NUTRITION
A nurse is planning a high-energy diet for a patient. What nutrient provides energy to the body and should be increased in the diet? A) Carbohydrates B) Vitamins C) Minerals D) Water
A
When checking the placement of a gastrostomy or jejunostomy tube, the nurse must make regular comparisons of: A) Tube length B) Gastric fluid C) pH D) Air pressure
A
Which of the following factors increase BMR? Select all that apply. A) Growth B) Infections C) Fever D) Emotional tension E) Aging
A, B, C, D: Factors that increase BMR include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones, especially epinephrine and thyroid hormones. Aging, prolonged fasting, and sleep all decrease BMR.
A nurse is evaluating patients to determine their need for parenteral nutrition (PN). Which patients would be the best candidates for this type of nutritional support? Select all that apply. A) A patient with irritable bowel syndrome who has intractable diarrhea B) A patient with celiac disease not absorbing nutrients from the GI tract C) A patient who is under weight and needs short-term nutritional support D) A patient who is comatose and needs long-term nutritional support E) A patient who has anorexia and refuses to take foods via the oral route F) A patient with burns who has not been able to eat adequately for 5 days
A, B, F: Assessment criteria used to determine the need for PN include an inability to achieve or maintain enteral access; motility disorders; intractable diarrhea; impaired absorption of nutrients from the GI tract; and when oral intake has been or is expected to be inadequate over a 7- to 14-day period. PN promotes tissue healing and is a good choice for a patient with burns who has an inadequate diet. Oral intake is the best method of feeding; the second best method is via the enteral route. For short-term use (less than 4 weeks), a nasogastric or nasointestinal route is usually selected. A gastrostomy (enteral feeding) is the preferred route to deliver enteral nutrition in the patient who is comatose because the gastroesophageal sphincter remains intact, making regurgitation and aspiration less likely than with NG tube feedings. Patients who refuse to take food should not be force fed nutrients against their will.
The nurse is assessing adequate nutrition for residents of a long-term care facility. Which strategies are recommended to address age-related changes affecting nutrition? (Select all that apply.) A) Avoid cold liquids with decreased peristalsis in the esophagus. B) Serve a variety of foods at each meal for loss of sense of taste and smell. C) Avoid eating right before bedtime for gastroesophageal reflux. D) Eat a high-fiber diet for slowed intestinal peristalsis. E) Eat more protein for lowered glucose tolerance. F) Offer large meals at frequent intervals for reduction in appetite and thirst sensation.
A, C, D
Which nursing actions follow guidelines for preventing complications with enteral feedings? (Select all that apply.) A) Elevate the head of the bed by 30 to 45 degrees during the feeding and for at least 1 hour afterward. B) Give large, infrequent feedings. C) Flush the tube before and after feeding. D) Clean and moisten the nares every 4 to 8 hours. E) Change the delivery set every other day according to facility policy. F) Check the residual before intermittent feedings and every 8 hours during continuous feedings.
A, C, D
A nurse is evaluating a patient following the administration of an enteral feeding. Which findings are normal and are criteria that indicate patient tolerance to the feeding? Select all that apply. A) Absence of nausea, vomiting B) Weight gain C) Bowel sounds within normal range D) Large amounts of gastric residue E) Absence of diarrhea and constipation F) Slight abdominal pain and distention
A, C, E: Criteria to consider when evaluating patient feeding tolerance include: absence of nausea, vomiting, minimal or no gastric residual, absence of diarrhea and constipation, absence of abdominal pain and distention, presence of bowel sounds within normal limits.
As a nurse is aspirating the contents during a tube feeding, the nurse finds that the tube is clogged. What would be appropriate nursing interventions in this situation? (Select all that apply.) A) Use warm water and gentle pressure to remove clog. B) Flush with a carbonated beverage such as a cola soft drink. C) Use a stylet to unclog the tube. D) If necessary, replace the tube. E) Ensure that adequate flushing is completed after each feeding. F) Administer an antiemetic to the patient.
A, D, E
Which examples of patients would the nurse expect to have an increase in BMR? (Select all that apply.) A) A toddler who is having a growth spurt B) An older adult who is in a long-term care facility C) A teenager who has been fasting to lose weight D) An adolescent who has a fever E) An adult who is going through an emotional time due to divorce F) An adult who has hypersomnia
A, D, E
What information do anthropometric measurements provide in adults? A) Indirect measure of protein and fat stores B) Direct measure of degree of obesity C) Indication of degree of growth rate D) Reflection of social interaction with others
A: Anthropometric measurements are used to determine body dimensions. In children, they are used to assess growth rate; in adults, they give indirect measurements of body protein and fat stores.
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? A) Infection B) Advanced age C) Prolonged fasting D) Long periods of sleep
A: 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 caring for a young adult female client who has a folic acid deficiency. When teaching the client about this condition, the nurse would include a discussion about the client's increased risk for which of the following? A) Neural tube deficits in the fetus B) Inadequate absorption of calcium and phosphorus C) Hemolysis of red blood cells D) Impaired neuromuscular functioning
A: Folic acid deficiency in pregnant women can lead to neural tube deficits like spina bifida in the fetus. Because fetal neural development begins so early in pregnancy, women in their childbearing years must have adequate folic acid intake. Deficiency in vitamin D intake leads to inadequate absorption of calcium and phosphorus, and a deficiency of mineralization in bones and teeth. Increased hemolysis of red blood cells, poor reflexes, impaired neuromuscular functioning, and anemias are signs of vitamin E deficiency, not folic acid deficiency.
Which of the following are signs and symptoms of poor nutritional status? A) Flaky facial skin, facial edema, pale skin color B) Tongue is a deep red in color with surface papillae present. C) Firm, pink nail beds D) Firm hair that is resistant to plucking
A: Healthy skin is uniform in color and not swollen.
A nurse is administering a tube feeding for a patient who is post bowel surgery. When attempting to aspirate the contents, the nurse notes that the tube is clogged. What would be the nurse's next action following this assessment? A) Use warm water or air and gentle pressure to remove the clog. B) Use a stylet to unclog the tubes. C) Administer cola to remove the clog. D) Replace the tube with a new one.
A: In order to remove a clog in a feeding tube, the nurse should try using warm water or air and gentle pressure to unclog it. A stylet should never be used to unclog a tube, and cola and meat tenderizers have not been shown effective in removing clogs. The nurse should first attempt to remove the clog, and if unsuccessful, the tube should be replaced.
Which of the following laboratory results indicates the presence of malnutrition? A) Serum albumin 2.8 g/dL B) Hemoglobin (Hgb) 11.3 g/dL C) Creatinine 1.9 mg/dL D) Hematocrit (Hct) 56%
A: Increased Hct indicates dehydration.
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, the nurse should do which of the following? A) Confirm that the strip and the meter share the same code. B) Massage the client's finger toward the selected puncture site. C) Cleanse the client's finger with alcohol. D) Pierce the client's skin with the lancet.
A: 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 his/her skin.
Which of the following nutritional guidelines should a nurse provide to a client who is entering the second trimester of her pregnancy? A) "You'll need to eat more calories and to make sure you eat a balanced diet high in nutrients." B) "Try to eat your normal number of calories, but aim to eat a diet that's higher in fruits and vegetables." C) "The more food energy you consume, the greater the chances that you will have a healthy pregnancy." D) "Maintain your regular calorie intake, but take some supplements and emphasize organic foods."
A: Nutrient needs during pregnancy increase to support growth and maintain maternal homeostasis, particularly during the second and third trimesters. During the last two trimesters, women of normal weight need approximately 300 extra calories per day. Key nutrient needs include protein, calories, iron, folic acid, calcium, and iodine. It would be inaccurate to encourage the client to maximize calorie intake.
A dietitian is providing an in-service for the nurses on a medical-surgical unit. During the in-service, she informs the group that there are six classes of nutrients, and three supply the body with energy. What are the three sources of energy? A) Carbohydrates, protein, and lipids B) Vitamins, minerals, and water C) Carbohydrates, protein, and water D) Lipids, vitamins, and minerals
A: Of the six classes of nutrients, three supply energy (carbohydrates, protein, and lipids), and three are needed to regulate body processes (vitamins, minerals, and water).
For which of the following clients should the nurse anticipate the need for a pureed diet? A) A man whose stroke has resulted in difficulty swallowing B) A woman who has required gallbladder surgery C) A man with dementia who is unable to follow instructions D) An obese woman after bariatric surgery
A: Pureed diets are indicated for clients who have significant problems chewing and/or swallowing. Surgery and confusion are not indications for this change in the texture and consistency of food.
A nurse is feeding a patient who states that she is feeling nauseated and can't eat what is being offered. What would be the most appropriate initial action of the nurse in this situation? A) Remove the tray from the room. B) Administer an antiemetic and encourage the patient to take small amounts. C) Explore with the patient why she does not want to eat her food. D) Offer high-calorie snacks such as pudding and ice cream.
A: The first action of the nurse when a patient has nausea is to remove the tray from the room. The nurse may then offer small amounts of foods and liquids such as crackers or ginger ale. The nurse may also administer a prescribed antiemetic and try small amounts of food when it takes effect.
A nurse performing a nutritional assessment determines that the BMI of a 5'11" (1.8 meters) male client who weighs 81 kilograms is which of the following? A) 25.1 B) 18.5 C) 20.3 D) 28.6
A: The formula for calculating BMI is (body weight in kilograms) divided by (body height in meters squared). (weight in kg)/(height in meters) * (height in meters)
A patient has been admitted to the alcoholic referral unit in the local hospital. Based on an understanding of the effects of alcohol on the GI tract, which is a priority concern related to nutrition? A) Vitamin B malnutrition B) Obesity C) Dehydration D) Vitamin C deficiency
A: The need for B vitamins is increased in alcoholics because these nutrients are used to metabolize alcohol, thus depleting their supply. Alcohol abuse specifically affects the B vitamins. Obesity, dehydration, and vitamin C deficiency may be present, but these are not directly related to the effect of alcohol on the GI tract.
The nurse caring for a client for several days has assessed that he has been eating poorly during his hospitalization. Which nursing measure should the nurse implement to assist the client in improving his nutritional intake? A) Encourage his daughter to prepare food at home and bring it to the client. B) Serve large meals and encourage the client to eat as much as possible. C) Provide distractions while the client is fed so that he will eat more. D) Provide bland meals.
A: 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 feeding and older adult patient who has dementia. Which intervention should the nurse perform to facilitate this process? A) Stroke the underside of the patient's chin to promote swallowing. B) Serve meals in different places and at different times. C) Offer a whole tray of various foods to choose from. D) Avoid between-meal snacks to ensure hunger at mealtime.
A: To feed a patient with dementia, the nurse should stroke the underside of the patient's chin to promote swallowing, serve meals in the same place and at the same time, provide one food item at a time since a whole tray may be overwhelming, and provide between-meal snacks that are easy to consume using the hands.
Most nutritionists recommend increasing fiber in the diet. In addition to other benefits, how does fiber affect cholesterol? A) Increases fecal excretion of cholesterol B) Decreases fecal excretion of cholesterol C) Facilitates intake and use of trans fat D) Raises blood cholesterol levels
A: To help lower serum cholesterol levels, researchers recommend limiting cholesterol intake, eating less total fat, eating more unsaturated fat, and increasing fiber intake. Fiber increases fecal excretion of cholesterol.
A client is interested in losing 15 pounds, and she informs the nurse she is counting her calorie intake each day. The client has a goal of losing one pound a week until she reaches her goal. The client asks the nurse how many calories she should decrease daily to lose a pound a week. What is the nurse's best response? A) 500 calories/day B) 200 calories/day C) 300 calories/day D) 400 calories/day
A: To lose 1 pound (0.45 kg) in a week, daily calorie intake should be decreased by 500 calories a day. One pound of body fat equals about 3,500 calories; 3,500 calories divided by 7 days = 500 calories/day.
A nurse is caring for a client with a history of cardiac and vascular disease. Which of the following fats should the nurse allow in the client's diet for his condition? A) Unsaturated fats B) Trans fats C) Saturated fats D) Hydrogenated fats
A: 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.
A nurse is caring for a newly placed gastrostomy tube of a postoperative patient. Which nursing action is performed correctly? A) The nurse dips a cotton-tipped applicator into sterile saline solution and gently cleans around the insertion site. B) The nurse wets a washcloth and washes the area around the tube with soap and water. C) The nurse adjusts the external disk every 3 hours to avoid crusting around the tube. D) The nurse tapes a gauze dressing over the site after cleaning it.
A: When caring for a new gastrostomy tube, the nurse would use a cotton-tipped applicator dipped in sterile saline to gently cleanse the area, removing any crust or drainage. The nurse would not use a washcloth with soap and water on a new gastrostomy tube, but may use this method if the site is healed. Also, once the sutures are removed, the nurse should rotate the external bumper 90 degrees once a day. The nurse should leave the site open to air unless there is drainage. If there is drainage, one thickness of precut gauze should be placed under the external bumper and changed as needed to keep the area dry.
What independent nursing intervention can be implemented to stimulate appetite? A) Administer prescribed medications. B) Recommend dietary supplements. C) Encourage or provide oral care. D) Assess manifestations of malnutrition.
C: 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.
The nurse is assessing patients for BMR. Which patient would the nurse suspect would have an increased BMR? A) An older adult patient B) A patient who has a fever C) A patient who is fasting D) A patient who is asleep
B
Which nursing action associated with successful tube feedings follows recommended guidelines? A) Check tube placement by adding food dye to the tube feed as a means of detecting aspirated fluid. B) Check the residual before each feeding or every 4 to 8 hours during a continuous feeding. C) Assess for bowel sounds at least four times per shift to ensure the presence of peristalsis and a functional intestinal tract. D) Prevent contamination during enteral feedings by using an open system.
B
Which nursing action is performed according to guidelines for aspirating fluid from small-bore feeding tube? A) Use a small syringe and insert 10 mL of air. B) Inject air boluses into the tube with a large syringe and slowly apply negative pressure to withdraw fluid. C) Continue to instill air until fluid is aspirated. D) Place the patient in the Trendelenburg position to facilitate the fluid aspiration process.
B
A nurse researching a diet for a client with diabetes includes foods that supply energy to the body. Which of the following are classes of nutrients that supply this energy? Select all that apply. A) Vitamins B) Proteins C) Fats D) Minerals E) Carbohydrates
B, C, E: 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 has documented that a client has anorexia. What does this term mean? A) Eating more than daily requirements B) Lack of appetite C) Vitamin C deficiency D) Fluid deficit
B: Anorexia is lack of appetite. It may be related to multiple factors, including diseases, psychosocial causes, impaired ability to chew and taste, or inadequate income.
A nurse is calculating the body mass index (BMI) of a 35-year-old male patient who is extremely obese. The patient's height is 5′6′′ and his current weight is 325 lb. What would the nurse document as his BMI? A) 50.5 B) 52.4 C) 54.5 D) 55.2
B: BMI = (weight in pounds (325)/(height in inches)(66) x (height in inches)(66)) x 703 BMI = 52.4
To promote health of the fetus, the nurse should instruct the woman in the first trimester of pregnancy to do which of the following? A) Eliminate high-fiber foods B) Eat foods high in folic acid C) Consume saturated fats D) Consume milk products in the last trimester
B: Folic acid deficiency in pregnant women can lead to neural tube deficits in the fetus. Women during pregnancy may experience constipation. Increased fiber intake is recommended. Saturated fats are to be eaten only in moderation. Milk products are important during the entire pregnancy.
A patient who has COPD is refusing to eat. Which intervention would be most helpful in stimulating appetite in this patient? A) Administering pain medication after meals. B) Encouraging food from home when possible. C) Scheduling his respiratory therapy before each meal. D) Reinforcing the importance of his eating exactly what is delivered to him.
B: Food from home that the patient enjoys may stimulate him to eat. Pain medication should be given before meals, respiratory therapy should be scheduled after meals, and telling the patient what he must eat is no guarantee that he will comply.
A nurse is caring for a client with complaints of chest pain. Which of the following test results would indicate whether the client is at risk for cardiac disease? A) Test results of levels of unsaturated fats B) Test results for dyslipidemia C) Test results of levels of balanced proteins D) Test results of levels of calories in each food intake
B: Health care providers test for dyslipidemia to assess clients' risks for cardiovascular disease. Measuring levels of protein, calories, or unsaturated fats will not help to assess if a client is at risk for cardiac and vascular disease.
A nurse nutritionist is collecting assessment data for a patient who complains of "tiredness" and appears malnourished. The nurse orders tests for hemoglobin and hematocrit. What condition might these tests confirm? A) Malabsorption B) Anemia C) Protein depletion D) Reduction in total muscle mass
B: Test results for hemoglobin (normal=12to18g/dL): if decreased it indicates anemia; results for hematocrit (normal = 40% to 50%): if decreased indicates anemia, if increased indicates dehydration. Serum albumin tests for malnutrition and malabsorption. Protein depletion and malnutrition are diagnosed with serum albumin, pre-albumin, transferrin, and blood urea nitrogen tests. The creatinine test may indicate dehydration, reduction in total muscle mass, and severe malnutrition.
The nurse prepares to administer an intermittent feeding to a client who has a nasogastric feeding tube. Arrange the following steps in the correct order: 1. Verify correct tube placement. 2. Position client with head of bed elevated 30 to 45° degrees 3. Aspirate all gastric contents. 4. Flush tube with 30 mL water. 5. Verify that residual volume is less than 400 mL. 6. Administer feeding. A) 1, 2, 3, 4, 5, 6 B) 2, 1, 3, 5, 4, 6 C) 2, 3, 1, 4, 6, 5 D) 1, 3, 2, 4, 5, 6 E) 1, 4, 2, 3, 5, 6
B: The correct order for administering an intermittent feed to a client who has a nasogastric feeding tube is (1) Position client with head of bed elevated 30 to 45° degrees; (2) Verify correct tube placement; (3) Aspirate all gastric contents; (4) Verify that residual volume is less than 400 mL; (5) Flush tube with 30 mL water; and (6) Administer feeding.
A hospitalized client has been NPO with only intravenous fluid intake for a prolonged period. What assessments might indicate protein-calorie malnutrition? A) Fever, joint pain, dehydration B) Poor wound healing, apathy, edema C) Sleep disturbances, anger, increased output D) Weight gain, visual deficits, erythema of skin
B: 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.
A nurse is assessing the nutritional needs of patients. Which criterion indicates that a patient most likely needs TPN? A) Serum albumin level of 2.5 g/dL or less B) Residual of more than 100 mL C) Absence of bowel sounds D) Presence of dumping syndrome
C
The nurse is performing a nutritional assessment of an obese patient who visits a weight control clinic. What information should the nurse take into consideration when planning a weight reduction plan for this patient? A) To lose 1 lb/wk, the daily intake should be decreased by 200 calories. B) One pound of body fat equals approximately 5,000 calories. C) Psychological reasons for overeating should be explored, such as eating as a release for boredom. D) Obesity is very treatable, and 50% of obese people who lose weight maintain the weight loss for 7 years.
C
What consideration based on biologic sex would a nurse make when planning a menu for a male patient with well-defined muscle mass? A) Men have a lower need for carbohydrates. B) Men have a higher need for minerals. C) Men have a higher need for proteins. D) Men have a lower need for vitamins.
C
Which method of feeding would a nurse normally provide if a patient can attempt eating regular meals during the day and is prepared to ambulate and resume activities? A) Continuous feeding B) Intermittent feeding C) Cyclic feeding D) Ambulatory feeding
C
The nurse researches factors that may alter nutrition. Which statements accurately describe factors that influence nutritional status? (Select all that apply.) A) During adulthood, there is an increase in the basal metabolic rate with each decade. B) Because of the changes related to aging, the caloric needs of the older adult increase. C) During pregnancy and lactation, nutrient requirements increase. D) Nutritional needs per unit of body weight are greater in infancy than at any other time in life. E) Men and women differ in their nutrient requirements. F) Trauma, surgery, and burns decrease nutrient requirements.
C, D, E
A home health care nurse is teaching a patient and caregivers how to administer an enteral feeding. Which teaching points are appropriate? (Select all that apply.) A) When checking residuals, routinely discard residuals to prevent an acid-base imbalance. B) When cleaning around a gastric tube insertion site, be careful not to rotate the guard after cleaning around it. C) Check for leaking of gastric contents around the insertion site. (Is guard too loose or balloon not filled adequately?) D) Clean around the gastric tube with soap and water, making sure it is adequately rinsed. E) Keep the head elevated while delivering a gastric feeding and for approximately an hour after the feeding. F) Mark gastrostomy tubes with an indelible marker and check the mark to make sure it is at the level of the abdominal wall.
C, D, E, F
A nurse who is planning a diet for a patient who has anorexia chooses nutrients that supply energy to the body including: (Select all that apply.) A) Vitamins B) Minerals C) Carbohydrates D) Protein E) Water F) Lipids
C, D, F
A nurse performs pre-surgical assessments of patients in an ambulatory care center. Which patient would the nurse report to the surgeon as possibly needing surgery to be postponed? A) A 19-year-old patient who is vegan. B) An older adult patient who takes daily nutritional drinks. C) A 43-year-old patient who takes ginkgo biloba and an aspirin daily. D) An infant who is breastfeeding.
C: A patient taking gingko biloba (an herbal), aspirin, and vitamin E (dietary supplement) may have to have surgery postponed due to an increased risk for excessive bleeding, because each of these substances have anticoagulant properties. Being a vegan should not affect surgery unless the patient has serious nutritional deficiencies. Drinking nutritional drinks and breastfeeding do not adversely affect the outcomes of surgery.
A nurse calculates the BMI of a client during a general survey as 26. Under which of the following categories would this client fall? A) Underweight B) Normal C) Overweight D) Obesity Class I
C: BMI values are: Underweight less than or equal to 18.5; normal 18.5 to 24.9; overweight 25.0 to 29.9; obesity class I 30.0 to 34.9; obesity class II 35.0 to 39.9; and extreme obesity 40.0+.
A nurse is caring for a client with excessive abdominal fat. Which of the following is a risk associated with excessive abdominal fat about which the nurse should inform the client? A) Emaciation B) Cachexia C) Cardiovascular disease D) Anorexia
C: Excess abdominal fat may lead to cardiovascular disease, hypertension, and diabetes. Anorexia is the loss of appetite. Emaciation is characterized by excessive leanness. Cachexia is the general wasting away of body tissue.
Which client will have an increased metabolic rate and require nutritional interventions? A) A healthy young adult who works in an office B) A retired person living in a temperate climate C) A person with a serious infection and fever D) An older, sedentary adult with painful joints
C: Factors that increase metabolic rate include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of some hormones. Aging, prolonged fasting, and sleep decrease metabolic rate.
A nutritionist helps to plan a diet for a client with diabetes. Which of the following foods is a carbohydrate that should be included to help improve glucose tolerance? A) Milk B) Eggs C) Oatmeal D) Nuts
C: Oatmeal is a water-soluble carbohydrate that helps improve glucose tolerance in diabetics. Milk, eggs, and nuts are proteins.
A nurse is helping a client design a weight-loss diet. To lose one pound of fat (3,500 calories) per week, how many calories should be decreased each day? A) 100 B) 250 C) 500 D) 1,000
C: One pound of body fat equals about 3,500 calories. To gain or lose one pound in a week, daily calorie intake should be reduced by 500 calories per day (3,500 calories divided by 7 = 500 calories per day).
A client visits a health care facility with complaints of loss of appetite following a prolonged illness. How should the nurse document the client's condition? A) Emaciation B) Cachexia C) Anorexia D) Nausea
C: 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.
Which nursing diagnosis would be most appropriate for a patient with a body mass index (BMI) of 18? A) Risk for Imbalanced Nutrition: More than Body Requirements B) Imbalanced nutrition: More than body requirements C) Readiness for Enhanced Nutrition D) Imbalanced Nutrition: Less Than Body Requirements
D: A patient with a body mass index (BMI) of 18 is considered underweight, therefore a diagnosis of Imbalanced Nutrition: Less than Body Requirements is appropriate. The patient is not at risk for imbalanced nutrition because it is already a problem and certainly is not experiencing nutrition that is more than body requirements. Readiness for Enhanced Nutrition is appropriate when there is a healthy pattern of nutrient intake that is sufficient for meeting metabolic needs and can be strengthened and enhanced.
A patient who is moved to a hospital bed following throat surgery is ordered to receive continuous tube feedings through a small-bore nasogastric tube. Following placement of the tube, which nursing action would the nurse initiate to ensure correct placement of the tube? A) Auscultate the bowel sounds. B) Measure the gastric aspirate pH. C) Measure the amount of residual in the tube. D) Obtain an order for a radiographic examination of the tube.
D: Although a radiographic examination exposes the patient to radiation and is costly, it is still the most accurate method to check correct tube placement. Other methods that can be used are aspiration of gastric contents and measurement of the pH of the aspirate. The recommended method for checking placement, other than a radiograph, is measuring the pH of the aspirate. Visual assessment of aspirated gastric contents is also suggested as a tool to check placement. In addition, the length of the exposed tube is measured after insertion and documented. Tube length should be checked and compared with this initial measurement, in conjunction with the previous two methods for checking tube placement. The auscultatory method is considered inaccurate and unreliable. Measurement of residual amount does not confirm placement.
A client has been prescribed a clear liquid diet. What food or fluids will be served? A) Milk, frozen dessert, egg substitutes B) High-calorie, high-protein supplements C) Hot cereals, ice cream, chocolate milk D) Jell-O, carbonated beverages, apple juice
D: Clear liquid diets contain only foods that are clear liquids at room or body temperature. Included are gelatin, fat-free broth, bouillon, ice pops, clear juices, carbonated beverages, regular and decaffeinated coffee, and tea. A full liquid diet includes all fluids and foods that become liquid at room temperature. This would include ice cream, chocolate milk, and liquid dietary supplements.
A client is discussing weight loss with a nurse. The patient says, "I will not eat for two weeks, then I will lose at least 10 pounds." What should the nurse tell the client? A) "What a good idea. Go ahead. That will jump start your weight loss!" B) "Many people find that to be an ideal way to lose weight quickly and easily." C) "That will increase your metabolic rate and help you lose weight." D) "That will decrease your metabolic rate and make weight loss more difficult."
D: Most nutritionists agree that fasting or following a very low-calorie diet defeats a weight-loss plan because the body interprets this eating pattern as starvation, and compensates by slowing down the basal metabolic rate, making it even more difficult to lose weight.
The nurse is discussing infant care with a woman who just had a baby girl. What type of nutrition would the nurse recommend for the infant? A) Solid foods after the first month B) No solid foods until age 1 year C) Bottle feeding with cow's milk D) Breast-feeding or formula with iron
D: Nutritional needs per unit of weight are greater in infants than at any other time in the life cycle. Breast-feeding or a commercial formula with iron is recommended as the major source of nutrition for the first 6 to 12 months of life. Cow's milk is not recommended for infants under 1 year. Solid foods are usually not introduced until 6 months.
What is the route of administration for TPN? A) Oral B) Subcutaneous C) Intramuscular D) Intravenous
D: TPN meets the client's nutritional needs by way of nutrient-filled solutions administered intravenously through a central line, usually the subclavian or internal jugular veins.
A nurse is feeding a client. Which of the following statements would help a person maintain dignity while being fed? A) "I am going to feed you your cereal first, and then your eggs." B) "I wish I had more time so I could feed you all of your meal." C) "I know you don't like me to feed you, but you need to eat." D) "What part of your dinner would you like to eat first?"
D: 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 person his or her preference regarding the order of items eaten can help maintain dignity while being fed.
A nurse is assessing a patient who has been NPO (nothing by mouth) prior to abdominal surgery. The patient is ordered a clear liquid diet for breakfast, to advance to a house diet as tolerated. Which assessments would indicate to the nurse that the patient's diet should not be advanced? A) The patient consumed 75% of the liquids on her breakfast tray. B) The patient tells you she is hungry. C) The patient's abdomen is soft, non-distended, with bowel sounds. D) The patient reports fullness and diarrhea after breakfast.
D: Tolerance of diet can be assessed by the following: absence of nausea, vomiting, and diarrhea; absence of feelings of fullness; absence of abdominal pain and distention; feelings of hunger; and the ability to consume at least 50% to 75% of the food on the meal tray.
How often would a nurse recommend a client eat or drink a source of vitamin C? A) Once a week B) Once a month C) Three times a week D) Every day
D: Vitamin C, a water-soluble vitamin, is usually not stored in the body. Deficiency symptoms are apt to develop quickly when intake is inadequate; a daily intake is recommended.
While reviewing an adult client's chart, a nurse notes average daily intake of fluids as 2,000 mL/day. What will the nurse do based on this information? A) Change the plan of care to include forcing fluids. B) Ask the client to drink more water during the day. C) Post a sign limiting fluids to 1,000 mL every 24 hours. D) Continue with care; this is a normal fluid intake.
D: Water intake averages 2,000 to 2,500 mL/day for adults. The nurse would continue with care, because the client has a normal fluid intake.
A nurse is feeding a patient who is experiencing dysphagia. Which nursing intervention would the nurse initiate for this patient? A) Feed the patient solids first and then liquids last. B) Place the head of the bed at a 30-degree angle during feeding. C) Puree all foods to a liquid consistency. D) Provide a 30-minute rest period prior to mealtime.
D: When feeding a patient who has dysphagia, the nurse should provide a 30-minute rest period prior to mealtime to promote swallowing; alternate solids and liquids when feeding the patient; sit the patient upright or, if on bedrest, elevate the head of the bed at a 90-degree angle; and initiate a nutrition consult for diet modification and food size and/or consistency.