CHAPTER 3 PROTEIN

The client asks what foods are rich in protein and are less expensive than meat. Which of the following foods would the nurse recommend she eat more of? a. Breads and cereals b. Legumes c. Fruit and vegetables d. Fish and shellfish

B

The nurse is caring for a client status one day after colon resection with anastomosis. The client has a nasogastric tube in place, putting him on NPO status. The nurse is aware this places the client in what state? A) Protein-energy malnutrition C) Marasmus B) Negative nitrogen balance D) Neutral nitrogen balance

B Feedback: A negative nitrogen balance indicates that protein catabolism is occurring at a faster rate than protein synthesis, which occurs during starvation or the catabolic phase after injury. Protein-energy malnutrition does not occur one day after a major surgery. Marasmus does not follow an acute event such as surgery. A neutral nitrogen balance is the state where protein intake equals protein catabolism.

An Upper Limit (UL) for protein has not been established

TRUE Due to lack of sufficient data, a UL has not been established for protein or any of the amino acids. However, the Institute of Medicine warns against using any single amino acid in amounts significantly higher than those found in food.

Most Americans eat more protein than they need.

TRUE Most Americans consume more protein than they need.

The quality of soy protein is comparable to or greater than that of animal proteins.

TRUE Soy protein is complete. It is a high biologic value protein and is comparable in quality to animal protein.

A client says that she doesn't eat much meat. After teaching the client about serving sizes, the nurse determines that the teaching has been effective when the client states that an ounce of meat provides approximately the same amount of protein as which of the following? a. 8 oz of milk b. 8 oz of nuts c. 2 oz of cheese d. 2 eggs

A

An adult in the hospital has been diagnosed with marasmus. Which of the following would you expect? a. The client has experienced severe weight loss. b. The client denies hunger. c. The client has edema and a swollen abdomen. d. The onset of the deficiency was rapid.

A

What is the RDA for protein for a healthy adult who weighs 165 pounds? a. 60 g b. 75 g c. 100 g d. 165 g

A

An 18-month-old victim of a car accident is being admitted to the pediatric ICU. In reviewing the orders for this client, the nurse expects to see diet orders that provide what kind of nutritional therapy? A) Aggressive C) Protein restrictive B) Slow and sure D) Protein delayed

A Feedback: Aggressive nutritional support is used to restore metabolic balance as quickly as possible. Kwashiorkor results mainly from acute critical illnesses such as trauma, sepsis, and other illnesses seen in intensive care units. The nutritional support used in marasmus is slow. Nutritional support that is protein restrictive or protein delayed is not associated with the treatment of Kwashiorkor.

In evaluating the new client's needs, the nurse realizes the client will need additional protein due to which of the following situations? A) Peritoneal dialysis C) Menopause B) Hypometabolic condition D) Diabetes mellitus

A Feedback: Clients receiving peritoneal dialysis lose protein in the dialysis fluid and need higher protein intake to compensate.

A nutrition class is learning about the relationship between protein and nitrogen. The assignment given to the class is to calculate how many grams of nitrogen are provided by 80 g of protein. What is the correct answer expressed in whole grams? A) 13 g B) 20 g C) 27 g D) 34 g

A Feedback: Eighty grams of protein provides approximately 13 g of nitrogen. The total amount of protein consumed (in grams) is divided by 6.25 because protein is 16% nitrogen by weight (80 g ÷ 6.25 = 13 g)

The nurse is admitting a client to the hospital unit with a diagnosis of marasmus. This diagnosis is most likely secondary to what? A) A chronic disease B) A recent trauma C) The influence of affluence D) The quality of the protein in the diet

A Feedback: In the United States, marasmus occurs secondary to chronic diseases such as cancer, AIDS, and chronic pulmonary disease. Kwashiorkor occurs secondary to an acute incidence like a trauma. Affluence and protein quality are not associated with marasmus.

Nitrogen balance in specific groups of people can be a concern. What is the state of nitrogen balance in infants, children, adolescents, and pregnant and lactating women? A) Neutral nitrogen balance C) Negative nitrogen balance B) Positive nitrogen balance D) Metabolic turnover

B Feedback: A positive nitrogen balance exists during growth, pregnancy, or recovery from injury. Therefore, infants, children, adolescents, and pregnant and lactating women are in a state of positive nitrogen balance. This indicates that protein synthesis exceeds protein breakdown.

he school nurse is working with a 16-year-old high school student who is interested in starting a vegetarian diet. The nurse explains the importance of getting enough protein in the diet. The student will need to learn which proteins are complete and incomplete. Which of the following is a source of complete protein? A) Gelatin B) Soy C) Kidney beans D) Peanut butter

B Feedback: A source of complete protein is soy. Soy protein is the only complete plant protein. Gelatin, kidney beans, and peanut butter are incomplete proteins. Complete proteins provide all nine essential amino acids.

What is the term used for practicing vegetarians who choose to occasionally eat meat, fish, or poultry products? A) Vegans C) Semi-vegetarians B) Flexitarians D) Lacto-ovo vegetarians

B Feedback: Flexitarians primarily eat a plant-based diet but occasionally allow themselves meat, fish, poultry, or dairy foods. Vegans eat no flesh or flesh products. Lacto-ovo vegetarians eat plant-based diets augmented with dairy and egg products. "Semi-vegetarians" do not exist.

Determining nitrogen balance in the clinical setting can be very valuable. To determine a client's state of nitrogen balance, a 24-hour urinary urea nitrogen collection is done. What do you also need to do? A) Calculate the client's total calorie intake for that same day. B) Add a coefficient of 4 to that number to account for nitrogen lost in feces, hair, nails, and skin. C) Collect a 24-hour stool specimen on that same day to determine fecal nitrogen losses. D) Be sure that client takes nothing by mouth on the day of the urine collection.

B Feedback: In the clinical setting, nitrogen balance is determined by comparing nitrogen intake with nitrogen excretion over a 24-hour period. To calculate nitrogen intake, protein intake is measure for a 24-hour period. The total amount of protein consumed (in grams) is then divided by 6.25 because protein is 16% nitrogen by weight. The result is the grams of nitrogen consumed per 24 hours. Nitrogen excretion is ascertained by having a 24-hour urine sample analyzed for the amount (grams) of urinary urea nitrogen it contains. A coefficient of 4 is added to this number to account for the estimated daily nitrogen loss in feces, hair, nails, and skin. Finally, the amount of nitrogen consumed is compared with the total amount of nitrogen excreted to reveal a positive, negative, or neutral nitrogen balance. The other answers are not part of determining the nitrogen balance of the body.

Vegetarians do not always have adequate diets. Clinicians need to encourage vegetarians to do what? A) Eat meat. B) Eat adequate calories. C) Take amino acid supplements. D) Eat complementary proteins at every meal.

B Feedback: It is important to encourage vegetarians to eat enough calories. Adequate calories are necessary to avoid using amino acids for energy, which could lead to a shortage of amino acids for protein synthesis. You do not encourage a vegetarian to eat meat. It is not always necessary for a vegetarian to take amino acid supplements. Many foods included in vegetarian diets are complete proteins so it is not necessary to eat complementary proteins at every meal.

The nutrition class is discussing the various elements that are important to be found in the diet to ensure proper nutrition. It is pointed out that protein is different from carbohydrates and fat because it contains what? A) Hydrogen B) Nitrogen C) Oxygen D) Calcium

B Feedback: Protein differs from carbohydrate and fat in that it contains nitrogen. Amino acids, which are composed of carbon, hydrogen, oxygen, and nitrogen atoms, are the building blocks of protein. All living tissue contains hydrogen and oxygen; calcium is a mineral that is not contained in protein.

The ability of the body to digest protein occurs at different levels depending on the source of the protein. What is the approximate protein digestibility for soy and legumes? A) 85% B) 90% C) 95% D) 100%

B Feedback: Protein digestibility is over 90% for soy and legumes, 90% to 99% for animal proteins, and 70% to 90% for other plant proteins.

The nurse is discussing protein with a client. The nurse describes that protein is formed from essential and nonessential amino acids. The client is having difficulties understanding the difference. The nurse should explain that essential amino acids are what? A) The only amino acids necessary for growth and tissue maintenance B) Amino acids that must be consumed in the diet C) Amino acids that are found only in animal products and soy D) Amino acids that are more important than nonessential amino acids

B Feedback: The body cannot make essential amino acids so they must be supplied through the diet. All amino acids are necessary for growth and tissue maintenance. Essential amino acids can be found in other than animal products and soy. Essential amino acids are not more important than nonessential amino acids.

Each of us has a specific energy need for our body to function optimally. Once this energy need is met, what will our body do with any excess protein consumed? A) Store it unchanged as protein. B) Convert it to fatty acids and store it. C) Excrete it unchanged in the urine. D) Convert it to urea and excrete it in the feces.

B Feedback: When protein is consumed in excess of need, the liver converts protein to fatty acids that form triglycerides for storage in adipose tissue. The body does not store protein. Protein is not excreted unchanged in the urine. Nitrogenous wastes are converted to urea for excretion by the body, not protein.

A client who is in a positive nitrogen balance is most likely to be a. A healthy adult b. Starving c. Pregnant d. Losing weight

C

Protein must be broken down into smaller substances before the body can fully use it. For the body to absorb protein, it must first be broken down into what? A) Polypeptides B) Proteases C) Amino acids D) Glucose

C Feedback: Amino acids are the basic building blocks of all proteins and the end products of protein digestion.

There are several types of vegetarian diets including a lacto-vegetarian diet. What do lacto-vegetarians avoid eating? A) Cheese B) Butter C) Eggs D) Nuts

C Feedback: Lacto-vegetarians do not eat eggs. The diets of lacto-vegetarians include milk and milk products, such as cheese and butter; whereas, nuts are a part of a typical vegetarian (non-animal products) diet.

The nurse is talking to a third-grade class about protein digestion during a nutrition class. The nurse explains that the principal site of protein digestion is where? A) Mouth B) Stomach C) Small intestine D) Large intestine

C Feedback: Most protein digestion occurs in the small intestine.

The nurse is teaching a nutrition class at the local high school. The subject for today is "Dietary Supplements and Caloric Intake." One of the class activities is to answer the following question: "An amino acid supplement that provides 15 g of protein and no other nutrients provides how many calories?" Which of the following is the correct response? A) 0 calories because the amino acids are in pill form B) 30 calories C) 60 calories D) 80 calories

C Feedback: Protein provides 4 cal/g. An amino acid supplement that provides 15 g of protein and no other nutrients provides 60 calories (4 cal/g × 15 g = 60 calories).

It is necessary to restrict protein intake in clients diagnosed with certain disease processes, such as clients in renal failure who are unable to excrete nitrogenous wastes. What other disease process necessitates a protein-restricted diet? A) Pancreatitis C) Severe liver disease B) Congestive heart failure D) Diabetes mellitus

C Feedback: Protein restriction is used for people with severe liver disease and those with renal failure who are unable to excrete nitrogenous wastes. There is no physiologic reason to restrict protein intake in the other disease processes.

Many people throughout the world are practicing vegetarians. Those who are pure vegans are at risk for nutritional deficiencies because they do not eat natural food sources of specific nutrients. One problem with a pure vegan diet is that it does not include any natural food sources of what? A) Iron B) Zinc C) Vitamin B12 D) Calcium

C Feedback: Pure vegans do not eat any natural food sources of vitamin B12. This is of concern for vegans because vitamin B12 does not occur naturally in plants; it is naturally found only in animals. Iron, zinc, and calcium can be found in various quantities in a pure vegan diet.

The clinic nurse is teaching newly diagnosed type 2 diabetics about nutritional diets. One of the subjects covered is how to figure out the recommended dietary allowance for protein in a healthy adult. The class is given the following exercise: What is the RDA for an individual weighing 75 kg? Which of the following is the correct RDA for protein for this individual? A) 30 g B) 45 g C) 60 g D) 75 g

C Feedback: The RDA for protein for a healthy adult is 0.8 g/kg; therefore, a healthy adult who weighs 75 kg has an RDA for protein of 60 g (0.8 g/kg × 75 kg = 60 g).

The nurse is admitting a healthy adult woman to the outpatient department for the removal of a plantar wart. She weighs 70 kg. What is her recommended dietary allowance (RDA) for protein? A) 42 g B) 49 g C) 56 g D) 63 g

C Feedback: The RDA for protein for a healthy adult is 0.8 g/kg; therefore, a healthy adult woman who weighs 70 kg has an RDA for protein of 56 g (0.8 g/kg × 70 kg = 56 g).

The client weighs 130 pounds. Calculate the client's protein RDA to the nearest whole gram. A) 33 g B) 40 g C) 47 g D) 54 g

C Feedback: The client's weight is divided by 2.2 to determine the weight in kilograms. The kilograms is then multiplied by 0.8 to determine the protein RDA, thus 130 ÷ 2.2 = 59; 59 × 0.8 = 47.2.

The nurse knows that instructions have been effective when the client verbalizes that a source of complete, high-quality protein is found in a. Peanut butter b. Black-eyed peas c. Soy burgers d. Corn

D

Which of the following sources of protein would be most appropriate on a low-fat diet? a. Eggs b. Ground chicken c. Boiled ham d. Turkey breast without skin

D

Which statement indicates the client understands vegetarian diets? a. "Vegetarians need to eat more calories than nonvegetarians in order to spare protein." b. "Vegetarian diets are always healthier than nonvegetarian diets." c. "Vegetarians usually do not consume enough protein." d. "Vegetarians may need to take supplements of iron, vitamin B12, and calcium."

D

The nurse has been explaining to a group of clients that proteins have many different functions in the body. What determines a protein's function? A) The quality of the protein B) The amino acids contained in the protein C) The completeness of the protein D) The shape of a protein

D Feedback: A protein's shape determines its function. The quality of the protein, the amino acid content, and the completeness of the protein do not determine the function of the protein in the body.

The body does not truly store protein. It does, however, maintain recycled amino acids from broken-down body proteins. What is this called? A) Metabolic store C) Amino acid store B) Protein turnover D) Metabolic pool

D Feedback: Although protein is not truly stored in the body as are glucose and fat, a supply of each amino acid exists in a metabolic pool of free amino acids within cells and circulating in blood. This pool consists of recycled amino acids from body proteins that have broken down and also amino acids from food.

The body needs an adequate supply of energy to prevent its protein being burned for energy. To prevent the burning of protein, termed "protein sparing," what does the body need an adequate supply of? A) Glucose B) Fat C) Carbohydrate D) Carbohydrate and fat

D Feedback: An adequate supply of energy from carbohydrate and fat is needed to spare protein from being burned for calories. The intake of glucose, fat, or carbohydrate alone does not prevent protein sparing.

Complementary proteins are made by combining two protein sources to make a complete protein. What is an example of a complementary protein? A) Black beans and kidney beans C) Butterscotch pudding B) Strawberry milk shake D) Macaroni and cheese

D Feedback: An example of a complementary protein is macaroni and cheese. Combining two different incomplete proteins or a small amount of any complete protein with an incomplete protein boosts the overall quality to that of a complete protein. Proteins that can be combined to obtain sufficient quantities and proportions of all essential amino acids are called complementary proteins. The components of the other foods do not act together to form a complete protein.

Amino acids, the building blocks of proteins, have the ability to act as buffers in the body. This means that proteins can maintain normal blood pH. By maintaining normal blood pH, the body's proteins are protected from being what? A) Neutralized B) Naturalized C) Deneutralized D) Denatured

D Feedback: Because amino acids contain both an acid (COOH) and a base (NH2), they can act as either acids or bases depending on the pH of the surrounding fluid. The ability to buffer or neutralize excess acids and bases enables proteins to maintain normal blood pH, which protects body proteins from being denatured. Proteins are not neutralized, naturalized, or deneutralized.

The range for protein for adults as recommended by the Acceptable Macronutrient Distribution Range for protein is what percentage of total calories? A) 25% to 50% B) 20% to 45% C) 15% to 40% D) 10% to 35%

D Feedback: The Acceptable Macronutrient Distribution Range for protein for adults is 10% to 35% of total calories.

Protein is an important nutrient that helps supply the body with the elements necessary for life. Protein can be used by the body for fuel when what occurs? A) Complete proteins are consistently ingested. B) When there are inadequate stores of iron in the body C) When the RDA for B vitamins are met D) When there is inadequate intake of calories

D Feedback: The nutrient that athletes most need to increase in their diet is calories. To bulk up, athletes need exercise, enough calories, and adequate protein. Protein is not used for fuel by the body just because it is consistently ingested, there are inadequate stores of iron present, or the RDA for B vitamins has not been met.

Protein is found in all MyPlate groups

FALSE Fruits generally provide negligible protein, and oils are protein free

Healthy adults are in a state of positive nitrogen balance.

FALSE Healthy adults are in neutral nitrogen balance: protein synthesis is occurring at the same rate as protein breakdown.

Protein is the nutrient most likely to be defi cient in a purely vegetarian diet.

FALSE Over the course of a day, if the food consumed is varied and contains sufficient calories, most vegetarian diets meet or exceed the RDA for protein.

Vegetarian diets are not adequate during pregnancy

FALSE Properly planned vegetarian diets are nutritionally adequate during all phases of pregnancy and lactation.

A protein classifi ed as "high quality" has the majority of calories provided by protein with few fat or carbohydrate calories.

FALSE The quality of a protein is determined by the balance of essential amino acids provided.

A high protein intake over time leads to kidney damage.

FALSE There are no proven risks to having a high protein intake.

The body stores extra amino acids in muscle tissue.

FALSE Unlike glucose and fat, the body is not able to store excess amino acids for later use.