose will be used for fetal growth." "Diet and insulin needs won't change, and maternal and fetal needs will be met." "Protein needs will increase and adjustments to insulin dosage will be necessary." "Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."
"Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring." may decrease in early pregnancy because of increased fetal needs for nutrients and the possibility of maternal nausea and vomiting. Insulin requirements increase in the second and third trimesters as resistance to insulin develops. The blood glucose level is monitored to prevent ketoacidosis and harm to both the mother and fetus. Telling the client that protein needs will increase and adjustments to the insulin dosage will be necessary conveys information that is true only during early pregnancy. Even the nondiabetic woman makes dietary adjustments to keep pace with the increased nutritional demands of pregnancy; in addition, insulin requirements increase in the second and third trimesters. Most nutrient requirements, not just protein, increase during pregnancy.
A nurse provides a list of foods for a breastfeeding client with phenylketonuria (PKU) to avoid. Which nutrient is included on the list? Lactose Glucose Fatty acids Amino acids
Amino acids PKU is an inborn error of metabolism involving an inability to metabolize phenylalanine, an essential amino acid. Lactose, glucose, and fatty acids are all metabolized by people with PKU.
A 30-month-old boy with cystic fibrosis is admitted to the pediatric unit with a severe upper respiratory infection. The toddler is small for his age. What pathological process does the nurse know is the cause of his small stature? Increased salt retention An atrioventricular defect Retention of carbon dioxide An absence of pancreatic enzymes
An absence of pancreatic enzymes Fats, proteins, and carbohydrates are not digested because of a deficiency of pancreatic enzymes and therefore physical growth is hampered. Children with cystic fibrosis lose sodium and chlorides. There is no evidence that the child has an atrioventricular defect. It is not the retention of carbon dioxide but the deprivation of nutrients and oxygen to all body cells that limits physical growth.
Three days after admission to the hospital for a brain attack (cerebrovascular accident [CVA]), a client has a nasogastric tube inserted and is receiving continuous tube feedings. What should the nurse do to best evaluate whether the feeding is being absorbed? Aspirate for a residual volume. Evaluate the intake in relation to the output. Instill air into the client's stomach while auscultating. Compare the client's body weight with the baseline data.
Aspirate for a residual volume. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends that a gastric residual ≥250 mL should be checked again in 4 hours for critically ill clients, and 6 to 8 hours in non-critically ill clients. If it is still ≥250 mL, the nurse should seek a prescription for a promobility agent. If the residual is >500 mL, the nurse should hold the feeding until the following are accomplished: a gastrointestinal (GI) evaluation, assessment of glycemic control (hyperglycemia can cause decreased GI motility), minimization of sedation, and a prescription for a promotility agent if not already prescribed. Recommendations indicate that an enteral feeding should not be stopped for a residual < 500 mL unless other signs of feeding intolerance are present (e.g., emesis, abdominal distention, constipation, uncomfortable feeling of fullness, abdominal pain, or nausea). Evaluating the intake in relation to the output evaluates fluid balance and is best performed over a 24-hour period. Instilling air into the client's stomach while auscultating is a method for evaluating tube placement. Although weighing the client regularly is important to evaluate overall nutritional progress, it does not provide information about absorption of a particular feeding. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.
A child with celiac disease is prescribed a gluten-restricted diet. Which lunch selection for the child indicates that the parent understands the dietary instruction provided by the nurse? Frankfurter on a roll, cookies, fat free milk Macaroni and cheese, banana, pineapple juice Beef taco, corn, canned peaches, chocolate milk Peanut butter sandwich, oatmeal cookies, apple juice
Beef taco, corn, canned peaches, chocolate milk Products that contain wheat, rye, barley, and oats are not tolerated by children with celiac disease. Beef tacos, corn, peaches, and milk are acceptable in a gluten-restricted diet; tortillas may be made with corn flour. Most frankfurters have fillers that contain gluten; the roll and most cookies contain wheat flour. Macaroni contains wheat flour. The bread used for the sandwich contains wheat flour, and oatmeal cookies contain oat and wheat flour.
A client is admitted with anorexia, weight loss, abdominal distention, and abnormal stools. A diagnosis of malabsorption syndrome is made. What nursing action should the nurse implement to best meet this client's needs? Allow the client to eat food preferences. Encourage the consumption of high-protein foods. Institute intravenous (IV) therapy to improve the client's hydration. Maintain nothing by mouth status because food precipitates diarrhea.
Encourage the consumption of high-protein foods. The diet should be high in protein and calories, low in fat, and gluten-free for individuals with malabsorption syndrome . Protein is needed for tissue rebuilding. The client may prefer foods high in gluten, which will potentiate malabsorption. IV therapy is a dependent function and does not provide all the necessary nutrients. Diarrhea is caused by malabsorption, which accounts for the depressed nutritional status; once the diarrhea is corrected, it is essential to compensate by providing a nutritious diet.
After being hospitalized for a transient ischemic attack (TIA) related to hypertension, a client is discharged with a prescription of hydrochlorothiazide (HCTZ). What should the nurse instruct the client to do when taking this medication? Increase the intake of potassium Drink a protein supplement daily Avoid eating foods high in insoluble fiber Resume regular eating habits
Increase the intake of potassium The client must increase the dietary intake of potassium because of potassium loss associated with HCTZ. Protein supplements are not necessary. Protein should be obtained from meat, fish, and dairy products in the diet. Foods high in insoluble fiber are part of the food pyramid and should be included in the diet. The client should be taught about medication-induced deficiencies, which may necessitate a change in diet, and not just return to regular eating habits once home.
A client who recently immigrated to the United States has a chronic vitamin A deficiency. What information about vitamin A should the nurse consider when assessing this client for clinical indicators of this deficiency? Vitamin A is an integral part of the retina's pigment called melanin. It is a component of the rods and cones, which control color visualization. Vitamin A is the material in the cornea that prevents the formation of cataracts. It is a necessary element of rhodopsin, which controls responses to light and dark environments.
It is a necessary element of rhodopsin, which controls responses to light and dark environments. Vitamin A is used in the formation of retinol, a component of the light-sensitive rhodopsin (visual purple) molecule. Melanin is a pigment of the skin. Vitamin A does not influence color vision, which is centered in the cones. The cornea is a transparent part of the anterior portion of the sclera; a cataract is opacity of the usually transparent crystalline lens. Vitamin A does not prevent cataracts.
A 16-year-old high school student who has anorexia nervosa tells the clinic nurse that she thinks she that is pregnant even though she has had intercourse only once, more than a year ago. What is the most appropriate inference for the nurse to make about the student? Using magical thinking Submitting to peer pressure Lying about the last time she had intercourse Lacking knowledge that anorexia can cause amenorrhea
Lacking knowledge that anorexia can cause amenorrhea The loss of body fat due to anorexia can cause amenorrhea; the client needs information. No data are available to support the fact that the client is using magical thinking, which is characterized by the belief that thinking or wishing something can cause it to occur; in light of the client's diagnosis of anorexia, this is not the first conclusion. Submitting to peer pressure is not related to this type of concern. Although the nurse should question the timeline again, the client's nutritional status should be explored first.
A nurse is caring for several school-aged children on the pediatric unit who are on prolonged bedrest and eating regular diets. Which breakfast should the nurse recommend to the children? Oatmeal with raisins and milk Pancakes with sausage and syrup Scrambled eggs with home fries and toast French toast with bacon and cinnamon sugar
Oatmeal with raisins and milk Prolonged immobility can result in constipation and demineralization of bone. Oatmeal and raisins contain roughage, which helps prevent constipation, and milk contains calcium, which is needed for bone strength and growth. Pancakes and french toast each lack roughage and contains inadequate calcium.
Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematological studies? Calcium Chloride Phosphorus Parathormone
Phosphorus Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorous levels decrease (greater than 3 mg/dL; greater than 0.1 mmol/L). Serum calcium levels will increase because of the action of elevated levels of serum parathormone; serum calcium levels usually exceed 10 mg/dL (2.50 mmol/L). Serum chloride levels will increase, not decrease, with hyperparathyroidism. Parathormone, produced in the parathyroid gland, will increase with hyperparathyroidism.
A depressed client has been sitting alone in a chair most of the day and displays no interest in eating. How should the nurse plan to meet this client's nutritional needs? Stay with the client during meals Take the client to the dining room Bring the client a tray of finger foods Talk with the client about the importance of nutrition
Stay with the client during meals Active support is demonstrated when the nurse sits with the client during meals. Even if taken to the dining room, a depressed client may lack the physical or emotional energy to eat. Finger foods are more effectively given to clients experiencing mania. Discussing the importance of nutrition is too passive an intervention for a depressed client and usually will not stimulate the client to take action or change eating behaviors.
Evaluation of clients with anorexia nervosa requires reassessment of behaviors after admission. Which finding indicates that the therapy is beginning to be effective? Food is hidden in the client's pockets. The client states that the hospitalization has been helpful. The client has gained 6 lb since admission 3 weeks ago. The client remains in the dining room eating for 1 hour after others have left.
The client has gained 6 lb since admission 3 weeks ago. Weight gain of 6 lb since admission 3 weeks ago is objective proof that the client's eating behaviors have improved. "Stashing" of food is a characteristic of an eating disorder, not a sign of improvement. The statement that the hospitalization has been helpful is subjective information and may be manipulative. "Marathon meals" with little actual food ingestion are common in people with anorexia.
Following a regular health checkup and health interview of an 8-year-old child, the nurse concludes that the child's gastrointestinal system is well developed. Which findings support the nurse's conclusion? The child is tolerant to milk and milk-based products. The child is able to maintain stable blood sugar levels. The child eats after 3 to 4 hours without feeling hungry in between. The child likes to eat all kinds of foods, including fruits and vegetables. The child had less than three episodes of stomach upset in the previous year.
#2, 3 and 5 The gastrointestinal system matures in school-age children and becomes well developed. As the absorption of food and its metabolism become well established, blood glucose levels are stable and maintained. Stomach capacity increases, and the child may not feel hungry too often. The gastrointestinal system becomes functional and strong, resulting in fewer episodes of stomach upset. Tolerance of milk and milk-based products indicates the child's tolerance to lactose; it may not indicate a well-developed gastrointestinal system. The child's preferences in foods do not indicate maturity of the gastrointestinal system.
On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? (multiple) Iron Calcium Folic acid Vitamin C Vitamin B 12
**Iron **Folic acid Because pregnant women with heart disease are more likely to have anemia, there may be an additional need for and also for folic acid. If the pregnant client with heart disease is eating the recommended pregnancy diet and taking prenatal vitamin and mineral supplements, there is no additional need for calcium, vitamin C, and vitamin B 12 .
A nurse is assisting a client to plan a therapeutic diet that is high in vitamin C. What excellent sources of vitamin C should be included in the plan? 1. Lettuce Oranges Broccoli Apricots Strawberries
**Oranges **Broccoli **Strawberries One cup of fresh orange sections contains 96 mg of vitamin C. Vitamin C (ascorbic acid), an antioxidant, is found in vegetables such as broccoli, tomatoes, and potatoes; 1 cup of broccoli contains 140 mg of vitamin C. A cup of strawberries contains 106 mg of vitamin C. Apricots contain 11 mg of vitamin C; they are a source of beta-carotene. An entire head of lettuce contains 13 mg of vitamin C.
After reading that nutrition during pregnancy is important for optimal growth and development of a baby, a pregnant woman asks the nurse what foods she should be eating. The nurse begins the teaching/learning process by: Asking the client what she usually eats at each meal Explaining to the client why spicy foods should be avoided Instructing the client to add calories while continuing to eat a healthy diet Providing the client with a list of foods for reference when planning meals
Asking the client what she usually eats at each meal Successful dietary teaching should incorporate the client's food preferences and dietary patterns. Spicy foods are permissible if the client does not experience discomfort after eating them. Instructing the client to add calories while continuing to eat a healthy diet presupposes that the client has been eating a healthy diet. It does not provide for the additional protein requirements of pregnancy. Providing the client with a list of foods for reference when planning meals does not take into consideration the client's likes and dislikes or cultural preferences.
During a prenatal interview at 20 weeks' gestation, the nurse determines that the client has a history of pica. What is the most appropriate nursing action? Seeking a psychological referral for the client Ensuring that the client's diet is nutritionally adequate Informing the client of the danger this poses to her fetus Obtaining a prescription for a multivitamin supplement for the client
Ensuring that the client's diet is nutritionally adequate The primary concern when a pregnant woman practices pica is that other intake will be nutritionally inadequate to meet both fetal and maternal needs. Pica does not necessarily indicate a psychological/emotional disturbance; more often it is related to the client's culture. If a substance is not toxic to the mother, generally it is not fetotoxic, either. Obtaining a prescription for a multivitamin supplement for the client is not necessary if other nutritional intake is adequate.
The nurse is teaching a prenatal class to expectant mothers in their first trimester of pregnancy. In addition to discussing the need for 0.6 mg/day of folic acid replacement, which dietary choice that is high in folic acid should the nurse recommend? One egg Slice of bread Half cup of corn Half cup of cooked spinach
Half cup of cooked spinach A half cup of cooked spinach provides 100 mcg of per serving. One egg, a slice of bread, and half a cup of corn each provides only 20 mcg per serving.
When discussing the therapeutic regimen of vitamin B12 for pernicious anemia with a client, the nurse explains that: Weekly Z-track injections provide needed control Daily intramuscular injections are required for control Intramuscular injections once a month will maintain control Oral tablets of vitamin B12 taken daily will provide symptom control
Intramuscular injections once a month will maintain control Intramuscular injections bypass the vitamin B12 absorption defect (lack of intrinsic factor, the transport carrier component of gastric juices). A monthly dose usually is sufficient because it is stored in active body tissues, such as the liver, kidney, heart, muscles, blood, and bone marrow. The Z-track method need not be used as it is for iron dextran injections. Because it is stored and only slowly depleted, injections once a month usually are sufficient. Vitamin B12 cannot be taken by mouth because of the lack of intrinsic factor.
A client has cholelithiasis with possible obstruction of the common bile duct. What should be determined about the client's nutritional status before surgery is scheduled? Is the client deficient in vitamins A, D, and K? Does the client eat adequate amounts of dietary fiber? Does the client consume excessive amounts of protein? Are the client's levels of potassium and folic acid increased?
Is the client deficient in vitamins A, D, and K? Bile promotes the absorption of fat-soluble vitamins; an obstruction of the common bile duct limits the flow of bile to the duodenum. Knowing if the client eats adequate amounts of dietary fiber is not relevant to the situation. Knowing if the client consumes excessive amounts of protein is unnecessary; however, protein is desirable for wound healing. An increase in potassium and folic acid are not expected.
What should the nurse do when interacting with an adolescent client with the diagnosis of anorexia nervosa? Set limits Maintain control Demonstrate empathy Focus on a healthy diet
Set limits The client's security is increased by the setting of limits; guidelines remove responsibility for behavior from the client and increase compliance with the regimen. Simply maintaining control is not therapeutic and increases the power struggle. The client needs structure, not empathy. Emphasis on dietary intake increases the power struggle between the client and the staff.