SCL 103 Exam 1

Determining Fluid Needs • Can determine based on calorie intake OR weight

1 ml of fluid for every calorie intake OR Weight in kg x Fluid factor Fluid Factors: 25 ml X kg body wt for > 75 yo or inactive 30 ml X kg body wt for 55-75 yo or moderately active 35 ml X kg body wt for 20-55 yo or moderately active 40 ml X kg body wt for 16-30 yo or highly active

What is lactated ringers used for?

*Expands ECF- treats burns and GI losses; good for septic patients *give for Fluid volume deficit *give to treat hypovolemia *ideal in surgery

What are the signs and symptoms of hyperkalemia?

- EKG changes: peaked T waves, wide QRS complexes - dysrhythmias, ventricular fibrillation, heart block - cardiac arrest - muscle twitching and weakness - numbness in hands and feet and around mouth - nausea - diarrhea

What are the signs and symptoms of hypokalemia?

- anorexia, nausea, vomiting - weak peripheral pulses - muscle weakness, paresthesias, decreased deep tendon reflexes - impaired urine concentration - ventricular dysrhythmias - increased instance of dig toxicity - shallow respirations

What are the signs and symptoms of hypernatremia?

- elevated temp - weakness - disorientation - irritibility and restlessness - thirst - dry, swollen tongue - sticky mucous membranes - hypotension - tachycardia

What is lactated ringers?

-Contains Na, K, Cl, Calcium, Lactate (precursor of bicarb) in the same concentrations about as the ECF -Used to treat losses from burns and lower GI

The nurse is preparing to administer medication via a nasogastric tube. Which intervention should the nurse implement first? 1. Assess and verify tube placement. 2. Check the residual volume. 3. Elevate the foot of the client's bed. 4. Pour medication into the syringe barrel.

1. Assessment is the first intervention, and verifying that the tube is in the stomach is the priority when administering medications via the nasogastric tube. 2. If the residual is greater than 100 mL for an adult, the medication should not be administered because this indicates the client is not digesting the feedings. 3. The head of the client's bed should be elevated to prevent aspiration. The foot of the bed should not be elevated. 4. The medication should not be poured into the syringe until the placement of the tube is verified, the residual is checked, and the head of the bed is elevated.

The HCP has recommended the client take 100 mg of zinc a day. Which statement best supports the scientifi c rationale for taking zinc daily? 1. Zinc is needed for the formation of connective tissue. 2. Zinc is vital for hemoglobin (Hgb) regeneration in the client's body. 3. Zinc is thought to help alleviate the common cold. 4. Zinc aids in the absorption of iron and in the conversion of folic acid.

1. Copper is needed for the formation of RBCs and connective tissue. 2. Iron is vital for Hgb regeneration. More than 60% of the iron in the body is found in Hgb. 3. The use of zinc has greatly increased in the past few years. It is thought by some that zinc can alleviate the symptoms of the common cold. 4. Vitamin C aids in the absorption of iron and in the conversion of folic acid.

The client diagnosed with pernicious anemia is prescribed cyanocobalamin. Which intervention should the nurse implement? 1. Administer the intramuscular injection via Z-track. 2. Instruct the client to sip medication through a straw. 3. Double-check the dose with another registered nurse. 4. Monitor the client's serum potassium level.

1. Intramuscular iron, not vitamin B12, must be administered Z-track to prevent staining of the skin. 2. Cyanocobalamin does not stain the teeth and therefore does not need to be administered through a straw. Liquid iron must be administered through a straw. 3. This is required when administering insulin or digoxin IVP, but it is not required when administering this medication. 4. Because conversion to normal red blood cell (RBC) production—the purpose of giving cyanocobalamin (Cyanabin), vitamin B12—increases the need for potassium, hypokalemia is a possible side effect of this medication, especially during the first 48

The client diagnosed with anemia is taking an iron tablet daily. Which statement indicates the client understands the medication teaching? 1. "I will call my HCP if my stools become black or dark green." 2. "I must take my iron tablet with meals and one glass of milk." 3. "I will sit upright for 30 minutes after taking my iron tablet." 4. "I will have to take an iron tablet for the rest of my life."

1. Iron turns the stool a harmless black or dark green. This statement indicates the client does not understand the medication teaching. 2. The iron tablet should be taken between meals and with 8 ounces of water to promote absorption. The iron tablet should not be taken within 1 hour of ingesting antacid, milk, ice cream, or other milk products such as pudding. This statement indicates the client does not understand the medication teaching. 3. Sitting upright will prevent esophageal corrosion from reflux. This statement indicates the client understands the medication teaching. 4. The drug treatment for anemia is generally less than 6 months. This statement indicates the client does not understand the medication teaching.

The nurse is taking the male client's medication history. The client informs the nurse he takes megadoses of vitamin C daily, a daily aspirin, and an iron tablet. Which statement is the nurse's best response? 1. "I am glad you take megadoses of vitamin C because it prevents the common cold." 2. "Taking aspirin and megadoses of vitamin C may cause crystals in your urine." 3. "Megadoses of vitamins and a balanced diet will help prevent you from getting sick." 4. "You should take megavitamins—not just megadoses of vitamin C alone."

1. Most authorities believe that vitamin C does not cure or prevent the common cold. Rather, it is believed that vitamin C has a placebo effect. This would not be appropriate information to share with the client. 2. Megadoses of vitamin C taken with aspirin or sulfonamides may cause crystalluria, crystal formation in the urine. 3. Megadoses of vitamins can cause toxicity and might result in a minimal desired effect. 4. The use of megavitamin therapy, massive doses of vitamins, is questionable at best. The nurse should not recommend this action.

The nurse is administering medications through a gastrostomy tube (GT). Which intervention should the nurse implement first? 1. Place the crushed pills in the GT. 2. Flush the gastrostomy with at least 30 mL of tap water. 3. Use the plunger to push the medication into the GT. 4. Clamp the GT closed.

1. Only crushed or liquid medication should be administered through the GT, but this is not the first intervention the nurse should implement. 2. The nurse should first flush the gastrostomy with tap water to ensure that it is patent before putting any medication into the GT. 3. The medication can be administered via gravity or a plunger can be used, if needed, but this is not the nurse's first intervention. 4. After the medication is administered, the nurse should flush the GT with tap water to make sure all the medication is in the stomach and not in the tubing.

The client is taking vitamin A. Which assessment data indicates to the nurse that the client is experiencing vitamin A toxicity? 1. Nausea, vomiting, and diarrhea. 2. Tingling and numbness of extremities. 3. Dermatitis, fatigue, and dementia. 4. Bleeding gums and gingivitis.

1. Signs and symptoms of vitamin A overdose include nausea, vomiting, anorexia, dry skin and lips, headache, and loss of hair. The nurse should instruct the client to quit taking vitamin A immediately. 2. Paresthesia is not a sign of vitamin A toxicity. It may be a sign of thiamine deficiency, along with neuralgia and progressive loss of feeling and reflexes. 3. Dermatitis, fatigue, and dementia are symptoms of advanced niacin deficiency. 4. Bleeding gums and gingivitis are signs of vitamin C deficiency.

The client diagnosed with full thickness burns is prescribed TPN. Which interventions should the nurse implement? Select all that apply. 1. Check the client's glucose level. 2. Administer sliding-scale regular insulin. 3. Assess the peripheral IV site. 4. Monitor the client's oral fluid intake. 5. Change the subclavian dressing per protocol.

1. TPN is high in dextrose, which is glucose; therefore, the client's blood glucose level must be monitored closely. 2. The client may be on sliding-scale regular insulin coverage for the high glucose level. 3. The TPN must be administered via a subclavian line because of the high glucose level. 4. The client would be NPO to put the bowel at rest, which is the rationale for administering the TPN. 5. The TPN must be administered via a subclavian line due to the high glucose level, which can cause a peripheral line to collapse. Dressing changes may be daily, every 3 days, or weekly, depending on the dressing and biopatch.

The client diagnosed with IBD is receiving TPN bag #5 at 73 mL/hr. The HCP writes an order to discontinue the TPN. Which intervention should the nurse implement? 1. Discontinue the TPN after bag #5 has infused. 2. Question the HCP's order. 3. Decrease the TPN IV rate to 68 mL/hr. 4. Discontinue the TPN immediately.

1. The TPN must be weaned or the client will experience hypoglycemia. 2. The nurse should question the HCP's order because the TPN must be weaned to prevent hypoglycemia, and there is no order to decrease the rate just to discontinue the TPN. 3. The nurse cannot decrease the TPN rate without an HCP's order, so the nurse cannot implement this intervention. 4. The nurse cannot discontinue the TPN immediately because the TPN must be weaned to prevent hypoglycemia.

The client is receiving TPN bag #3 and TPN bag #4 is brought to the unit by the pharmacy technician. Which intervention should the nurse implement first? 1. Place the TPN bag in the refrigerator. 2. Check the TPN bag #4 with the HCP's order. 3. Place new IV tubing on the TPN bag. 4. Obtain the client's glucose level prior to hanging.

1. The TPN should be kept in the refrigerator until 1 hour before administering to the client, but this is not the first intervention the nurse should implement. 2. The nurse should first check the TPN bag #4 label with the HCP's order to ensure the prescription is correct. Each TPN bag may have amounts of dextrose, amino acids, lipids, and potassium. TPN should be treated as a medication. 3. The nurse must use new tubing with every bag, but this is not the first intervention. The bag should be spiked just before hanging TPN bag #4. 4. The client's glucose level is checked every 6 hours around the clock, not prior to administering the TPN bag.

The nurse and unlicensed assistive personnel (UAP) are caring for the client receiving TPN at 70 mL/hr. Which task is most appropriate for the nurse to delegate to the UAP? 1. Instruct the UAP to weigh the client. 2. Ask the UAP to change the subclavian dressing. 3. Tell the UAP to assist the client with feeding. 4. Request the UAP to assess the client's bowel sounds.

1. The UAP can weigh the client because he or she is not assessing, teaching, evaluating, or administering medications. 2. The subclavian dressing change is a sterile procedure and the UAP cannot perform sterile procedures. 3. The client receiving TPN should be NPO; therefore, the nurse should not delegate this to the UAP. 4. The nurse cannot delegate assessment to the UAP.

The client's TPN bag #1 has 25 mL in the bag and bag #2 is not on the unit. The client's IV rate is 68 mL/hr. Which intervention should the nurse implement? 1. Administer D5W at 68 mL/hr. 2. Decrease the IV rate to 30 mL/hr. 3. Administer dextrose 10% at 68 mL/hr. 4. Notify the HCP.

1. The client must have the same glucose content as the TPN. The nurse cannot administer D5W because the client will experience hypoglycemia. 2. The client will experience hypoglycemia if the nurse decreases the rate to 30 mL/ hr. The rate should be weaned 5 mL/hr when discontinuing TPN. 3. The nurse must ensure the same glucose content will be administered until TPN bag #2 is ready, so this is the most appropriate intervention. 4. The nurse does not need to notify the HCP because hanging D10 is appropriate until TPN bag #2 is ready.

Which statement indicates the client diagnosed with IBD receiving TPN needs more teaching? 1. "I should not eat any food while receiving TPN." 2. "I can drink 1,000 mL of water a day, but no other fluids." 3. "I must have my blood glucose checked every 6 hours." 4. "I can walk in the hallways while receiving TPN."

1. The client with IBD needs to rest the bowel; therefore, the client should not eat any food while on TPN. This statement indicates the client understands the teaching. 2. The client with IBD must rest the bowel, which means no food or fluids; therefore, the client needs more teaching. 3. The client's blood glucose must be checked every 6 hours, which indicates the client understands the teaching. 4. The client can ambulate; therefore, the client understands the client teaching.

The client is receiving TPN bag #4 via a right subclavian line. Which medication should the nurse administer if it is just prior to breakfast? 1. Administer 4 units of regular insulin. 2. Administer 6 units of regular insulin. 3. Administer 8 units of regular insulin. 4. Administer 10 units of regular insulin.

1. The client's blood glucose (BG) level is 311; therefore, 4 units is not the appropriate dose. 2. Six units of regular insulin does not cover a BG level of 311. 3. The HCP order requires 10 units of regular insulin, not 8 units. 4. The client has a BG level of 311 per the client's chart. This requires 10 units of regular insulin, a pancreatic hormone.

Which laboratory data requires the nurse to notify the HCP? 1. The serum potassium level is 6.2 mEq/mL. 2. The serum sodium level is 145 mEq/mL. 3. The serum glucose level is 252 mg/dL. 4. The serum total protein level is 7.2 g/dL.

1. The client's potassium level is high and needs immediate intervention because this could cause cardiac problems. A normal potassium level is 3.5 to 5.5 mEq/L. 2. The normal serum sodium level is 135 to 145 mEq/L, so the nurse does not need to notify the HCP. 3. This glucose level is elevated (normal would be 70-120 mg/dL), but the nurse has a sliding-scale insulin to cover this glucose level. The HCP does not need to be notifi ed. 4. The normal serum total protein level is 6.4 to 8.3 g/dL; therefore, the nurse does not need to notify the HCP.

Which intervention should the nurse implement first for the client receiving TPN bag #8? 1. Check the IV pump with a sounding alarm. 2. Request TPN bag #9 from the hospital pharmacy. 3. Notify the HCP of the inflamed insertion site. 4. Obtain the client's serum potassium level.

1. The nurse should first check the IV pump that is sounding an alarm because there is something wrong with the IV fluid. Air in the line is a potential life-threatening complication of TPN. 2. The nurse should ensure the next bag of TPN is available when the current bag is empty, but it is not a priority over an alarm on the IV pump. 3. The nurse should notify the HCP about an inflamed insertion site, but the nurse should first assess the alarm on the pump to correct a problem immediately. 4. The nurse should monitor the client's serum potassium level, but laboratory results are not a priority over an alarm on an IV pump.

The client is prescribed folic acid. Which information should the nurse discuss with the client? 1. "Do not use any laxatives that contain mineral oil." 2. "Avoid drinking any type of alcoholic beverage." 3. "See the ophthalmologist periodically." 4. "Increase your intake of milk and milk products."

1. This is appropriate information for the client who is taking vitamin A. Mineral oil inhibits the absorption of vitamin A. 2. The client should avoid drinking alcohol because it increases folic acid requirements. 3. This is appropriate information for the client who is taking vitamin A. Vitamin A may cause miosis, papilledema, and nystagmus. 4. Milk and milk products are a good source of vitamin D, not folic acid. MEDICATION MEMORY JOGGER: Alcohol consumption is always discouraged when taking any prescribed or OTC medication because of adverse interactions. The nurse should encourage the client not to drink alcoholic beverages.

The nurse is discussing vitamins with a group of women at a community center. The nurse is discussing water-soluble vitamins and fat-soluble vitamins. Which vitamins are fat-soluble vitamins? Select all that apply. 1. Vitamin A. 2. Vitamin D. 3. Vitamin E. 4. Vitamin C. 5. Folic acid.

1. Vitamin A is a fat-soluble vitamin that is essential for the maintenance of epithelial tissues, skin, eyes, hair, and bone growth. 2. Vitamin D is a fat-soluble vitamin that has a major role in regulating calcium and phosphorus metabolism, and is needed for calcium absorption from the intestines. 3. Vitamin E is a fat-soluble vitamin that has antioxidant properties that protect cellular components from being oxidized and RBCs from hemolysis. 4. Vitamin C is a water-soluble vitamin that aids in the absorption of iron and conversion of folic acid. 5. Folic acid is a water-soluble vitamin that is essential for body growth. It is needed for DNA synthesis, and without folic acid there is a disruption in cellular division.

The client asks the clinic nurse, "Vitamin E is a primary antioxidant. What does that mean?" Which statement is the nurse's best response? 1. "Antioxidants minimize damage and keep your body's cells healthy." 2. "Vitamin E is essential for general growth and development." 3. "Antioxidants prevent the formation of free radicals in your muscles and skin." 4. "The antioxidants are vitamins that help the blood clot."

1. Vitamin E is a primary antioxidant that prevents the formation of free radicals that damage cell membranes and cellular structure. 2. This is the role of vitamin A in the body. It is essential for general growth and development. 3. This statement includes medical jargon that the client probably would not understand. The nurse needs to explain information in layman's terms. 4. Vitamin K, not the antioxidant vitamin E, is required by the body to help the blood clot.

The female client having her annual physical exam tells the clinic nurse, "I take vitamins daily, but I have not had the money to buy any for the past week." Which response is most appropriate for the nurse? 1. "I will have the HCP give you a prescription for some vitamins." 2. "As long as you eat a balanced diet you do not need to take vitamins." 3. "Daily vitamins are necessary, so please get them as soon as possible." 4. "This should not hurt you because vitamin deficiencies do not occur for some time."

1. Vitamins are usually OTC medications. If the client does not have money for OTC medications, she would not have money for a prescription. 2. A balanced diet can provide all of the vitamins a client needs daily, but if the client was taking a daily vitamin, the nurse should not discourage her from taking the vitamins. 3. Vitamin supplements are not necessary if the person is healthy and receives proper nutrition on a regular basis. 4. Signs or symptoms of vitamin deficiencies will not occur if the client has not taken the vitamins in more than a week. Vitamin deficiencies may take months to occur, and if the client is eating a well-balanced diet, vitamin deficiencies will not occur.

What is the normal plasma osmolality?

275-295 mOsm/kg

The HCP writes an order to decrease TPN rate by 5 mL every hour while discontinuing TPN. The current rate is 77 mL/hr. What rate should the nurse set 3 hours after transcribing the order?

62 mL/hr. The nurse should decrease the rate by 5 mL every hour. In 3 hours it should be decreased by 15 mL. The nurse should subtract 15 mL from 77 mL to get 62 mL.

A client who is receiving total parenteral nutrition (TPN) through a subclavian triple lumen catheter expresses concern to a nurse about bacteria entering the blood through the catheter. The nurse explains that the risk of catheter-related infections can be decreased by doing which of the following? 1. Applying an antibiotic ointment at the catheter insertion site 2. Changing the dressing over the catheter insertion site daily 3. Designating one port of the triple lumen catheter exclusively for the TPN solution 4. Instilling an antibiotic solution daily into each port of the triple lumen catheter

ANSWER: 3 Consistently utilizing one port for TPN solution minimizes the risk of infection. Unless loose, soiled, or bloody, the dressing should be changed weekly or every 10 days depending on the cleansing solution used. Using antibiotic ointment and instilling antibiotic solution do not decrease the risk of infection and may predispose to the development of antibiotic-resistant bacteria. ➧ Test-taking Tip: Focus on the nutrient content of the TPN, which is high in dextrose, and the relationship to increased infection risk. Content Area: Fundamentals; Category of Health Alteration: Safety, Disaster Preparedness, and Infection Control; Integrated Processes: Nursing Process Implementation; Client Need: Safe and Effective Care Environment/Safety and Infection Control/Medical and Surgical Asepsis; Cognitive Level: Application Reference: Cresci, G. (2005). Nutrition Support for the Critically Ill Patient: A Guide to Practice. (p. 307). Boca Raton, FL: CRC Press. EBP Reference: National Guideline Clearinghouse. (n.d.). Guidelines for the Prevention of Intravascular Catheter-Related Infections. Available at: www.guideline.gov/summary/summary.aspx?doc_id=3387&nbr=002613& string=guidelines+AND+prevention+AND+intravascular+AND+catheterrelated+ AND+infections

VITAMIN E

An antioxidant that helps protect cells from damage. Also important for the health of RBCs. • Found in many foods, such as vegetable oils, nuts, and green leafy vegetables. • Avocados, wheat germ, and whole grains are also good sources.

What is Kayexalate?

An exchange resin. It exchanges a K+ for a Na+ in the colon to remove K+ from the body

VITAMIN K

AquaMEPHYTON Promotes clotting by providing fat-soluble vitamin necessary for clotting mechanisms. Allows the blood to clot normally. Helps protect bones from fracture. Helps prevent postmenopausal bone loss. Prevents calcification of arteries. Provides protection against liver and prostate cancer. • Vitamin K may be administered IM, subcutaneously, or IV; however, IV administration is dangerous and should only be used as a last resort. • Explain to the client that green leafy vegetables are high in vitamin K; provided in parsley, kale, spinach, Brussels sprouts, green beans, asparagus, broccoli, mustard and turnip greens, collard greens, romaine lettuce, cabbage, and celery. • Too much vitamin K causes excessive bleeding, including heavy menstrual bleeding, gum bleeding, bleeding within the digestive tract, or nose bleeding; easy bruising. • Problems with bone fracture or bone weakening.

What is a riboflavin deficiency?

Ariboflavinosis (inflammation of mouth and tongue)

A nurse in a provider's office is reviewing the medical records of a group of clients. Which of the following clients is at risk for iron deficiency? (Select all that apply.) A. A client who is postmenopausal B. A client who is a vegetarian C. A middle adult male client D. A client who is pregnant E. A toddler who is overweight

B. A client who is a vegetarian D. A client who is pregnant E. A toddler who is overweight A client who is a vegetarian might require additional iron because the availability of iron in vegetable food sources is limited. During pregnancy, maternal blood volume increases, and the fetus requires additional iron. Therefore, the RDA of iron for clients who are pregnant is increased to 27 mg per day. Toddlers who are overweight may get most of their calories from milk and foods that are not considered healthy, which increases their risk for iron-deficiency anemia. Incorrect Answers:A. Iron requirements are increased for women who have excessive blood loss due to menstruation. Generally, postmenopausal women do not require additional iron. C. Most adult males consume adequate iron in their diet and do not require supplementation.

What is riboflavin?

B2

Analysis of BMI

BMI< 18.5 = Underweight BMI 18.5 -24.9 = Normal BMI 25-29.9 = Overweight BMI 30 - 34.9 Class 1 Obesity BMI 35 - 39.9 = Class 2 Obesity BMI over 40 = Class 3 Extreme Obesity

What does calcium do?

Builds strong bones and teeth

What are the signs and symptoms of hypocalcemia?

C.A.T.S - Convulsions, Arrhythmias, Tetany, Stridor and spasms.

What is the function of Vitamin B12?

Coenzyme in formation of nucleic acids and proteins, and in red blood cell formation

A nurse is calculating the protein needs of a young adult client who weighs 132 lb. The RDA for protein for an adult who has no medical conditions is 0.8 g/kg. How many grams of protein per day should the nurse recommend for this client? (Fill in the blank with the numeric value only.)

Correct Answer: 48 132/2.2 = 60 kg 60 kg x 0.8 g = 48 g

A nurse is providing teaching for a client who has a prescription for a low-sodium diet to manage hypertension. Which of the following statements by the client indicates an understanding of the teaching? A. "I can snack on fresh fruit." B. "I can continue to eat lunchmeat sandwiches." C. "I can have cottage cheese with my meals." D. "Canned soup is a good lunch option."

Correct Answer: A. "I can snack on fresh fruit." The nurse should identify that fresh fruits contain little to no sodium and are a good snack for a client who has hypertension. Incorrect Answers:B. Lunchmeats are usually high in sodium and should be avoided. The nurse should recommend choosing lower-sodium options, such as fresh fish or poultry. C. Cottage cheese contains 390 mg per 113 g (1/2 c) of sodium. The nurse should recommend choosing low-fat yogurt as a low-sodium snack. D. Canned soups contain high amounts of sodium. The nurse should instruct the client to avoid convenience and fast foods such as canned or dry-packaged soups.

A nurse is teaching a client with heart disease about a low-cholesterol diet. Which of the following client statements indicates the teaching was effective? A. "I should remove the skin from poultry before eating it." B. "I will eat seafood once per week." C. "I should use margarine when preparing meals." D. "I can use whole milk in my oatmeal."

Correct Answer: A. "I should remove the skin from poultry before eating it." The nurse should identify the client understands the teaching when he states he will remove the skin from poultry before eating, as the skin contains the greatest amount of fat. Incorrect Answers:B. A client who has heart disease and is on a low-cholesterol diet should eat seafood at least twice per week because it is high in omega-3 fatty acids. C. A client who has heart disease and is on a low-cholesterol diet should use liquid oils such as canola oil instead of margarine, which is a solid fat. D. A client who has heart disease and is on a low-cholesterol diet should use nonfat or low-fat milk instead of whole milk in oatmeal or cereal.

A provider tells a client at 12 weeks gestation who practices Hinduism that she needs more protein in her diet and suggests eating more meat. After the provider leaves the examination room, the client tells the nurse that eating animal products will cause her to miscarry. Which of the following responses should the nurse make? A. "Let's discuss other foods that are also high in protein that you could substitute for meat." B. "Eating meat during pregnancy provides necessary protein and does not cause miscarriage." C. "Why do you think that eating animal products will cause you to have a miscarriage?" D. "Your doctor is recommending what is best for you and your baby."

Correct Answer: A. "Let's discuss other foods that are also high in protein that you could substitute for meat." Many cultures have beliefs about food that the nurse should respect. Discussing non-animal protein sources can help the client identify foods that do not conflict with her religious and cultural beliefs. Incorrect Answers:B. This is a nontherapeutic response that contradicts the client's beliefs. C. Asking a "why" question is nontherapeutic. The client might not know the answer and could become defensive. D. This is a nontherapeutic response that dismisses the client's concerns.

A nurse is providing dietary teaching for a client with AIDS who has stomatitis of the mouth. Which of the following instructions should the nurse include in the teaching? A. "You can suck on popsicles to numb your mouth." B. "Season food with spices instead of salt." C. "Avoid the use of a straw to drink liquids." D. "Eat foods at hot temperatures."

Correct Answer: A. "You can suck on popsicles to numb your mouth." The nurse should instruct the client to suck on popsicles or ice chips, which can numb the mouth. Incorrect Answers:B. The client should avoid spices, acidic foods, and salt, which can irritate and burn the mouth. C. The client should instruct the client that using a straw can decrease the comfort when drinking liquids. D. The client should consume foods that are cold or at room temperature. Hot foods can be irritating or possibly burn the mouth.

A nurse is teaching about a low-cholesterol diet to a client who had a myocardial infarction. Which of the following meal selections by the client indicates an understanding of the teaching? A. Chicken breast and corn on the cob B. Shrimp and rice C. Cheese omelet and turkey bacon D. Liver and onions

Correct Answer: A. Chicken breast and corn on the cob The nurse should identify that chicken breast is low in cholesterol, and all vegetables, including corn, are cholesterol-free; therefore, this food selection by the client indicates an understanding of the teaching. Incorrect Answers:B. Shrimp are high in cholesterol and should be eaten in moderation; therefore, this food selection does not indicate an understanding of a low-cholesterol diet. C. Eggs and cheese are high in cholesterol; therefore, this food selection does not indicate an understanding of a low-cholesterol diet. D. Liver and other organ meats are high in cholesterol; therefore, this food selection does not indicate an understanding of a low-cholesterol diet.

A nurse is caring for a client during her first prenatal visit and notes that she is lactose-intolerant. Which of the following foods should the nurse include on a list of calcium sources for this client? A. Collard greens B. Cottage cheese C. Orange juice D. Broccoli

Correct Answer: A. Collard greens Collard greens are a good source of lactose-free calcium. One cup of collard greens provides approximately the same amount of calcium as the equivalent volume of 240 mL (8 oz) of milk. Collard greens also contain folic acid, which is a nutrient women should consume during pregnancy to prevent birth defects. Incorrect Answers:B. Cottage cheese is a good source of calcium but contains lactose, which the client cannot tolerate. C. Orange juice is high in vitamin C, but unless the orange juice is calcium-fortified, it is not a rich source of calcium. D. Broccoli is high in folic acid, but it is not a rich source of calcium.

A nurse is teaching the parent of a school-age child who has celiac disease. Which of the following foods selected by the parent indicates an understanding of the teaching? A. Corn tortilla with black beans B. Pizza C. Canned soup D. Hot dogs

Correct Answer: A. Corn tortilla with black beans Children who have celiac disease are placed on a gluten-free diet. Gluten is found in wheat, rye, and barley. Selecting products made from corn indicates an understanding of the teaching, as corn and beans are gluten-free foods. Incorrect Answers:B. Pizza often contains gluten. Gluten is found in wheat, rye, and barley and should be avoided by a child who has celiac disease. C. Prepared soups often contain gluten. D. Hot dogs and hot dog buns often contain gluten.

A nurse is reviewing the laboratory findings of a client who has protein-calorie malnutrition. Which of the following findings should the nurse expect? A. Decreased albumin B. Elevated hemoglobin C. Elevated lymphocytes D. Decreased cortisol

Correct Answer: A. Decreased albumin A decrease in the albumin level can be an indication of long-term protein depletion. Other potential conditions that result in decreased albumin levels include burns, wound drainage, and impaired hepatic function. Incorrect Answers:B. Protein-calorie malnutrition can negatively impact the production of RBCs, resulting in a decrease in hemoglobin. C. Nutritional deficiencies such as protein-calorie malnutrition can result in low lymphocyte levels, which increases the client's risk of infection. D. Cortisol is a glucocorticoid that plays a role in the metabolism of proteins, fats, and carbohydrates. Low levels are associated with Addison's disease. However, cortisol is not reflective of protein-calorie malnutrition.

A nurse is teaching a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching as the purpose of bile? A. Digesting fats B. Producing chyme C. Stimulating gastric acid secretion D. Providing energy

Correct Answer: A. Digesting fats Bile is a product of the liver and aids in the digestion of fats. Incorrect Answers:B. Chyme is a semi-solid mixture of food and gastric secretions that is formed in the stomach. C. Gastrin is a hormone produced by the stomach mucosa that stimulates the release of gastric secretions during the process of digestion. D. Glycogen is stored in the liver and is released in the form of glucose to meet the body's energy needs.

A nurse is caring for a client who has protein malnutrition. Which of the following foods should the nurse identify as a source of complete protein? A. Eggs B. Cereal C. Peanut butter D. Pasta

Correct Answer: A. Eggs Complete proteins contain all of the essential amino acids to support growth and homeostasis. Examples of complete proteins include eggs, meat, poultry, seafood, milk, yogurt, cheese, soybeans, and soybean products. Incorrect Answers:B. Incomplete proteins are missing one or more of the essential amino acids necessary to support growth and maintain homeostasis. Cereal is an example of an incomplete protein. However, it can be combined with skim milk to make a complete protein. C. Peanut butter is an example of an incomplete protein. However, it can be combined with whole-wheat bread to make a complete protein. D. Pasta is an example of an incomplete protein. However, it can be combined with cheese to make a complete protein.

A nurse is reviewing the laboratory results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin level is 8 g/dL. The nurse should expect a prescription for which of the following medications? A. Erythropoietin B. Erythromycin C. Filgrastim D. Calcitriol

Correct Answer: A. Erythropoietin Erythropoietin stimulates the production of RBCs and is used to treat anemia associated with chronic renal failure. Incorrect Answers:B. Erythromycin is used to treat infections. There is no indication that this client is experiencing an infection. C. Filgrastim is used to stimulate the production of neutrophils. There is no indication that this client is experiencing neutropenia. D. Calcitriol is used to prevent hypocalcemia in clients who have chronic kidney disease. There is no indication that this client is experiencing hypocalcemia.

A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe bananas C. Steamed broccoli D. Green leafy vegetables

Correct Answer: A. Fortified milk Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the gastrointestinal tract. Adults up to age 70 need 600 international units of vitamin D per day and 800 international units thereafter. Therefore, fortified milk is a good source of vitamin D. Incorrect Answers:B. Bananas are a good source of potassium and can reduce bone loss. However, bananas do not promote calcium absorption. C. Broccoli is a good source of vitamin C, which is important for bone matrix formation. However, steamed broccoli does not promote calcium absorption. D. Green leafy vegetables are a good source of vitamin K. However, green leafy vegetables contain oxalic acid, which decreases calcium absorption.

A nurse is teaching dietary-modification strategies to a client who has been newly diagnosed with cirrhosis. Which of the following foods should the nurse recommend? A. Grilled chicken B. Potato soup C. Fish sticks D. Baked ham

Correct Answer: A. Grilled chicken The nurse should identify that a client who has cirrhosis requires protein to compensate for disease-related weight loss. Increasing protein intake from animal or plant sources will also provide the client with more energy. Incorrect Answers:B. A client who has cirrhosis should avoid foods that are high in sodium content, especially if ascites is present; therefore, the nurse should recommend another food choice. C. A client who has cirrhosis should avoid foods that are high in fat, especially if the client is experiencing steatorrhea; therefore, the nurse should recommend another food choice. D. A client who has cirrhosis should avoid foods that are high in sodium, especially if ascites is present; therefore, the nurse should recommend another food choice.

A nurse is providing nutritional counseling for a client who is pregnant. Which of the following nutrients should the nurse instruct the client to increase in her daily diet? A. Iron B. Calcium C. Vitamin E D. Vitamin K

Correct Answer: A. Iron Iron supplements are recommended during pregnancy to promote adequate transfer of iron to the fetus and to support the expansion of the maternal RBC mass. Incorrect Answers:B. Calcium is essential for fetal bone and tooth development. However, the recommended daily calcium intake for women of childbearing age is sufficient for a client who is pregnant. C. Vitamin E is essential for protection against oxidative stress, so it is important for women who are pregnant to have an adequate supply of this nutrient. However, the recommended daily vitamin E intake for women of childbearing age is sufficient for a client who is pregnant. D.) Vitamin K can help prevent a rare bleeding disorder in newborns. However, the recommended daily vitamin K intake for women of childbearing age is sufficient for a client who is pregnant.

A nurse is teaching a client with chronic kidney disease about predialysis dietary recommendations. The nurse should recommending restricting the intake of which of the following nutrients? A. Protein B. Carbohydrates C. Calcium D. Monounsaturated fats

Correct Answer: A. Protein Dietary restrictions for clients who have chronic kidney disease vary based on the degree of kidney function; however, most clients need protein limitations. Predialysis protein restriction can help preserve some kidney function. Incorrect Answers:B. Clients who have chronic kidney disease require enough calories to avoid the use of muscle protein for energy. Carbohydrates are a good source of calories for these clients. C. Many clients who have chronic kidney disease require calcium, vitamin D, and iron supplements. D. Clients who have chronic kidney disease require enough calories to avoid the use of muscle protein for energy. Foods like canola oil and olive oil are monounsaturated fats that can supply additional calories in the client's meals.

A nurse is caring for an older adult client who has dementia, gets up frequently to pace during meals, and eats sparingly. Which of the following actions should the nurse take? A. Provide finger foods for the client B. Offer food at fewer times each day to promote hunger C. Administer a benzodiazepine medication to the client before meals D. Assist the client to sit still during meals using soft restraints

Correct Answer: A. Provide finger foods for the client Finger foods will provide nutrition and accommodate the client's behavior. Incorrect Answers:B. Offering food at fewer times each day is likely to decrease the client's intake and is inappropriate. Instead, the nurse should provide snacks between meals and in the evenings if the client is at risk of under nutrition. C. Administration of a benzodiazepine medication before meals is a form of restraint and should be used only for the safety of the client or others. In addition, the medication can make the client drowsy. D. Use of physical restraints should be reserved only for the safety of the client or others. In addition, restraining the client is likely to promote agitation.

A nurse is caring for a client who has peripheral edema. The nurse should identify that which of the following nutrients regulates extracellular fluid volume? A. Sodium B. Calcium C. Potassium D. Magnesium

Correct Answer: A. Sodium Sodium regulates extracellular fluid balance, nerve impulse transmission, acid-base balance, and various other cellular activities. Incorrect Answers:B. Calcium supports bone and tooth formation and facilitates nerve impulse transmission. However, it does not affect extracellular fluid volume. C. Potassium affects storage of glycogen, nerve impulse transmission, cardiac conduction, and smooth muscle contraction. However, it does not affect extracellular fluid volume. D. Magnesium affects enzyme and neurochemical activities and the excitability of cardiac and skeletal muscles. However, it does not affect extracellular fluid volume.

A nurse is caring for a client who has a deficiency of vitamin D. Which of the following foods should the nurse recommend the client include in his diet? A. Whole milk B. Chicken C. Oranges D. Dried peas

Correct Answer: A. Whole milk The fat-soluble vitamins (A, D, E, and K) require fatty substances or tissues to be dissolved and also require the presence of bile in the small intestine for absorption. Whole milk contains vitamins A and K and is often fortified with vitamin D. Incorrect Answers:B. The water-soluble vitamins (B complex and C) readily dissolve in water and are absorbed into the bloodstream from the small intestine. Chicken contains many of the B complex vitamins, including B2, B3, B6, B12, and pantothenic acid. C. The water-soluble vitamins (B complex and C) readily dissolve in water and are absorbed into the bloodstream from the small intestine. Oranges are a good source of vitamin C. D. The water-soluble vitamins (B complex and C) readily dissolve in water and are absorbed into the bloodstream from the small intestine. Dried peas are a good source of many of the B complex vitamins, including B1, folate, and pantothenic acid.

A nurse in a pediatric clinic is talking with the parent of a toddler who states that her child will not sit at the table to eat with the family. She asks the nurse for recommendations for "finger foods" for her child. Which of the following foods should the nurse suggest? A. Slices of ripe banana B. Popcorn C. Slices of hot dogs D. Raw carrots

Correct Answer: A. Slices of ripe banana Toddlers should have about 8 oz (1 cup) of fruit per day. Bananas are nutritious and, as long as they are soft, do not present a choking hazard for young children. Incorrect Answers:B. Popcorn, chunks of cheese, and raisins present choking hazards for young children. C. Hot dogs, sausages, and tough meat present choking hazards for young children. D. Raw carrots, nuts, and seeds present choking hazards for young children.

A nurse is providing teaching to a young adult client who has a history of calcium oxalate renal calculi. Which of the following instructions should the nurse include? A. "Drink fruit punch or juice with every meal." B. "Consume 1,000 mg of dietary calcium daily." C. "Take 1 g of a vitamin C supplement daily." D. "Increase your daily bran intake."

Correct Answer: B. "Consume 1,000 mg of dietary calcium daily." Clients who are prone to the development of calcium oxalate stones should consume the recommended daily allowance for calcium for their age. The RDA for calcium for adults ages 19 to 50 is 1,000 mg daily. Calcium should be obtained from dietary sources rather than supplements that can promote the development of renal calculi. Incorrect Answers:A. Clients who are prone to renal calculi should limit beverages with a high sugar content such as fruit punch or juice because these beverages can promote the development of renal calculi. C. Clients who are prone to the development of calcium oxalate stones should avoid taking nutritional supplements, such as vitamin C. Taking 1 g of vitamin C daily can result in toxicity and promote the development of renal calculi. D. Clients who are prone to renal calculi should exclude bran from their diet because bran is high in oxalates, which can precipitate the formation of renal calculi.

A nurse is completing dietary teaching with a client who has heart failure and is prescribed a 2 g sodium diet. Which of the following statements by the client indicates an understanding of the teaching? A. "I should use salt sparingly while cooking." B. "I can have yogurt as a dessert." C. "I should use baking soda when I bake." D. "I should use canned vegetables instead of frozen."

Correct Answer: B. "I can have yogurt as a dessert." The client understands the teaching when he selects yogurt as a dessert. Yogurt is low in fat and sodium and is a good source of calcium and protein. Incorrect Answers:A. The client requires further teaching when he states he will use salt sparingly while cooking. Salt should be eliminated from the client's diet. Spices or vinegar, which are low in sodium, can be used to season the client's food. C. The client requires further teaching when he states he will use baking soda when baking. Baking soda is high in sodium and should be eliminated from the client's diet. D. The client requires further teaching when he states he should select canned vegetables instead of frozen. Canned vegetables are high in sodium and should be eliminated from the client's diet. Frozen or fresh vegetables, which are low in sodium, should be included.

A nurse is providing teaching to a client who has COPD about maintaining proper nutrition. Which of the following statements by the client indicates an understanding of the teaching? A. "I will increase my fluid intake when I eat a meal." B. "I will eat more cold foods at meals rather than hot foods." C. "I will avoid high-fat foods like butter and gravies." D. "I will cook my meals instead of eating convenience foods."

Correct Answer: B. "I will eat more cold foods at meals rather than hot foods." The client should prepare more cold foods to eat because they provide a decreased feeling of fullness compared to hot foods. Incorrect Answers:A. Drinking fluids with meals will contribute to early satiety. The client should consume as much food as possible prior to feeling full or tired. C. The nurse should encourage the client to add items such as butter, sauces, and gravy to foods to increase caloric intake. D. The nurse should recommend the client eat convenience foods, easy-to-prepare meals, and ready-prepared meals because they take less energy to cook.

A nurse is presenting an in-service training session about nutrition. How many of the amino acids must be obtained from dietary intake? A. 6 B. 9 C. 11 D. 15

Correct Answer: B. 9 Proteins are made up of chains of amino acids, which are composed of carbon, hydrogen, oxygen, and nitrogen. Nine amino acids are considered essential for the human body and must be obtained from diet. These include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Incorrect Answers:A. C. D. Of the 20 amino acids identified, the body is able to manufacture 11. These are defined as nonessential amino acids.

A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from non-adherence to the dietary plan

Correct Answer: B. Ask the client to identify the types of foods she prefers The nurse should apply the nursing process priority-setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will promote her adherence to the dietary plan. Incorrect Answers:A. The nurse should work with a registered dietitian to provide the client with appropriate materials to use during the dietary teaching. Sample menus can give the client ideas of new foods or exchanges; however, there is another action that the nurse should take first. C. The nurse should identify the recommended blood glucose range that the client should maintain through diet, medication, and lifestyle changes; however, there is another action that the nurse should take first. D. The nurse should identify long-term complications so the client understands the importance of adherence to the dietary plan; however, there is another action that the nurse should take first.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following actions should the nurse take? A. Administer 0.9% sodium chloride until TPN is available from the pharmacy B. Check the client's capillary blood glucose level every 4 hr C. Obtain the client's weight each week D. Change the IV tubing every 3 days

Correct Answer: B. Check the client's capillary blood glucose level every 4 hr The nurse should check the client's capillary blood glucose level every 4 hours or according to facility policy due to the client's risk of hyperglycemia while receiving TPN. The dextrose concentration in TPN increases the risk of this complication. Incorrect Answers:A. The nurse should administer 10% dextrose in water or 20% dextrose in water if TPN is temporarily unavailable from the pharmacy. C. A client who is receiving TPN is at risk for fluid imbalance due to the fluid administration and hyperosmolarity of the TPN; therefore, the nurse should monitor the client's weight daily. D. The nurse should change the IV tubing used for TPN every 24 hours to decrease the client's risk of infection.

A nurse is teaching an assistive personnel (AP) about dietary restrictions for a client who is taking phenelzine to treat depression. The AP's selection of which of the following foods for the client's lunch indicates an understanding of the teaching? A. Bologna on wheat bread B. Chicken salad C. Cheddar cheese and crackers D. Pizza with pepperoni

Correct Answer: B. Chicken salad Phenelzine is an MAOI. Clients taking MAOIs must avoid foods that contain tyramine due to the potential for a dangerous food-drug interaction. Foods high in tyramine include those that are processed and aged, such as luncheon meats and cheeses. This menu selection does not contain food high in tyramine and indicates an understanding of the teaching. Incorrect Answers: A. This menu selection includes a highly processed meat that contains tyramine; therefore, it is not an appropriate choice. C. This menu selection includes an aged cheese that contains tyramine; therefore, it is not an appropriate choice. D. This menu selection includes pizza, which typically includes aged cheese (such as parmesan) and processed meat, both of which contain tyramine; therefore, it is not an appropriate choice.

A nurse is planning care for a client who is postoperative following a gastrectomy. Which of the following strategies should the nurse include to help prevent dumping syndrome? A. Have the client drink plenty of water with meals B. Eliminate simple sugars and sugar alcohols from the client's diet C. Limit the client's intake to 2 meals per day D. Offer the client meals that are low in protein or protein-free

Correct Answer: B. Eliminate simple sugars and sugar alcohols from the client's diet Sugar, honey, and sugar alcohols (e.g. sorbitol and xylitol) increase hypertonicity and propel food through the intestines faster than food without sweeteners. Incorrect Answers:A. The client should drink beverages between meals only, about 1 hour after eating solid foods. Mixing food and fluids propels the mixture through the gastrointestinal tract faster than solid food alone. C. The client should have several smaller meals that include only 1 or 2 foods throughout the day. D. The client should ingest protein at every meal to slow gastric emptying.

A nurse in a provider's office is assessing a client. The nurse determines the client's body mass index is 21.2. This finding is classified as which of the following? A. Underweight B. Healthy weight C. Overweight D. Obese

Correct Answer: B. Healthy weight Body mass index (BMI) is a measure of an individual's weight relative to height. A BMI from 18.5 to 24.9 is in the healthy range. Therefore, this client's weight is considered healthy. Incorrect Answers:A. A BMI below 18.5 is considered underweight and a health risk. C. A BMI from 25 to 29.9 is in the overweight range. D. A BMI greater than or equal to 30 is in the obese range.

A nurse is planning an in-service training session regarding nutrition. Which of the following minerals should the nurse identify as involved in oxygen transportation? A. Zinc B. Iron C. Phosphorus D. Magnesium

Correct Answer: B. Iron Iron transports oxygen by means of hemoglobin and myoglobin. It is also a component of enzyme systems. Incorrect Answers: A. Zinc plays a role in tissue growth and wound healing and supports immune function, but it does not affect oxygen transport. C. Phosphorus plays a role in bone and teeth formation and energy metabolism, but it does not affect oxygen transport. D. Magnesium affects enzyme and neurochemical activities and the excitability of cardiac and skeletal muscles, but it does not affect oxygen transport.

A nurse is planning an in-service training session about various dietary practices. Which of the following pieces of information should the nurse include in the teaching? A. Ovo-vegetarian diets exclude eggs. B. Kosher diets have restrictions regarding how the food must be prepared. C. Macrobiotic diets are plant-based and exclude all animals and seafood. D. Flexitarian diets exclude the consumption of dairy products.

Correct Answer: B. Kosher diets have restrictions regarding how the food must be prepared. Kosher diets are guided by a set of laws regarding the processing, preparation, and eating of food. Incorrect Answers:A. Ovo-vegetarian diets are primarily vegetable-based diets that exclude meat and dairy except for eggs. C. Macrobiotic diets are primarily plant-based but do include fish and seafood. D. Flexitarian diets are primarily plant-based with the occasional consumption of meat, fish, and dairy products.

A nurse is planning an in-service training session about nutrition. Which of the following pieces of information should the nurse include? A. Fat breaks down into amino acids. B. Protein serves as an energy source when other sources are inadequate. C. Glucose breaks down into ammonia. D. Carbohydrates provide 9 cal/g of energy.

Correct Answer: B. Protein serves as an energy source when other sources are inadequate. Protein is used as an energy source for the body when carbohydrates and fat stores are unavailable or depleted. Incorrect Answers:A. Protein breaks down into amino acids. C. Protein breaks down into ammonia. Glucose does not produce any products of metabolism. D. Carbohydrates provide 4 cal/g of energy. Fat provides 9 cal/g of energy.

A nurse is providing nutritional teaching to a group of clients. Which of the following definitions for the recommended dietary allowance (RDA) should the nurse include in the teaching? A. The RDA is a comprehensive term that includes various dietary standards and scales. B. The RDA defines the level of nutrient intake that meets the needs of healthy people in various groups. C. The RDA defines the levels of nutrients that should not be exceeded to prevent adverse health effects. D. The RDA is the daily percentage of energy intake values for fat, carbohydrate, and protein.

Correct Answer: B. The RDA defines the level of nutrient intake that meets the needs of healthy people in various groups. The RDA represents daily requirements considered adequate for healthy people. RDAs are based on estimated amounts for each nutrient, including additional amounts for individuals such as women or infants. Incorrect Answers:A. Dietary reference intakes (DRIs) include 4 nutrition-based standards that are used to plan dietary intake and evaluate a client's nutritional status. These dietary standards include RDAs, estimated average requirements (EARs), adequate intake (AI), and tolerable upper intake levels (ULs). C. Tolerable upper intake levels (ULs), not RDAs, are the levels of nutrients that should not be exceeded to prevent adverse effects. D. Acceptable macronutrient distribution ranges (AMDRs) are the daily percentage of energy intake values for fat, carbohydrate, and protein.

A nurse is conducting dietary teaching for a client who has AIDS. Which of the following instructions should the nurse include in the teaching? A. Discard leftovers after 8 hr B. Use a separate cutting board for poultry C. Thaw frozen foods at room temperature D. Store cold foods at 10°C (50°F) or less

Correct Answer: B. Use a separate cutting board for poultry The nurse should instruct the client to use a separate cutting board for raw poultry. Raw poultry can contain bacteria such as salmonella, which may contaminate other foods or work surfaces. Using a separate cutting board prevents cross-contamination of work surfaces when preparing food. Incorrect Answers:A. Leftover foods should be discarded after 24 hr to prevent the growth of bacteria that can cause a foodborne illness. C. The client should thaw frozen foods in the refrigerator to prevent the growth of bacteria that can cause a foodborne illness. D. The client should store cold foods at 4.4°C (40°F) or less. This prevents the growth of bacteria that can cause a foodborne illness.

A nurse is providing teaching about nutritious diets to a group of adult women. Which of the following statements should the nurse include? A. "Include at least 3 g of sodium in your daily diet." B. "Limit wine consumption to 230 mL daily." C. "Include 2.5 cups of vegetables in your daily diet." D. "Limit water intake to 1.5 L each day."

Correct Answer: C. "Include 2.5 cups of vegetables in your daily diet." Nutritious diets contain a variety of foods to ensure the required daily allowance of nutrients is ingested. The nurse should instruct the women to include 2.5 cups of vegetables and 2 cups of fruit in their daily diets. Fruits and vegetables should be a variety of colors to provide an assortment of nutrients. Incorrect Answers:A. The nurse should instruct the women to consume sodium in moderation. The American Heart Association recommends consuming less than 2.5 g of sodium daily, and the adequate intake (AI) is 1.5 g. Excessive intake of sodium can lead to hypertension. B. Although certain alcoholic beverages, such as red wine, contain phytochemicals that can reduce the risk of cardiovascular disease and offer anti-inflammatory properties, excessive intake can lead to a deficiency in other nutrients. The recommended amount of alcohol for women is a drink per day, which is equivalent to 350 mL (12 oz) of beer, 148 mL (5 oz) of wine, or 44 mL (1.5 oz) of hard alcohol that is over 80 proof. D. Water is an important component of a nutritious diet because it is necessary for the digestion, absorption, and transport of nutrients. The nurse should instruct these women to drink between 2 and 3 L of water daily to maintain homeostasis, based on client comorbidities, the climate, and the client's activity level.

A nurse is talking with the parent of a preschool-aged child who tells the nurse, "My child has suddenly become disinterested in certain foods." Which of the following statements should the nurse make? A. "During this phase, feed your child anything that she will eat." B. "Increase the amount of calories and water your child consumes." C. "Keep a diary of the foods your child eats each day." D. "Provide a large variety of fruit juices for your child to choose from."

Correct Answer: C. "Keep a diary of the foods your child eats each day." The nurse should encourage the parent to keep a diary of the foods the child eats throughout the day for 1 week. This can help the parent realize that the child may be eating better than expected. Evidence suggests that children can self-regulate their caloric intake. When they eat less at a meal, they can compensate by eating more at another meal or by having a snack. Incorrect Answers:A. The nurse should inform the parent that children's dietary habits can change from day to day. It is important to feed the child healthy foods and focus on the quality of food rather than the quantity of food during this time. B. The nurse should inform the client that calorie and fluid requirements decrease slightly in a preschool-aged child. The nurse should not promote an increase of calories and water in the child's diet. D. The nurse should inform the parent that excessive consumption of sweetened beverages, including fruit juices, can be associated with adverse health effects such as dental caries, obesity, and metabolic syndrome.

A nurse is providing teaching about nutrients to a client. Which of the following statements should the nurse include? A. "Carbohydrates transport nutrients throughout the body." B. "Fats prevent ketosis." C. "Protein builds and repairs body tissue." D. "Carbohydrates help regulate body temperature."

Correct Answer: C. "Protein builds and repairs body tissue." The primary function of protein involves building and repairing body tissues (e.g. muscles, tendons, and collagen). The skin, hair, and nails are also made of protein structures. A diet that is low in protein can impair wound healing. Incorrect Answers:A. Proteins transport nutrients such as fats and fat-soluble vitamins throughout the body. Protein in the form of hemoglobin transports oxygen; in the form of albumin, it transports many medications. B, Ketosis develops when the body relies only on fats to meet energy needs. Carbohydrates prevent ketosis by allowing the body to use fat effectively as an energy source without the production of ketones. D. Fats help regulate body temperature by providing a protective layer when the environmental temperature drops.

A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide? A. "Let's discuss this with your doctor; giving up daily pasta may not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added-salt tomato products on your pasta."

Correct Answer: C. "You don't have to give up pasta; just adjust the amount you eat." The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful assessment of the client's usual dietary practices and modifications is an important part of teaching clients to manage this disorder. Incorrect Answers:A. The nurse is capable of counseling clients and providing resources about appropriate dietary choices without consulting the provider. B. Although this idea has some merit, the client is expressing dismay about giving up pasta. Often, there is no substitute for what the client really enjoys. D. While reduced sodium intake is recommended for most clients, especially those who have hypertension, this is not a solution for this client's concern about pasta. Additionally, it does not relate to glycemic control, which is a critical issue for this client.

A nurse is providing teaching to a client who is beginning a vegan diet and is concerned about maintaining adequate protein intake. Which of the following food servings should the nurse recommend as having the highest amount of protein? A. 1/2 cup tomato soup B. 1/2 cup of raw broccoli C. 2 tablespoons of peanut butter D. 1 cup penne pasta

Correct Answer: C. 2 tablespoons of peanut butter The nurse should determine that peanut butter is the best food source to recommend because it contains 7.11 g of protein per 2 tablespoons. Incorrect Answers:A. The nurse should recommend a different food because there is another choice that contains more protein. Tomato soup contains 1.08 g of protein per 1/2 cup. B. The nurse should recommend a different food because there is another choice that contains more protein. Raw broccoli contains 3.6 g of protein per 1/2 cup. D. The nurse should recommend a different food because there is another choice that contains more protein. Penne pasta contains 5.81 g of protein per cup.

A nurse is assisting a client who has dysphagia with eating meals. Which of the following actions should the nurse take? A. Add water to soups for a thinner consistency B. Encourage using water to clear the client's mouth C. Ask the client to think of a food that produces salivation D. Remind the client to rest after meals

Correct Answer: C. Ask the client to think of a food that produces salivation To prevent dryness in the mouth during meals, which can be a risk factor for choking, the nurse should ask the client to think of a food that promotes salivation (e.g. lemon slices or dill pickles). Incorrect Answers:A. Thick liquids are easier for clients who have dysphagia to manage when swallowing. B. Clients who have dysphagia should only drink fluids after clearing the mouth of food. They should use coughing and dry swallowing to remove food particles from the mouth. D. Clients who have dysphagia should rest before meals to avoid fatigue when focusing on swallowing safely.

A nurse is reviewing the laboratory reports of a client who is receiving enteral feedings. Which of the following values indicates a complication of enteral feeding that the nurse should report to the provider? A. Sodium 143 mEq/L B. Potassium 4.2 mEq/L C. BUN 25 mg/dL D. Glucose 185 mg/dL

Correct Answer: C. BUN 25 mg/dL A BUN level of 25 mg/dL is above the expected reference range of 10 to 20 mg/dL and indicates dehydration, which is a complication of enteral feedings. The nurse should report this laboratory value to the provider. Incorrect Answers:A. A sodium level of 143 mEq/L is within the expected reference range of 136 to 145 mEq/L and does not indicate a complication of enteral feeding. B. A potassium level of 4.2 mEq/L is within the expected reference range of 3.5 to 5.0 mEq/L and does not indicate a complication of enteral feeding. D. A glucose level of 185 mg/dL is within the expected reference range of <200 mg/dL for casual blood glucose and does not indicate a complication of enteral feeding.

A nurse is caring for a client from the Middle East who has celiac disease. Which of the following actions should the nurse perform regarding the client's diet? A. Provide foods prepared according to kosher dietary law B. Ask the kitchen to prepare grits to meet the client's dietary need for grains C. Determine the client's dietary preferences D. Prepare a diet tray that includes vegetable and barley soup

Correct Answer: C. Determine the client's dietary preferences While generalizations are often made regarding the traditional eating practices of clients based on their cultural backgrounds, individual food choices can deviate from these generalizations. The nurse should assess the client's dietary habits before planning to meet dietary needs. Incorrect Answers:B. Although clients who have celiac disease are unable to consume grains such as wheat, rye, and barley, it is not culturally sensitive to request the preparation of certain foods without consulting the client. D. Clients who have celiac disease are unable to process certain grains, including wheat, rye, and barley. If consumed, these grains can result in diarrhea, abdominal pain, and weight loss.

A nurse is caring for a client who has a BMI of 29 and expresses a desire to lose weight. Which of the following actions should the nurse take first? A. Refer the client to a nutritionist B. Discuss eating strategies with the client C. Determine the client's intention to change current eating habits D. Instruct the client to perform 30 min of vigorous exercise daily

Correct Answer: C. Determine the client's intention to change current eating habits When using the nursing process, the nurse should first assess the client's readiness to commit to a change in behavior. Incorrect Answers:A. Effective weight management involves establishing and following healthy eating habits. The nurse should refer the client to a nutritionist for an evaluation of the client's dietary needs and dietary recommendations to promote weight loss. However, this is not the first action the nurse should take. B. The nurse should discuss various eating strategies, such as portion control and the reduction or elimination of sugar-sweetened beverages, as a means of reducing weight. However, this is not the first action the nurse should take. D. Although the nurse should recommend increasing physical activity to promote overall health and weight loss, this is not the first action the nurse should take.

A nurse is providing teaching to a client who has constipation. Which of the following instructions should the nurse include? A. Use bismuth subsalicylate regularly B. Consume a low-fiber diet C. Eat yogurt with live cultures D. Use bisacodyl suppositories regularly

Correct Answer: C. Eat yogurt with live cultures Yogurt with live bacterial cultures provides dietary probiotics that help maintain and promote bowel function. Incorrect Answers:A. Bismuth subsalicylate is an antidiarrheal agent and will increase constipation. B. Increasing fiber gradually can prevent constipation. A low-fiber diet is recommended for clients who have diarrhea. D. The regular use of stimulant laxatives can result in decreased defecation reflexes, causing a reliance on stimulant laxatives for bowel movements. This may eventually cause electrolyte imbalances and colitis.

A nurse is reviewing the dietary choices of a client who has chronic pancreatitis. Which of the following food items should the nurse suggest removing from the client's menu for the following day? A. White rice B. Broiled cod C. Ice cream D. Canned peaches

Correct Answer: C. Ice cream Clients who have chronic pancreatitis should limit their fat intake to no more than 30% to 40% of total calories. Ice cream is high in fat, with 48 g of fat in a 1-cup serving of vanilla ice cream. The client should choose healthier fat-containing options to support a balanced diet, such as avocados and nuts. Incorrect Answers:A. Foods high in fiber can reduce lipase activity, making a low-fiber diet helpful for clients who have chronic pancreatitis. White rice is low in fiber, with only 1 g of fiber in a 1-cup serving. B. Clients who have chronic pancreatitis need an adequate amount of protein, about 1.5 g/kg/day. Fish is a good source of protein, with 26 g of protein in a 170 g portion of cod. D. Foods high in fiber can reduce lipase activity, making a-low fiber diet helpful for clients who have chronic pancreatitis. Canned peaches are low in fiber, with only 3 g of fiber in a 1-cup serving.

A nurse is caring for an infant who has gastroenteritis and is dehydrated. Which of the following characteristics places the infant at a higher risk of electrolyte imbalances compared to an adult client? A. Less extracellular fluid B. Reduced body surface area C. Longer intestinal tract D. Decreased rate of metabolism

Correct Answer: C. Longer intestinal tract Compared to adults or older children, infants have a longer intestinal tract. This results in greater fluid losses, especially through diarrhea. Incorrect Answers:A. Compared to adults or older children, infants have a larger amount of extracellular fluid. This results in a larger fluid volume and more rapid water loss in this age group. B. Compared to adults or older children, infants have a larger body surface area. This results in greater fluid losses through insensible means. D. Compared to adults or older children, infants have an increased rate of metabolism. This results in the production of more metabolic waste, which must be excreted by the kidneys.

A nurse is caring for a client who is receiving intermittent enteral feedings through an NG tube. The specific gravity of the client's urine is 1.035. Which of the following actions should the nurse take? A. Deliver the formula at a slower rate B. Request a lower-fat formula C. Provide more water with feedings D. Instill a lactose-free formula

Correct Answer: C. Provide more water with feedings The elevation in the client's specific gravity indicates dehydration. The nurse should provide more fluids either by adding free water to feedings or by instilling water between feedings. Another strategy is to request a formula that contains less protein. Incorrect Answers:A. Slowing the delivery rate is an intervention for diarrhea. B. Instilling a lower-fat formula is an intervention for abdominal distention and bloating. D. Instilling a lactose-free formula is an intervention for nausea and vomiting.

A nurse is caring for a client who has xerostomia with a lack of saliva. Which of the following nutrients will be affected by the lack of salivary amylase? A. Fat B. Protein C. Starch D. Fiber

Correct Answer: C. Starch Salivary amylase begins the process of digestion in the mouth with the initial breakdown of starches. The majority of starch breakdown occurs in the small intestine with pancreatic amylase. Incorrect Answers:A. Lipase breaks down fats. B. Pepsin breaks down proteins. D. Fiber is not digestible, but fermentation occurs in the large intestine by intestinal microbes, which results in the release of methane, hydrogen, water, and fatty acids.

A nurse is caring for a client who has a new diagnosis of pernicious anemia. The nurse should expect the client's provider to prescribe which of the following medications for this client? A. Ferrous sulfate B. Epoetin alfa C. Vitamin B12 D. Folic acid

Correct Answer: C. Vitamin B12 The nurse should expect the client's provider to prescribe vitamin B12 for pernicious anemia. Incorrect Answers:A. The nurse should expect a prescription for ferrous sulfate for a client who has iron-deficiency anemia. B. The nurse should expect a prescription for epoetin alfa for a client who has anemia secondary to chemotherapy. D. The nurse should expect a prescription for folic acid for a client who has anemia due to a folic acid deficiency.

A nurse is caring for a client who has scurvy. Which of the following vitamin deficiencies should the nurse identify as the cause of this disease? A. Vitamin A B. Vitamin B3 C. Vitamin C D. Vitamin D

Correct Answer: C. Vitamin C Vitamin C deficiency produces symptoms of scurvy such as delayed wound healing and capillary fragility. Incorrect Answers:A. A deficiency in vitamin A produces manifestations of night blindness and immunodeficiency. It is not associated with scurvy. B. A deficiency in vitamin B3 produces manifestations of pellagra, which include a scaly rash on sun-exposed skin, confusion, paranoia, and diarrhea. D. A deficiency in vitamin D produces manifestations of rickets and osteomalacia, which include bowed legs, fractures, and malformed teeth.

A nurse is providing postoperative teaching about the management of dumping syndrome to a client who had a partial gastrectomy. Which of the following instructions should the nurse include in the teaching? A. "Consume at least 4 oz of fluid with meals." B. "Take a short walk after each meal." C. "Use honey to flavor foods such as cereal." D. "Eat protein with each meal."

Correct Answer: D. "Eat protein with each meal." The nurse should instruct the client to eat meals that are high in protein and fat with low to moderate carbohydrate content. Protein should be included in every meal because it delays digestion, which helps reduce the manifestations of dumping syndrome. Incorrect Answers:A. The client should avoid fluids at mealtimes to decrease gastric stimulation. B. The client should lie down when experiencing early manifestations of dumping syndrome (e.g. tachycardia, syncope, or sweating) to slow the progress of food through the gastrointestinal tract. C. The client should avoid simple carbohydrates such as honey, sugar, and syrup because they aggravate the stomach and worsen manifestations of dumping syndrome.

A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to eliminate sweet desserts from my diet." B. "I should avoid using sucralose in my coffee." C. "I should consume alcohol between meals in moderation." D. "I should replace white bread with whole-grain bread.

Correct Answer: D. "I should replace white bread with whole-grain bread." Clients with diabetes mellitus have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber. Incorrect Answers:A. Sweet desserts are not prohibited for clients who have diabetes mellitus. Instead, they should be consumed in moderation and substituted for other carbohydrates in the client's meal plan. B. Sucralose is a non-nutritive sweetener that has been approved by the Food and Drug Administration for this use. It is considered safe for clients who have diabetes mellitus. C. Although clients who have diabetes mellitus can consume alcohol in moderation, the nurse should instruct the client to consume alcohol with food to avoid hypoglycemia.

A nurse is providing teaching about nutrition to an older adult client. The client asks, "Don't I need the same amount of nutrients that I did when I was younger?" Which of the following responses should the nurse make? A. "Older adults need less protein." B. "Older adults need an increased amount of carbohydrates." C. "Older adults need an increased amount of iron." D. "Older adults need an increased amount of calcium."

Correct Answer: D. "Older adults need an increased amount of calcium." Older adults require increased amounts of calcium as well as vitamins D, B12, and A. Incorrect Answers:A. Many older adults require increased amounts of protein because total body protein can decrease as the body ages. B. Older adults do not require an increased amount of carbohydrates, although some older adults might require increased amounts of fiber. C. Older adults do not require increased amounts of iron. However, their intake of iron is often inadequate.

A nurse is assessing a client's nutritional status. The nurse determines the client is consuming 500 calories more per day than his energy level requires. If his dietary habits do not change, how long will it take the client to gain 4.5 kg (10 lb)? A. 10 months B. 5 months C. 5 weeks D. 10 weeks

Correct Answer: D. 10 weeks Because 1 lb of body fat is equivalent to 3,500 calories, consuming 500 extra calories each day for 7 days would lead to a total of 3,500 calories and a 1 lb gain per week. At the rate of 1 lb per week, the client would gain 10 lb in 10 weeks. Incorrect Answers:B. At the rate of 1 lb per week, the client would gain 20 to 25 lb in 5 months. C. At the rate of 1 lb per week, the client would gain 5 lb in 5 weeks.

A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. To increase the protein density of the client's meals, which of the following recommendations should the nurse make to the client's caregiver? A. Use sour cream instead of plain yogurt B. Add honey to cooked cereals C. Use salad dressing in place of mayonnaise D. Add chopped hard-boiled eggs to soups and casseroles

Correct Answer: D. Add chopped hard-boiled eggs to soups and casseroles Eggs are a good source of protein. Adding them to combination foods and coating meats with raw eggs before breading and cooking increases the protein density of those foods. Incorrect Answers:A. To increase protein density, the caregiver should use plain yogurt in place of sour cream. B. Adding honey to cereal increases the caloric density, not the protein density. C. Mayonnaise contains more protein than most salad dressings.

A nurse is planning care for a client who has AIDS and has developed stomatitis. Which of the following interventions should the nurse include in the plan of care? A. Rinse the mouth with chlorhexidine solution every 2 hr B. Limit fluid intake with meals C. Provide oral hygiene with a firm-bristled toothbrush after each meal D. Avoid salty foods

Correct Answer: D. Avoid salty foods Stomatitis is an inflammation of the mucosa of the mouth, usually with ulcerations. Foods that are spicy, acidic, or salty should be avoided to prevent further irritation and damage to the oral mucosa. Incorrect Answers:A. Chlorhexidine is an antiseptic that could cause further irritation to the oral mucosa. The nurse should provide the client with 0.9% sodium chloride solution or baking soda to mix with water and use as a rinse aid. B. The nurse should plan to provide moist foods and liquids with meals to decrease the client's discomfort and to promote nutritional intake. C. The client's oral care should be provided with a soft-bristled toothbrush to avoid further irritation and damage to the oral mucosa.

A home health nurse is planning care for a client who is receiving chemotherapy and has neutropenia. Which of the following foods should the nurse include in the client's plan of care? A. Soft-boiled eggs B. Brie cheese made with unpasteurized milk C. Cold deli-meat sandwiches ✔ D. Baked chicken

Correct Answer: D. Baked chicken Well-cooked meats, including baked chicken, do not pose a threat to clients who have neutropenia and may be included in the client's dietary plan. For optimal safety, poultry should be cooked to an internal temperature of 74°C (165°F). Incorrect Answers:B. Soft cheeses like brie, which are made with unpasteurized milk, can contain bacteria and should be avoided by clients who have neutropenia. Hard or processed cheeses or those clearly labeled as made with pasteurized milk are an alternative to brie for a client who has neutropenia. C. Cold deli meats and lunch meats can contain Listeria monocytogenes. These bacteria remain viable at refrigerated and room temperatures and can make a client who is immunocompromised severely ill. As an alternative, the nurse should recommend heating all deli meats or lunch meats.

A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? A. Canned fruit B. White bread C. Broiled hamburger D. Coleslaw

Correct Answer: D. Coleslaw Coleslaw contains raw cabbage, which is high in fiber. Clients who are following a low-fiber diet should avoid most raw vegetables. Incorrect Answers:A. Canned fruit is an appropriate low-fiber food for a client who is following a low-fiber diet. Fresh fruit contains more fiber. B. White bread is an appropriate low-fiber food for a client who is following a low-fiber diet. Wholegrain bread contains more fiber. C. Broiled hamburger is an appropriate low-fiber food for a client who is following a low-fiber diet. Fish and poultry are also low in fiber.

A nurse is updating the plan of care for a client who has dumping syndrome. Which of the following instructions should the nurse include? A. Consume beverages with meals B. Eat 3 large meals per day C. Include high-fiber foods in the diet D. Eat a source of protein with each meal

Correct Answer: D. Eat a source of protein with each meal The nurse should include in the client's plan of care the instruction to eat a source of protein with each meal because protein delays gastric emptying. Incorrect Answers:A. The nurse should recommend consuming beverages between meals, which delays gastric emptying. B. The nurse should recommend consuming small, frequent meals each day to delay gastric emptying and assist with digestion. C. The nurse should recommend including low-fiber foods in the diet to delay gastric emptying.

A nurse is reviewing a client's 24 hr dietary recall. The client reports eating a slice of toasted white bread with butter, a banana, a glass of milk, and a cup of coffee for breakfast; grilled chicken, a baked potato, and a glass of milk for lunch; an apple and cheddar cheese for a snack; and 2 servings of chicken, 2 cups of steamed broccoli, and a glass of milk for dinner. This client's diet is deficient in which of the following food groups? A. Dairy B. Vegetables C. Fruits D. Grains

Correct Answer: D. Grains This client only consumed 1 serving of grains on the day of the 24-hour dietary recall. USDA dietary guidelines recommend 3 or more ounce-equivalents of whole-grain products per day. Additionally, the choice of white bread is low in fiber, which can lead to constipation and an increased risk of developing hyperlipidemia. The USDA guidelines recommend that at least half of the grains consumed should be whole grain. Incorrect Answers:A. The client consumed 3 servings of dairy throughout the day, which is the recommended daily amount according to USDA dietary guidelines. B. The client consumed 2.5 cups or more of vegetables, which is the recommended daily amount according to USDA dietary guidelines. C. The client consumed 2 servings of fruit, which is the recommended daily amount according to USDA dietary guidelines.

A nurse is creating a plan of care for a client who adheres to Kosher dietary laws. Which of the following food selections should the nurse recommend? A. Baked pork chop B. Cheeseburger C. Ham and cheese omelet D. Grilled salmon

Correct Answer: D. Grilled salmon The nurse should recommend grilled salmon for a client who observes Kosher dietary laws. Grilled salmon is a fish with fins and scales, which can be consumed. Seafood with shells, such as lobster or crab, is prohibited. Incorrect Answers:A. A baked pork chop is a source of pork, which is prohibited by Kosher dietary laws. B. A cheeseburger contains both meat and dairy products, which may not be eaten at the same time and is prohibited by Kosher dietary laws. C. A ham and cheese omelet contains pork, which is prohibited by Kosher dietary laws.

A nurse is planning care for a client who has anorexia and nausea due to cancer treatment. Which of the following interventions should the nurse include? A. Serve foods at warm or hot temperatures B. Offer the client low-density foods C. Make sure the client lies supine after meals D. Limit drinking liquids with food

Correct Answer: D. Limit drinking liquids with food Drinking beverages with food leads to early satiety and bloating, which results in the client consuming fewer calories. Incorrect Answers:A. The nurse should make sure the client receives cold or room-temperature foods. B. To increase the nutritional value of the food and the client's caloric intake, the nurse should make sure that the client receives high-protein, high-calorie, nutrient-dense foods. The client should also eat nutrient-dense foods first during meals. C. To reduce nausea, the client should sit upright for 1 hour after meals. The client should also rest before meals to conserve energy for eating and digesting food.

A nurse is providing dietary teaching to a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following recommendations should the nurse include in the teaching? A. Avoid foods containing protein B. Drink liquids during each meal C. Eat foods that contain simple sugars D. Maintain a supine position after meals

Correct Answer: D. Maintain a supine position after meals The nurse should instruct the client to lie supine after eating to help slow the rapid emptying of food into the small intestine. A client who has dumping syndrome should decrease the amount of food eaten at once, eat small meals more frequently, and eliminate fluids at mealtime. Fluid shifts occur in the upper gastrointestinal tract when food contents and simple sugars exit the stomach too rapidly, attracting fluid into the upper intestine and decreasing blood volume, which causes the client to experience nausea and vomiting, sweating, syncope, palpitations, increased heart rate, and hypotension. Incorrect Answers:A. The nurse should instruct the client to include foods containing protein at each meal and only to eat 1 or 2 foods from each food group at once. Protein, fats, and complex carbohydrates are better tolerated by a client who recently had gastric bypass surgery. B. The nurse should instruct the client to avoid drinking liquids during meals and to wait 30 to 60 minutes after eating solid foods to drink liquids. Drinking liquids with meals increases the motility of the gastrointestinal tract. C. The nurse should instruct the client to avoid eating foods that contain simple sugars. Simple sugars increase the hypertonicity of the gastrointestinal tract, which increases the movement of the food bolus.

A nurse is caring for a client who is receiving radiation therapy for breast cancer and reports a metallic taste in the mouth. Which of the following dietary recommendations should the nurse share with the client? A. Eat with metal utensils B. Limit coffee C. Avoid citrus foods D. Offer mints

Correct Answer: D. Offer mints The nurse should encourage the client to suck on mints, which can overcome the metallic taste the client is experiencing as a result of the radiation therapy. Incorrect Answers:B. The nurse should encourage the client to add coffee to sweet beverages or milk, as the coffee overcomes the sweetness of the beverage. C. The nurse should encourage the client to consume foods that contain citrus or that have a tart flavor. This overcomes the metallic taste.

A nurse is planning an in-service training session for a group of nurses regarding the role of enzymes in digestion. Which of the following enzymes plays a role in the digestion of protein? A. Amylase B. Lipase C. Steapsin D. Pepsin

Correct Answer: D. Pepsin Pepsin is an enzyme secreted by the gastric mucosa that breaks down protein into polypeptides. Other enzymes such as trypsin and aminopeptidase further break down the polypeptides into amino acids, which can be used by the body. Incorrect Answers:A. Amylase is an enzyme secreted by the pancreas and intestine that breaks down starches into glucose. B. Lipase is an enzyme secreted by the pancreas that breaks down triglycerides into monoglycerides. C. Steapsin is an enzyme secreted by the gastric mucosa that breaks down triglycerides into monoglycerides.

A nurse is caring for a client who is receiving radiation therapy for mouth cancer and reports a dry mouth. Which of the following dietary recommendations should the nurse provide? A. Offer graham crackers as a snack B. Avoid foods containing citrus C. Rinse the mouth with an alcohol-based mouthwash before eating ✔ Correct answer DD. Use gravies or sauces to soften food

Correct Answer: D. Use gravies or sauces to soften food The nurse should instruct the client to use gravies or sauces to soften foods and make them easier to eat. Incorrect Answers:A. The client should avoid eating dry, coarse foods such as graham crackers. This type of food can make the client's mouth feel more dry and unpleasant. B. The client should consume foods containing citrus to stimulate saliva. C. The client should rinse the mouth with an alcohol-free mouthwash before eating. Alcohol-based mouthwash can make the client's mouth drier.

A nurse is caring for a group of clients on a medical-surgical unit. Which of the following disorders should the nurse identify as increasing the client's metabolic needs? (Select all that apply.) A. COPD B. Hypothyroidism C. Cancer D. Parkinson's disease E. Major burns

Correct Answers: A. COPD C. Cancer D. Parkinson's disease E. Major burns Clients who have COPD develop hypermetabolism as a result of the increased amount of energy used to breathe. Cancer can cause a number of metabolic changes, including hypermetabolism as a result of the tumor growth. Clients who have Parkinson's disease develop hypermetabolism because they burn calories due to muscular rigidity. Finally, clients who have major burns develop severe metabolic stress, which includes hypermetabolism and hypercatabolism. Incorrect Answer:(B) Insufficient thyroid hormone results in decreased metabolism.

A nurse is teaching a group of parents of toddlers about measures to reduce the risk of choking. Which of the following foods increase the risk of choking in toddlers? (Select all that apply.) A. Hot dogs B. Grapes C. Bagels D. Marshmallows E. Graham crackers

Correct Answers: A. Hot dogs B. Grapes C. Bagels D. Marshmallows Foods that are shaped like a tube, such as hot dogs and grapes, place toddlers at risk for choking because they can completely block the throat when swallowed whole due to their shape and solidity. Foods that are hard to chew, such as bagels and marshmallows, place toddlers at risk for choking; if swallowed before they are adequately chewed, they can block the airway. Incorrect Answer:E. All foods and fluids can potentially cause choking. However, graham crackers become soft quickly when mixed with saliva. Their consistency when wet is more like cooked cereal or soft cookies soaked in milk. Therefore, graham crackers do not pose an increased choking hazard for toddlers.

A nurse is planning care for a client who is receiving chemotherapy and has a protein deficiency. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Mix powdered skim milk into liquid milk B. Add a raw egg to fruit smoothies C. Add a slice of cheese to hot vegetables D. Add honey to hot tea E. Mix yogurt into fresh fruit

Correct Answers: A. Mix powdered skim milk into liquid milk C. Add a slice of cheese to hot vegetables E. Mix yogurt into fresh fruit Dairy products are good sources of protein. Mixing powdered skim milk into liquid milk can provide the client with additional protein. Adding cheese to a vegetable can increase the client's protein intake. Adding yogurt to fresh fruit will increase the client's protein intake. Incorrect Answers:B. Clients who are immunocompromised should avoid foods that contain raw eggs because they are a potential source of infection. D. Adding honey to hot tea can increase the client's caloric intake, but this will not increase the client's protein intake.

A nurse is providing teaching to a client who has gout and urolithiasis. The client asks how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? (Select all that apply.) A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine D. Decrease daily fluid intake E. Avoid citrus juices

Correct Answers: A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine The nurse should inform the client that allopurinol is an antigout medication that reduces uric acid, which helps prevent uric acid stone formation. Immobility is a risk factor for stone formation; therefore, the client should maintain a healthy lifestyle, including regular exercise. Purine increases the risk of uric acid stone formation; organ meats, poultry, fish, red wine, and gravy are high in purine. Incorrect Answers:D. Maintaining an adequate fluid intake of 2 to 3 L per day reduces the risk of stone formation. E. Citrus juices alkalinize the urine, which helps prevent uric acid stone formation.

A nurse is assessing a client. Which of the following findings should the nurse identify as an indication of protein-calorie malnourishment? (Select all that apply.) A. Gingivitis B. Dry, brittle hair C. Edema D. Spoon-shaped nails E. Poor wound healing

Correct Answers: B. Dry, brittle hair C. Edema E. Poor wound healing Dry, brittle hair that falls out easily suggests inadequate protein intake and malnutrition. Edema can occur when albumin levels are lower than the expected reference range and indicates protein-calorie malnutrition. Adequate wound healing depends on the ingestion of sufficient protein, calories, water, vitamins (especially C and A), iron, and zinc. Incorrect Answers:A. Gingivitis is a manifestation of vitamin C deficiency. D. Spoon-shaped nails are a manifestation of iron deficiency.

A nurse in a provider's office is teaching a client about foods that are high in fiber. Which of the following food choices made by the client indicate an understanding of the teaching? (Select all that apply.) A. Canned peaches B. White rice C. Black beans D. Whole-grain bread E. Tomato juice

Correct Answers: C. Black beans D. Whole-grain bread Dried peas and beans, including black beans, are high in fiber. Whole grains consist of the entire kernel and are also high in fiber. Incorrect Answers:A. Canned fruits, including peaches, are recommended for clients on a low-fiber diet. Fresh fruits contain more fiber. B. White rice is recommended for clients on a low-fiber diet. Brown rice is higher in fiber. E. Canned juices, with the exception of prune juice, are recommended for clients on a low-fiber diet.

VITAMIN B12

Cyanocobalamin (Cyanabin) Vitamin B12 injection Helps to make RBCs and is important for nerve cell function. Stimulates a key reaction in the synthesis of thymidylate, a component of DNA. Deficiency results in the release of too few blood cells. • Found naturally in fish, red meat, poultry, milk, cheese, and eggs; also added to some breakfast cereals. • Must be given IM to bypass the intestine for systemic absorption. • Vitamin B12 injections are virtually free of adverse effects. • Initially take by daily injections and then monthly throughout life.

MAGNESIUM SULFATE

Electrolyte replacement effective in decreasing muscular excitability. Acts as an anticonvulsant to prevent and control seizures in preeclampsia and to decrease uterine activity. Useful in preterm labor. • Monitor BP, respiratory rate, deep tendon reflexes, and urinary output frequently during IV administration. • Antidote is calcium gluconate. • Adverse reactions include CNS depression, and hypotension.

ZINC

Important for normal growth, strong immunity, and wound healing. • Found in red meat, poultry, oysters and other seafood, nuts, dried beans, soy foods, milk and other dairy products, whole grains, and fortified breakfast cereals.

IODINE-CONTAINING AGENTS

Inhibits release of stored thyroid hormone and retards hormone synthesis. • Administer for short term before thyroidectomy; medication has a short half-life. • Dilute oral iodine solution in juice or beverage of choice; administer through straw with fluids to prevent staining of teeth.

How is vitamin B12 absorbed?

Intrinsic factor secreted in the stomach binds to the large B12 compound, creating a combination that can bind to mucosal receptors in the ileum.

What does Thiamine do to the body?

It allows the body to convert its store of glycogen into glucose as part of the Krebs cycle

What does activated charcoal do?

It is an adsorbent that binds poisons to its surface, thus reducing the amount that gets absorbed into the bloodstream. It should not be used with strong acids or alkalis, lithium or iron tablets. It does not work on all poisons, and has no effect on alcohol poisoning.

VITAMIN A

Keeps skin healthy. Seeds cellular turnover, thereby clearing keratin plugs from the pilosebaceous ducts. • Caution the client to avoid sun exposure. • Explain to the client that noticeable improvement may take 8-12 weeks, during which time skin redness and peeling are common.

What medications decrease potassium levels?

Laxatives, enemas, kayexalate, corticosteroids, antibiotics, insulin/glucose, potassium, wasting diuretics, and amphotericin

Waist Circumference

Males < 40 inches = Healthy Females < 35 inches = Healthy

Analysis of Waist-to-Hip Ratio

Males > 0.9 Abdominal Obesity Females >0.85 Abdominal Obesity

What are the signs and symptoms of hyponatremia?

Nausea Muscle cramps Confusion Muscular twitching, coma Seizures Headache

VITAMIN C

Needed to form collagen, a tissue that helps to hold cells together. Essential for healthy bones, teeth, gums, and blood vessels. Helps the body absorb iron and calcium. Aids in wound healing. Contributes to brain function. • Found in red berries, kiwi, red and green bell peppers, tomatoes, broccoli, spinach, and juices made from guava, grapefruit, and orange.

IRON SUPPLEMENTS

Oral—ferrous sulfate Parenteral—iron dextran Synthesizes heme, the essential protein of hemoglobin. • Inform the client that the stool will be dark and tarry; instruct on ways to prevent constipation. • Tell the client to notify the HCP of adverse effects, such as diarrhea, constipation, GI upset, or nausea and vomiting that become severe or intolerable. • Forewarn the client that liquid iron may stain teeth. • Suggest diluting the iron and administering it through a straw or dropper placed at the back of the tongue. • Administer using Z-track technique to avoid leakage into subcutaneous tissues. • Caution the client that preparation may discolor skin and cause local pain. • Be alert for possible anaphylactic reaction.

What are the signs and symptoms of fluid overload?

Peripheral edema/third spacing, distended neck veins, crackles in the lungs, increased CVP, BP increases, and the weight increases

What is the antidote for warfarin?

Phytonadione (vitamin K) (Mephyton)

What is refeeding syndrome?

Starved patient, fed Hypokalemia, hypomagnesemia, hypophophatemia

VITAMIN D

Strengthens bones because it helps the body absorb bone-building calcium. • Body manufactures vitamin D when skin is exposed to sunlight. • Found in egg yolks, fish oils, and fortified foods like milk.

What is chromium used for?

Supplement used to dec. blood GLU levels, HbA1C (but don't use in PT with renal problems)

FOLIC ACID

Supplements folic acid intake; minimum daily requirement is 50 g (folic acid is found in most meats, fresh vegetables, and fresh fruits, but is destroyed when cooked more than 15 minutes). Helps the body make RBCs. It is also needed to make DNA. • Warn the client that these medications cause drowsiness initially but diminish with continued use. • Instruct the client to avoid hazardous activities; do not mix these medications with alcohol or other depressants. • Taper baclofen (Lioresal) to prevent rebound seizures. • Liver, dried beans and other legumes, green leafy vegetables, asparagus, and orange juice are good sources of this vitamin. So are fortified bread, rice, and cereals.

What are the signs and symptoms of hypercalcemia?

Symptoms: bones, stones, groans, moans. Bone resorption, kidney stones, abdominal pain, ileus, nephrolithiasis, peptic ulcer disease, constipation, pancreatitis Signs: shortened QT interval on EKG, weakness, polyuria, bone changes and kidney stones, renal failure

A nurse is providing teaching about calcium intake to a client who is breastfeeding. Which of the following is the recommended daily calcium intake for a client who is breastfeeding? A. 800 mg B. 400 mg C. 1,000 mg D. 2,000 mg

The nurse should instruct the client that 1,000 mg of calcium is recommended for women age 19 and older, as well as those who are lactating. This amount of calcium is sufficient to meet the needs of the client and the infant because additional calcium is absorbed from the intestines during this time.

A nurse is conducting dietary teaching with a client who has a history of renal calculi. Which of the following instructions should the nurse include in the teaching? A. Consume foods containing vitamin C B. Drink 3.8 L (4 qt) of water throughout the day C. Suggest almonds as a snack D. Limit sodium intake to 3 g per day

The nurse should instruct the client to drink 3.8 L of water per day to keep urine diluted and decrease the risk of kidney stone formation. A. The nurse should instruct the client to avoid large amounts of vitamin C, which can increase the risk of kidney stone formation. C. The nurse should instruct the client to avoid high-oxalate foods like almonds or other types of nuts because they increase the risk of kidney stone formation. D. The nurse should instruct the client to limit sodium intake to 2 g per day. A high-sodium diet increases the risk of kidney stone formation

A nurse is educating a client who is at 10 weeks gestation and reports frequent nausea and vomiting. Which of the following statements should the nurse include in the teaching? A. "You should eat foods served at warm temperatures." B. "You should brush your teeth right after you eat." C. "You should try to eat sweet foods when you feel nauseated." D. "You should eat dry foods that are high in carbohydrates when you wake up."

The nurse should instruct the client to eat foods that are high in carbohydrates such as dry toast or crackers upon waking or when nausea occurs. Incorrect Answers: A. The nurse should instruct the client to eat foods served at cool temperatures to decrease nausea and vomiting. B. The nurse should instruct the client to avoid brushing her teeth immediately after eating to decrease vomiting. C. The nurse should instruct the client to eat salty and tart foods during periods of nausea.

What does Niacin treat?

Treat hypercholesterolemia and pellagra (niacin deficiency)

What is hydrochlorothiazide used for?

Treats HTN and peripheral edema

What are the food sources of Vitamin A?

Vit A- foods of animal origin, milk and milk products, fortified cereals, butter, eggs.

What is pyridoxine?

Vitamin B6

Determining Protein Needs

Weight in kg X protein factor Protein Factor: Normal activity 0.8gm/kg/day Daily physical activity 1.0-1.2 gm/kg/day Heavy daily physical activity 1.2-1.5 gm/kg./day

Body Mass Index (BMI)

Weight in pounds x 703 (height in inches)2

What is Nicotinic acid?

a vitamin found in many foods (B3 or niacin)

What are the signs and symptoms of hypochloremia?

agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma

COLLOIDAL SOLUTION

albumin 5% Expands plasma volume and maintenance of cardiac output in situations associated with fluid volume deficit, including shock, hemorrhage, and burns. Increases intravascular fluid volume. • Assess for signs of vascular overload, including rales/crackles, dyspnea, hypertension, jugular venous distention during and after administration. • Administer through a large-bore gauge needle (at least 20 gauge). • Record lot number of medication in client's chart. • Solution should be clear amber; do not administer solutions that are discolored or contain particulate matter.

PHOSPHATE-BINDING AGENTS

aluminum hydroxide (Amphojel) Decreases absorption of phosphate from the intestines, thereby decreasing serum phosphate levels. • Instruct the client to restrict sodium intake, drink plenty of fluids, and follow a low phosphate diet.

ELECTROLYTE REPLACEMENTS

calcium gluconate Maintains capillary integrity and normal functioning of the nervous, muscular, and skeletal systems. • Administer the amount prescribed slowly through a large vein to avoid infiltration, which may cause severe necrosis and sloughing of tissue. • Keep the client on bedrest for at least 1 hour after drug administration to prevent orthostatic hypotension. • Keep the medication at the bedside with the necessary IV equipment.

What is digoxin?

cardiac glycoside = treats HF, atrial fibrillation

What is dumping syndrome caused by?

caused by food contents rapidly emptying into the small intestines

What is dumping syndrome?

delivery of a large amount of hyperosmolar chyme into the small bowel, usually after vagotomy and a gastric drainage procedure (pyloroplasty/gastrojejunostomy); results in autonomic instability, abdominal pain, and diarrhea

What is the function of Vitamin A?

differentiation of cells, vision in reduced light (retinol makes up rhodopsin cells), antioxidant

ERYTHROPOIETIN

epoetin alfa (Epogen) Aids in the production of red blood cells (RBCs). • May be administered IV or subcutaneously in clients not receiving dialysis. • Monitor BP, complete blood count (CBC) with differential BUN, and platelet counts.

IRON

ferrous sulfate (Ferralyn) Helps RBCs carry oxygen to all parts of the body. Symptoms of iron-deficiency anemia include weakness and fatigue, light-headedness, and shortness of breath. • Iron-rich foods include red meat, pork, fish and shellfish, poultry, lentils, beans, and soy foods, green leafy vegetables, and raisins. Some flours, cereals, and grain products are also fortified with iron. • Inform client that stool will become black in color and constipation is common. Increase fluid intake, fiber, and exercise.

What is the valsalva maneuver?

forced expiration against a closed glottis

What is digoxin used to treat?

heart failure, atrial fibrillation

How is vitamin B12 administered?

injection - bc deficiency is due to malabsorption

What is Kayexalate used for?

it is a drug therapy used to increase potassium excretion, it promotes intestinal sodium absorption and potassium excretion via stool.

What does Niacin do?

lowers lipid levels

What food sources are high in niacin?

mushroom, meat, poultry, fish, nuts

What does niacin deficiency cause?

pellagra: dermatitis, diarrhea, dementia

What is hydrochlorothiazide?

potassium wasting diuretic *check bp, Na, and K before admin.

ION EXCHANGE RESINS

sodium polystyrene sulfonate (Kayexalate) Exchanges a sodium ion for a potassium ion in the intestinal tract. • If administered by retention enema, the client should retain for 30 minutes. • Sorbitol is often administered with medication to induce a diarrhea-type effect. • Monitor serum potassium level.

What is refeeding syndrome characterized by?

tachycardia tachypnea monitor all electrolytes stop intake restart feeding at lower rate

What are the signs and symptoms of hyperchloremia?

tachypnea, lethargy, weakness, rapid, deep respirations, hypertension, cognitive changes

What does niacin toxicity cause?

vasodilation and flushing

What are the signs and symptoms of fluid deficit?

weight loss sluggish skin turgor dry mucus membranes sunken eyeballs weak, rapid pulse decrease bp cap refill > 3 sec

What does Vitamin B6 do?

• Immune function • Nervous system function • Protein, carbohydrate, and fat metabolism • Red blood cell formation