RN Nutrition Online Practice 2023 A
A nurse is caring for a client. Exhibit 1: Nurses' Notes: 2 months ago: Client discharged from hospital following total gastrectomy. Client tolerating full liquid diet. May advance to pureed diet in 1 week. Client instructed to schedule appointments with surgeon for monthly follow-up visits. Today: Client presents to surgeon's office for monthly follow-up visit. Client reports that they advanced their diet to a soft diet as instructed. Client states, "I am eating fine, but about 15 minutes after I eat, I get abdominal cramps, nausea, diarrhea, and it feels like my heart is racing. When that happens, my muscles feel weak, and I get sweaty." Exhibit 2: Vital Signs 2 months ago: Temperature 37° C (98.6° F)Heart rate 82/minRespiratory rate 14/minBlood pressure 129/84 mm HgSpO2 98% on room air Today: Temperature 37° C (98.6° F)Heart rate 62/minRespiratory rate 16/minBlood pressure 122/76 mm HgSpO2 99% on room air
Dumping syndrome: abdominal cramping, muscle weakness, nausea, diarrhea, and sweating that occur after eating. Hypoglycemia: muscle weakness and sweating. Refeeding syndrome: muscle weakness. Clients who have had a total gastrectomy are at risk for dumping syndrome due to the rapid emptying of food into the small intestine which stimulates bowel motility. Dumping syndrome can cause vasomotor responses, such as muscle weakness, flushing, tachycardia, and sweating which are similar to manifestations of hypoglycemia.
A nurse in an antepartum clinic is teaching a client about nutritional recommendations during pregnancy. Which of the following client statements indicates an understanding of the teaching? a. "I should take a daily iron supplement during my pregnancy." b. "I should decrease protein intake during my pregnancy." c. "I should plan to gain at least 50 pounds during my pregnancy." d. "I should increase my fat intake during the first trimester of my pregnancy."
a. "I should take a daily iron supplement during my pregnancy." Clients who are pregnant should take 30 mg of iron supplementation daily to reduce the risk for iron-deficiency anemia.
A nurse is administering a continuous tube feeding at 60 mL/hr with 50 mL of water every 4 hr. What should the nurse document as the total mL of enteral fluid administered during the 8 hr shift? (Round the answer to the nearest whole number. Do not use a trailing zero.)
580 mL Step 1: What is the unit of measurement the nurse should calculate? mLStep 2: Should the nurse convert the units of measurement? NoStep 3: Calculate the total amount of enteral tube feeding administered during the 8-hr shift. The nurse should administer the continuous tube feeding at 60 mL/hr for the 8-hr shift.60 mL x 8 = 480 mLStep 4: Calculate the total amount of water administered via the enteral route during the 8-hr shift. If the nurse should administer 50 mL every 4 hr then the client should receive this amount 2 times during the 8-hr shift.50 mL x 2 = 100 mLStep 5: Add the amount of tube feeding administered with the amount of water administered.480 mL + 100 mL = 580 mLStep 6: Round if necessary.Step 7: Reassess to determine whether the total amount makes sense. If the client is to receive 60 mL/hr for 8 hr, as well as 50 mL of water every 4 hr during an 8-hr shift, it makes sense that the client's total fluid intake is 580 mL. The nurse should document 580 mL of enteral fluid administered during the 8-hr shift.
A nurse is caring for a client in a health clinic. Exhibit 1: Nurses' Notes 6 months ago: Older adult client brought to the clinic by adult child for reports of increasing forgetfulness and confusion. Child states, "My father went shopping and forgot where he left the car." Today's weight is 75.7 kg (167 lb). Today: Client presented to provider's office with adult child for follow-up visit for dementia that was diagnosed 6 months ago. Child reports client has continued forgetfulness and confusion. Child states, "Sometimes I come over to his house and find uneaten food in the microwave." Client denies forgetting to eat and reports eating 3 meals per day. Today's weight is 68 kg (150 lb). Malnutrition Screening Tool (MST) score of 4 which indicates potential malnutrition. Exhibit 2: Vital Signs 6 months ago: Temp 37° C (98.6° F)HR 72/min Respiratory rate 14/min BP 122/82 mm HgSpO2 98% on room air Today: Temp 37
Age, weight loss, albumin results, diagnosis of dementia, and MST score are risk factors for malnutrition. Clients between the ages of 65 to 75 years old are at moderate risk for malnutrition. The client is displaying an unintentional 10% weight loss over the past 6 months, which places them at high risk for malnutrition. The client's albumin level is below the expected range, indicating a compromised protein status, which is a risk factor for malnutrition and requires further evaluation. The client's medical history of dementia also increases the risk for malnutrition. The client's MST score is 4. A score of greater than 2 indicates the client is at risk for malnutrition which requires a nutritional consult and immediate nutritional interventions.
A nurse is providing dietary instructions for a client who has a prescription for warfarin. Which of the following foods should the nurse recommend the client eat in moderation while taking this medication? a. Leafy green vegetables b. Whole grains c. Fruits with skin d. Nuts and seeds
a. Leafy green vegetables The nurse should recommend the client eat in moderation and maintain consistent intake of leafy green vegetables, which contain a natural form of vitamin K that can negate the anticoagulation effects of warfarin.
A client reports constipation during a routine checkup. The client was previously encouraged to increase their intake of mineral supplements. Which of the following minerals should the nurse identify as the possible cause of the constipation? a. Phosphorus b. Potassium c. Magnesium d. Calcium
d. Calcium Calcium can lead to constipation by decreasing peristalsis.
A nurse in a pediatric clinic is caring for a toddler. exhibit 1: vital signs visit 1: Temp 36.7° C (98° F) HR 94/min Resp rate 28/min Visit 2: Temp 36.8° C (98.2° F) HR 88/min Resp rate 26/min exhibit 2: Nurses' Notes Visit 1: Toddler here for well child visit at 13 months of age. Toddler walking around exam room independently, interacting with parent and playing with stuffed animal. Toddler weighs 9.5 kg (21 lb), height is 71 cm (28 inches). Visit 2: Toddler here for well child visit at 18 months of age, accompanied by parent. Toddler speaks in 2 to 3 word sentences, interacts appropriately with parent and nurse. Weight is 10 kg (22 lb), height is 73 cm (28.75 inches). Parent voices concerns that toddler has been having several episodes of large "foul-smelling" loose stools that look "oily" and napping more frequently. Mild abdominal distention noted.Provider prescribed laboratory testing for toddler. Follow-up
When generating solutions, the nurse should recommend foods that do not have gluten as the toddler's manifestations of diarrhea, fatigue, abdominal distention, and weight gain below the expected standards, accompanied by an elevated tissue transglutaminase IgA result indicate that the toddler has celiac disease. The nurse should recommend foods such as eggs, cheese, vegetables, fruits, corn, potatoes, and rice as these do not contain gluten. Foods that contain gluten include those made from wheat, rye, barley, and oats, and should be avoided.
A nurse is caring for a client on a medical-surgical unit. Exhibit 1: Nurses' Notes 0700: Client presents to the emergency department with reports of severe abdominal pain, inability to eat, and peripheral edema. Client rates pain as 10 on a scale of 0 to 10. Pancreatic enzymes obtained and client sent for abdominal ultrasound. Ketorolac IV administered for pain and temperature. 0900: Client admitted to medical surgical unit for treatment of acute pancreatitis. Exhibit 2: Vital Signs 0700: Temp 38.7° C (101.7° F) HR 98/min Resp rate 18/min BP 136/89 mm Hg SpO2 98% on room air 0900: Temp 37.7° C (99.9° F) HR 78/min Resp rate 16/min BP 128/82 mm Hg SpO2 99% on room air Exhibit 3: Diagnostic Results 0730: Abdominal ultrasound: inflammation of the pancreas indicative of pancreatitis Exhibit 4: Laboratory Results 0800: Lipase 186 units/L (0 to 160 units/L)Amylase 340 units/L (30 to 220 units/L)WBC count 13,000 (5,000
When prioritizing hypothesis, and using the urgent versus non-urgent priority framework, the nurse should recognize that administering pain medications as needed, monitoring pancreatic enzyme levels, and administering antibiotics are the priority interventions in the client's plan of care. Controlling a client's pain is a priority intervention to promote client comfort. Monitoring pancreatic enzyme levels determines the effectiveness of treatment and can indicate a worsening of a client's condition. Antibiotic therapy is instituted to reduce infection. Pancreatitis causes inflammation that can injure intestinal mucosa, allowing the normal flora in the gut to multiply, and producing opportunistic infection. While measuring intake and output and obtaining daily weights would be included in the client's plan of care, these are not priority interventions.
A nurse is providing information regarding breastfeeding to the parents of a newborn. Which of the following statements should the nurse make? a. "Breast milk is the source of complete nutrition for an infant up to 6 months of age." b. "Iron-fortified infant formulas are nutritionally inferior to breast milk." c. "Supplemental water is needed to provide an adequate fluid intake." d. "Use whole cow's milk if you discontinue breastfeeding in the first year."
a. "Breast milk is the source of complete nutrition for an infant up to 6 months of age." Breast milk is a source of complete nutrition to support the growth and development of newborns and infants. The introduction of solid foods can occur after 6 months of age.
A nurse is caring for a client who has cirrhosis and ascites. Which of the following dietary instructions should the nurse provide for this client? a. "Decrease your sodium intake to 1 to 2 grams per day." b. "Increase your daily fluid intake to 3 liters per day." c. "Consume 0.5 grams per kilogram of protein per day." d. "Eliminate foods that contain vitamin K."
a. "Decrease your sodium intake to 1 to 2 grams per day." To decrease fluid retention, a client who has cirrhosis should limit their daily sodium intake to 2,000 mg.
A nurse is providing teaching about cancer prevention to a group of clients. Which of the following client statements indicates an understanding of the teaching? a. "I will eat five servings of fruits and vegetables each day." b. "I should limit my alcohol intake to a maximum of three drinks daily." c. "I should eat more refined wheat and oat products." d. "I will eat processed meats to achieve my required protein intake."
a. "I will eat five servings of fruits and vegetables each day." The nurse should instruct the clients to consume four to five servings, or about 2.5 cups, of fruits and vegetables daily. Eating various fruits and vegetables assists in decreasing blood pressure and weight.
A nurse is teaching a client who has chronic kidney disease about limiting dietary calcium intake. Which of the following food choices should the nurse include in the teaching as having the highest amount of calcium? a. 1 cup low-fat yogurt b. 1 oz cheddar cheese c. 1 egg d. ½ cup spinach
a. 1 cup low-fat yogurt The nurse should determine that low-fat yogurt contains 314 mg of calcium per cup, which is the highest amount of calcium; therefore, the client should limit low-fat yogurt in the diet.
A nurse is providing teaching to a client who has dumping syndrome and is experiencing weight loss. Which of the following instructions should the nurse include in the teaching? a. Consume liquids between meals. b. Increase intake of simple carbohydrates. c. Decrease foods high in fat content. d. Eat meals low in protein
a. Consume liquids between meals. The nurse should teach the client to drink liquids between meals to slow movement of food from the stomach.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The current bag of TPN is empty and a new bag is not available on the unit. Which of the following solutions should the nurse infuse until a new bag of TPN is available? a. Dextrose 10% in water b. 0.45% sodium chloride c. Dextrose 5% in lactated Ringer's d. 0.9% sodium chloride
a. Dextrose 10% in water The nurse should administer dextrose 10% in water at the same rate as the TPN to prevent hypoglycemia.
A nurse is caring for an adolescent who has type 1 diabetes mellitus. Which of the following actions should the nurse take to assess for Somogyi phenomenon? a. Monitor blood glucose levels during the night. b. Check for urinary ketones at the same time each day for 1 week. c. Perform an oral glucose tolerance test after administering a dose of insulin. d. Compare current glycosylated hemoglobin level with the level at time of diagnosis.
a. Monitor blood glucose levels during the night. Somogyi phenomenon is fasting hyperglycemia that occurs in the morning in response to hypoglycemia during the nighttime. The nurse should assess for this phenomenon by monitoring blood glucose levels during the night.
A nurse is caring for a group of clients. A client who has which of the following conditions has an increased protein requirement? a. Pressure injury b. Early-stage kidney disease c. Coronary artery disease d. Peptic ulcer
a. Pressure injury A client who has a pressure injury needs additional protein to promote healing.
A nurse is planning dietary interventions for a client who is prescribed external radiation for laryngeal cancer. The client reports manifestations of stomatitis. Which of the following interventions should the nurse include? a. Provide meals at room temperature. b. Offer the client additional seasonings for food. c. Instruct the client to eat citrus fruits at the beginning of the meal. d. Encourage the client to drink warm tomato juice in place of high-protein supplements.
a. Provide meals at room temperature. The nurse should plan to offer the client's foods at room temperature or colder. Foods at these temperatures are less irritating to the mucosa.
A nurse is providing teaching regarding diet modifications to a client who is at a high risk for cardiovascular disease. The client is accustomed to cultural Mexican foods and wants to continue to include them in their diet. Which of the following recommendations should the nurse give the client? a. Use canola oil instead of lard for frying. b. Use soy milk instead of cow's milk. c. Use vegetables in salads rather than in soups. d. Limit ground beef intake to 8 oz per day.
a. Use canola oil instead of lard for frying. The nurse should teach the client to use monounsaturated fats, such as canola oil, instead of saturated fats, such as lard, to reduce the risk for cardiovascular disease.
A nurse is teaching about increasing dietary intake of micronutrients to a client who has difficulty seeing at night. Which of the following micronutrients should the nurse include in the teaching? a. Vitamin A b. Calcium c. Vitamin B6 d. Phosphorus
a. Vitamin A Vitamin A enables the eyes to adapt to dim lighting more rapidly at night, which improves night vision.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN) therapy. Which of the following findings indicates the client is experiencing a complication of the therapy? a. cardiac dysrhythmias b. oliguria c. hyperkalemia d. neutropenia
a. cardiac dysrhythmias. Cardiac dysrhythmias can occur as a complication of TPN therapy due to refeeding syndrome. TPN therapy can increase the client's blood glucose and insulin levels causing electrolytes like potassium to quickly move out of the bloodstream. Hypokalemia can lead to cardiac dysrhythmias.
A nurse is assessing a client who has type 2 diabetes mellitus. The nurse should recognize which of the following as a manifestation of hypoglycemia? a. confusion b. polydipsia c. vomiting d. ketonuria
a. confusion The nurse should recognize confusion as a manifestation of hypoglycemia.
A nurse is assessing a client who is suspected of having lactose intolerance. Which of the following is an expected finding? a. flatulence b. bloody stools c. hyperemesis d. steatorrhea
a. flatulence Flatulence, bloating, cramping, and diarrhea are expected findings associated with lactose intolerance.
A nurse is caring for a client. Exhibit 1: Nurses' Notes 0800: Client is admitted for treatment of hypovolemia due to vomiting and diarrhea for 2 days. Client is awake, but lethargic. Reports dizziness upon standing and no urination since 1600 yesterday. Client states, "I feel like I am going to faint when I stand up." Heart rhythm regular, S1 and S2 present. Respirations even and non-labored, lung sounds clear bilaterally. Abdomen soft, non-distended, hyperactive bowel sounds. Bilateral extremities cool to the touch. Skin is dry and intact. Skin turgor with tenting noted. Capillary refill 4 seconds. 20 gauge IV initiated in left cephalic with 0.45% sodium chloride infusing via infusion pump at 125 mL/hr. 2200: Client is alert and oriented to person, place, time, and situation. Denies dizziness upon standing. Heart rhythm regular. S1 and S2 present. Respirations even and non-labored. Lungs clear anterior and posteri
alert and oriented to person, place, time and situation, reports no dizziness upon standing, abdomen soft rounded with normoactive bowel sounds in all 4 quadrants, urine output 300 mL in past 8 hr, skin is warm, dry, and intact, and capillary refill is 2 seconds. These are expected findings for a client who has received IV fluids to treat a fluid volume deficit.
A nurse is providing dietary teaching to a client who has celiac disease. Which of the following statements by the client indicates an understanding of the teaching? a. "I can return to my normal diet after I follow this diet for 1 month." b. "I can have tapioca pudding for dessert." c. "I will choose canned soups that do not contain meat products." d. "I will eat my sandwiches on whole wheat bread."
b. "I can have tapioca pudding for dessert." A client who has celiac disease can consume tapioca because this starch does not contain gluten.
A nurse is providing teaching to a client who reports nausea during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? a. "I should drink liquids with meals." b. "I will eat dry cereal before I get out of bed." c. "I will increase the fat content in my diet." d. "I should drink a cup of hot tea between meals."
b. "I will eat dry cereal before I get out of bed." Carbohydrates, such as dry cereal, are absorbed quickly and readily raise blood sugar levels, which should reduce nausea.
A nurse is providing discharge teaching to a postpartum client about breast milk use and storage. Which of the following statements should the nurse make? a. "Refrigerate unused breast milk immediately after bottle feeding." b. "You cannot place thawed breast milk back in the freezer." c. "You can store expressed breast milk in the freezer for up to 18 months." d. "Defrost frozen breast milk on the lowest defrost setting in the microwave."
b. "You cannot place thawed breast milk back in the freezer." The nurse should instruct the client that completely thawed breast milk can be stored in the refrigerator but must be used within 24 hr. Breast milk that has been previously frozen should not be refrozen once it has thawed completely. Thawing creates a possibility for bacterial growth and causes a decrease in antibacterial activity, which destroys antibodies in the milk.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN) and is prescribed an oral diet. The client asks the nurse why the TPN is being continued since they are now eating. Which of the following responses should the nurse make? a. "your blood glucose levels need to be within normal range before the TPN can be stopped" b. "you should consume at least 60% of your calories orally before the parenteral nutrition can be discontinued" c. "you should have a weight gain of at least 1 kg per day before the therapy is stopped" d. "your bowel movements need to be regular before the therapy can be discontinued"
b. "you should consume at least 60% of your calories orally before the parenteral nutrition can be discontinued" TPN can be discontinued when oral intake exceeds at least 60% of the client's estimated daily caloric requirements.
A nurse is providing nutritional teaching to the guardians of a 2-year-old toddler. Which of the following snack foods should the nurse recommend including in the toddler's diet? a. 1 cup of fruit gel bites b. 1 cup of yogurt c. ½ of a hot dog d. ½ of a peanut butter and jelly sandwich
b. 1 cup of yogurt The nurse should recommend yogurt as a snack food for a 2-year-old toddler. The consistency of yogurt poses no choking hazard, and because of their increased activity level, toddlers require 13 to 16 g of protein each day to meet the demands for muscle growth. At 8 g/cup, yogurt is a high-quality source of protein. The nurse can also teach the guardians to make yogurt smoothies by combining yogurt and the child's favorite fruit in a blender.
A nurse is admitting a client who has diabetic ketoacidosis. Which of the following findings should the nurse expect? a. Tremors b. Increased urination c. Heart palpitations d. Sweating
b. Increased urination The nurse should identify that increased urination is a manifestation of diabetic ketoacidosis. Other manifestations can include fruity breath, Kussmaul respirations, excessive thirst, and orthostatic hypotension.
A nurse is caring for a client who expresses a desire to lose weight. Which of the following actions should the nurse take first? a. Recommend checking weight once weekly. b. Obtain a 24-hr dietary recall. c. Assist with creating an exercise plan. d. Initiate a plan for diet modification.
b. Obtain a 24-hr dietary recall. The first action the nurse should take using the nursing process is to obtain a diet history, such as a 24-hr dietary recall. Having the client write down everything consumed over a 24-hr period is a crucial component of the assessment process to identify eating behaviors and, therefore, be able to recommend dietary modifications based on the data received.
A nurse is admitting a client who has had a fever and diarrhea for the past 3 days. Which of the following findings should indicate to the nurse the client is dehydrated? a. Distended neck veins b. Orthostatic hypotension c. Weight gain d. Peripheral edema
b. Orthostatic hypotension The nurse should identify a client who is dehydrated can experience orthostatic hypotension due to the fluid loss from the client's body, which causes low blood volume, resulting in low blood pressure.
A nurse is caring for a client who is receiving intermittent enteral feedings every 4 hr via an NG tube. Which of the following actions should the nurse take to reduce the risk for aspiration? a. Check placement of the NG tube once per day. b. Place the client in a semi-Fowler's position. c. Flush the tubing with 20 mL of water prior to each feeding. d. Administer the formula chilled.
b. Place the client in a semi-Fowler's position. The nurse should maintain the client in a semi-Fowler's position to reduce the risk for aspiration of stomach contents during the feeding and for at least 30 min after the completion of the feeding.
A nurse in a provider's office is assessing a client who has HIV. The nurse should identify which of the following findings as an indication to increase the client's nutritional intake? a. A 2.3 kg (5 lb) weight gain since last appointment b. Presence of herpes simplex virus infection c. HIV viral load below detectable levels d. Increased lean body mass
b. Presence of herpes simplex virus infection Secondary infection triggers inflammatory responses that increase the client's metabolic rate. Therefore, the nurse should identify the presence of herpes simplex virus infection as an indication to increase the client's nutritional intake.
A nurse is teaching a client who has hypertension about decreasing sodium intake. Which of the following information should the nurse include in the teaching? a. Use soy sauce as a marinade for meats. b. Season foods with herbs and spices. c. Select processed cheese products when available. d. Choose a frozen dinner for a quick meal option.
b. Season foods with herbs and spices. The nurse should instruct the client to replace salt with herbs and spices when seasoning foods.
A nurse in a long-term care facility is monitoring a client during mealtime who has Parkinson's disease. Which of the following findings should the nurse identify as the priority? a. The client eats all of their cake and a few bites of bread. b. The client drools while eating. c. The client's hand trembles when they hold their spoon. d. The client chooses to sit alone during the meal.
b. The client drools while eating. Drooling while eating can indicate that this client is at greatest risk for aspiration of food from dysphagia, which can lead to pulmonary complications; therefore, the nurse should identify this as the priority finding.
A nurse is assessing a client who has end-stage kidney disease (ESKD). Which of the following dietary habits increases the client's risk for dysrhythmias? a. consuming a diet low in fat b. eating a diet rich in potassium c. consuming a diet rich in protein d. eating a diet deficient in iron
b. eating a diet rich in potassium. A client who has ESKD has impaired kidney function and is unable to eliminate potassium. As urine output declines, hyperkalemia develops, which can cause cardiac dysrhythmias.
A nurse is teaching a client who is newly diagnosed with type 1 diabetes mellitus how to count carbohydrates. Which of the following statements made by the client indicates an understanding of the teaching? a. "I am including vegetables as starch items in my carbohydrate count." b. "I am limiting the number of carbohydrates to four carbohydrate choices or 60 grams per day." c. "I know the serving size can affect the number of carbohydrates I eat." d. "I know the carbohydrate count is dependent on the calories in the food item."
c. "I know the serving size can affect the number of carbohydrates I eat." The nurse should instruct the client that the portion size affects the number of carbohydrates.
A nurse is planning discharge teaching for a client who is postoperative following placement of a colostomy. Which of the following statements should the nurse plan to include? a. "Resume a regular diet by 4 weeks after surgery." b. "Add high-fiber foods to your diet." c. "Increase your intake of foods containing pectin." d. "Drink 4 to 6 cups of water per day."
c. "Increase your intake of foods containing pectin." The nurse should instruct the client to consume foods that thicken the consistency of feces, such as foods containing pectin.
A nurse is assessing a client's risk for pressure injuries using a skin risk assessment tool. The client eats more than half of most meals but occasionally refuses a meal. Which of the following information should the nurse document on the nutrition category of the skin risk assessment tool? a. 1 (very poor) b. 2 (probably inadequate) c. 3 (adequate) d. 4 (excellent)
c. 3 (adequate) A client who eats more than half of most meals, occasionally refuses a meal, and has four servings of protein each day scores a 3 (Adequate) in the nutrition category of the skin risk assessment tool.
A nurse is providing dietary teaching about increased zinc intake for a client who has chronic skin ulcers of the lower extremities. Which of the following foods should the nurse recommend as containing the highest amount of zinc? a. 1 cup of apple slices b. 4 oz low-fat cottage cheese c. 4 oz ground beef patty d. 1 cup of raw spinach
c. 4 oz ground beef patty. The nurse should determine that a ground beef patty is the best food source to recommend because a 4 oz ground beef patty contains 5.49 mg of zinc.
A nurse is teaching a client about measures to reduce the risk of osteomalacia. Which of the following instructions should the nurse include in the teaching? a. Increase intake of foods high in purine. b. Avoid foods with copious amounts of antioxidants. c. Consume 20 mcg of vitamin D daily. d. Take 150 mg of vitamin E daily.
c. Consume 20 mcg of vitamin D daily. The nurse should instruct the client to consume 20 mcg of vitamin D daily. Osteomalacia is characterized by a lack of vitamin D, which leads to insufficient bone mineralization. This disorder coincides with osteoporosis, thereby increasing the risk of falls leading to fractures in older adult clients. Vitamin D supplements are recommended for clients age 65 and older to decrease bone loss and maintain bone mineralization, thereby reducing the risk of a softening of the bones.
A nurse is updating a plan of care for a client who is receiving intermittent enteral feedings and is experiencing diarrhea. Which of the following interventions should the nurse include in the plan? a. Discard the client's opened cans of formula within 48 hr. b. Administer the client's formula cold. c. Feed the client in small, frequent volumes. d. Consider a low-calorie formula for the client
c. Feed the client in small, frequent volumes. The nurse should administer the feedings in small, frequent volumes because a large volume or rapid feeding of the formula can cause diarrhea.
A nurse is creating a plan of care for a client who has mucositis following head and neck radiation therapy to treat cancer. Which of the following interventions should the nurse include in the plan? a. Encourage three servings of citrus foods daily. b. Provide lemon-glycerin swabs for oral hygiene after meals. c. Increase fluid intake to 2 L per day. d. Heat oral hygiene mouth rinses before use.
c. Increase fluid intake to 2 L per day. A client who has mucositis should increase fluid intake to promote hydration and peristalsis.
A nurse is reviewing the laboratory findings of a client who has acute pancreatitis. Which of the following is an expected finding? a. Increased calcium b. Decreased bilirubin c. Increased glucose d. Decreased alkaline phosphatase
c. Increased glucose The nurse should expect an increased glucose level in a client who has acute pancreatitis due to decreased insulin production by the pancreas.
A nurse is caring for a client who has advanced Parkinson's disease and dysphagia. Which of the following actions should the nurse take? a. Turn the television on to distract the client during meals. b. Give the client fluids to clear the mouth of solid foods during meals. c. Offer the client a high-calorie diet. d. Encourage the client to maintain a low-Fowler's position following meals.
c. Offer the client a high-calorie diet. The nurse should add high-calorie food to the client's diet because muscular rigidity increases metabolic rate, which increases caloric need.
A nurse is performing a comprehensive nutritional assessment for a client. After reviewing the client's laboratory results, which of the following findings should the nurse report to the provider as an indication of protein deficiency? a. WBC count 4,800/mm3 (5,000 to 10,000/mm3) b. Sodium 135 mEq/L (136 to 145 mEq/L) c. Prealbumin 8 mg/dL (15 to 36 mg/dL) d. Thyroxine (T4) 3 mcg/dL (4 to 12 mcg/dL)
c. Prealbumin 8 mg/dL (15 to 36 mg/dL) Prealbumin is a plasma protein. A prealbumin level of 8 mg/dL is a critical value that indicates severe malnutrition and requires reporting to the provider who can prescribe a nutritional intervention.
A nurse is planning care for a client who is receiving radiation to the neck and has developed stomatitis. Which of the following interventions should the nurse include in the plan? a. Avoid the use of a straw when drinking liquids. b. Drink high-carbohydrate nutritional supplements. c. Relieve mouth pain by consuming frozen foods. d. Rinse the mouth with hydrogen peroxide after eating.
c. Relieve mouth pain by consuming frozen foods. The nurse should encourage the client to consume frozen foods, such as frozen bananas, ice cream, or popsicles, which can numb the mouth and help alleviate pain.
A nurse is teaching a client who has a BMI of 22 about dietary recommendations during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? a. "I should avoid a vegetarian diet." b. "I should decrease my intake of protein." c. "I should increase my daily intake by 600 calories." d. "I should plan to gain a total of 25 to 35 pounds."
d. "I should plan to gain a total of 25 to 35 pounds." The nurse should teach a client whose weight is within the expected reference range to gain 11.3 to 15.9 kg (25 to 35 lb) during pregnancy.
A nurse is reviewing the introduction of solid foods with the guardian of a 6-month-old infant. Which of the following statements by the guardian indicates an understanding of the teaching? a. "My baby should consume 2 tablespoons of solid food at each feeding." b. "The majority of my baby's calories should come from solid food." c. "I will give my baby two bottles of fruit juice each day." d. "I will introduce a new solid food at least every 3 days."
d. "I will introduce a new solid food at least every 3 days." The client understands that new solid food items can be introduced every 3 to 5 days to monitor for indications of food allergies.
A nurse is assessing the meal pattern of a client who has diverticular disease and a prescription for a high-fiber diet. Which of the following food choices by the client contains the most fiber? a. 1 medium banana b. 1/2 cup oatmeal c. 1 medium apple with skin d. 1/2 cup bran cereal
d. 1/2 cup of bran cereal A high-fiber diet is recommended for clients who have diverticular disease because bulky, soft stools are easier for the client to pass and result in decreased pressure within the colon. The nurse should determine that a ½ cup of bran cereal contains the most fiber at 10 g per serving.
A nurse is reviewing the laboratory data of four clients. The nurse should identify that which of the following clients is experiencing fluid overload? a. A client who has an albumin level of 5.5 g/dL (3.5 to 5 g/dL) b. A client who has a urine specific gravity of 1.035 (1.005 to 1.03) c. A client who has a Hct of 55% (42% to 52%) d. A client who has a sodium level of 130 mEq/L (136 to 145 mEq/L)
d. A client who has a sodium level of 130 mEq/L (136 to 145 mEq/L) The nurse should identify that this client's sodium level is lower than the expected reference range and indicates hyponatremia. Hyponatremia, often called water deficit, is a decrease of sodium concentration in the blood caused by an excess of water. Manifestations of hyponatremia include confusion, headache, nausea, and fatigue.
A nurse is caring for a client who has undergone a radical head and neck resection to treat cancer and is receiving radiation therapy. The nurse should monitor for which of the following potential adverse effects? a. Bone marrow suppression b. Radiation enteritis c. Malabsorption of nutrients d. Changes in the production of saliva
d. Changes in the production of saliva Changes in salivation are a potential complication of a head and neck resection and radiation therapy.
A nurse is assessing a client who has an elevated blood pressure, headache, and is sweating. The client recently started taking an MAOI. The nurse should question the client regarding the consumption of which of the following foods? a. Grapefruit juice b. Whole milk c. Whole grain bread d. Cheddar cheese
d. Cheddar cheese Clients who take MAOIs should avoid the consumption of most types of cheese and other foods that contain high levels of tyramine, which can lead to hypertensive crisis.
A nurse is providing dietary teaching for a client who has COPD. Which of the following instructions should the nurse include in the teaching? a. Eat at least three well-proportioned large meals a day. b. Drink low-protein, low-calorie nutrition formulas between meals. c. Avoid adding gravies and sauces to foods. d. Consume foods that are soft in texture and easy to chew.
d. Consume foods that are soft in texture and easy to chew. Eating a soft diet and avoiding foods that are difficult to chew will decrease shortness of breath while eating.
A nurse is teaching about nutritional requirements for a client who is starting a vegetarian diet. Which of the following information should the nurse include in the teaching? a. Consume high-fat cheese to replace meats when on a vegetarian diet. b. A vegetarian diet is high in vitamin B12. c. Fewer calories are required when on a vegetarian diet. d. Include two servings per day of nuts when on a vegetarian diet.
d. Include two servings per day of nuts when on a vegetarian diet. The nurse should instruct the client to eat two servings of nuts or flaxseed per day to receive the daily requirement of omega-3 fatty acids.
A nurse is providing discharge teaching to a client who has Parkinson's disease and a prescription for levodopa-carbidopa. Which of the following foods should the nurse instruct the client to consume with the medication? a. 6 oz Greek yogurt b. 1 oz cheddar cheese c. Six peanut butter crackers d. One slice wheat toast
d. One slice wheat toast Absorption of levodopa-carbidopa decreases when consumed with protein. One slice of wheat toast is the lowest source of protein at 3 g per slice.
A nurse is providing teaching to a client who is a vegetarian and requires an increase in zinc intake. Which of the following foods should the nurse include in the teaching as the best source of zinc? a. Pineapple b. Green grapes c. Cauliflower d. Pinto beans
d. Pinto beans The nurse should determine that pinto beans are the best food source to recommend because they contain the highest amount of zinc per serving.
A nurse is caring for a client who develops diarrhea while receiving a continuous enteral tube feeding. Which of the following actions should the nurse take? a. Provide a low-protein formula. b. Elevate the head of the bed to 30°. c. Switch to intermittent feedings. d. Warm the formula to room temperature.
d. Warm the formula to room temperature. A client can develop diarrhea if the formula being infused is too cold. Therefore, the nurse should warm the formula to room temperature prior to administration.
A nurse is preparing to administer an influenza vaccine to an adult client who reports food allergies. Which of the following food allergies could place the client at risk for a reaction? a. Peanuts b. Milk c. Shellfish d. Eggs
d. eggs A hypersensitivity to eggs can place a client at risk for allergic reactions when receiving the influenza vaccine. The vaccine should only be administered by a healthcare provider who can recognize and respond to severe allergic reactions.
A nurse is caring for a client in an emergency department (ED). Exhibit 1: Nurses' Notes 1500: Client presents to ED with severe pain of right flank area. Reports nausea, vomiting and appears diaphoretic. Client works outside building homes and reports a medical history of diabetes. Client's current weight 86.4 kg (190 lb), height 170 cm (67 inches). BMI 29.8. 1530: Ketorolac 30 mg IV bolus given. Exhibit 2: Vital Signs 1500: Temp 37° C (98.6° F) HR 102/min Respiratory rate 26/min BP 136/88 mm Hg O2 sat 98% on room air Pain level 10 on 0 to 10 pain scale 1600: Temp 37.2° C (98.9° F) HR 86/min Respiratory rate 20/min BP 120/80 mm Hg O2 sat 98% on room air Pain level 6 on 0 to 10 pain scale Exhibit 3: Diagnostic Results 1515: Urinalysis: Appearance: cloudy (clear) Color: deep amber Odor: aromatic pH: 4.3 (4.6 to 8) Protein: 4 mg/dL (0 to 8 mg/dL) Specific gravity: 1.35 (1.01 to 1.025) Leukocyte esterase: negativ
increasing fluid intake, eating more fruits and vegetables, drinking low-fat dairy products, consuming adequate calcium-rich foods, and avoiding drinking sugar-sweetened beverages. When taking action, the nurse should provide dietary instructions to manage the client's condition of kidney stones. Clients who have kidney stones (nephrolithiasis) are at increased risk for developing reoccurring stones due to nutrition and lifestyle factors. Dehydration and certain diets are risk factors for developing kidney stones, therefore the client should increase fluid intake to promote excretion of stones and prevent dehydration. The client should consume a diet high in fruits, vegetables, low-fat dairy products, and calcium-rich foods, and avoid drinking sugar-sweetened beverages to prevent stone formation.