Ch:35 Nutrition

A client with diabetes must monitor intake of sugar. Which client statement requires nursing intervention?

"At every meal, I eat bread with honey." A client monitoring carbohydrate intake should be mindful of the intake sugar, which is found in honey. All other dietary choices are acceptable.

A client is discussing vitamin and mineral intake with the nurse. Which client statement requires further nursing teaching?

"My husband and I are ordering a product that has megadoses of vitamins." Consuming megadoses (amounts exceeding those considered adequate for health) of vitamins and minerals can be dangerous. This statement requires further nursing teaching

A client is discussing vitamin and mineral intake with the nurse. Which client statement requires nursing intervention?

"Taking megadoses of vitamins will help me increase muscle mass quickly." Consuming megadoses of vitamins and minerals can be dangerous, so this statement requires intervention. The nurse should find out the type and dose of vitamins that the client takes. The other statements do not require intervention.

Normal Albumin Levels

3.5 to 5.5 g/dL

The nurse is caring for four older adult clients. Which does the nurse identify as highest risk for cardiometabolic syndrome?

70-year old with a body mass index (BMI) of 34.8 Waist circumference and obesity are linked with cardiometabolic syndrome. Therefore, the client with a BMI of 34.8 is obese and is at highest risk for cardiometaolic syndrome

A 45-year-old client on the inpatient unit has just resumed eating a normal diet. The nurse checks a blood sugar with the morning labs and the result is 99.10 mg/dL (5.5 mmol/L). How would the nurse interpret this blood glucose?

A 45-year-old client on the inpatient unit has just resumed eating a normal diet. The nurse checks a blood sugar with the morning labs and the result is 99.10 mg/dL (5.5 mmol/L). How would the nurse interpret this blood glucose?

BMR

A client who has a fever would have an increased BMR. The energy needs of the body are increased due to the client's fever. The BMR is decreased in an older adult client, a client who is fasting, and a client who is asleep.

At what period of life do nutrient needs stabilize?

Adulthood Nutrient needs stabilize during adulthood. Periods of intense growth and development (such as during infancy, adolescence, pregnancy and lactation) increase nutrient needs.

The nurse is caring for a client who refuses most foods on the dietary tray. Which nursing intervention is appropriate?

Assess when client generally eats meals. There are many reasons a client may refuse food that is served. The nurse should assess for food preferences, when the client generally eats, whether the client has digestive concerns, and cultural beliefs about foods. Leaving the client alone to eat, or simply delegating feeding, does not encourage intake. The client does not need an appetite stimulant until a full assessment has been conducted and other interventions have been implemented.

A 16-year-old adolescent informs her nurse that she became a vegetarian 1 year ago. Lately she is reporting fatigue and has trouble concentrating. A quick blood test ordered by her licensed provider informs the nurse that she has pernicious anemia. This is a deficiency of what vitamin?

B12 Vitamin B12 deficiency is most commonly found in vegetarians, particularly in strict vegans. Individuals who have such rigid dietary restrictions must take care to supplement this vitamin.

Extreme Obesity 40.0+

BMI

Underweight <18.5

BMI

Normal Glucose levels for healthy adults

Between 4.0 to 6.0 mmol/L (72 to 108 mg/d)

A nurse is teaching a client about diabetes and glucose monitoring. What should the nurse include in the teaching

Blood from the fingertips shows changes in glucose more quickly than other testing sites. With glucose monitoring, blood from the fingertips shows changes in blood glucose more quickly than other testing sites. With signs and symptoms of hypoglycemia, a fingertip site should be used. Calibrate the glucose monitors at least every month. Glucose levels increase with illness and stress to the body.

A nurse is teaching an adolescent client about nutrition following a hospital admission. What should the nurse understand about adolescent nutrition?

Childhood nutrition problems may worsen during adolescence. Adolescents may have childhood nutrition problems worsen during this period. During puberty, nutritional needs increase to support growth. Adolescents tend to eat away from home in fast-food places, leading to poor nutrition practices. Another characteristic of adolescence is eating quickly, therefore leading to overeating.

The nurse is teaching four clients in a community health center. Which client does the nurse identify as needing more servings per day of milk?

Children, adolescents, pregnant women, and breast-feeding mothers require more servings per day of certain food groups, particularly the milk group. Therefore, the teen (adolescent) who is pregnant will require more milk servings.

Clear liquid diets

Clear liquid diets contain foods that are clear liquids at room temperature or body temperature, such as gelatin, fat-free broth, bouillon, ice pops, clear juices, carbonated beverages, regular and decaffeinated coffee, and tea

Clear-Liquid diet

Composed only of clear fluids or foods that become fluid at body temperature and includes clear broth, coffee, tea, clear fruit juices (apple, cranberry, grape), gelatin, popsicles, commercially prepared clear liquid supplements. A clear liquid diet requires minimal digestion and leaves minimal residue.

A nurse is caring for a client who has been ordered a clear liquid diet. Which of the following can be included in the client's diet?

Cranberry juice

Which nursing actions follow guidelines for preventing complications with enteral feedings? Select all that apply.

Elevate the head of the bed at least 30 degrees during the feeding and for at least 1 hour afterward. Flush the tube before and after feeding. Clean and moisten the nares every 4 to 8 hours. The delivery set would be changed more often than every other day due to infection control issues. The nurse would check the residual before intermittent feedings, and every 4 to 6 hours during continuous feedings.

A woman consumes pasta, grains, and other carbohydrates for which purpose?

Energy

A client is receiving total parenteral nutrition (TPN). The nurse will assess for complications related to what?

Fluid and electrolyte levels It is important to assess fluid and electrolyte levels because total parenteral nutrition is high in nutrients and electrolytes. The other choices are not reflective of complications related to TPN.

Full liquid diets

Full liquid diets contain all the items on a clear liquid diet, but also include milk and milk drinks, custards, puddings, plain frozen desserts, pasteurized eggs, cereal gruels, vegetable juices, and milk and egg substitutes.

Infants and solid foods

Generally, solid foods are not introduced before the infant is developmentally ready, usually at about 6 months of age. At this age, the infant gains control of the head, neck, jaw, and tongue; develops hand-eye coordination; and the ability to sit, chew, and drink. New foods should be introduced one at a time for a period of 5 to 7 days so that any allergic reaction, such as rashes, fussiness, vomiting, diarrhea, or constipation, can be easily identified (Dudek, 2014). By 1 year of age, the infant typically is eating table food. Iron-fortified foods are recommended.

A nurse is learning about religious dietary restrictions at a nursing conference. Which of the following religious meal selections should the nurse understand is appropriate?

Hindus: Vegetable plate

Older adult consideration

Low serum albumin level (<3.5 mg/dL) may be a reflection of the aging process rather than a nutritional risk factor. Albumin synthesis declines with age.

Full-Liquid diet

Low-fat milk, juices with fruit pulp (orange and grapefruit) are considered full-liquid diet.

During an annual physical examination the client reports feeling a lack of muscle energy when walking and doing simple chores around the house. When reviewing the client's diet, deficiencies in which of the following would be associated with the symptoms reported? Select all that apply.

Niacin Thiamine Vitamins in the B complex such as niacin and thiamine are associated with confusion and motor weakness.

A 45-year-old client on the inpatient unit has just resumed eating a normal diet. The nurse checks a blood sugar with the morning labs and the result is 99.10 mg/dL (5.5 mmol/L). How would the nurse interpret this blood glucose?

Normal

Normal Glucose levels

Normal blood glucose is 80 to 110 mg/dL (4 to 7 mmol/L).

A client has just had abdominal surgery, and the nurse is consulting with him about his diet now that he is allowed to eat. Which nutrient is most important for wound healing?

Protein

The average dietary nutrient intake level that meets the nutritional requirement of almost all healthy people in a selected age and gender group is the:

RDA level

A nurse is caring for a client with chronic anemia. What should be included in the diet of this client?

Red meat Red meat is a source of iron Hindus do not consume beef because cows are considered a sacred creature. They are typically vegetarians; therefore, a vegetable plate is appropriate for this client. Orthodox Jews must have Kosher foods. Shrimp and pork are prohibited in this religion. Mormons do not use coffee, tea, or alcohol and they limit their meat consumption

Which laboratory test is the best indicator of a client in need of TPN?

Serum albumin Total Parenteral nutrition Assessment of serum albumin level is the best indicator of a client in need of total parenteral nutrition (TPN). Clients whose levels are 2.5 g/dL (25 g/L) or less are at severe risk for malnutrition.

A nurse is caring for a client who has a malabsorption disease. The nurse should understand that which structure in the gastrointestinal system absorbs the majority of digested food and minerals?

Small intestine Most absorption of digested food and minerals occurs in the small intestines. The stomach is responsible for storing food, secreting digestive enzymes, and digestion. The large intestine forms feces and absorbs water to regulate the consistency of stool. The digestive function of the liver is the production of bile.

The charge nurse is observing a new nurse care for a client who is receiving a continuous feeding through a nasogastric feeding tube. Which actions by the new nurse would require intervention by the charge nurse?

The new nurse places the client in the left lateral recumbent position. The client should be assisted to a high-Fowler's position (45 degrees).

Which nursing action associated with successful tube feedings follows recommended guidelines?

The nurse should check the residual before each feeding or every 4 to 8 hours during a continuous feeding. High gastric residual volumes (200 to 250 mL or greater) can be associated with high risk for aspiration and aspiration-related pneumonia. A closed system is the best way to prevent contamination during enteral feedings. The bowel sounds do not have to be assessed as often as 4 times per shift. Once a shift is sufficient.

A physician orders nutritional therapy administered via a central vein for a patient who cannot take foods orally. What is the term for this type of nutrition?

Total parenteral nutrition (TPN) TPN is nutritional therapy that bypasses the gastrointestinal tract and is administered through a central vein. PPN (partial parenteral nutrition) is nutritional therapy used for patients who have an inadequate oral intake and require supplementation of nutrients through a peripheral vein. A PEG is a surgically placed gastrostomy tube and a PEJ is a surgically placed jejunostomy tube.

Which vitamin is found only in animal foods?

Vitamin B12

A client is prescribed warfarin, an anticoagulant. When educating this client about potential diet and drug interactions, the nurse would caution the client about foods containing which nutrient?

Vitamin K

A client is prescribed warfarin, an anticoagulant. When educating this client about potential diet and drug interactions, the nurse would caution the client about foods containing which nutrient?

Vitamin K Specific foods may interact with medications, altering the effectiveness of the drug. Vegetables high in vitamin K decrease the effectiveness of the commonly used anticoagulant warfarin because Vitamin K is a coagulator, if a pt. is taking an anticoagulant... the Vitamin K will make their drug less effective.

A client who has bleeding tendencies has a deficiency in which vitamin?

Vitamin K Vitamin K deficiencies are manifested in two ways: an increased tendency to hemorrhage and hemorrhagic disease of the newborn, which is common in premature or anoxic newborns.

Vitamins A, D, E, and K, the fat-soluble vitamins,

Vitamins A, D, E, and K, the fat-soluble vitamins, are absorbed with fat into the lymphatic circulation. Like fat, they must be attached to a protein to be transported through the blood. Secondary deficiencies of the fat-soluble vitamins can occur anytime fat digestion or absorption is altered, such as during malabsorption syndromes and pancreatic and biliary diseases. The body stores excesses of the fat-soluble vitamins mostly in the liver and adipose tissue. Because they are stored, a daily intake is not imperative and deficiency symptoms may take weeks, months, or years to develop. Excessive intake, particularly of vitamins A and D, is toxic.

Water-soluble vitamins include vitamin C and the B-complex vitamins (ascorbic acid, thiamin, riboflavin, niacin, pyridoxine, biotin pantothenic acid, folate, cobalamin). water soluble (Cynthia Bitch)

Water-soluble vitamins include vitamin C and the B-complex vitamins (ascorbic acid, thiamin, riboflavin, niacin, pyridoxine, biotin pantothenic acid, folate, cobalamin). They are absorbed through the intestinal wall directly into the bloodstream. Although some tissues are able to hold limited amounts of water-soluble vitamins, they usually are not stored in the body. Deficiency symptoms are apt to develop quickly when intake is inadequate; therefore, a daily intake is recommended. However, because water-soluble vitamins are not stored, amounts consumed in excess of need are excreted in the urine. Toxicities are not likely, although megadoses of certain water-soluble vitamins can be harmful.

The nurse is assessing clients for basal metabolic rate (BMR). Which client would the nurse suspect would have an increased BMR?

a client who has a fever

The nurse is helping a client who eats a normal diet of 2000 calories daily to read a nutritional label on a box of cereal. Which nutrient does the nurse identify as appropriate for this client?

cholesterol less than 300 mg Daily values are calculated in percentages based on standards set for total fat, saturated fat, cholesterol, sodium, carbohydrate, and fiber in a 2000-cal diet. Total fat should be less than 65 g; saturated fat should be less than 20 g; cholesterol should be less than 300 mg; and sodium should be less than 2400 mg.

Hemoglobin (normal = 12-18 g/dL)

decreased → anemia

Hematocrit (normal = 40%-50%

decreased → anemia increased → dehydration

Transferrin (normal = 240-480 mg/dL

decreased → anemia, protein deficiency

Serum albumin (normal = 3.3-5 g/dL

decreased → high risk for morbidity, mortality, and malnutrition (prolonged protein depletion), malabsorption

A woman age 20 years has announced her intention to implement a zero-fat diet in order to lose weight and maximize her health. What is a potential consequence of completely eliminating fat sources from the woman's diet?

impaired vitamin absorption In addition to providing caloric needs, fats are necessary for the absorption of fat-soluble vitamins. It would be inadvisable to wholly eliminate fats from the diet in an effort to limit calorie intake.

Creatinine (normal = 0.4-1.5 mg/dL)

increased → dehydration decreased → reduction in total muscle mass, severe malnutrition

Blood urea nitrogen (normal = 17-18 mg/dL)

increased → starvation, high protein intake, severe dehydration decreased → malnutrition, overhydration

A client with influenza is prescribed a diet that is rich in fiber and carbohydrates. Which would the nurse incorporate into the education plan as a major reason for the high fiber diet?

maintenance of normal bowel elimination Dietary fiber is a minimal source of energy but plays an essential role in stimulating peristalsis and maintaining normal bowel elimination. Proteins have specific functions of producing hemoglobin for carrying oxygen to tissues, insulin for blood glucose regulations, and albumin for regulating osmotic pressure in the blood.

When a client provides a return demonstration of appropriate food selections for carbohydrates, which food does the nurse acknowledge as rich in carbohydrates?

milk oatmeal bread

Dietary fiber is a minimal source of energy but plays an essential role in stimulating peristalsis and maintaining normal bowel elimination. Proteins have specific functions of producing hemoglobin for carrying oxygen to tissues, insulin for blood glucose regulations, and albumin for regulating osmotic pressure in the blood.

pasta, rice, bread, cereals) are considered complex carbohydrates.

Which clients, at risk for poor nutritional intake, would benefit from nutritional counseling from the nurse? (Select all that apply.)

pregnant teenagers people with substance abuse problems older adults living on fixed incomes Examples of those in the United States at risk for an inadequate nutritional intake include older adults who are socially isolated or living on fixed income, homeless people, children of economically deprived parents, pregnant teenagers, people with substance abuse problems, and clients with eating disorders.

Anthropometric Data

• Because of age-related changes in body composition, skin-fold measurements, if used, should be taken from several body sites.

Dietary data for older adults

• Dietary recall may be inaccurate because of vision and memory problems. • Question use of vitamin and mineral supplements. • Gather information concerning medication regimen (prescribed and over-the-counter) to assess for food-drug interactions and adverse effects of medications.