pharm ch 24

Which vitamins are fat soluble vitamins? (select all that apply) a. Vitamin A b. Vitamin C c. Vitamin D d. Vitamin B2 e. Vitamin E f. Vitamin K g. Vitamin B12

ANS: A, C, E, F Vitamins A, D, E, and K are fat-soluble vitamins. Fat-soluble vitamins are stored in the liver and fatty tissues, and are eliminated more slowly than water-soluble vitamins. Fat-soluble vitamins are not lost when the foods that contain them are cooked.

A patient is prescribed to receive 240 mL of the supplemental feeding, Jevity, over 2 hours. At what rate in milliliters per hour will you set the feeding pump?

ANS: 120 240 mL/2 hours = 120 mL/h

Which is a water-soluble vitamin? a. Vitamin C b. Vitamin A c. Vitamin E d. Vitamin K

ANS: A Water-soluble vitamins can dissolve in water. Water-soluble vitamins are carried to the body's tissues but are not stored in the body. They are found in plant and animal foods or dietary supplements and must be taken in daily. Vitamin C and members of the vitamin B complex are water-soluble. Vitamins A, E, and K are fat-soluble vitamins.

Which statement about water soluble vitamins is accurate? a. They are not stored in the body. b. They are stored in the liver. c. They do not need to be taken in every day. d. They are not lost when foods containing them are cooked.

ANS: A Water-soluble vitamins dissolve in water. They are carried to the body's tissues but are not stored in the body. These vitamins are found in plant and animal foods or dietary supplements and must be taken in each day. Water-soluble vitamins are easily lost during cooking or when improperly stored.

What are the intended responses of the trace mineral zinc? (select all that apply) a. Helps blood clot b. Supports protein structures c. Strengthens bones d. Essential for taste and smell e. Supports the immune system f. Assists with iron metabolism

ANS: A, D, E Trace minerals carry out a wide variety of tasks. Zinc helps blood clot, is essential for taste and smell, and supports the immune response. Sulfur supports protein structures, fluoride (among others) supports bone health, and copper helps form an enzyme that assists with iron metabolism.

Which substances are considered macrominerals? (select all that apply) a. Calcium b. Cobalt c. Copper d. Magnesium e. Manganese f. Phosphorus g. Selenium h. Sulfur

ANS: A, D, F, H Cobalt, copper, manganese, and selenium are considered microminerals because they exist in the body in small amounts and are known as trace elements. Calcium, magnesium, phosphorus, and sulfur are present in larger mounts and are known as macrominerals.

Every time you administer an intermittent supplemental enteral feeding through a feeding tube what must you do after? a. Run tap water through the tube until time for the next feeding. b. Flush the feeding tube completely to prevent clogging of the tube. c. Check the stomach for residual enteral feeding in the stomach. d. Get an abdominal x-ray to ensure that the feeding tube is correctly placed.

ANS: B After giving an intermittent enteral supplement flush the tube to prevent clogging.

A patient with COPD is to receive Pulmocare at 40 mL/h. How many milliliters would you hang to cover 4 hours?

ANS: 160 40 mL ´ 4 h = 160 mL

What is the major adverse risk when administering an enteral supplemental feeding to a patient through a feeding tube? a. Aspiration of tube feeding contents. b. Abdominal pain when given too fast. c. Toxicity from too many vitamins and minerals. d. Peritonitis if the bowel ruptures.

ANS: A An adverse effect of enteral nutritional supplements administered by a feeding tube is the risk for aspiration and aspiration pneumonia. Elevate the head of the bed to protect the patient from aspiration of the formula.

What should you check before administering an enteral feeding by mouth? a. Gag reflex b. Frequency of reflux c. Foods that cause nausea d. Consistency of bowel movements

ANS: A Before giving a patient anything to eat or drink it is important to check for and intact gag reflex as well as the ability to swallow.

Deficiency of which nutrient during pregnancy can cause spina bifida in the unborn baby? a. Folic acid b. Chromium c. Ascorbic acid d. Cholecalciferol

ANS: A Folic acid is a critical element in the formation of the brain and spinal cord in embryonic and fetal development. When too little of this nutrient is present during pregnancy, the spinal cord does not close completely and spina bifida results.

After giving a daily multivitamin supplement, for which side effect must you monitor? a. Constipation and nausea b. Belching and reflux c. Abdominal distention and discomfort d. Diarrhea and electrolyte imbalances

ANS: A Multivitamins may cause constipation, nausea, or upset stomach. These side effects are usually not permanent and improve as a patient's body gets used to the drug.

Which statement about total parenteral nutrition (TPN) is accurate? a. TPN provides all of a patient's daily nutritional needs. b. TPN is always given through a peripheral IV line. c. TPN can only be given in a hospital or long-term care setting. d. TPN provides nutrition but prevents normal lifestyles.

ANS: A TPN provides all of a patient's daily nutritional needs. A peripheral IV line can be used for a short period with a less concentrated formula. When nutritional support is needed for a long period of time, concentrated solutions are used and require central venous access (e.g., peripherally inserted central catheter [PICC line]; triple lumen catheter [TLC]). TPN formulas are individualized and prepared by pharmacists according to patient needs. This form of nutrition is given in the hospital and at home. In many cases TPN allows people who have lost small intestine function to lead fairly normal lives.

Which vitamin is eliminated the most slowly? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin X

ANS: A Vitamin A is a fat soluble vitamin that is stored in the liver and fat cells. The storage sites serve as "time release capsules" delaying elimination. Vitamins B and C are water soluble and rapidly eliminated daily. Vitamin X does not exist.

What is the recommended daily dose of calcium for a healthy adult? a. 500 mg b. 1000 mg c. 1500 mg d. 2000 mg

ANS: B As listed in Table 24-3 the U.S. Food and Drug Administration has established 1000 mg daily as the recommended dose of calcium for healthy adults.

Which statement by a patient prescribed supplemental calcium indicates the need for additional teaching? a. "Because I am older, my prescriber wants me to take the calcium for bone health." b. "Once I have bone scan I will no longer need to take the calcium." c. "I will drink vitamin D enriched milk every day to help absorb my calcium." d. "Fish, milk, tofu, and broccoli are all good dietary sources of calcium."

ANS: B Decreased appetite or reduced ability to buy and prepare healthy foods can lead to older people not getting enough essential vitamins or minerals. Supplements are often ordered by prescribers to make up for these deficits. Older adults often need additional calcium for bone health and to prevent osteoporosis. As people age, bone scans often lead to a diagnosis of calcium deficit or even osteoporosis. Older adults often are prescribed calcium supplements for bone health and to prevent osteoporosis.

Which is the main side effect of enteral feedings? a. Electrolyte imbalance b. Diarrhea c. Bloating d. Reflux

ANS: B Diarrhea is the main side effect of enteral nutritional supplemental feedings. Other GI side effects may include constipation and nausea/vomiting. Often these side effects disappear once a patient's body adjusts to the nutritional supplement. Severe prolonged diarrhea can lead to electrolyte imbalances.

The parents of a child ask you why fluoride is essential for the health of their child. What is your best response? a. "Fluoride is essential for nerve health as your child grows." b. "Fluoride helps your child grow strong bones and prevents tooth decay." c. "Fluoride supports your child's immune system and prevents infections." d. "Fluoride aids your child's body in maintenance of proper fluid balance."

ANS: B Fluoride is a trace mineral that strengthens bones and prevents tooth decay.

Which foods should you teach a patient who has a mild vitamin K deficiency to eat? a. Eggs and fortified milk b. Spinach and romaine lettuce c. Sunflower seeds and almonds d. Carrots, sweet potatoes, and pumpkin

ANS: B Foods with large amounts of vitamin K are green, leafy, vegetables. Milk is fortified with vitamin D.

Which statement by a patient indicates the need for additional teaching? a. "I will take my multivitamin every morning with breakfast to avoid the feeling of nausea." b. "Now that I am taking a daily multivitamin I will not have to worry about what foods I eat." c. "If I experience any signs of allergic reaction such as rash or swelling I will contact my prescriber." d. "My multivitamin also contains essential minerals that I need to take in every day."

ANS: B Patients need to understand that a nutritious diet is the best way to take in vitamins and minerals. Teach patients that vitamin and mineral supplements are not intended to replace a balanced, healthy diet.

Which mineral helps maintain water balance in the body? a. Calcium b. Sodium c. Sulfur d. Fluoride

ANS: B Some minerals help to maintain the proper balance of water in the body. Sodium, chloride, and potassium take the lead in doing this. Calcium is important for healthy bones. Sulfur helps stabilize protein structures, and fluoride is important for strong bones and teeth.

Which type of nutrient deficiency should you assess for in a patient who eats mostly fresh fruit, red and yellow vegetables, rice, milk, and other dairy products? a. Vitamin A b. Iron c. Sodium d. Fluoride

ANS: B Sources of iron include organ meats, red meat, fresh poultry, shellfish, egg yolks, legumes, dried fruits, dark green leafy vegetables, and iron enriched bread and cereals.

Which substance should a patient avoid when prescribed a potassium supplement? a. Table salt b. Salt substitutes c. Garlic salt d. Onion salt

ANS: B Teach patients to avoid salt substitutes if they are receiving mineral supplementation with potassium. Salt substitutes use potassium instead of sodium, thus when used with a potassium supplement they could cause an elevated potassium level.

Which enteral supplemental feedings are specialized formulas? (select all that apply) a. Optimental b. NutriHep c. Glytrol d. Osmolite e. Nepro f. Jevity g. Pulmocare

ANS: B, C, E, G Specialized formulas are designed for supplement in a variety of clinical conditions or disease states. NutriHep is for liver disease, Glytrol is for diabetes, Pulmocare is for COPD, and Nepro is for kidney disease. Optimental is an elemental formula. Osmolite and Jevity are standard enteral formulas.

Which condition results from a deficit of vitamin C? a. Beriberi b. Pellagra c. Scurvy d. Megaloblastic anemia

ANS: C A deficit of vitamin C can lead to scurvy. A deficit of niacin can lead to pellagra, a deficit of thiamine can cause beriberi, and a deficit of Cyanocobalamin (vitamin B12) can lead to megaloblastic anemia.

Which statement about multivitamins is accurate? a. Multivitamins are essential organic micronutrients the body needs in small amounts for various roles throughout the human body. b. Multivitamins are essential micronutrients which are inorganic elements. c. Multivitamins are preparations that contain several vitamins essential for health. d. Multivitamins are only water soluble vitamins and trace minerals.

ANS: C A multivitamin is a pill or other preparation (e.g., liquid, chew) that contains several vitamins essential for health. It is usually intended as a dietary supplement and often includes essential dietary minerals.

Which vitamin is essential in preventing blindness? a. Vitamin D b. Vitamin C c. Vitamin A d. Vitamin K

ANS: C Adequate intake of vitamin A prevents blindness, vitamin C prevents scurvy, vitamin K helps strengthen bones, and vitamin D prevents rickets.

A patient is to be discharged to home with a continuous supplemental enteral feeding through a feeding tube. The spouse of the patient asks how much feeding to hang. What is your best response? a. "Hang enough for 12 hours." b. "Hang enough for 8 hours." c. "Hang enough for 4 hours." d. "Hang enough for 2 hours."

ANS: C For continuous administration of a nutritional supplement, remind patients and family members to hang only 4 hours volume of the supplement. Teach them that with supplements hung for longer than 4 hours there is an increased risk for growth of infectious organisms. Also teach families to change enteral feeding containers and tubing every 24 hours to prevent organism growth and infection.

A patient prescribed iron supplements tells you that his stools appear dark black. What is your best response? a. "I will send a stool sample to the lab for occult blood testing." b. "Your prescriber should be informed about this immediately." c. "This is a common and expected occurrence after taking iron supplements." d. "Have you noticed any bright red blood in your stool or have you vomited blood?"

ANS: C Remind patients that iron supplements can cause stool to appear black but this is not harmful.

A patient tells you that after taking a daily multivitamin and mineral supplement he experiences stomach upset. What is your best advice? a. "Drink a full glass of water with your multivitamin." b. "Be sure to sit up for at least 2 hours after taking your multivitamin." c. "Take your multivitamin with food to avoid stomach upset." d. "Report this to your prescriber because a different brand might not cause this problem."

ANS: C Side effects of multivitamins are rare but may include upset stomach, headache, and an unusual or unpleasant taste in the mouth. If a patient experiences upset stomach, teach him of her that supplements can be given with food to avoid this side effect. Teach patients that this side effect is usually temporary and resolve as the body becomes accustomed to the supplement.

Why should continuous enteral nutrition formulas be administered within 4 hours? a. When given over a period longer than 4 hours the patient's nutrition will be inadequate. b. The water soluble vitamins contained in enteral formulas quickly degrade outside of the body. c. The risk for overgrowth of infectious microorganisms in the enteral formula increases after 4 hours. d. The risk for clogging the feeding tube increases when enteral formulas are administered more slowly.

ANS: C The enteral nutrition equipment is kept clean not sterile. When the formula runs through the administration system longer than 4 hours at room temperature, infectious organisms overgrow rapidly.

What is the purpose of an elemental formula such as Optimental or Vivonex? a. A formula with intact protein containing balanced amounts of macronutrients that will often meet a patient's nutrient requirements. b. A formula that provides all of the nutritional requirements for a patient that is given by the intravenous (IV) route. c. A formula that is often predigested for patients with limited GI function. d. A formula designed for a use as a supplement in a clinical condition or disease state.

ANS: C The three classes of enteral nutritional formulas are standard, elemental, and specialized. Elemental formulas are often predigested formulas for patients with limited GI function.

A patient is receiving supplemental enteral feedings with Osmolite, 1 can three times a day between meals. For which main side effect should you monitor? a. Constipation b. Nausea c. Vomiting d. Diarrhea

ANS: D Diarrhea is the main side effect of enteral nutritional supplemental feedings. Other GI side effects may include constipation and nausea/vomiting. Often these side effects disappear once a patient's body adjusts to the nutritional supplement.

A patient has a deficiency of the mineral iodine. Which sign of deficiency should you teach the patient and family to report to the prescriber? a. Dehydration b. Lethargy c. Loss of appetite d. Swollen thyroid gland

ANS: D Iodine deficiency can cause a goiter (a swollen thyroid gland) and reduced production of thyroid hormones.

How does intake of vitamin D supplements provide safety for older adults in nursing care facilities? a. Vitamin D helps older adults to maintain vision longer. b. Vitamin D helps older adults maintain the sense of hearing for many years. c. Vitamin D helps older adults maintain appetite and nutrition status. d. Vitamin D helps older adults maintain bone strength and decreases falls.

ANS: D Research has demonstrated that administration of vitamin D supplements is effective in decreasing falls in nursing care facilities

Which is a trace mineral? a. Calcium b. Potassium c. Sodium d. Zinc

ANS: D Trace minerals are needed by the body in very small amounts. These include iron, manganese, copper, iodine, zinc, cobalt, fluoride, and selenium. Calcium, potassium, and sodium are macrominerals needed in much larger amounts than trace minerals.

Which type of supplemental feeding makes use of the gastrointestinal tract? a. TPN (total parenteral nutrition) b. Intravenous feedings c. Intraosseous feedings d. Enteral feedings

ANS: D When patients are unable to take in adequate nutrition, they may need nutritional supplements. Supplements may be provided by way of the gastrointestinal (GI) tract if it is functional (enteral nutrition) or parenterally (intravenous formula) with total parenteral nutrition (TPN). Enteral feedings are preferred as long as the GI tract is working.