Nutrition Hesi Exam part 1

The nurse has completed diet teaching for a client who has been prescribed a low-sodium diet to treat hypertension. The nurse determines that there is a need for further teaching when the client makes which statement?

"Fresh foods such as fruits and vegetables are high in sodium." A low-sodium diet is used as an adjunct to antihypertensive medications for the treatment of hypertension. Sodium retains fluid, which leads to hypertension secondary to increased fluid volume. Fresh foods such as fruits and vegetables are low in sodium.

A caregiver states that the client eats only about 25% of the food that is offered and is losing weight. The caregiver asks the nurse about feeding the client by a tube into the stomach. Which initial response by the nurse would be appropriate?

"Tube feedings can provide adequate amounts of required nutrients."

When reinforcing dietary instructions to a client with irritable bowel syndrome whose primary symptom is alternating constipation and diarrhea, the nurse should tell the client that which foods are best to include in the diet for this disorder? Select all that apply.

Apples wholegrain bread A high-fiber, high-residue diet is used for constipation, irritable bowel syndrome when the primary symptom is alternating constipation and diarrhea, and asymptomatic diverticular disease. High-fiber foods include fruits and vegetables and whole-grain products. Gas-forming foods such as beans, cabbage, and Brussels sprouts should be limited.

he nurse reinforces instructions regarding diet for a client at risk for hypokalemia. The nurse determines there is a need for further teaching when the client selects which foods as sources high in potassium? Select all that apply.

Bread and butter Carrots and peas Peppers and onions Clients taking thiazide or loop diuretics need to have adequate potassium intake and benefit from dietary teaching about the potassium values of foods. Bread and butter, carrots and peas, and peppers and onions are relatively low sources of potassium. Meats and certain fruits and vegetables are high in potassium and include beef and potato salad and avocados and mushrooms.

The nurse reinforces dietary instructions to a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines the client has understood if the client plans to include which foods in the diet? Select all that apply.

Raisins Kiwifruit Bananas Foods that are high in potassium include bananas, cantaloupe, kiwifruit, oranges, and dried fruits such as raisins. Fruits low in potassium include apples, cherries, grapefruit, canned peaches, pineapple, and cranberries.

A client has a prescription to take sodium polystyrene sulfonate for several days. The client also needs to make some dietary changes. Which foods should the client avoid? Select all that apply.

Cabbage Mushrooms Strawberries Sodium polystyrene sulfonate is a cationic exchange resin used as treatment for hyperkalemia (potassium level greater than 5.0 mEq/L [5.0 mmol/L]) Besides taking the medication, the client should avoid foods that are high in potassium content, including cabbage, mushrooms, and strawberries. Foods low in potassium are peaches and soybeans.

The nurse is asked to assist with preparing a client who will be receiving a continuous total parenteral nutrition (TPN) solution via a central line. The nurse plans to institute which interventions for this client related to the TPN? Select all that apply.

Central line dressing changes per protocol Blood glucose monitoring around the clock Using an electronic infusion pump with the infusion Reviewing prescribed blood laboratory values including electrolytes The client receiving TPN is at an increased risk for fluid and electrolyte imbalance, hyperglycemia, and infection. The central line dressing is changed according to protocols set up to prevent infection. The TPN rate of infusion needs to be closely regulated with use of an electron infusion pump. The TPN contains increased concentration of glucose, so the blood glucose levels are monitored around the clock. Blood laboratory values are monitored often (3 times per week) because the electrolyte balance is totally dependent on the prescribed TPN solution. The TPN formula is adjusted and prescribed according to the client's laboratory results. Administration of TPN does not involve monitoring central venous pressure although that is possible through a central intravenous line. The client will be able to ambulate and so SCD are not required but may be prescribed for other reasons.

An abdominal postoperative client has been tolerating a full liquid diet, and the nurse plans to advance the diet to solid food as prescribed. The nurse collects data regarding which important item before advancing the diet to solids?

Dentition and ability to chew

The nurse is preparing to administer an intermittent tube feeding to a client. The nurse aspirates 90 mL of residual from the tube. What should the nurse do? Select all that apply.

Document the amount of residual. Reinstill the residual and administer the feeding.

The nurse is reinforcing instructions to a client about complete/high quality protein foods. Which food choices would indicate the client understood the teaching? Select all that apply.

EGGS CHICKEN

A hospitalized client is a lacto-vegetarian. Which food item should the nurse remove from the meal tray?

Eggs Lacto-vegetarians eat milk, cheese, and dairy foods but avoid meat, fish, poultry, and eggs.

The nurse is assigned to assist in caring for a client who is receiving parenteral nutrition with fat emulsion. The nurse is instructed to monitor the client for signs of fat overload. The nurse monitors for which signs and symptoms of this complication?

Fever and pruritic urticaria IV fat emulsions are sometimes administered with parenteral nutrition to supply needed calories and essential fatty acids. This fat emulsion must be infused by pump at a set rate, usually over 10 to 12 hours. Signs and symptoms of fat overload include fever, leukocytosis, hyperlipidemia, and pruritic urticaria, and focal seizures are possible. Hepatosplenomegaly also may be present. Bradycardia, altered taste, muscle weakness, hypertension, and decreased urine output are not signs of this complication.

The nurse is providing dietary instructions to a client with a diagnosis of ulcerative colitis. The client is prescribed to follow a low residue diet during episodes of diarrhea. Which food should the nurse instruct the client to avoid?

Fresh corn on the cob Ulcerative colitis is a chronic inflammatory bowel disease in which the colon becomes edematous, develops ulcerated areas, and results in bloody diarrhea that occurs with exacerbations. A low-residue (low-fiber) diet is prescribed for some clients during exacerbations because this places less strain on the intestines and is easier to digest. The item that contains high residue and thus would place strain on the intestines is the fresh corn on the cob.

The nurse is developing a nutritional plan for an assigned client. Which is the most critical piece of data to collect before formulating the plan?

The presence of food allergies

The nurse is instructing a client with osteomalacia about appropriate food items to include in the diet. Which food items should be included in the client's diet? Select all that apply.

Wild caught salmon Milk Osteomalacia is the softening of bone tissue characterized by inadequate mineralization of osteoid. It is the adult equivalent of rickets and vitamin D deficiency in children. Of the food items presented, milk, which has vitamin D added, provides the best source of vitamin D. Oily fish, especially wild caught such as salmon and mackerel, are also rich in vitamin D. Citrus fruits are high in vitamin C. Bread products are high in niacin. Green, leafy vegetables are high in folic acid.

A client is receiving total parenteral nutrition and has been NPO. The primary health care provider (PHCP) prescribed small amounts of clear liquids today. The nurse's priority is to collect data regarding which criterion before giving the client anything by mouth?

The presence of the swallow reflex The nurse ensures that the client has intact gag and swallow reflexes before giving clear liquids. The nurse should also check for the presence of bowel sounds. The pulse, blood pressure, and weight require ongoing monitoring, but they are not the most important items given the wording of the question. The client may be expected to have a poor appetite after being without oral intake for a period of time.

A client who has recently been started on enteral feedings begins to complain of abdominal cramping, followed by passage of two liquid stools. The nurse notes that the client has abdominal distention as well. The nurse reviews the nutritional content on the label of the can to see if it contains which ingredient?

lactose Several tube feeding formulas contain lactose. A client with an unreported history of lactose intolerance would develop symptoms such as these in response to nutritional therapy with these formulas. If the client is diagnosed as lactose intolerant, a lactose-free formula should be prescribed by the primary health care provider. This will resolve the client's symptoms and promote adequate nutrition for the client.

The nurse reinforces instructions to a client to increase the amount of riboflavin in the diet. The nurse should tell the client to select which food item that is high in riboflavin?

milk Food sources of riboflavin include milk, lean meats, fish, and grains. Tomatoes and citrus fruits are high in vitamin C. Green leafy vegetables are high in folic acid.

A newly pregnant client is asking how to prevent neural-tube birth defects. The nurse reinforces which food choices to include in the diet? Select all that apply.

orange brocoli grapefruit Folic acid (folate) helps prevent neural tube birth defects; it is found in green, leafy vegetables; liver, beef, and fish; legumes; and grapefruit and oranges. Peanuts are high in protein and niacin. Milk is high in calcium and vitamin D. Egg yolks are high in vitamin A, iron, and cholesterol.

The nurse employed in a well-baby clinic is reinforcing nutrition instructions to the mother of a 1-month-old infant. Which instruction should the nurse provide the mother?

Offer breast milk or formula as the main food. Breast milk or formula is the main food throughout infancy. Rice cereal mixed with breast milk or formula is introduced at 4 months of age. Strained vegetables, fruits, and meats, are introduced one at a time and can begin at 6 months of age.

A client receiving total parenteral nutrition (TPN) asks the nurse if he has developed diabetes when the capillary blood glucose level is monitored and he is given insulin. The nurse explains that which is the reason for monitoring glucose levels and administering insulin?

TPN contains concentrated carbohydrates and raises blood glucose. TPN contains a high concentration of glucose and also amino acids, which are proteins. With a continuous infusion, the body does not produce enough insulin to use the glucose effectively. The glucose is monitored usually around the clock if the client is not eating. Fast, or rapid-acting, insulin is administered according to the client's capillary blood glucose level. TPN does not impair pancreatic function or raise cortisol levels. TPN does increase the risk for infection, which often raises glucose levels, but there is no actual infection.

The nurse is reinforcing dietary instructions to a client with tuberculosis who has lost weight. The nurse reinforces instructions for the client to increase intake of protein and vitamin C. The nurse determines that teaching has been effective when the client selects which food items in the daily diet?

Hamburger and oranges The client with tuberculosis often is malnourished and needs dietary support to recover while receiving treatment. Food sources that are rich in protein include meats and legumes. Foods rich in vitamin C include citrus fruits, berries, melons, pineapple, broccoli, cabbage, green peppers, tomatoes, potatoes, chard, kale, asparagus, and turnip greens.

The nurse teaches the family of an infant with spina bifida that the infant should not be given which baby foods that may trigger a latex-type food allergy? Select all that apply.

Kiwi Banana avocado Infants with spina bifida develop a latex allergy due to repeated exposure to latex in surgery and having urinary catheters and should be in a latex-free environment. Parents should be informed about food sensitivities that are common to children with latex allergies. Foods that can cause a cross allergy to latex and should be avoided are bananas, avocados, and kiwi. Prunes and apples will not cause a latex-type reaction.

A client has a serum sodium level of 151 mEq/L (151 mmol/L), and the nurse reinforces dietary teaching about the types of foods to avoid. The nurse determines that there is a need for further teaching if the client states that which food choices are good? Select all that apply.

Sauerkraut American cheese he client's laboratory value reflects hypernatremia because the normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). Based on this finding, the nurse should instruct the client to avoid foods high in sodium. Sauerkraut and American cheese are high in sodium content. These should include foods from animal sources, which contain physiological saline, and highly processed meats and other foods that often have sodium added as a preservative. Spinach and rhubarb are good food sources of calcium. Cabbage is low calorie and a good source of vitamin C. Fish is high in phosphorus.

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week, yet is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern about not being able to continue the tube feedings at home with family caregivers. Which nursing response would be appropriate at this time?

"Tell me more about your concerns with your feedings after going home." A client often has fears about leaving the secure, cared-for environment of the health care facility. This client has a fear about not being able to provide self-care at home and not being able to handle the tube feedings at home. An open communication statement such as, "Tell me more about..." often leads to valuable information about the client and the client's concerns. Giving false assurance, giving advice, and dismissing client feelings are nontherapeutic statements.