Craven Ch 33: Nutrition

What is the body mass index (BMI) of a client who is 1.68 meters tall and weighs 70 kg? - 20.2 - 22.4 - 24.8 - 26.2

- 24.8 Explanation: A BMI of 24.8 is correct. The BMI is the ratio of height to weight that more accurately reflects total body fat stores in the general population. To calculate the BMI: divide the weight in kilograms (kg) by the height in meters (m) then divide the answer by the height again to get the BMI.

A nurse administers a continuous tube feeding via an NG tube. The nurse must check for residual every: - 2 hours. - 4 to 6 hours. - 8 to 12 hours. - 12 to 24 hours.

- 4 to 6 hours. Explanation: Check for residual before each feeding or every 4 to 6 hours during a continuous feeding, according to institutional policy. This is implemented to identify delayed gastric emptying. Research suggests continuing the feedings with residuals up to 400 mL. If greater than 400 mL, the nurse should confer with the physician or hold feedings according to agency policy.

In planning to meet the nutritional needs of a critically ill client in the intensive care unit, which factor will increase the client's basal metabolic rate? - Infection - Advanced age - Prolonged fasting - Long periods of sleep

- Infection Explanation: Factors that increase a person's basal metabolic rate (BMR) include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones (epinephrine and thyroid hormones). Aging, prolonged fasting, and sleep all decrease BMR.

A nurse is discussing neonatal care with a new parent. Which statement by the nurse best describes the value of breastfeeding? - "Breastfeeding helps you bond with the neonate, but formula must be added for complete nutrition." - "Breastfeeding helps your body recover from pregnancy." - "Breastfeeding provides extra iron for the growing neonate." - "Breastfeeding provides the neonate with immunity against some bacteria and viruses."

- "Breastfeeding provides the neonate with immunity against some bacteria and viruses." Explanation: Breast milk provides neonates with immunity against some bacteria and viruses, results in different intestinal flora than with artificial formula, decreases the incidence of allergies, and provides a well-balanced and ideal source of nutrition. Breastfeeding does help the new parent bond with the neonate and is a complete source of nutrition.

A student is following current recommendations for assessing tube placement. A staff nurse says, "Oh, just insert air and listen for a 'whoosh' sound." How would the student respond? - "Thank you. That would be much easier for me to do." - "That procedure has been found to be unreliable." - "My instructor told me to do it this way, so I will." - "I appreciate your advice. Let me ask the client."

- "That procedure has been found to be unreliable." Explanation: Some clinicians remain reluctant to abandon the auscultatory method of checking tube placement. This procedure has proven unreliable and may result in tragic consequences if used as the sole indicator of tube placement.

A client informs the nurse that they have been following a strict low-calorie diet and skipping meals to lose weight faster. The client reports feeling upset about not losing any weight and wants to know what to do. What is the best response by the nurse? - "If you keep cutting out a lot of calories, you will lose weight." - "The body will go into starvation mode by slowing metabolic rate and it will be hard to lose weight." - "Are you sure you are cutting back as much as you say you are? You should be losing weight." - "Losing weight is hard and sometimes no matter what you do, it doesn't work."

- "The body will go into starvation mode by slowing metabolic rate and it will be hard to lose weight." Explanation: Fasting or following a very-low-calorie diet may defeat a weight-loss plan because the body interprets this eating pattern as starvation and compensates by slowing down the resting metabolic rate, making it even more difficult to lose weight.

The nurse is flushing a client's feeding tube with 50 mL of water after giving medications through it. When the client asks, "Why are you doing that?" what is the appropriate nursing response? - "This fluid will help your medication to dissolve." - "Water helps keep the feeding tube free from obstruction." - "I'm providing water through the tube to keep you hydrated." - "It appears that you are concerned about this procedure."

- "Water helps keep the feeding tube free from obstruction." Explanation: The nurse will respond by teaching the client that this amount of water helps to keep the feeding tube patent. It is not meant to dissolve medication, nor to hydrate the client. Observing that the client seems concerned about a procedure does not answer the client's actual question.

The nurse is educating a client taking furosemide for heart failure about eating foods that are rich in potassium. Which statement made by the client indicates that education was effective? - "When I take my medication, I will eat a banana or take it with a glass of orange juice." - "I am going to increase my intake of dairy products like milk and cheese." - "Because I am losing sodium with the medication, I need to increase my salt intake." - "It would be better to eat small frequent meals each day instead of three large meals."

- "When I take my medication, I will eat a banana or take it with a glass of orange juice." Explanation: The client demonstrates that the teaching was effective by identifying bananas and orange juice as foods rich in potassium. The desired effect of the medication is to excrete sodium to avoid the accumulation of fluid in the lungs. To increase the amount of salt in the diet would be counterproductive. Dairy products such as milk and cheese are not potassium-rich foods. Eating small frequent meals versus three meals per day is irrelevant in increasing potassium level.

A nurse is establishing an ideal body weight for a 5'9" (175 cm) healthy female. Based on the rule-of-thumb method, what would be this client's ideal weight? - 130 lb/ 58.9 kg - 135 lb/ 61.2 kg - 140 lb/ 63.5 kg - 145 lb/ 65.7 kg

- 145 lb/ 65.7 kg Explanation: A general guideline, often called the rule-of-thumb method, determines ideal weight based on height. This formula is as follows: For adult females: 100 lb/45.3 kg (for height of 5 feet or 152 cm) + 5 lb / 2.2 kg for each additional inch (2.5 cm) over 5 feet. For adult males: 106 lb / 48 kg (for height of 5 feet) + 6 lb / 2.7 kg for each additional inch over 5 feet.

A nurse performing a nutritional assessment determines the BMI of a 5'11" (180 cm) male client who weighs 180 pounds (82 kg). What would be the BMI for this client? - 18.5 - 20.3 - 25.1 - 28.2

- 25.1 Explanation: BMI is equal to:weight in kg/height in m2.

The nurse is caring for four clients. Which does the nurse identify as highest risk for development of cardiometabolic syndrome? - 23-year old with ankle fracture and anxiety - 36-year old with obesity who smokes - 44-year old with hypertension and undernutrition - 59-year old with lupus who exercises three times weekly

- 36-year old with obesity who smokes Explanation: Cardiometabolic syndrome is a cluster of modifiable risk factors that can potentially lead to cardiovascular diseases and type 2 diabetes mellitus, if uncontrolled. The syndrome includes combinations of obesity (particularly abdominal fat), hypertension, elevated blood glucose (insulin resistance), abnormal blood fat levels, smoking, and inflammatory markers. The client with two of these modifiable factors - insulin resistance, and who smokes - is at highest risk for developing cardiometabolic syndrome. The other clients are not at as high of a risk for cardiometabolic syndrome.

The nurse calculates the intake of a client who received a bolus tube feeding of 250 ml. The nurse administered 60 ml of water prior to the feeding and 60 ml of water after the feeding. The nurse administered crushed medications in 45 ml of water. Calculate the amount of fluid, in milliliters, the client received. Record your answer using a whole number.

- 415 mL Explanation: The nurse calculates fluid intake for a client who receives tube feedings to ensure adequate hydration and to avoid too much fluid at one time. 60 ml of water + 250 ml of tube feeding + 60 ml of water + 45 ml of crushed medications in water = 415 ml

A nurse is discussing vitamin supplementation. Which groups are more prone to mild vitamin deficiencies? Select all that apply. - Adolescents - Middle-age adults - Pregnant or lactating women - Non-smokers - Strict vegetarians

- Adolescents - Pregnant or lactating women - Strict vegetarians Explanation: Vitamin deficiencies are inherent with a few populations. Adolescents often eat fast food or skip breakfast and are prone to having vitamin deficiencies. Pregnant or lactating women have higher nutritional demands and may not consume enough vitamins to meet the demand. The vegan or total vegetarian diet includes only foods from plants: fruits, vegetables, legumes (dried beans and peas), grains, seeds and nuts and they lack protein vitamins. Middle aged adults and non-smokers are not at risk.

The nurse is attempting to insert an NG tube and, as the tube is passing through the pharynx, the client begins to retch and gag. What nursing interventions are appropriate in this situation? Select all that apply. - Inspect the other nostril and attempt to pass the nasogastric tube down that nostril. - Ask the client if he needs to pause before continuing insertion. - Continue to advance tube when the client relates that he is ready. - Have the emesis basin nearby in case client begins to vomit. - Give small air boluses until gastric contents can be aspirated. - Insert a nasointestinal tube.

- Ask the client if he needs to pause before continuing insertion. - Continue to advance tube when the client relates that he is ready. - Have the emesis basin nearby in case client begins to vomit. Explanation: The nurse would ask the client if she should pause before continuing insertion of the NG tube. The client retching and gagging is often part of the normal process of placing an NG tube. The nurse would continue to advance the tube when the client states he is ready. The emesis basin should be nearby in case the client begins to vomit. The nurse would not inspect the other nostril; if the client is retching and gagging, the issue is not the nostril. The nurse would not give small air boluses or insert a nasointestinal tube.

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. - Nutritional needs decrease during adolescence. - Adolescents tend to eat meals at home. - Adolescents eat their food slowly.

- Childhood nutrition problems may worsen during adolescence. Explanation: 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.

A client who is receiving tube feedings has developed diarrhea. Which nursing intervention is appropriate? - Use a small-diameter feeding tube. - Consult with the health care provider about using a milk-free formula. - Maintain the sitting position for at least 30 minutes after feeding. - Increase the amount of supplemental water that is given.

- Consult with the health care provider about using a milk-free formula. Explanation: The nurse will consult with the health care provider about using a milk-free formula since milk can induce diarrhea. Other interventions do not address the problem of diarrhea.

The nurse is teaching an older adult client how to administer tube feedings at home. Despite several interventions, the client cannot provide a return demonstration. Which nursing action is appropriate? - Ask the client what is so fearful about the procedure. - Assure the client of the capability to perform this task. - Contact home health services for a home health nurse. - Remind the client that this is the only means to obtain nutrition.

- Contact home health services for a home health nurse. Explanation: A home health nurse can be of assistance if a client is afraid or unable to self-administer tube feedings. Other actions are inappropriate and do not effectively address the client's inability to demonstrate the task.

An older adult client who has a BMI of 28.1 and gastroesophageal reflux disease (GERD) reports heartburn frequently. The nurse plans to teach the client how to manage and prevent heartburn. What information will the nurse include in the teaching for this client? Select all that apply. - Do not use products that contain nicotine, such as tobacco and vaping devices. - As long as you sleep with two pillows, you may eat prior to bedtime. - Maintain a diet that is low in fat. - Plan a nutritious diet that will allow you to lose weight. - One ounce of alcohol with the evening meal is allowed.

- Do not use products that contain nicotine, such as tobacco and vaping devices. - Maintain a diet that is low in fat. - Plan a nutritious diet that will allow you to lose weight. Explanation: When teaching a client who has GERD, the nurse will include the following information: no smoking, a diet low in fat, and lose weight. Nicotine in tobacco and vaping products lower esophageal sphincter pressure, allowing reflux of stomach contents into the esophagus. Fat in the diet delays emptying of the stomach and increases the likelihood of reflux. Being overweight (a BMI greater than 25) increases intra-abdominal pressure, pushing gastric contents into the esophagus. The client is instructed to raise the head of the bed 30 to 40 degrees. This means placing the legs of the head of the bed on blocks. Using two pillows causes a bend in the neck. Pillows do not raise the level of the esophagus. The client is also instructed to avoid eating before bedtime. Again, eating before bedtime allows for reflux. Alcohol relaxes the lower esophageal sphincter pressure and increases the production of gastric acid. Both of these physiologic actions allow for reflux.

The nurse has assessed 50 mL of gastric residual after completing a tube feeding. What is the appropriate nursing action? - Administer additional tube feeding. - Hold the next scheduled feeding. - Document the assessment finding. - Notify the health care provider.

- Document the assessment finding. Explanation: Gastric residual should be no more than 100 mL or no more than 20% of the previous hour's tube-feeding volume. This finding is normal and should be documented as such. The other options are not appropriate.

The nurse has assessed 100 mL of gastric residual after completing a tube feeding. What is the appropriate nursing action? - Administer more tube feeding. - Hold the next scheduled feeding. - Document the assessment finding. - Immediately notify the health care provider.

- Document the assessment finding. Explanation: Gastric residual should be no more than 100 mL or no more than 20% of the previous hour's tube-feeding volume. This finding is normal and should be documented. The other actions are inappropriate based on the normal finding.

What independent nursing intervention can be implemented to stimulate appetite? - Administer prescribed medications. - Recommend dietary supplements. - Encourage or provide oral care. - Assess manifestations of malnutrition.

- Encourage or provide oral care. Explanation: There are many methods of stimulating appetite in a client to prevent malnutrition. One independent nursing intervention that is useful is to encourage or provide oral care. Administering medications and recommending dietary supplements are useful but are not independent nursing actions. The health care provider would need to prescribe the medications. Assessing manifestations of malnutrition occurs after malnutrition is recognized.

A client resides in a long-term care facility. Which nursing intervention would promote increased dietary intake? - Encourage the client to eat in the dining room. - Feed the client their meal while in bed. - Allow the client to eat when they want to. - Discourage family from visiting during meals.

- Encourage the client to eat in the dining room. Explanation: Encouraging the client to eat in the dining room will allow for socialization during meal time. This will have a positive effect on the amount of food consumed and provide enjoyment. Feeding the client in bed encourages isolation from other residents. Allowing the client to eat whenever they want does not support socialization. Discouraging the family is not recommended, as the family can provide support and be assistive to the client and their food needs.

The nurse caring for a client for several days has assessed that the client has been eating poorly during this hospitalization. Which nursing measure should the nurse implement to assist the client in improving the client's nutritional intake? - Encourage the client's adult child to prepare food at home and bring it to the client. - Serve large meals and encourage the client to eat as much as possible. - Provide distractions while the client is fed so that the clientt will eat more. - Provide bland meals.

- Encourage the client's adult child to prepare food at home and bring it to the client. Explanation: The nurse should solicit food preferences and encourage favorite foods from home, when possible. Be sure the foods look attractive and the eating area is free of odors, clutter, and distractions during mealtime. Provide small, frequent meals to avoid overwhelming the client with large amounts of food.

A nurse is caring for a client with a gastrostomy tube. Which activity should the nurse perform? - Ensure that the sutures holding the tube are intact. - Verify the placement area with the help of an x-ray. - Slide the external bumper of the tube up, so it is flush with the skin. - Avoid the use of skin barrier ointments.

- Ensure that the sutures holding the tube are intact. Explanation: The nurse should ensure that the sutures holding a surgically placed tube are intact to prevent tube migration. An x-ray is required for nasointestinal tubing, not for managing gastrostomy. The nurse should slide the external bumper of the tube down, so it is flush with the skin, and sliding also restabilizes the tube. Skin barrier ointments, such as zinc oxide and hydrocolloid dressings, are used if the skin appears irritated, and they also protect the skin and promote healing.

A nurse is caring for a client with a nasogastric tube. The nurse enters the room to flush the nasogastric tube and check gastric residual. Which action should the nurse perform first? - Ensure the head of the bed is elevated. - Check placement of the tube. - Flush the tube with the ordered amount of water. - Aspirate gastric contents with a syringe.

- Ensure the head of the bed is elevated. Explanation: The head of the bed should be elevated before giving medications or performing a tube feeding. Following this, the placement of the tube should be checked, aspirate the gastric contents with a syringe, and then flush the tube with the ordered amount of water.

The nurse is teaching a parent of a toddler about healthy eating habits. Which practices will the nurse recommend? Select all that apply. - Establish patterns for meals. - Encourage healthy body image. - Educate self and family about nutrition. - Make time available for food preparation. - Promote food preferences in early childhood.

- Establish patterns for meals. - Encourage healthy body image. - Educate self and family about nutrition. - Make time available for food preparation. Explanation: Establishing meal patterns, encouraging healthy body image, educating self and family about nutrition, making time for food preparation, and discouraging food preferences by offering many types of foods in early childhood reflect healthy eating habits. Promoting food preferences in early childhood can inhibit healthy eating behaviors.

A nurse is teaching a client about nutrition. Which facts should the nurse include about fat-soluble vitamins? Select all that apply. - Fat-soluble vitamins are A, D, E, and K. - The body excretes all excess water-soluble vitamins. - Deficiencies may take hours or days to develop. - Fat-soluble vitamins must be attached to a protein for transport in the blood. - Deficiencies of fat-soluble vitamins can occur with malabsorption syndromes.

- Fat-soluble vitamins are A, D, E, and K. - Fat-soluble vitamins must be attached to a protein for transport in the blood. - Deficiencies of fat-soluble vitamins can occur with malabsorption syndromes. Explanation: Fat-soluble vitamins are A, D, E, and K. These vitamins must be attached to a protein to be transported through the blood. Deficiencies can occur during malabsorption diseases because fat digestion or absorption is altered. Fat-soluble vitamins are stored in the liver and adipose tissue. Therefore, deficiencies can take weeks, months, or years to develop.

A nurse is delivering meal trays to clients on the unit. One client has a fractured dominant arm which is in a sling. What is the first nursing action when bringing the tray into the client's room? - Identify the name of the client. - Remove the lids covering the foods. - Assist the client with opening containers of liquids. - Cut food into bite-size pieces.

- Identify the name of the client. Explanation: When serving meal trays, the nurse first identifies the name of the client to ensure the client receives the correct meal tray. The nurse will then assist this client, who has limited mobility of the arm, in preparing the food by removing lids from the food items, opening cartons of fluids, and cutting food into bite-sized pieces.

Which nursing action is performed according to guidelines for aspirating fluid from a small-bore feeding tube? - Use a small syringe and insert 10 mL of air. - If fluid is obtained when aspirating, measure its volume and pH and flush the tube with water. - Continue to instill air until fluid is aspirated. - Place the client in the Trendelenburg position to facilitate the fluid aspiration process.

- If fluid is obtained when aspirating, measure its volume and pH and flush the tube with water. Explanation: The nurse would measure the volume and pH of the aspirated fluid, then flush the tube with water. The nurse would not place the client in Trendelenburg position as this could lead to reflux of the feeding from the stomach and possibly cause aspiration of the solution into the lungs. The nurse would not use a small syringe or continue to instill air until fluid is aspirated.

Which is an appropriate intervention when unexpected situations occur during the administration of a tube feeding? - When checking for residue, if a large amount is aspirated, replace the residue before feeding. - If the client reports nausea after tube feeding, lower the head of the bed and administer an antiemetic. - If the tube is found to be in the stomach instead of the esophagus, follow the recommended steps to replace the tube. - If the tube becomes clogged when aspirating contents, use warm water and gentle pressure to remove the clog.

- If the tube becomes clogged when aspirating contents, use warm water and gentle pressure to remove the clog. Explanation: Warm water and gentle pressure, not a stylet, should be used to unclog a tube. If a large amount of residue is accidentally aspirated, the physician should be notified. If the client is nauseated, the head of the bed should remain elevated and an antiemetic administered as prescribed. The tube should be in the stomach, not the esophagus.

A nurse is administering a prescribed dose of IV fluid to a young client with anorexia at the health care facility. Which information regarding contributing factors should the nurse include when educating the family? - Poor nutrition can contribute to anorexia. - Illness can contribute to anorexia. Attention deficit hyperactivity disorder (ADHD) can contribute to anorexia. The client's age can contribute to anorexia.

- Illness can contribute to anorexia. Explanation: Anorexia can be caused by depression, gastrointestinal dysfunction, infections, illnesses, malignancies, and side effects of many medications. Anorexia results in decreased food intake. Poor nutrition, the client's age, and ADHD are not precursors to anorexia.

A nurse is working with a client who is interested in losing weight. What suggestion(s) can the nurse offer to this client to promote a healthy weight loss? Select all that apply. - Cut carbohydrates to 45% of intake. - Increase the number of complex carbohydrates. - Decrease the number of calories ingested. - Increase physical activity. - Do not eat anything that is white, such as flour or sugar.

- Increase the number of complex carbohydrates. - Decrease the number of calories ingested. - Increase physical activity. Explanation: Cutting carbohydrates is not necessary for long-term weight loss. The most beneficial method of long-term weight loss is to eat fewer calories than the client expends. Eating more complex carbohydrates and increasing physical activity will be helpful for creating a healthy weight loss program. It is not necessary for the client to avoid white flour and sugar, although some diets recommend avoiding those foods. Regardless of the diet chosen, the client may eat foods that are white in color.

A nurse is caring for a client with a wound infection. The dietician has prescribed a diet rich in vitamin A. The client asks the nurse, "Why do I need vitamin A?" The nurse integrates an understanding of which rationale as a major reason when responding to the client? - It helps maintain healthy epithelium. - It mobilizes phosphorus from bone. - It promotes renal reabsorption of calcium. - It maintains normal mineralization of cartilage.

- It helps maintain healthy epithelium. Explanation: Vitamin A is important for maintenance of healthy epithelium, maintenance of normal vision (especially in dim light), promotion of normal skeletal and tooth development, and promotion of normal cellular proliferation. Vitamin D promotes mobilization of calcium and phosphorus from bone, renal reabsorption of calcium, normal mineralization of bone and cartilage, intestinal absorption of calcium, and maintenance of calcium extracellular fluid for normal muscle contraction.

What should the nurse consider when teaching a man with well-defined muscle mass about meal planning? - Men have a lower need for carbohydrates. - Men have a higher need for minerals. - Men have a higher need for proteins. - Men have a lower need for vitamins.

- Men have a higher need for proteins. Explanation: Due to the higher percentage in muscle mass in men, they have a higher need for proteins in their diet. Men do not have a higher or lower need for carbohydrates, minerals, or vitamins.

A nurse has assessed the residual amount before beginning a nasogastric tube feeding and has found 100 ml What will the nurse do next? - Nothing; this amount is within normal limits. - Report the finding to the physician. - Omit the feeding and document the reason. - Rinse the tube and repeat the assessment.

- Nothing; this amount is within normal limits. Explanation: A residual of more than 200 mL for a nasogastric tube and 100 mL for a gastrostomy tube may indicate that the feeding should be interrupted or delayed for 30 to 60 minutes. A finding of 100 mL is within normal limits; the nurse should administer the tube feeding.

A nutritionist helps to plan a diet for a client with diabetes. Which food is a carbohydrate that should be included to help improve glucose tolerance? - Milk - Eggs - Oatmeal - Nuts

- Oatmeal Explanation: Oatmeal is a water-soluble carbohydrate that helps improve glucose tolerance in diabetics. Milk, eggs, and nuts are proteins.

A nurse is feeding a client. Which action will the nurse take? - Explain that a bib will be used in case the meal gets messy. - Inform the client that the experience will be quick, approximately 10 minutes. - Feed the client the meal starting with the protein, explaining it is the most important. - Offer options of foods and for the order to be eaten.

- Offer options of foods and for the order to be eaten. Explanation: The loss of independence that comes with the inability to self-feed can be a severe blow to a person's self-esteem. Asking the client's preference regarding the order of items eaten can help maintain dignity while being fed. The nurse should be prepared to spend as much time with the client to assist with the entire meal to support self-worth for the client. Telling a client what the nurse will do does not promote self-esteem but identifies the nurse wanting to control the feeding. Although the meal can get messy, the nurse should never use the term "bib" but let the client know a clothing protector will be used.

A client with partial-thickness (second-degree) burns is encouraged to increase the proteins in the diet. Which food selection from the hospital menu indicates that the client understands how to choose foods high in protein? - Pasta with Alfredo sauce - Scrambled eggs with cheese - Cereal and milk - Toasted bran muffin and jelly

- Scrambled eggs with cheese Explanation: Scrambled eggs with cheese is a food choice high in protein content. Egg and cheese are both proteins. Pasta is a carbohydrate, but the Alfredo sauce is made with milk or a milk base, which is protein. Cereal is a complex carbohydrate with a variety of fortified nutrients, and the milk is a protein/carbohydrate source. Bran muffin and jelly are both carbohydrate sources.

The nurse is caring for a client who has dysphagia and is unable to eat independently. The nurse is preparing to assist the client in eating a meal. Which action is appropriate? - Speak to the client but limit the need for the client to respond verbally while chewing and swallowing. - Arrange food items in a clock face pattern and inform the client what time on a clock corresponds to each food item. - Create a positive social environment by asking the client about childhood food memories. - Encourage the client to eat using a consistent, efficient pace to prevent hot foods from becoming too cool and cool foods from becoming too warm.

- Speak to the client but limit the need for the client to respond verbally while chewing and swallowing. Explanation: Clients who have dysphagia need to eat slowly and be continually observed for signs of aspiration.

A client receiving tube feedings has a gastric residual of 500 ml. Which nursing intervention is most appropriate? - Increase the infusion rate. - Decrease the infusion rate. - Stop the infusion. - Assess the pH of the residual.

- Stop the infusion. Explanation: Gastric residual volumes (GVR) in the range of 200 to 500 mL should raise concern and lead to the implementation of measures reducing risk of aspiration. If the gastric residual is high, the feeding is stopped and the gastric residual is rechecked every 30 minutes until it is within a safe volume for resuming the feeding. Therefore, other answers are incorrect.

The nurse is preparing to check gastric residual for a client who had a tube feeding. After washing hands and donning gloves, what is the nurse's first action? - Measure the aspirated fluid. - Stop the tube-feeding infusion. - Report excessive residual amounts to the health care provider. - Reinstill the fluid that was aspirated.

- Stop the tube-feeding infusion. Explanation: The nurse will first stop the tube-feeding infusion and then continue to aspirate fluid, measure, and reinstill the aspirated fluid before reporting excessive amounts to the health care provider.

A nurse is caring for a client receiving total parenteral nutrition (TPN). Which should the nurse educate the client about regarding TPN therapy? Select all that apply. - TPN is an isotonic solution. - TPN has three primary components: proteins, carbohydrates, and fats. - TPN has a high glucose concentration. - Lipids are added to decrease caloric value. - TPN requires a PICC line or central venous access.

- TPN has three primary components: proteins, carbohydrates, and fats. - TPN has a high glucose concentration. - TPN requires a PICC line or central venous access. Explanation: Total parenteral nutrition (TPN) has three primary components: proteins, carbohydrates, and fats; it also has a high glucose concentration. TPN does require a PICC line or central venous access. TPN is a hypertonic solution. Lipids or fats are added to add caloric value to meet energy requirements.

A nurse observes that a client coughs and chokes when eating. What instructions should the nurse prepare for this client? - Instruct the dietary department to prepare a liquid diet. - Tell the client to chew his food very thoroughly. - Instruct the client to avoid drinking beverages with meals. - Restrict milk and other dairy products in the diet.

- Tell the client to chew his food very thoroughly. Explanation: The nurse should suggest that the client chew the food thoroughly and encourage repeated swallowing attempts. Preparing a liquid diet or restricting milk and beverages is not a solution for preventing choking during meals.

A client having a bowel surgery asks why being NPO after surgery is necessary. Which statement by the nurse best describes the reason? - To allow gas to accumulate and promote healing - To rest the gastrointestinal tract and promote healing - To increase mucus in the bowel that helps to promote healing - To prevent gas from forming in the bowel and interfere with healing

- To rest the gastrointestinal tract and promote healing Explanation: Withholding food may be indicated in the following situations: to rest the gastrointestinal tract to promote healing, clear the gastrointestinal tract of contents before surgery or diagnostic procedures, prevent aspiration during surgery or in high-risk clients, give normal intestinal motility time to return, treat severe vomiting or diarrhea, and to treat medical problems, such as bowel obstruction or acute inflammation of the gastrointestinal tract. Withholding food does not cause gas to accumulate or increase the amount of mucus in the bowel.

The nurse has observed that a client's food intake has diminished in recent days. What intervention should the nurse perform in order to stimulate the client's appetite? - Try to ensure that the client's food is attractive and sufficiently warm. - Reduce the frequency of meals in order to allow the client to develop an appetite. - Offer nutritional supplements and explain the potential benefits of each. - Offer larger meals and encourage the client to eat as much as is comfortable.

- Try to ensure that the client's food is attractive and sufficiently warm. Explanation: Food in the health care setting can often be unattractive and cool. Ensuring that it is appealing to the eyes and presented at the correct temperature can stimulate the client's appetite. Meals should be small and more frequent, not less frequent and larger. Supplements may be nutritionally necessary, but these do not act to increase the client's appetite.

A client has a history of long-term alcohol use. Which nutrient would need to be required in increased amounts? - Calcium - Vitamin B - Vitamin C - Thiamin

- Vitamin B Explanation: The use of alcohol depletes the production of B vitamins in the liver; thus, they would need to be replaced. Calcium is a mineral that is an essential part of bones and teeth. Vitamin C, also known as ascorbic acid and L-ascorbic acid, is a vitamin found in food and used as a dietary supplement. The disease scurvy is prevented and treated with vitamin C-containing foods or dietary supplements. Thiamin is just of the B vitamins that would need to be replaced due to the depletion by alcohol. The other elements of the B Vitamins include the following: B1 Thiamin, B2 Riboflavin, B3 Niacin, B5 Pantothenic Acid, B6 Pyridoxine, B7 Biotin, B9 Folic Acid, and B12 Cobalamin.

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? - Calcium - Vitamin K - Potassium - Vitamin C

- Vitamin K Explanation: 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. Calcium, potassium, and Vitamin C do not interact with warfarin.

The nurse is assessing clients for basal metabolic rate (BMR). Which client would the nurse suspect would have an increased BMR? - an older adult client - a client who has a fever - a client who is fasting - a client who is asleep

- a client who has a fever Explanation: 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.

What is the most reliable method for verifying the correct placement of a nasogastric tube? - a radiographic exam that can confirm position - confirmation that pH of the aspirate is less than 5.5 - absence of bubbling when the distal end of the tube is placed into a glass of water - a whooshing sound over the abdomen when 15 to 20 mL of air is rapidly injected into the distal end of the tube

- a radiographic exam that can confirm position

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? - new mother who is bottle-feeding an infant - older adult who lives with grown children - adolescent who is in the second trimester of pregnancy - middle-age male who works night shift

- adolescent who is in the second trimester of pregnancy Explanation: Children, adolescents, pregnant women, and breast-feeding mothers require more servings per day of certain food groups, particularly the milk group. Therefore, the adolescent who is pregnant will require more milk servings. The other clients do not require more servings of milk.

A client visits a health care facility reporting loss of appetite following a prolonged illness. How should the nurse document the client's condition? - emaciation - cachexia - anorexia - nausea

- anorexia Explanation: The nurse should document the loss of appetite following prolonged illness as anorexia. Emaciation is excessive leanness. Cachexia is the general wasting away of body tissue. Nausea usually precedes vomiting and is associated with gastrointestinal sensations.

A nurse is caring for a client who had an appendectomy earlier in the day. The client now has bowel sounds and is passing flatus. Which food is appropriate for the nurse to serve to the client at this time? - sherbet - apple juice - Ensure - chopped fruit

- apple juice Explanation: A postoperative client whose bowel sounds return and is passing flatus is ready to begin a diet. The first diet offered is a clear liquid diet. Apple juice is a clear liquid because it can be seen through. Sherbet and Ensure would belong on a full liquid diet. Chopped fruit is a mechanically altered diet and is typically used when a client has chewing or swallowing difficulty.

A nurse is preparing an education plan for a client who is scheduled for a diagnostic procedure that requires a clear liquid diet the day before the procedure. When teaching the client about what he may consume, which foods would the nurse include? Select all that apply. - apple juice - ice cream - gelatin - pureed vegetables - tea

- apple juice - gelatin - tea Explanation: A clear liquid diet includes only liquids that lack residue, such as juices without pulp (apple, cranberry), tea, gelatin, soda pop, and clear broth. A full liquid diet includes all foods and fluids that become liquid at room temperature, such as ice cream. Pureed vegetables would be appropriate for a mechanical soft diet, often used for clients who have difficulty chewing.

The nurse is teaching an older adult client about different types of proteins that can be eaten. Which foods will the nurse identify as containing dietary protein? Select all that apply. - beans - nuts - poultry - butter - fish

- beans - nuts - poultry - fish Explanation: Dietary proteins are obtained from animal and plant food sources, which include milk, meat, fish, poultry, eggs, soy, legumes (peas, beans, and peanuts), nuts, and components of grains. Butter is a fat and not a source of protein.

The physician has asked the nurse to prepare a list of laboratory tests needed to assess an obese client's daily fat intake. Which test would the nurse include on the list? - complete blood count - serum albumin test - transferrin level test - cholesterol level test

- cholesterol level test Explanation: The cholesterol test, along with triglyceride and lipoprotein levels, needs to be conducted to adjust the amount of fats an obese client consumes. Complete blood count, serum albumin, and transferrin level tests will not help in estimating the amount of fat the client eats. The complete blood count is done especially for the hemoglobin, hematocrit, and number of lymphocytes. The serum albumin and transferrin level tests indicate the protein status in the body.

The nurse is testing the blood glucose levels of a client with a history of diabetes. The nurse has performed hand hygiene, checked the order, informed the client and turned on the monitor. After removing a test strip from the vial, what action should the nurse perform next? - confirm that the strip and the meter share the same code. - massage the client's finger toward the selected puncture site. - cleanse the client's finger with alcohol. - pierce the client's skin with the lancet.

- confirm that the strip and the meter share the same code. Explanation: It is important to confirm that the code on the strip and the meter match. This should precede massaging and cleansing the client's finger or piercing the client's skin.

The nurse should begin the process of removing a client's nasogastric (NG) tube by: - confirming the physician's order to remove the tube. - confirming the placement of the NG tube. - separating the tube from suction. - flushing the tube with 10 mL of water or normal saline.

- confirming the physician's order to remove the tube. Explanation: Prior to beginning the process of removing a client's NG tube, it is important to confirm that the relevant order has been written.

The nurse is teaching a client about ways in which to reduce sodium in the diet. Which foods will the nurse recommend that the client avoid? Select all that apply. - cured ham - table salt - egg yolks - whole wheat pasta - whole milk - bacon

- cured ham - table salt - bacon Explanation: Sodium is found in higher concentrations in table salt, bacon, and processed meats. The other choices do not have a high concentration of sodium.

A nurse is caring for a client who is reporting nausea. Which is a sign of nausea? - dizziness and perspiration - impaired swallowing - slow pulse rate - emotional distress

- dizziness and perspiration Explanation: Nausea usually precedes vomiting. It is associated with dizziness and perspiration. Impaired swallowing is associated with clients who have dysphagia and not typically nausea. Slow pulse rate is not a symptom of nausea. Emotional distress may or may not be related to the client's condition.

A client asks the nurse about suggestions to ensure that he consumes an adequate amount of complete proteins. Which food(s) would be appropriate for the nurse to suggest? Select all that apply. - fish - peanut butter - rice - cheese - eggs

- fish - cheese - eggs Explanation: Sources of complete proteins include meats, fish, poultry, milk, cheese, and eggs. Peanut butter and rice are examples of incomplete proteins.

A nurse is assessing the volume of liquid nutrition that has been tube-fed to a client. What will happen if the volume of feeding exceeds the client's physiologic capacity? - diarrhea - pallor - obesity - gastric reflux

- gastric reflux Explanation: Overfilling the client's stomach can cause gastric reflux, regurgitation, vomiting, aspiration, and pneumonia. Exceeding the volume of feeding beyond a client's physiologic capacity does not lead to diarrhea, pallor, or obesity. As a rule of thumb, the gastric residual should be no more than 100 mL or no more than 20% of the previous hour's tube-feeding volume.

Which type of feeding tube would be most appropriate for a client requiring enteral feeding for a long period of time? - gastrostomy tube - nasogastric tube - nasointestinal tube - Salem Sump tube

- gastrostomy tube Explanation: When enteral feeding is required for a long-term period, an enterostomal tube may be placed through an opening created into the stomach (gastrostomy) or into the jejunum (jejunostomy) (Smeltzer, et al., 2008).

A client with nonhealing wounds requires a feeding tube. Which type of formula does the nurse anticipate will be ordered? - high-protein - standard isotonic - fiber-containing - partially hydrolyzed

- high-protein Explanation: The nurse anticipates that the client with nonhealing wounds will need a formula that is high in protein and other nutrients to support tissue integrity and healing. Other formulas do not provide this type specific of nutrition.

A client has developed an abscess following abdominal surgery, and the client's food intake has been decreasing over the past 2 weeks. Which laboratory finding may suggest the need for nutritional support? - low prealbumin levels - proteinuria - low random blood glucose levels - increased white blood cells

- low prealbumin levels Explanation: Prealbumin levels are a good indicator of a client's short-term nutritional status; decreased levels are suggestive of malnutrition. Protein in the client's urine, low blood sugars, and increased white blood cells are not necessarily indicative of malnutrition. Proteinuria is urine having an abnormal amount of protein. The condition is often a sign of kidney disease. Random blood sugar can be affected by food intake. White blood cells are indicative of infection.

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 - mildly elevated - severely elevated - low

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

An unconscious client has been receiving complete calorically-dense liquid nutrition via a nasointestinal tube at a continuous drip for the past 4 days. Which action should the nurse prioritize after receiving the laboratory results for this client? - notify the health care provider - document results - suggest increasing water intake - verify current placement of tube

- notify the health care provider Explanation: The glycated hemoglobin (A1c) is high and suggests this client has diabetes. A normal result should be less than 7% (0.07). The health care provider should be notified so further testing can be conducted and feeding formula changed or the client given insulin. The other test results are all within normal limits.

The community nurse is educating client groups about nutrition. Which group does the nurse identify that will benefit most from nutritional counseling and intervention? - married, pregnant women over 30 years of age - double income, married individuals - older adults living on a fixed income - people who live in farming communities

- older adults living on a fixed income Explanation: Older adults who are socially isolated or living on fixed incomes will benefit most from nutritional counseling and intervention. Other individuals are not at the same level of risk.

A nurse is working with a 45-year-old construction worker. The nurse obtains his height and weight and calculates that his BMI is 28. How would the nurse best classify James? - underweight - ideal body weight (IBW) - overweight - obese

- overweight Explanation: A body mass index (BMI) between 25 and 29.9 is considered overweight.

A nurse calculates the BMI of a client during a general survey as 26. Under which category would this client fall? - underweight - normal - overweight - obesity class I

- overweight Explanation: This client has a BMI of 26, which falls in the category of overweight: 25.0 to 29.9. The other BMI values are: underweight, <18.5; normal, 18.5 to 24.9; obesity class I, 30.0 to 34.9; obesity class II, 35.0 to 39.9; and extreme obesity, 40.0+.

A hospitalized client has been NPO. with only intravenous fluid intake for a prolonged period. What assessments might indicate protein-calorie malnutrition? - fever, joint pain, dehydration - poor wound healing, apathy, edema - sleep disturbances, anger, increased output - weight gain, visual deficits, erythema of skin

- poor wound healing, apathy, edema Explanation: The stress of illness, surgery, or prolonged periods of time on simple intravenous therapy without oral intake places hospitalized clients at risk for developing protein-calorie malnutrition. This can result in weakness, poor wound healing, mental apathy, and edema. Fever, joint pain, and dehydration are indicative of infection. Fluid overload would have signs and symptoms of weight gain and increased output.

A nurse researching a diet for a client with diabetes includes foods that supply energy to the body. Which are classes of nutrients that supply this energy? Select all that apply. - vitamins - proteins - fats - minerals - carbohydrates

- proteins - fats - carbohydrates Explanation: Of the six classes of nutrients, three supply energy (carbohydrates, proteins, lipids [fats]) and three are needed to regulate body processes (vitamins, minerals, water).

A nurse is caring for a client diagnosed with high risk for cardiovascular disease. Which item should the nurse make sure is not on the client's dietary tray? - corn - fish - red meat - eggs

- red meat Explanation: A client with a high risk of cardiovascular disease should not be given red meat, which is high in cholesterol. Cholesterol absorbs fatty acids and binds them to molecules of protein referred to as lipoproteins (combination of fats and proteins). High-density lipoprotein (HDL) is referred to as "good cholesterol" because the cholesterol is delivered to the liver for removal. Low-density lipoprotein (LDL) is called "bad cholesterol" because the cholesterol is deposited within the walls of arteries, which can eventually result in cardiovascular disease. Corn does not contain cholesterol. Fish and eggs have less cholesterol than does red meat.

The nurse is providing education to a client who has been diagnosed with iron-deficiency anemia. The client has asked the nurse to review a list of preferred foods to determine which should be included more often in the diet. Which food(s) will the nurse encourage the client to increase in the diet? Select all that apply. - roasted chicken breast - lean hamburgers - flavored yogurts - kale salad - spinach smoothies - cucumber and tomato salad

- roasted chicken breast - lean hamburgers - kale salad - spinach smoothies Explanation: In addition to medicinal iron, clients who have iron-deficiency anemia need to eat a diet that is rich in dietary iron. The foods on the client's preferred list should include meats (e.g., lean hamburgers), poultry (e.g., roasted chicken breast), fish, leafy greens (e.g., kale salad and spinach smoothies), legumes, and iron-enriched pastas and grains. Dairy products such as yogurt are not a source of dietary iron. Cucumber and tomato do not provide a significant source of dietary iron.

The nurse is helping a client, who wishes to increase Omega-3 fatty acids, to order breakfast. Which food will the nurse recommend? - egg whites - wheat toast - salmon - coffee

- salmon Explanation: Omega-3 fatty acids are found in fish such as salmon, halibut, sardines, olive oil, flaxseed, walnuts, and certain types of legumes. The other food choices do not contain Omega-3 fatty acids.

A 66-year-old woman has atrial fibrillation for which she is on warfarin therapy. She asks the nurse if she has any dietary restrictions. The nurse would need to monitor the client's intake of: - bananas. - spinach. - mangos. - broccoli.

- spinach. Explanation: Spinach is high in vitamin K.

A nurse is caring for a client with a history of cardiac and vascular disease. Which fats should the nurse allow in the client's diet for their condition? - unsaturated fats - trans fats - saturated fats - hydrogenated fats

- unsaturated fats Explanation: Unsaturated fat is a healthier form of fat than saturated fat, because it contains less hydrogen, and therefore can be included in the client's diet. Saturated fats are lipids that contain as much hydrogen as their molecular structure can hold and are generally solid. Most saturated fats are found in animal sources, such as the marbled fat in meat. Saturated fats are responsible for cardiac and vascular diseases. Trans fats are unsaturated fats that have been hydrogenated, a process in which hydrogen is added to the fat. Consumption of trans fats, saturated fats, and hydrogenated fats increases the risk of coronary heart disease.

The nurse is preparing to administer a client's tube feeding. How should the nurse position the client prior to beginning the infusion? - with the head of the bed at least 30 to 45 degrees - supine - with the head of the bed raised between 20 and 30 degrees - in a left side-lying position

- with the head of the bed at least 30 to 45 degrees Explanation: Tube feedings should be administered with the head of the client's bed at least 30 to 45 degrees, or as near to normal eating position as possible. Side-lying, low-lying, and supine positions would constitute a risk of aspiration.

Carbonated sodas (such as Coca-Cola) are effective to clear a clogged feeding tube. - True - False

- False

The nurse is caring for a client who refuses most foods on the dietary tray. Which nursing intervention is appropriate? - Allow the client privacy during mealtime. - Delegate feeding assistance to the unlicensed assistive personnel. - Assess when client generally eats meals. - Contact the healthcare provider to prescribe an appetite stimulant.

- Assess when client generally eats meals. Explanation: 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.

The nurse is providing discharge teaching for a client who will continue to administer tube feedings at home. The client states, "I don't think I can do this." What is the appropriate nursing response? - "I am confident that you can do this." - "If you don't do this, who will feed you?" - "Perhaps we can contact a home health nurse to assist." - "Why are you afraid of this procedure?"

- "Perhaps we can contact a home health nurse to assist." Explanation: A home health nurse can be of assistance if a client is afraid or unable to self-administer tube feedings. Reassuring the client, inquiring who will feed the client, and why the client is afraid do not effectively address the client's need.

A nurse provides discharge education for a client diagnosed with ketosis. Which nutrient would be added to this client's diet?. - Carbohydrates - Proteins - Fats - Minerals

- Carbohydrates Explanation: Ketosis is the catabolism of fatty acids that occurs when an individual's carbohydrate intake is not adequate; without adequate glucose, the catabolism is incomplete and ketones are formed, resulting in increased ketones. Proteins, fats, and minerals breakdown does not cause ketosis.

A nurse is preparing a presentation for a local community group on healthy nutrition using information from the USDA's website, ChooseMyPlate.gov. Which recommendation would the nurse be least likely to include? - using appropriate portion sizes - switching to whole milk - replacing sugary drinks with water - making fruits and vegetables account for half of your plate

- switching to whole milk Explanation: According to the ChooseMyPlate.gov food guide, individuals should switch to fat-free or low-fat (1%) milk, monitor portion sizes, drink water instead of sugary drinks, and make one-half the plate for fruits and vegetables.

Which nutrient does the nurse identify as appropriate for a client with a normal dietary order who is consuming 2000 calories daily? - total fat less than 65 g - cholesterol greater than 300 mg - sodium less than 2000 mg - saturated fat greater than 20 mg

- total fat less than 65 g Explanation: Daily values (DVs) are calculated in percentages based on standards set for total fat, saturated fat, cholesterol, sodium, carbohydrate, and fiber in a 2,000-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.