Nutrition: Neuropsych
The school nurse is teaching nutrition to a group of primary school students. After presenting MyPlate to the students and discussing their food options, the nurse knows teaching has been effective when the students make what comment? A. "Half our plate should be fruits and vegetables." B. "We should drink whole milk." C. "Our plate should have twice as much grains as protein." D. "We should never eat foods with added sugar."
A. "Half our plate should be fruits and vegetables." Rationale: The MyPlate graphic devotes 1/2 the plate to fruit and vegetables, 1/4 to protein, and 1/4 to grains. Foods low in saturated fat are encouraged, so low-fat or fat-free milk would be preferable to whole milk. Although MyPlate recommends that people older than 2 years of age limit consumption of added sugar, it does not prohibit it. However, MyPlate recommends that children younger than 2 years avoid added sugar completely.
A daycare center has contacted the clinic requesting assistance in providing better choices for snacks for their clients. Which of the following are the best choices to recommend for these preschool children? Select all that apply. A. Apple slices B. Chocolate milk C. Oranges D. Fruit drink with 25% juice E. Whole-grain cookies
A. Apple slices C. Oranges Rationale: Providing fresh fruit versus crackers and cookies is better option. Fruit drinks (that are not 100% juice), chocolate milk, and cookies can contain added sugar and/or saturated fats that are not needed by the children. The fresh fruit will also provide more essential nutrients.
The nurse has been emphasizing the importance of reading labels to know the content of foods the client is eating. When reading a nutrition label, the client recognizes which of the following fats is the best option? A. Canola oil B. Palm oil C. Partially hydrogenated oil D. Milk fat
A. Canola oil Rationale: The decreased consumption of saturated or solid fats is recommended to decrease the risk of chronic disease. Oils derived from plants, such as olive oil, canola oil, and corn oil provide unsaturated fat and Vitamin E. Palm oil and partially hydrogenated oils are plant oils that are high in saturated fats, and milk fats are considered solid fats.
The nurse is caring for a client who is considering bariatric surgery. The client asks, "Why is an assessment of body mass index (BMI) important? What reason should the nurse provide in the response? A. "Knowing your BMI helps determine how people metabolize fat." B. "Calculating the BMI helps in determining the risk of health problems." C. "A high BMI is associated with leptin deficiency." D. "BMI can help determine a person's body level of ghrelin."
B. "Calculating the BMI helps in determining the risk of health problems." Rationale: Overweight and obesity increase the risk of all-cause mortality. High BMI is a major risk factor for cardiovascular disease, diabetes, musculoskeletal disorders and some cancers. Central obesity is linked to increased risk of obesity comorbidities. Knowing the BMI does not provide information about how each individual metabolizes fat, although obesity is caused by an increase in the number and/or size of fat cells, and this is related to a person's fat composition in childhood and during puberty. There is no evidence to support the notion that a high BMI is associated with a leptin deficiency; in fact, this type of deficiency is rare. Ghrelin levels are associated with appetite, but knowledge of the BMI offers no estimate of them.
When describing the overall goals of Dietary Guidelines for Americans to a client who wants to make changes in his eating pattern, what is the best way for the nurse to describe this initiative? A. "It is an initiative aimed at improving the health of people with chronic disease." B. "It is an initiative aimed at helping people choose fat-free options most." C. "It is an initiative aimed at helping people make higher quality food choices." D. "It is an initiative aimed at eliminating health disparities among Americans."
C. "It is an initiative aimed at helping people make higher quality food choices." Rationale: Dietary Guidelines for Americans is a program that focuses on urging Americans to make gradual changes in their eating patterns by shifting their food choices to higher quality selections. This initiative is aimed at both healthy people and people who could be at risk for developing chronic disease. While the guidelines recommend choosing fat-free dairy options for those who consume dairy, this is only one of many recommendations, not an overall goal. The initiative aims to help minimize health disparities among Americans, but eliminating disparities is far beyond its scope.
The nurse is teaching a client how to achieve weight loss through calorie deficit. If the client desires to lose 0.5 lb/week, what deficit should the nurse tell the client to target? A. 125 calories/day B. 250 calories C. 375 calories/day D. 500 calories/day
B. 250 calories Rationale: One pound of body fat equals approximately 3500 calories. To lose 1 pound each week, one would need to ingest 3500 fewer calories each week, which equals 500 calories each day (3500 ÷ 7 = 500). Since this client is trying to lose 0.5 lb each week, the deficit should be 250 calories/day.
A client seeking nutritional counseling states, "I know that a serving of meat is about 3 oz, but I don't have a scale to weigh it." The nurse can offer the client a practical way to estimate this portion by comparing it to the size of what common item? A. Tennis ball B. Deck of cards C. Golf ball D. Smartphone
B. Deck of cards Rationale: A 3-oz serving of meat, seafood, or poultry is approximately the size of a deck of cards. A smartphone is likely to be significantly larger. A golf ball is a good estimate for a 1/4-cup serving of food, and a tennis ball is approximately the size of a 1-cup serving of food or a medium piece of fruit.
The nurse is reinforcing teaching regarding eating strategies for a client who was recently diagnosed with bulimia nervosa (BN). What recommendation should the nurse include in the teaching? A. Eliminate snacking. B. Eat every 4-5 hours. C. Avoid "forbidden" or problem foods. D. Eat each meal quickly.
B. Eat every 4-5 hours. Rationale: Clients diagnose with BN should initially eat every 4-5 hours while learning to recognize hunger cues. The client should consume 3 meals and 2-3 snacks each day to reestablish structure in the eating pattern. Clients should be instructed to eat slowly and to avoid food restriction, since that behavior can lead to binge eating.
A client reports having difficulty finding a practical way to remain within the daily calorie limit that will promote weight loss. What strategy should the nurse suggest to help the client? A. Opt for low-fat foods. B. Eat most of the day's calories at breakfast. C. Do not eat immediately upon feeling hungry. D. Eat fruit in place of vegetables.
C. Do not eat immediately upon feeling hungry. Rationale: Hunger pangs may occasionally go away soon after appearing. By waiting 10 minutes when the urge to eat first appears, the client can control intake. Foods that are low in fat are not necessarily low in calories, nor are the necessarily nutrient-dense. Calories should be distributed throughout the day to ensure sufficient energy for activities of the day and to prevent overeating from hunger later on in the day. Although both fruit and vegetables are nutrient-dense and should be included in the eating pattern, replacing vegetables with fruit is likely to increase total calorie intake while also reducing intake of some nutrients.
After the nurse informs a client that their body mass index (BMI) value is 25, the client asks, "What does that mean?" What term would the nurse indicate is associated with this value? A. Underweight B. Normal weight C. Overweight D. Obesity
C. Overweight Rationale: A BMI of 25 to 29.9 is considered overweight. A value of less than 18.5 is underweight, and a value of 18.5-24.9 is normal. A value of 30-34.9 is obesity class I, and 35.0-39.9 is obesity class II. Values of 40 or greater indicate extreme obesity.
The nurse is providing education to a client who weighs 260 pounds and has a body mass index (BMI) of 32.5. If the client is attempting to lose weight over the next 6 months, how much weight should the nurse recommend the client lose on average/week? A. 0.5 to 1 pounds B. 1.5 to 2 pounds C. 2 to 3.5 pounds D. 3.5 to 5 pounds
A. 0.5 to 1 pounds Rationale: For clients who are overweight or obese, a weight loss of 5% to 10% within 6 months is recommended. Since this client currently weights 260 lb, a weight loss of 13-26 lb would be recommended. Over 6 months (26 weeks), this averages to 0.5-1 lb/week. The other options would result in significantly greater weight loss if maintained over 6 months, and some ranges are likely unrealistic (e.g., 3.5-5 lb/week).
The nurse is teaching a class about the Dietary Guidelines for Americans (DGA). What should the nurse identify as the focus groups of the DGA? A. All people regardless of age B. Adults and children older than 2 years C. All people older than 14 years of age D. Adults only
A. All people regardless of age Rationale: The DGA is a report containing evidence-based advice on food and beverages to consume to promote health, reduce the risk of chronic disease, and meet nutrient needs. Although it includes some age-specific guidelines (for example, regarding the consumption of foods with added sugars), it is intended for people of all ages.
The nurse is conducting nutrition counseling for a young adult in the clinic when the clients asks, "What do you mean when you say, 'calories for other uses?'" How would the nurse explain this term? A. Foods that aren't nutrient dense but fit within in the eating pattern B. Foods that don't contain calories C. Foods that don't provide energy D. Items that should be prohibited from the eating pattern
A. Foods that aren't nutrient dense but fit within in the eating pattern Rationale: If a person chooses only foods that are nutrient dense, then it is likely that a small number of calories will remain within the overall calorie limit for the eating pattern. These calories are referred to as "calories for other uses." The individual can choose to allocate these calories in any way they see fit, as long as they are meeting macronutrient needs and not exceeding the recommended limits for added sugars, saturated fats, and alcohol. Healthy eating patterns don't prohibit any food items, but instead, incorporate them in healthy ways.
The client is a healthy college student who is interested in maintaining a healthy weight by following a 2000-calorie diet. How many cup equivalents of vegetables should the nurse recommend the student eat on a daily basis? A. 2 B. 2 1/2 C. 3 D. 3 1/2
B. 2 1/2 Rationale: The 2000-calorie diet MyPlate diet guidelines recommend that individuals age 2 years and older should eat 2 1/2 cup equivalents of a variety of vegetables daily.
The client is learning to make healthy choices in the food by using MyPlate. The nurse determines that teaching has been effective when the client states that approximately what portion of the plate should be protein? A. 15% B. 25% C. 35% D. 45%
B. 25% Rationale: MyPlate is a visual tool intended to promote healthy eating patterns by suggesting the proportions of foods to include in meals. It features a place setting with 1/2 the dinner plate devoted to fruits and vegetables, 1/4 to protein, and 1/4 to grain, with dairy accompanying the plate.
A nurse has attended a seminar covering the objectives of the Dietary Guidelines for Americans. Upon returning to the clinic, the nurse is asked what the clinic could do differently to meet the objectives. What would be an appropriate response? A. "Discuss with clients how to customize and enjoy dietary choices." B. "Tell clients to weigh themselves regularly." C. "Encourage all adult clients to achieve a caloric intake of 2000 cal/day." D. "Recommend a vegetarian diet to clients who eat meat."
A. "Discuss with clients how to customize and enjoy dietary choices." Rationale: The Dietary Guidelines for Americans include evidence-based advice on selecting foods and beverages to consume to promote health, reduce the risk of chronic disease, and meet nutrient needs. Within these guidelines, clinicians should encourage clients to customize choices to reflect personal preferences, cultural traditions, and budgetary considerations. Telling clients to weigh themselves regularly is not part of the recommendations. Daily calorie requirements vary widely among individuals and for a variety of factors; not all people should be encouraged to consume 2000 cal/day. Although vegetarianism is one option for a potentially healthy eating pattern, lean, unprocessed meats also have a place.
The nurse is working with a group of clients in a weight loss clinic. One client asks if their obesity results from genetic makeup. What is the best way for the nurse to respond? A. "Lifestyle and environment along with genetics play a role in obesity." B. "Obesity is caused mainly by low activity level." C. "Having obese parents guarantees a person will be obese." D. "Obesity is largely determined by the food choices people make."
A. "Lifestyle and environment along with genetics play a role in obesity." Rationale: Study results suggest that genetics play a role in whether a person may be predisposed to obesity, not that genes predestine a person to obesity. Even when a genetic susceptibility exists, the presence and severity of the condition depend not on any single factor but rather on interaction of multiple variables, including behavioral, sociocultural, and environmental.
A client with a body mass index (BMI) of 28 who hopes to reduce reliance on blood pressure medication is seeing the clinic nurse to develop a weight loss plan. What information should the nurse teach the client related to this goal? A. "You should aim to lose at least 5% of your body weight." B. "Blood pressure can improve with a 3% reduction of body weight." C. "A weight loss of 30 to 35 pounds will probably be enough." D. "You are unlikely to lose enough weight to affect your medication requirements."
A. "You should aim to lose at least 5% of your body weight." Rationale: Although a sustained weight loss of 3% to 5% can cause clinically significant improvements in some health measures (e.g., triglycerides, A1c), a reduction in the need for blood pressure medications often requires greater loss. For clients who are overweight or obese, a loss of 5-10
The nurse is helping the client develop a meal plan based on 2000-calorie MyPlate plan. Which menu suggests the client understands the plan? A. 1 cup plain yogurt with fresh strawberry slices, 1 small banana, 1 hard-boiled egg, 1 cup herbal tea, 1 slice whole-grain toast B. 2 cups crisp rice cereal with 1 cup 2% milk, 1 cup sliced strawberries with 2 tsp sugar, 1 slice whole-wheat toast with 1 tsp butter and grape jelly, 1 cup black coffee C. 1 cup raspberry flavored yogurt with 1 tsp flax seeds, 2 sliced toasted sourdough bread with 1 tsp canola margarine, 1 cup coffee with 2 tbsp cream D. 2 cups oatmeal with 2 tbsp brown sugar, 1/2 cup raisins and 1 cup whole milk, 1 cup hot tea with 1 tsp honey
A. 1 cup plain yogurt with fresh strawberry slices, 1 small banana, 1 hard-boiled egg, 1 cup herbal tea, 1 slice whole-grain toast Rationale: The breakfast consisting of plain yogurt with strawberries, egg, toast, and tea best follows the guidelines of MyPlate 2000-calorie diet. The other choices contain a variety of hidden fats, sugars, and refined grains.
The nurse is working with an adult client to select a lunch menu for the day based on MyPlate guidance. The nurse determines that teaching has been effective when the client chooses which meal as the best option? A. 1 cup steamed spinach, 3 oz poached salmon with dill, 1 small apple, 1 whole-wheat roll, and 1 cup tea sweetened with 1 tsp sugar B. A sandwich consisting of 2 slices white bread, 1 tbsp mayo, 2 slices bologna, 1 slice American cheese, 1 tsp mustard C. 1 cup yogurt with fruit, 1 cup pea and ham soup, 1 cup coffee with 2 tbsp cream and 2 tsp sugar D. 2 cups white spaghetti with meat sauce, 2 cups mixed garden salad, and 3 tbsp ranch dressing
A. 1 cup steamed spinach, 3 oz poached salmon with dill, 1 small apple, 1 whole-wheat roll, and 1 cup tea sweetened with 1 tsp sugar Rationale: MyPlate guidelines encourage meals that emphasize a variety of fruit and vegetables, that include smaller portions of lean proteins and (mostly whole) grains, and that limit added solid fats and sugars. The meal option of spinach, salmon, apple, whole-wheat roll, and tea best follows the guidelines in variety and portion sizes. The sandwich includes several less ideal choices, including processed meat. The meal that includes the soup has little in the way of fruits and vegetables and includes significant amounts of added saturated fat and sugar. The pasta meal includes only refined grains and a significant amount of added fat in the 3 tbsp of dressing.
The nurse is helping a client develop some menus based on a 1500-calorie low fat diet. Which meal option is most representative of this diet? A. 3 oz of baked chicken breast, 1 cup of strawberries with ½ cup of low-fat yogurt, 1.5 cups of steamed broccoli, and 4 oz of quinoa B. 4 oz patty of 85% lean ground beef, 1 cup of cottage cheese, 1 cup of skim milk, 1 cup of mixed vegetables, and 2 slices of sourdough bread C. 1.5 cups of corn, 1.5 cups of watermelon, 1 cup of milk, and 4 oz of chicken wings D. 1 cup of green beans, 1 cup of raw carrot and celery sticks, 1 cup of raspberries with 1 teaspoon of honey, and 5 oz of fried chicken strips
A. 3 oz of baked chicken breast, 1 cup of strawberries with ½ cup of low-fat yogurt, 1.5 cups of steamed broccoli, and 4 oz of quinoa Rationale: The meal consisting of 3 oz of baked chicken breast, 1 cup of strawberries, 1.5 cups of steamed broccoli, and 4 oz of quinoa is most representative of the low-fat diet. The baked chicken breast contains less fat than the beef patty or the other chicken preparations. Additionally, it is closest to meeting the MyPlate recommendations of including fruits and vegetables, whole grains, dairy, and a protein food.
The nurse is suggesting a 1500 cal/day plan for a client who wants to lose weight by following a balanced diet plan. In helping the client identify food options, what foods would the nurse indicate the client could consume daily? Select all that apply. A. 5 oz grilled chicken breast B. 2 cups of leafy greens C. 5 tsp olive oil D. 6 oz hamburger with bun E. 7 oz lean steak F. 3 cups 2% milk
A. 5 oz grilled chicken breast B. 2 cups of leafy greens C. 5 tsp olive oil Rationale: The 1500 cal/day balanced diet recommends the following: 7 servings of grains, 2 servings of non-starchy vegetables, 3 servings of fruits, 2 servings of fat-free dairy, 5 oz lean protein, and 5 servings of fats. The 6-oz hamburger, 7-oz steak, and 3 cups of 2% milk are all in excess of the 1500-calorie balanced diet.
The nurse is providing education to families about identifying signs of an eating disorder. The nurse should mention what physical signs when discussing anorexia nervosa with these families? Select all that apply. A. Amenorrhea B. Lanugo C. Diarrhea D. Hypotension E. Hypervitaminosis D
A. Amenorrhea B. Lanugo C. Diarrhea D. Hypotension Rationale: Anorexia nervosa can result in amenorrhea, lanugo, diarrhea, hypotension, bradycardia, hypothermia, and dangerous electrolyte imbalances. Since food intake is severely restricted, hypervitaminosis is unlikely.
The nurse is caring for a client with anorexia. When developing the plan of care, the nurse should include a goal that focuses on increasing what? A. Daily calorie intake B. Fat intake C. Protein intake D. Daily weight
A. Daily calorie intake Rationale: Restoring weight through gradual increases in calorie intake is one of the priorities in the initial stages of inpatient care and is a vital step in overall recovery. Although foods should be nutritionally dense to optimize a healthy weight gain, the total amount of each macronutrient intake daily should not be the focus. It is not effective to monitor weight gain daily. Small fluctuations in weight gain can trigger a sense of lack of control for clients with anorexia and should be avoided.
The nurse is providing dietary guidance related to cancer prevention. What recommendation would the nurse include from the American Institute for Cancer Research (AICR)? A. Develop a weight management strategy. B. Consume less than 2300 mg of sodium per day. C. Follow the healthy Mediterranean-style eating pattern. D. Limit saturated fat to 5% to 6% of total daily calories.
A. Develop a weight management strategy. Rationale: The AICR recommends for individuals to be as lean as possible without becoming underweight; therefore, the nurse should include a recommendation to develop a weight management strategy in a class on cancer prevention. The Dietary Guidelines for Americans (DGA) recommend limiting sodium intake to 2300 mg/day; this is not specifically mentioned by the AICR. The AICR does not recommend any specific eating pattern. The DGA recommends limiting saturated fat to 10% of daily calories; the AICR recommends leaner proteins but does not identify any specific percentage.
The nurse is working with a group of clients in a weight loss clinic. The nurse recognizes that what diet plan is most likely to result in weight loss? A. Individualized diet B. Low-fat diet C. Low-carbohydrate diet D. High-protein diet
A. Individualized diet Rationale: Because most low-calorie diets lead to clinically important weight loss if the diet is followed, the "best" diet is the one the client will adhere to. The more the diet is individualized to the client's preference and health status, the more likely it will be followed. A diet is only successful if the client follows it.
The nurse is asked to discuss weight loss drugs with a group of bariatric clients. What information should the nurse include regarding phentermine-topiramate? A. It works by making the body "think" it is full. B. It has the greatest benefit when used for 3-4 months. C. The only known side effects are headache and excess salivation. D. It is intended only for clients with a body mass index (BMI) of 25 or greater.
A. It works by making the body "think" it is full Rationale: Weight-loss medications are sometimes prescribed along with lifestyle modification to promote weight loss. Phentermine-topiramate is one such medication. Phentermine is an appetite suppressant, which promotes the feeling of fullness. Weight-loss medications are intended for long-term use; short-term use (less than 6 months) has not been shown to achieve lasting benefits. Phentermine-topiramate has several common side effects, including paresthesia, dizziness, altered taste sensation, insomnia (not sedation), dry mouth (not excess salivation), and constipation. The Food and Drug Administration (FDA) has approved weight-loss drugs for use in clients with a BMI of 30 or greater without weight-related complications or 27 or greater in clients with at least one weight-related complication.
The nurse is conducting an educational session about overweight and obesity. When discussing the complications associated with obesity, what should the nurse be certain to include? A. Obstructive sleep apnea B. Kidney stones C. Intestinal polyps D. Seizure disorders
A. Obstructive sleep apnea Rationale: Obesity is associated with a wide variety of comorbidities, including diabetes, hyperlipidemia, fatty liver disease, obstructive sleep apnea, gastroesophageal reflux disease (GERD), vertebral disk disease, osteoarthritis, and increased risk of certain cancers. There is no evidence that links obesity to kidney stones, intestinal polyps, and seizure disorders.
The nurse is working with a client who has been newly diagnosed client with bulimia nervosa (BN). What information should the nurse understand about the disorder when caring for the client? Select all that apply. A. People with BN recognize their behavior is abnormal. B. Clients with BN lack of sense of control over eating. C. Those with BN tend to be of normal or slightly above normal weight. D. BN has a higher mortality rate than anorexia nervosa. E. BN is typically associated with compulsive exercise.
A. People with BN recognize their behavior is abnormal. B. Clients with BN lack of sense of control over eating. C. Those with BN tend to be of normal or slightly above normal weight. Rationale: Individuals with BN recognize their behavior is abnormal, but they lack the self-control regarding their eating habits. They experience weight fluctuations and tend to be of normal or slightly above normal weight. Bulimia has a lower mortality rate than anorexia nervosa. Compulsive exercise is associated with anorexia nervosa, not with BN.
Parents of a preschooler have expressed concern that their child is gaining too much weight. What suggestions can the nurse make to help the parents? Select all that apply. A. "Switch the child to a 1000-calorie diet." B. "Increase her activity level." C. "Limit your child to one can of soda per day." D. "Keep healthy snacks on hand." E. "Read labels to reduce sugar intake."
B. "Increase her activity level." D. "Keep healthy snacks on hand." E. "Read labels to reduce sugar intake." Rationale: The Dietary Guidelines for Americans stress the importance of making smart food choices to balance intake with individual needs (including caloric needs). This involves selecting nutrient-dense food and beverage choices for the bulk of the eating pattern and limiting intake of added sugars and saturated fats. Reading food labels can help the parents monitor, and thus control, added sugar. Keeping healthy snacks on hand can ensure that the eating pattern focuses on nutrient-dense foods. Increasing the child's activity level will increase energy consumption, which will aid in weight control. Although reducing calories can aid in weight loss, 1000 calories is likely inadequate for a preschooler. Even one can of soda per day likely contains too much added sugar for the child's diet.
The nurse is discussing healthy changes that a client can make to their eating pattern. When providing recommendations regarding eating less-than-healthful foods, what statement would the nurse make? A. "Eat them as much as you want as long as you're getting sufficient macronutrients." B. "It's fine to have these foods as long as you don't overdo it." C. "Just make sure you don't eat them after dinner." D. "You should avoid this type of food entirely."
B. "It's fine to have these foods as long as you don't overdo it." Rationale: Less-than-healthful foods—those that contain added sugar, added refined starches, solid fats, or alcohol—should be limited, but they do not have to be completely eliminated from the eating pattern. As long as the client's eating pattern is within Acceptable Macronutrient Distribution Ranges, there is room for careful inclusion of these foods. It would be incorrect to tell the client to eat any desired amount of less-than-healthful food as long as macronutrient requirements are met; this would likely result in exceeding recommended amounts of added sugar, alcohol, and saturated fat. There is no evidence to demonstrate that less-than-healthful foods can be consumed earlier in the day without having an impact on overall health.
The nurse is teaching a client about diet changes due to a recent cholecystectomy with emphasis on low-fat choices. The nurse knows that teaching has been effective when the client chooses what as an example of a good menu selection? A. 1/2 cup sweet potatoes, 1 cup steamed broccoli, 1 cup macaroni and cheese, 3 oz ham B. 1 cup sweet potatoes, 1 cup steamed collard greens, 3 oz wild rice, 3 oz ham C. A cheeseburger consisting of 1 hamburger bun with sesame seeds, 4 oz hamburger patty, 1 slice American cheese, onion, tomato, and lettuce, and 1 tbsp ketchup and mayo D. 4 oz chicken thigh baked in skin, 1 cup mashed potatoes with 1 tsp butter and 1 tsp sour cream, 2 cups mixed green salad, and 2 tbsp oil and vinegar dressing
B. 1 cup sweet potatoes, 1 cup steamed collard greens, 3 oz wild rice, 3 oz ham Rationale: Following MyPlate suggestions, the meal choice of sweet potatoes, collard greens, wild rice, and ham best fit the recommendations in variety and portion size. The other choices contain added fat, which could lead to gastric upset in this post-cholecystectomy client.
The nurse has assessed a young adult female client as being at risk for having an unrealistic weight loss goal. The client weighs 150 lb and is moderately active. The nurse should what daily caloric intake range as realistic for this client in order to lose weight at a healthy pace? A. 1000 to 1300 B. 1200 to 1500 C. 1500 to 1800 D. 1800 to 2100
B. 1200 to 1500 Rationale: A hypocaloric eating pattern may be achieved by choosing a general target to create a calorie deficit, such as 1200 to 1500 calories/day for women and 1500 to 1800 calories/day for men. These levels are adjusted according to the individual's body weight and physical activity levels. Based on the client's current weight and activity level, an intake of 1000 to 1300 calories/day is likely to be too low, and intakes greater than 1500 calories/day may be too high to achieve weight loss.
The nurse is seeing a client who has a body mass index (BMI) of 36 along with type 2 diabetes and hypertension. The client has tried restrictive dieting unsuccessfully several times. The nurse knows the client should be considered for which intervention? A. Orlistat B. Bariatric surgery C. Behavior modification D. Phentermine
B. Bariatric surgery Rationale: Bariatric surgery should be considered for a client with a BMI of 40 or greater or a BMI of 35 or greater accompanied by severe complications. Diabetes and hypertension place this client in the latter category. Behavior modification would be recommended, but it is unlikely to achieve the desired weight loss quickly enough to adequately address the comorbidities. Similarly, weight-loss medications would likely be prescribed in place of surgery if the client's BMI were lower (e.g., no higher than 27).
The nurse is teaching behavior modification techniques to a client with a body mass index (BMI) of 30 who is attempting to lose weight. What suggestion should the nurse include in the teaching? A. Reduce caloric intake by occasionally skipping a meal. B. Eat meals from a small plate. C. Identify calorie-dense foods that should never be eaten. D. Eat with a distraction present to avoid overeating.
B. Eat meals from a small plate. Rationale: Modifying some behaviors during eating can help control intake. One such behavior is serving food from small plates, which can make portions appear larger than they actually are. Skipping meals reduces structure in the eating pattern and can lead to binging later. Although clients should focus on nutrient dense foods, no food should be considered forbidden; allowing oneself an occasional treat can help improve satisfaction and increase compliance with healthy behaviors. Distractions (e.g., television) during eating should be avoided because the client may lose track of intake.
The nurse asks a member of the nutrition class to state the basic messages of the Dietary Guidelines for Americans. The nurse recognizes that teaching has been effective when the class includes what in their answer? Select all that apply. A. Increase the consumption of protein. B. Manage weight by calorie balancing. C. Get at least 175 minutes of physical activity each week. D. Limit intake of saturated fats, sugars, and alcohol. E. Do not worry about empty calories.
B. Manage weight by calorie balancing. D. Limit intake of saturated fats, sugars, and alcohol. Rationale: The Dietary Guidelines for Americans have several key recommendations including balancing calories with activity level to manage weight and limiting consumption of sodium, empty calories, added sugars, saturated fat, alcohol. Individuals should be aware of empty calories and make conscious decisions when eating them. The DGA helps individuals obtain the correct amounts of macronutrients, including protein, but doesn't explicitly advocate for increased consumption of any. The DGA does not include specific recommendations for activity level, though it does point to those issued in other guidelines.
When treating a client for anorexia nervosa (AN), it is important to know what diet interventions work best. Which diet interventions are appropriate for clients with anorexia nervosa? Select all that apply. A. Increasing sodium intake B. Providing small, frequent feedings C. Supplementing with vitamins and minerals D. Selecting all foods for the client E. Avoiding fats
B. Providing small, frequent feedings C. Supplementing with vitamins and minerals Rationale: There are various strategies that can be used to encourage better eating habits in a person who is suffering from anorexia nervosa. They include providing small, frequent (every 3-4 hours) feedings to gradually increase the volume of food consumed. In addition, clients may require supplementation with vitamins and minerals due to prolonged food restriction and the consequent depletion of needed nutrients. Sodium intake should only be increased if there is an indication of low serum levels of sodium. It should be done so under close medical supervision. Involving the client in developing individualized goals and meal plans helps promote compliance with treatment. Sources of protein, fat and complex carbohydrates, preferably whole grains, at every meal and snack should be eaten.
One of the major messages conveyed by the Dietary Guidelines for Americans includes the consumption of alcohol. A client asks, "How much is advised?" What should the nurse recommend as the message about alcohol? A. "Drink alcohol to ward off heart disease." B. "If you drink alcohol, include it in your empty calories." C. "If you drink alcohol, drink in moderation." D. "Drink alcohol to lessen your risk of colon cancer."
C. "If you drink alcohol, drink in moderation." Rationale: If alcohol is consumed, it should be consumed in moderation—up to 1 drink/day for women and 2 drinks/day for men—and only by adults of legal drinking age. The guidelines do not promote consumption as a means of reducing risk for health problems, nor do they prohibit the practice entirely.
A nurse is meeting with a client who is seeking a healthier lifestyle by changing nutritional patterns. What statement is the most effective recommendation the nurse can make for this client? A. "Start by looking online for preplanned daily menus." B. "Avoid all canned foods." C. "Obtain nutrients from food, not supplements." D. "Change several lifestyle behaviors at the same time."
C. "Obtain nutrients from food, not supplements." Rationale: The MyPlate graphic and Dietary Guidelines are based on the philosophy that the nutrient needs, to the greatest extent possible, should be met through food and not supplements. Preplanned daily menus may be helpful at times, but it is important for all clients to first understand how to make healthier nutritional choices independently. All foods, including fresh, canned, dried, frozen, and 100% juices, can be included in healthy eating patterns when consumed in nutrient-dense forms. Changing several lifestyle behaviors at the same time can lead to increased stress and prevent a sustainable change in nutritional patterns, thus, the achievement of a health weight.
The nurse is conducting teaching with a client who has recently been diagnosed with bulimia nervosa. The client asks the nurse what the underlying issue is for the behavior associated with this eating disorder. What would be the nurse's best response? A. "It tends to happen to people who are obsessed with their size." B. "It is a problem that usually occurs in people who had a difficult childhood." C. "The cause is unique for each person; there are lots of factors involved." D. "The disorder affects people who generally have low self-worth."
C. "The cause is unique for each person; there are lots of factors involved." Rationale: Eating disorders result from complex interaction of genetic, developmental, family influences and sociocultural factors; however, the etiology of eating disorders is not known. Studies indicate that genetic heritability may account for 50% to 80% of the risk of developing anorexia and bulimia nervosa. Offering the client one simple explanation would not sufficiently answer the client's question.
A client is learning to prepare meals for the family based on the healthy U.S.-style eating pattern. How many servings of dairy should the nurse recommend be included each day for a family member consuming 2000 cal/day? A. 2 cup equivalents B. 21/2 cup equivalents C. 3 cup equivalents D. 31/2 cup equivalents
C. 3 cup equivalents Rationale: Individuals 2 years old and older should consume 3 cup equivalents of dairy products daily when following a 2000-calorie, healthy U.S.-style eating pattern.
An adult male client has asked the nurse about the possibility of taking weight loss medications. When providing education to the client, what should the nurse identify as an indication for their use? A. Waist circumference of 35 in. or more B. Inability to lose weight any other way C. Body mass index (BMI) of 30 or greater D. Weight greater than 200 lb
C. Body mass index (BMI) of 30 or greater Rationale: In conjunction with lifestyle changes of diet, behavior modification, and physical activity, pharmacotherapy is indicated for people with a BMI of 30 or greater or for people with a BMI of 27 and one or more with comorbid conditions. It can also be considered for clients with a BMI of 27 or greater in whom lifestyle modifications fail to achieve weight loss. By themselves, waist circumference, inability to lose weight, and body weight are not indications for drug therapy.
The nurse is asked to explain the concept of variety within a major food group. Which would be the best example to give to illustrate the concept of variety within a major food group? A. Orange juice, fresh grapefruit, lemonade B. Hamburger roll, waffle, saltine crackers C. Chicken, black beans, walnuts D. Margarine, butter, mayonnaise
C. Chicken, black beans, walnuts Rationale: Chicken, black beans, and walnuts are all found in the protein group. This example shows the greatest variety of choices. Choosing a variety of foods from within each food group helps ensure that the more than 40 known essential nutrients are consumed in adequate amounts based on the rationale that some nutrients (e.g., iron, calcium, vitamin C, and vitamin A) are concentrated in a few foods. There is less variety in the other options—for instance, orange juice, grapefruit, and lemonade are all some variation of citrus fruit—and many of those options are not nutrient dense, making less than ideal choices.
The nurse is meeting with a client who currently has no health concerns and has a history of unsuccessful restrictive dieting related to being overweight. The nurse should identify what as the most effective way to control weight and sustain good health? A. Bariatric surgical intervention B. Restricting carbohydrates in the diet C. Making lifestyle changes D. Counting daily intake of fat
C. Making lifestyle changes Rationale: Lifestyle/behavioral therapy serves as the foundation of weight management for all people who are overweight or obese regardless of complications. It is a three-pronged approach that includes a healthy, calorie-reduced eating plan, an increase in physical activity, and behavioral interventions to facilitate adherence to eating and activity changes Bariatric surgery is considered based on a body mass index (BMI) that is in the obesity range. People who choose this intervention tend to have health risks associated with being obese. A complete removal of carbohydrates from the diet may be an effective short-term weight loss strategy; however, because the client has attempted many restrictive diets unsuccessfully in the past, it is time to try to a diet that incorporates a balanced diet within the appropriate calorie range for weight control. Counting daily fat intake is also restrictive and will not be effective for a client who has tried similar methods in the past without success.
The nurse is a member of a panel discussing the optimal type of weight loss. When the panel members ask the audience to identify the most important factor affecting weight loss, which response indicates the discussion was effective? A. Source of the calories consumed B. Nutritional content of the calories consumed C. Number of calories consumed D. Time of day at which calories are consumed
C. Number of calories consumed Rationale: Weight loss requires a negative calorie balance, which is achieved by eating fewer calories, increasing physical activity, or both. Based on the assumption that 1 pound of fat mass is approximately equivalent to 3500 calories, a deficit of 500 calories/day theoretically leads to a 1-pound weight loss in 7 days. The first priority in obesity treatment is to decrease calorie intake. The source of the calories and the nutrition content are related to each other; while both influence the overall healthfulness of the eating pattern, neither plays as significant a role in weight loss as total calorie intake. The time of day at which calories are consumed is unlikely to place a measurable role in weight loss.
Numerous health organizations in the United States have issued dietary recommendations so that Americans can choose eating patterns that are aimed primarily at which goal? A. Reducing their weight B. Increasing their activity levels C. Reducing their risk of chronic disease D. Reducing the risk of acute heart disease
C. Reducing their risk of chronic disease Rationale: Healthy eating guidelines translate the science of nutrient needs into evidence-based public health recommendations for eating patterns to meet those needs. Common among these guidelines is the promotion of overall health the goals of reducing the risk of chronic disease. Although the guidelines promote maintenance of healthy weight, weight loss isn't necessarily their primary intent. Recommendations for activity level, while important in the maintenance of overall health, aren't technically dietary in nature.
The nurse educator is teaching a class of nursing students about diet adherence in the client with obesity. The students are given an assignment to break into groups and make a list of strategies that can be used to encourage clients to adhere to their diets. The instructor determines that teaching was effective if what strategy is on every list? A. Give the client a list of ingredients for suggested recipes. B. Offer the client a list of restaurants with low-calorie menu items. C. Teach the client about developing a grocery shopping list. D. Give the client a list of "potential diet buddies."
C. Teach the client about developing a grocery shopping list. Rationale: Behavior changes involve developing structure in the environment as well as in eating and shopping habits. By teaching the client how to develop a grocery list and emphasizing the importance of buying only items on the list, the nurse helps the client control impulse buying that can lead to overconsumption. Although suggesting recipes, restaurants with low-calorie menus, and "diet buddies" will not necessarily impede weight loss, they don't provide the same degree of structure required by developing and shopping from a grocery list.
The Dietary Guidelines for Americans is an evidence-based report published every 5 years by the U.S. government. The nurse would teach clients that a primary goal of the DGA is to help individuals do what? A. Reduce the number of calories consumed daily. B. Follow one of two specific styles of eating patterns. C. Use the guidelines as a framework to shift food choices. D. Decrease consumption of dairy products.
C. Use the guidelines as a framework to shift food choices. Rationale: The overall objective of Dietary Guidelines for Americans is to encourage healthy eating patterns by providing a framework that can be customized to individual needs. The focus of the Dietary Guidelines is to help Americans make food choices that are more nutritionally dense and higher quality, not necessarily just to consume fewer calories. The DGA includes 3 healthy eating patterns (U.S.-style, Mediterranean-style, and vegetarian) that are intended to illustrate how their recommendations can be applied. The guidelines recommend changing to low-fat or fat-free dairy products but not decreasing consumption of dairy.
The nurse is conducting nutrition counseling at the clinic. A client who is at risk for prostate cancer asks what can be done to reduce his risk. Which of the following is the most appropriate recommendation? A. "Transition to a vegetarian eating pattern." B. "Limit your consumption of alcohol to 2 drinks/week." C. "Take supplements that are known to prevent cancer." D. "Try to be as lean as possible without being underweight."
D. "Try to be as lean as possible without being underweight." Rationale: The American Institute for Cancer Research and Recommendations for Cancer Prevention suggest being as lean as possible without being underweight. These guidelines recommend that men limit alcohol consumption to 2 drinks/day, not per week. The recommendations do not include adopting a vegetarian eating pattern, but they do suggest limiting consumption of red and processed meats. The Institute discourages the use of supplements to protect against cancer
