HESI nutrition

What is the required average daily intake of calories in preschoolers?

1800

When a Schilling test is prescribed for a client suspected of having cobalamin deficiency because of pernicious anemia, what should the nurse plan to do?

24-48 hour urine A 24-hour to 48-hour urine specimen assesses parietal cell function. After radioactive cobalamin is administered, its excretion is measured; if cobalamin cannot be absorbed, as in pernicious anemia, very little is excreted in the urine. This test is not affected by medications. The results of this test are not affected by food; with pernicious anemia there is a deficiency of intrinsic factor, which is necessary for vitamin B12 use. Intake and output records are not necessary with a Schilling test.

A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. What is the primary cause of the client's ascites?

A decrease in plasma protein to maintain adequate capillary-tissue circulation Malnutrition and liver damage lead to a reduced serum albumin level and failure of the capillary fluid shift mechanism, resulting in ascites. Vitamins are unrelated to ascites. Iron promotes hemoglobin synthesis, which is unrelated to cirrhosis. The sodium level usually is excessive with cirrhosis.

discharge 3 day old baby what to report to provider

A loss of 12 oz (340 g) since birth, or more than 10%, is higher than the acceptable figure of 5% to 6%. Hemoglobin of 16.2 g/dL (162 mmol/L), total serum bilirubin of 10 mg/dL (171 µmol/L), and three wet diapers over the last 12 hours are all normal and expected findings.

nurse is caring for a client with heart failure. The healthcare provider prescribes a 2-gram sodium diet. What should the nurse include when explaining how a low-salt diet helps achieve a therapeutic outcome?

Allows excess tissue fluid to be excreted A decreased concentration of extracellular sodium causes a decrease in the release of antidiuretic hormone (ADH); this leads to increased excretion of urine. Sodium restriction does not control the volume of food intake; weight is controlled by a low-calorie diet and exercise (if permitted). The resulting elimination of excess fluid reduces the workload of the heart but does not improve contractility. Potassium is retained inefficiently by the body; an adequate intake of potassium is needed.

A client who has a history of seizures is scheduled for an arteriogram at 10:00 AM and is to have nothing by mouth before the test. The client is scheduled to receive an anticonvulsant medication at 9:00 AM. What should the nurse do?

Ask the healthcare provider to prescribe an alternate route of administration. To achieve the anticonvulsant effect, therapeutic blood levels must be maintained. If the client is not able to take the prescribed oral preparation, the healthcare provider should be questioned about alternate routes of administration. Omission will result in lowered blood levels, possibly to less than the necessary therapeutic level to prevent a seizure. The route of administration cannot be altered without healthcare provider approval. The client is being kept nothing by mouth.

Which nutrient deficiency in the pregnant adolescent may result in decreased birth weight as a consequence of low bone mineral density in the fetus?

calcium Calcium and vitamin deficiency may result in decreased birth weight as a consequence of low bone mineral density. Zinc deficiency may not lead to a decrease in bone mineral density. Iron deficiency may lead to anemia. Folic acid deficiency may result in neural tube defects.

The nurse finds that an adolescent has episodes of binge eating followed by self-induced vomiting and strenuous exercise. Which condition is the adolescent likely to have?

Bulimia Bulimia is a disorder characterized by repeated episodes of binge eating followed by inappropriate compensatory behavior, such as self-induced vomiting and/or strenuous exercise. Anorexia is an eating disorder characterized by low body weight. Orthorexia is a disorder in which the individual avoids certain foods, believing them to be harmful. Binge behavior is consumption of large amounts of foods in a brief time but without the subsequent compensatory behavior.

cushings disease

Common symptoms of Cushing disease are weight gain, truncal obesity, buffalo hump, and moon face because of deposits of adipose tissue. The condition is caused by excess cortisol secretion caused by hypersecretion of adrenocorticotropic hormone (ACTH). Other characteristics are diabetes mellitus, muscle wasting, osteoporosis, ecchymosis, and slow healing of wounds. Addison disease is adrenal insufficiency. Symptoms of Addison disease include hypotension, dehydration, hypoglycemia, and hyperpigmentation of the skin. Multiple sclerosis is a progressive disease involving destruction of the myelin sheath, leading to nerve damage. Kaposi sarcoma is a cancer associated with acquired immunodeficiency syndrome (AIDS)

A client with the diagnosis of bulimia nervosa, purging type, is admitted to the mental health unit after an acute episode of bingeing. Which clinical manifestation is most important for the nurse to assess?

dehydration The nurse should be alert for dehydration caused by fluid loss through vomiting in the binge-purge cycle. Weight gain is not expected because purging frequently follows a binge. Hyperactivity is not expected because many individuals with bulimia withdraw and vomit after a binge. Hyperglycemia is not expected because of the vomiting that follows a binge.

he nurse understands that research demonstrates that malnutrition occurs in as many as 50% of hospitalized clients. The nurse should assess a postoperative client with anorexia for what sign of malnutrition?

Delayed wound healing Delayed wound healing often is caused by a lack of nutrients, such as protein and vitamin C, in the diet. Dependent edema usually occurs with severe protein deficiency and heart failure. Spoon-shaped nails usually occur with iron deficiency anemia. Loose, decayed teeth usually indicate prolonged malnutrition.

A primary healthcare provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide to the client about the need to follow this diet?

Excessive aldosterone and cortisone cause retention of sodium and loss of potassium." Clients with Cushing syndrome must limit their intake of salt and increase their intake of potassium. The kidneys are retaining sodium and excreting potassium. An excessive secretion of adrenocortical hormones in Cushing syndrome, not increased or high sodium intake, is the problem. Although sodium retention causes fluid retention and weight gain, the need for increased potassium also must be considered. Because of steroid therapy, excess sodium may be retained, although potassium may be excreted.

The nurse is caring for a client 4 days after the client was admitted to the hospital with burns on the trunk and arms. The nurse collaborates with the dietician to develop a dietary plan for the following day. Which plan will the nurse follow?

High caloric intake, liberal potassium intake, and 3 g protein/kg/day A high-calorie diet is needed for the increased metabolic rate associated with burns; the administration of potassium prevents hypokalemia, which can occur after the first 48 to 72 hours when potassium moves from the extracellular compartment into the intracellular compartment; protein promotes tissue repair. High caloric intake, restricted potassium intake, and 1 g protein/kg/day do not meet the body's needs for tissue repair; the protein and potassium are too limited. Moderate caloric intake, liberal potassium intake, and 3 g protein/kg/day do not meet the body's needs for tissue repair; the calories are too limited. Moderate caloric intake, restricted potassium intake, and 1 g protein/kg/day do not meet the body's needs for tissue repair; the calories, potassium, and protein are too limited.

When discussing the therapeutic regimen of vitamin B12 for pernicious anemia with a client, what teaching does the nurse provide?

Intramuscular injections once a month will maintain control Intramuscular injections bypass the vitamin B12 absorption defect (lack of intrinsic factor, the transport carrier component of gastric juices). A monthly dose usually is sufficient because it is stored in active body tissues, such as the liver, kidney, heart, muscles, blood, and bone marrow. The Z-track method need not be used as it is for iron dextran injections. Because it is stored and only slowly depleted, injections once a month usually are sufficient. Vitamin B12 cannot be taken by mouth because of the lack of intrinsic factor.

The nurse is teaching a client about the prescribed diet after a Whipple procedure for cancer of the pancreas. Which statement should the nurse include in the dietary teaching?

Low-fat meals should be eaten to prevent interference with your fat digestion mechanism." Whipple procedure leads to malabsorption because of impaired delivery of bile to the intestine and interruption of glucose metabolism; interference with fat digestion occurs. Clients require small, frequent low-fat, high-protein, moderate-carbohydrate meals and supplemental feedings. The response "There are no dietary restrictions because the tumor has been removed" is false reassurance. High-calorie meals are needed to provide energy and to promote the use of protein for tissue repair. High protein is required for tissue building; there is no problem with the liver in clients with cancer of the pancreas unless metastasis occurs by direct extension.

Which statement is true about the diet plan for toddlers?

Milk should be supplemented with solid food items like vegetables and fruits. In toddlers, the parents should be supplementing the child's intake of milk with solid foods items, ensuring a balanced diet for adequate growth. Serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for independence and control. The intake of milk should be limited to 2 to 3 cups because the consumption of more than a quart of milk per day tends to decrease the child's appetite for essential solid foods and results in inadequate iron intake. Children below 2 years of age should not be given low-fat or skimmed milk because the fat is important for the physical and intellectual growth of the child.

The nurse is providing care to an infant who is diagnosed with cystic fibrosis (CF). Which parental statement indicates the need for further education related to the potential for poor growth?

My child will have a poor appetite, which will lead to poor growth. Pediatric clients who are diagnosed with CF experience poor growth despite a healthy appetite and diet; therefore, the parental statement indicates that the infant's poor appetite will lead to poor growth indicates the need for further education. Pediatric clients diagnosed with CF experience poor growth due to delayed bone growth, increased oxygen demands, and a decreased ability to absorb nutrients.

When assessing the characteristics of an adolescent with anorexia nervosa, how does the nurse expect to describe the adolescent?

Perfectionistic Perfectionistic standards and extremes of self-discipline are an attempt to maintain control and meet the client's own and others' expectations. People with anorexia nervosa are often anxious and depressed, not manic. People with anorexia nervosa are frequently compliant in an attempt to meet the expectations of others. People with anorexia nervosa usually use excessive exercise routines as a means of losing weight. Also, many are trying to become the thin, fit ideal woman depicted in the media.

A nurse instructs a client with viral hepatitis about the type of diet that should be ingested. Which lunch selected by the client indicates understanding about dietary principles associated with this diagnosis?

Salad, sliced chicken sandwich, gelatin dessert The diet should be high in carbohydrates, with moderate protein and fat content. A salad, chicken and gelatin meal is the best choice. Turkey salad, french fries, and sherbet are too high in fat. Cottage cheese, mixed fruit salad, and a milkshake are dairy products and may cause lactose intolerance; the hepatitis virus injures the intestinal mucosa and reduces the client's ability to metabolize lactose. Cheeseburger, tortilla chips, and chocolate pudding are too high in fat.

The nurse provides a list of appropriate food choices to a client with newly diagnosed diabetes. The client reviews the list and says, "I do not like and refuse to eat asparagus, broccoli, and mushrooms." In response, the nurse teaches the client about the food exchange list. The nurse evaluates that teaching was effective when the client states, "Instead of asparagus, broccoli, and mushrooms, I will eat which foods?

String beans, beets, or carrots. String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, or parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, or pretzels are from the bread exchange list.

A pregnant client with diabetes is referred to the dietitian in the prenatal clinic for nutritional assessment and counseling. What should the nurse emphasize when reinforcing the client's dietary program?

The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary Increased metabolic demands on the body during pregnancy require increased ingestion of calories; appropriate doses of insulin must be provided to permit glucose utilization by the body. The quantities of carbohydrates and fats, as well as of protein, are increased, not decreased, during pregnancy. Simply increasing carbohydrate intake is not sufficient to prevent ketosis. A low-calorie diet is contraindicated; it will not meet the demands of pregnancy on the client's body or the needs of the growing fetus.

A nurse is caring for a client with Addison disease. Which dietary instruction should the nurse teach the client to follow?

add salt Because of diminished mineralocorticoid secretion, clients with Addison disease are prone to developing hyponatremia. Therefore, the addition of salt to the diet is advised. Clients with Addison disease are prone to hyperkalemia. High-potassium foods can be restricted. Protein is not omitted from the diet; ingestion of essential amino acids is necessary for optimum metabolism and healing. Fluids are not restricted for clients with Addison disease.

Tests reveal that a client has phosphatic renal calculi. The nurse teaches the client that the diet may include which food item

apples Apples are low in phosphate; fresh fruit is low in phosphorus. Chocolate contains more phosphate than apples. Rye bread contains more phosphate than apples. Cheese is made with milk, which contains phosphate and should be avoided. Dairy products are high in phosphorus.

new salmonella

ask about the past 24 hour foods The salmonella organism thrives in warm, moist environments; all foods eaten within the last 24 hours are the most relevant data. Washing, cooking, and refrigerating food limit the growth of or eliminate the organism. Salmonellosis is unrelated to cancer. The salmonella organism, not stress, causes salmonellosis. The salmonella organism is ingested; it is not an airborne or blood-borne infection.

A nurse is helping an adolescent with type 1 diabetes establish a consistent meal pattern. What feedback from the adolescent indicates that further teaching is needed?

avoids complex carb substitutes Complex carbohydrates may be substituted, depending on caloric content and amount eaten per serving. Flexibility is needed to promote adherence to any dietary regimen. Using consistent portion sizes is a key to maintaining diabetic control. By weighing and measuring portion sizes for several months the adolescent learns to recognize the acceptable amount to be eaten at a glance. The adolescent should read nutrition labels carefully, especially for their carbohydrate and caloric content. Most dietetic foods contain sorbitol. Sorbitol metabolizes to fructose and then glucose, so its use should be restricted when possible.

All women of childbearing age are advised to include at least 400 mcg of folic acid in the daily diet to decrease the risk of neural tube defects in pregnancy. What should the nurse recommend to meet the recommendation? Select all that apply.

b9, and dark green leafy Vitamin B9 is folic acid, and legumes, dark-green leafy vegetables, and citrus fruits are natural sources of folic acid. Most women receive adequate vitamin A in their diets, and too much may cause birth defects. Vitamin B6 aids in metabolism conversion and the formation of red blood cells. Vitamin B12 is associated with nerve cells and red blood cells. Eggs, meat, and poultry are sources of vitamin B12.

After gastrointestinal surgery, a client's condition improves, and a regular diet is prescribed. Which food, included on a regular diet, should the nurse encourage the client to consume to decrease discomfort?

baked fish Baked fish is a low-residue, low-fat, high-protein, and non-gas-producing food that usually is tolerated well. Fresh fruit has fiber that irritates the gastrointestinal tract. Bran cereal has fiber that irritates the gastrointestinal tract. Whole milk irritates the gastrointestinal tract and stimulates mucus production.

A nurse is instructing a client with peptic ulcer disease (PUD) about the diet that should be followed during the acute phase. Which type of diet should the nurse stress?

bland A nurse is instructing a client with peptic ulcer disease (PUD) about the diet that should be followed during the acute phase. Which type of diet should the nurse stress?

Which food should be avoided by a client who is prescribed monoamine oxidase inhibitors (MAOIs)?

bologna Bologna has a high tyramine content; tyramine should not be consumed by clients taking monoamine oxidase inhibitors (MAOIs) because the drug interaction may cause severe hypertension. Potatoes and citrus fruits do not contain tyramine. Grapefruit juice may cause a negative drug interaction in clients taking buspirone.

hypokalemia

brocoli Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

A nurse is educating a group of parents about preschoolers. Which information provided by the nurse is incorrect? Select all that apply.

bulk and physical growth is faster Preschoolers have elongated legs, which makes their bodies appear slender. Their physical growth is slower than their cognitive development. The preschooler's intake of calories will be approximately 1800 per day. They consume a considerable amount of food equal to about one-half the diet of an adult. Preschoolers are choosy about their food around 4 years of age.

When determining whether a client has anorexia nervosa or bulimia nervosa, the nurse should identify those characteristics that relate only to anorexia nervosa. Select all that apply.

cachexia, delayed psychosexual development A state of malnutrition with muscle wasting, weakness, and emaciation (cachexia) occurs with anorexia nervosa; clients usually are 15% to 30% below ideal body weight. Many clients with anorexia nervosa exhibit psychological symptoms, including a lack of age-appropriate interest in sex and relationships. Recurrent episodes of the rapid consumption of a large amount of food in a discrete period (binge eating) are associated with bulimia nervosa. Constipation can occur with both anorexia nervosa and bulimia nervosa, usually because of a lack of adequate fluids and intestinally stimulating foods. Clients with anorexia nervosa or bulimia nervosa have intolerance of cold caused from a loss of body fat.

A client is to receive total parenteral nutrition (TPN) via a central venous access device/catheter. What information about this treatment would the nurse recognize as accurate?

can be intermitten Although the central venous catheter remains in situ, total parenteral nutrition does not have to infuse continuously. Continuous versus intermittent administration depends on the health care provider's prescription. Placement of the tube after the procedure is verified by x-ray, not fluoroscopy. The subclavian veins are used most often; the jugular vein is too close to hair-growing areas, which increases the possibility of sepsis, and neck movements may interfere with maintaining placement of the catheter. Although a feeling of pressure may be experienced, it is not a painful procedure.

getting rid of all cholesterol

cell membrane Cholesterol is an essential structural and functional component of most cellular membranes. That it is associated with atherosclerotic plaques does not detract from its essential functions. Cholesterol is not necessary for blood clotting; calcium and vitamin K are necessary. Cholesterol is not essential for bone formation; calcium, phosphorus, and calciferol are necessary. Cholesterol is not involved in muscle contraction; potassium, sodium, and calcium are necessary.

A client with hypertension is starting a 2-gram sodium diet. The nurse should teach the client to avoid which foods? Select all that apply.

chili and lunchmeat Canned chili is high in sodium and should be avoided. Luncheon meats are processed and have high sodium levels to help with their preservation and should be avoided. Ground beef is lower in sodium than are processed meats; however, beef is high in saturated fat. Canned salmon is high in sodium, but fresh salmon is not. Cooked, unprocessed broccoli does not have significant sodium levels.

What is the role of shark cartilage in the management of human immunodeficiency (HIV) and acquired immunodeficiency syndrome (AIDS)?

complimentary Shark cartilage is considered as an alternative or complementary therapy to prescribed medications for clients with HIV and AIDS. Lymphocyte transfusions and bone marrow transplants are used to improve immunity in clients with HIV and AIDS. Lemon juice and lemongrass may provide relief from oral thrush in some clients with HIV and AIDS. A high-calorie, high-protein diet is advised to clients with HIV and AIDS to improve their nutritional status.

A client with heart disease asks about cholesterol intake. When teaching the client, the nurse will explain what about cholesterol?

contributes to LDL Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats and can be decreased with unsaturated fats. Only animal foods furnish dietary cholesterol. Exercise, not cholesterol, increases HDL levels and helps decrease the risk of heart disease. Cholesterol is also produced by the body and is needed for the synthesis of bile salts and adrenocortical and steroid sex hormones and it should not be eliminated. Cholesterol contributes to heart disease but is not the cause.

A pregnant client asks the nurse for information regarding toxoplasmosis exposure during pregnancy. What information should the nurse teach this client?

cook pork and beef well Thorough cooking of pork and beef before consumption helps prevent ingestion of the cyst stage of the Toxoplasma protozoa. Even though toxoplasmosis is more prevalent in foreign countries, it occurs in the United States and its prevention should be addressed. Cooked shellfish are not related to toxoplasmosis, but raw or uncooked shellfish can be contaminated and should be avoided. Salad dressings made with mayonnaise are not linked to toxoplasmosis.

A nurse evaluates that a client with chronic kidney disease understands an adequate source of high biologic-value (HBV) protein when the client selects which food from the menu?

cottage cheese Cottage cheese contains more protein than the other choices. Apple juice is a source of vitamins A and C, not protein. Raw carrots are a carbohydrate source and contain beta-carotene. Whole wheat bread is a source of carbohydrates and fiber.

The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, what is the best recommendation the nurse can make?

decrease fast food Eating a variety of healthful foods instead of a fast-food diet that is high in fat and carbohydrates helps decrease excess weight and increase energy with which to engage in physical activities. Joining a gym is expensive and unnecessary. Physical activity can be achieved in the schoolyard or at home. A multivitamin will not promote weight loss. Vitamins and minerals are best obtained in a balanced diet. Diet soft drinks do not contribute to obesity.

While awaiting surgery, a client with a long history of Crohn disease is receiving total parenteral nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps to prepare for surgery by which process?

decreasing fecal bulk By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate gastrointestinal secretions. TPN promotes positive nitrogen balance.

A client presents to the emergency department with weakness and dizziness. The blood pressure is 90/60 mm Hg, pulse is 92 and weak, and body weight reflects a 3-pound (1.4 kilogram) loss in two days. The weather has been hot. Which condition should the nurse conclude is the priority for this client?

deficient fluid volume The low blood pressure indicates hypovolemia, the increased pulse is an attempt to maintain adequate oxygenation of tissues, and the rapid weight loss reflects loss of body fluid. Although impaired skin integrity is a concern with dehydration, it is not the priority. The rapid weight loss reflects a loss of fluid, not a loss of body tissue. Although the client may need assistance with activities, an inadequate intake of fluid has caused the client's dehydration, which is a serious medical problem that needs to be treated immediately.

to help prevent long-term complications associated with gastric bypass surgery, the nurse needs to educate the client. Identify the factors that should be included in the nurse's teaching plan for this client. Select all that apply.

eat calcium foods, injections of cyano, protein Calcium deficiency is a late complication of bariatric surgery because of inadequate absorption, even with an intake of calcium-rich foods; calcium supplementation may be necessary. Foods high in protein exit the stomach more slowly than foods high in carbohydrates, minimizing the dumping syndrome. Cyanocobalamin deficiency is a late complication of bariatric surgery because of a lack of intrinsic factor; gastric secretion is necessary for the absorption of cyanocobalamin. Lifelong supplementation may be necessary. Three small feedings daily will not provide adequate calories and nutrients; six small feedings with a total of 600 to 800 calories a day is routine once the client is eating. Clients need to increase, not limit, fluid intake; the dumping syndrome contributes to diarrhea, which can cause dehydration and electrolyte imbalance.

When caring for a client who is receiving enteral feedings, the nurse should take which measure to prevent aspiration

elevate HOB To prevent aspiration, the nurse should keep the head of the bed elevated between 30 and 45 degrees. Elevating the head any higher causes increased sacral pressure and increases the risk of skin breakdown. Decreasing flow rate, checking residual, and irrigating regularly will not prevent aspiration.

A client has been experiencing extreme fatigue lately. The nurse suspects anemia and examines the client to identify additional clinical manifestations to support this inference. Which locations on the client's body should the nurse assess? Select all that apply.

eyelids (conjunctiva), nail beds, palms Nail beds lose their pink coloration because of reduced hemoglobin. A reduced amount of hemoglobin decreases pink color of the lining of the eyelids (conjunctiva). Palms of the hands will become pale because of the decreased hemoglobin. Sclera is observed for signs of jaundice, not anemia, when they become pale yellow to orange. Bony prominences are not assessed when a client has anemia. Bony prominences are examined for redness caused by pressure that, if prolonged, can lead to a break in the skin and development of pressure ulcers.

A nurse is discussing an infant's diet with a mother who is breastfeeding. Why should the nurse recommend that the infant be offered solid foods by 5 or 6 months of age? Select all that apply.

fetal iron depleted, food can be taken from spoon Fetal iron reserves are depleted by the fifth to sixth month. Although breast milk or formula is the major form of nutrition during the second half of the first year, exogenous iron should be introduced in the form of foods, such as iron-fortified cereal. Exogenous iron prevents iron-deficiency anemia. Formula-fed infants can receive iron in iron-fortified formula and may be offered foods later in the first year. Because the extrusion reflex has disappeared by this age, breastfed infants should be offered foods that contain iron. Although overingestion of milk can cause weight gain, so can overingestion of solid food. It is not the bone marrow production of cells but the decreased production of hemoglobin that can cause iron-deficiency anemia. Breast milk still provides adequate nutrients. The American Academy of Pediatrics (Canada: Public Health Agency of Canada) recommends continuation of breastfeeding until at least 12 months of age.

kcal of sugars

for each gram of sugar it is 4 kcal

The nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history?

gastrectomy Removal of the fundus of the stomach (gastrectomy) destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B12 preliminary to its absorption in the ileum). Hemorrhaging may cause anemia; however, pernicious anemia occurs when the intrinsic factor is not produced. The beta cells of the pancreas are not involved in secretion of intrinsic factor. Dietary intake does not affect the production of intrinsic factor.

A pale, lethargic 1-year-old infant weighs 28 lb (12.7 kg) and has a hemoglobin level of 9 g/dL (90 mmol/L). The parent tells the nurse that the infant refuses solid food when it is offered by spoon and drinks between four and six full bottles of milk per day. What should the nurse recommend?

give finger foods A diet of only milk is not sufficient to meet the infant's iron needs. Meat and fortified cereals are high in iron. Finger foods are appropriate for older infants. At this age, weaning from the bottle is not the issue; supplementary iron intake is. Although health care and monitoring will be required, the metabolic clinic is not the appropriate referral. Although adding pureed baby foods to the milk would increase iron intake, a large hole in the nipple of the bottle is not desirable at this point.

While a nurse is teaching a client with diabetes about food choices, the client states, "I do not like broccoli." Which food should the nurse suggest to substitute for broccoli?

greenbeans According to exchange lists for meal planning, green beans and broccoli are equivalent vegetable substitutes. Peas are a starch and are not an equivalent vegetable substitute for broccoli. Corn is a starch and is not an equivalent vegetable substitute for broccoli. Mashed potato is a starch and is not an equivalent vegetable substitute for broccoli.

The parents of a school-aged child with newly diagnosed celiac disease ask a nurse what the intestinal biopsy revealed. Before responding in terms that the parents will understand, what should the nurse consider about the results of the biopsy?

intestinal wall trophic changes Celiac disease is a primary defect in which the intestinal mucosal transport system is impaired; the inability to digest gluten results in an accumulation of glutamine, which is toxic to mucosal cells and causes atrophy of the villi. The pancreatic acini degenerate with cystic fibrosis, not with celiac disease. Small areas of fatty plaques on the mucosal walls and irregular areas of superficial ulceration do not occur in celiac disease.

celiac disease

intolerance of gluten Celiac disease is an immunological small intestine enteropathy characterized by the inability to metabolize the gliadin component of gluten found in grains such as wheat, barley, rye, and oats; this results in excessive glutamine that is toxic to the mucosal cells. The stools are fatty and yellow. The intestinal villi are present but will atrophy if exposed to foods containing gluten. Fluid balance is not the basic problem with celiac disease; however, dehydration may occur in celiac crisi

During the initial prenatal visit of a woman at 23 weeks' gestation, the nurse discovers that she has a history of pica. What is the most appropriate nursing action?

is the diet sufficient Pica is characterized by having an appetite for non-nutritive substances such as ice. The primary concern for pregnant women with pica is that the diet may be nutritionally inadequate. Nutritional guidance may be necessary, depending on the findings of this assessment. Pica does not necessarily indicate a psychologic disturbance although sometimes it can. Frequently the client's culture promotes pica. If a substance is nontoxic to the mother, it is generally not fetotoxic either. Although iron is routinely prescribed during pregnancy, it does not specifically address the practice of pica. The nurse needs to assess this client first to see if she is currently practicing pica and, if so, evaluate its purpose for this client.

A nurse provides dietary teaching for a client with an acute exacerbation of ulcerative colitis, and afterward the client makes a list of foods that can be included on the diet. Which food choices indicate that the teaching by the nurse is effective? Select all that apply.

jelly, roast beef, eggs A jelly sandwich is low in residue and therefore is less irritating to the colon than other foods. Lean roast beef is low in residue and therefore is less irritating to the colon than other foods. Eggs are low in residue and therefore are less irritating to the colon than other foods. Orange juice contains cellulose (fiber), which is not absorbed and irritates the colon. Milk in creamed soup contains lactose, which is irritating to the colon

A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the client's discomfort?

lactase Milk and milk products are not tolerated well because they contain lactose, a sugar that is converted to galactose by lactase. Sucrase assists in the digestion of sucrose, which is not a milk sugar. Maltase assists in the digestion of maltose, which is not a milk sugar. Amylase assists in the digestion of starch, which is not a milk sugar

celiac disease

lifelong The diet must continue to be followed because the child will always have an absence of peptidase; some variations in the diet may be allowed, but this should not be promised. Each phase of child development may have problems related to dietary management; follow-up care is needed to prevent crises. A restricted diet is never easy to follow, especially for a growing child. Gluten must be avoided for a prolonged period and perhaps indefinitely.

A registered nurse provides dietary instructions to a client who is prescribed isocarboxazid for depression. Which statements made by the client indicates a need for further education? Select all that apply.

limiting fish, limiting yogurt, and limiting beer If a client is unresponsive to other antipsychotic drugs, isocarboxazid (a monoamine oxidase inhibitor) is used to treat depression. Clients taking isocarboxazid should avoid foods high in tyramine and should limit the intake of foods that contain a moderate amount of tyramine content because these foods may cause a hypertensive crisis. Fish, yogurt, and major domestic beers are low in tyramine content and should not be avoided as they generally do not cause hypertensive crisis. Large amounts of bananas or chocolate should be avoided as they can cause a reaction.

A pathology report states that a client's urinary calculus is composed of uric acid. Which food item should the nurse instruct the client to avoid?

liver Uric acid stones are controlled by a low-purine diet. Foods high in purine, such as organ meats and extracts, should be avoided. Milk should be avoided with calcium, not uric acid, stones. Cheese or animal protein should be avoided with cystine, not uric acid, stones. Vegetables do not have to be avoided.

To reduce the risk of recurrent painful gout attacks, the nurse teaches the client to avoid which foods? Select all that apply.

liver and shellfish Like other organ meats, liver is a high-purine food (range of 150 to 1000 mg/100 g) and should be avoided. Shellfish (e.g., shrimp, lobster) are also high-purine foods and should be avoided. Eggs and cheese have insignificant amounts of purine and are unrestricted. Foods that contain a moderate amount of purine (50 to 150 mg/dL), such as salmon, may be eaten four times a week.

A slightly overweight client is to be discharged from the hospital after a cholecystectomy. What is most important for the nurse to include in teaching the client about nutrition?

low fatty foods needed Bile, which aids in fat digestion, is not as concentrated as before surgery. Once the body adapts to the absence of the gallbladder, the client should be able to tolerate a regular diet that contains fat. Initially the client should avoid fatty foods unless otherwise indicated. A low-protein diet is not necessary. Although teaching the client about a low-calorie diet to promote weight reduction is important, it is not as important as temporary avoidance of fatty foods with the gradual resumption of a regular diet. While vitamin C, vitamin A, and zinc are important, they are not the priority

A client is admitted to the hospital with a diagnosis of Crohn disease. What is most important for the nurse to include in the teaching plan for this client?

meeting nutritional needs to avoid gastrointestinal pain and diarrhea, these clients often refuse to eat and become malnourished. The consumption of a high-calorie, high-protein diet is advised. Diarrhea, not constipation, is a problem with Crohn disease. Preventing an increase in weakness is a secondary concern that results from malnutrition; correcting the malnutrition will increase strength. Anticipating a sexual alteration generally is not a problem with Crohn disease.

A nurse is planning an evening snack for a child receiving NPH insulin. What is the reason for this nursing action?

nourishment counteracts late insulin activity A bedtime snack is needed for the evening. NPH insulin is intermediate-acting insulin, which peaks 4 to 12 hours later and lasts for 18 to 24 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycemia during the night when the NPH is still active. The snack is important for diet-insulin balance during the night, not encouragement. There are no data to indicate that extra calories are needed; a bedtime snack is routinely provided to help cover intermediate-acting insulin during sleep. The snack must contain mainly protein-rich foods, not simple carbohydrates, to help cover the intermediate-acting insulin during sleep.

What major cause of iron-deficiency anemia should the nurse include when planning a discussion with an infant's parents

overfeeding of milk Milk is an inadequate source of iron. Milk ingested in large amounts to the exclusion of solid foods after 4 to 6 months of age results in iron-deficiency anemia. Anemia is a type of blood disorder. Iron stores received from the mother in the last trimester usually are adequate for the infant's first 4 to 5 months. Lack of absorption of solid foods that are introduced too early is not the cause of anemia in infants.

cirrhosis of the liver

pasta banana A client with cirrhosis and ascites will require moderate to low fat and low sodium (penne pasta, spinach, banana, and decaffeinated iced tea). Caffeine can stimulate and cause distention. Ham, cheese, whole milk, potato chips, baked lasagna with sausage, milkshake, hamburger, french fries, and cola all have more fat and sodium than a client with cirrhosis should consume.

A parent is worried about the infant's excessive dependence on nonnutritive sucking. Which intervention will help decrease this dependence?

prolong feeding time An infant's dependence on nonnutritive sucking can be reduced by prolonging the feeding time, so that the sucking pleasure is increased. Using infant formulas will not help prevent nonnutritive sucking, because the child needs the pleasure of sucking. Using a pacifier as soon as the crying begins increases the child's dependence on nonnutritive sucking, because it reinforces a pattern of distress-relief. Wrapping the infant snugly most of the time may not be possible, because it may cause the infant to feel uncomfortable.

client is receiving total parenteral nutrition (TPN) through a central venous access device. What important nursing intervention should be included?

put into supine Placing the client in the supine position before changing the tubing decreases pressure in the vena cava, which helps prevent an air embolus when the catheter is disconnected. Infusion of high concentrations of glucose will cause hypervolemia, not hypovolemia. The infusion rate is changed only with a healthcare provider's prescription. Although insulin is contained in the parenteral nutrition formula, when blood glucose levels become elevated the healthcare provider may prescribe insulin coverage. No medications or solutions other than the parenteral nutrition should be administered through this line.

The nurse is helping an adolescent with iron-deficiency anemia make breakfast meal choices. Which foods should the nurse suggest?

raisin bran The iron content in the options is as follows: ¾ cup raisin bran, 13.5 mg; one slice of wheat bread, 0.9 mg; 1 cup of blueberry fruit yogurt, 0.2 mg; and apple fruit cup, 0.2 mg. The best choice is the bowl of raisin bran cereal, which has the highest iron content of all the choices.

A client is experiencing an exacerbation of ulcerative colitis. A low-residue, high-protein diet and IV fluids with vitamins have been prescribed. When implementing these prescriptions, which goal is the nurse trying to achieve?

reduce colonic irritation A low-residue diet is designed to reduce colonic irritation, motility, and spasticity. Reduction of gastric acidity is the aim of bland diets used in the treatment of gastric ulcers. Reducing colonic irritation, motility, and spasticity hopefully will increase, not reduce, intestinal absorption. This diet is to allow the bowel to rest, not to reduce infection rates.

duodenal ulcer pain

relieved with eating Duodenal ulcer pain is relieved with food and antacids and often awakens the client at night when sleeping. Gastric ulcer pain is worse with eating or one hour after eating.

A 17-year-old client is found to have anorexia nervosa. The psychiatrist, in conjunction with the client and the parents, decides to institute a behavior modification program. What does the nurse recall is a major component of behavior modification?

rewarding positive behavior In behavior modification [1] [2] [3], positive behavior is reinforced, and negative behavior is not reinforced or punished. Reducing the number or complexity of necessary restrictions, deconditioning the fear of weight gain, and reducing the number of anxiety-producing situations may all be part of the program, but none is a major component.

A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? Select all that apply.

rye, oats, and wheat

n older adult is returned to the surgical unit after having a subtotal gastrectomy. Which dietary modification should the nurse anticipate that the healthcare provider will most likely prescrib

small feedings Small, frequent feedings are tolerated best after a subtotal gastrectomy. Roughage may be irritating to the gastrointestinal (GI) tract after surgery. As soon as edema subsides, the individual generally is given small amounts of fluid, and then the diet is progressed gradually. Allowing only personal food preferences does not ensure inclusion of nutrients necessary for recovery.

A client with a history of a pulmonary embolus is to receive 3 mg of warfarin daily. The client has blood drawn twice weekly to ascertain that the international normalized ratio (INR) stays within a therapeutic range. The nurse provides dietary teaching. Which food selected by the client indicates that further teaching is necessary?

spinach Dark green, leafy vegetables are high in vitamin K. Influencing the level of vitamin K alters the activity of warfarin because vitamin K acts as a catalyst in the liver for the production of blood-clotting factors and prothrombin. The intake of foods containing vitamin K must be consistent to regulate the warfarin dose so that the INR remains within the therapeutic range. Eggs contain protein and are permitted on the diet. Yellow vegetables contain vitamin A and are permitted on the diet. Dairy products containing protein and bread supplying carbohydrates are permitted on the diet

The nurse is assessing a 2-year-old child for the presence of celiac disease. For what specific signs and symptoms should the nurse be alert? Select all that apply.

steaterhhea, distended abdomen, iron deficiency anemia The inability to absorb fat results in foul-smelling, bulky, fatty stools. A distended abdomen becomes noticeable in children between 6 and 18 months of age; this is in contrast to their spindly arms and legs and wasted buttocks. Inadequate protein absorption leads to iron-deficiency anemia. In contrast to the spindly extremities, these children have a plump face that hints of well-being. Hypoalbuminemia, not hyperalbuminemia, occurs because of inadequate protein absorption.

A nurse is teaching a client with diabetes about the treatment of hypoglycemia. The nurse knows that teaching was effective if the client picks which foods to treat a hypoglycemic attack?

sugar and bread The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); the simple sugar elevates the blood glucose level rapidly; the complex carbohydrates and protein produce a more sustained response. Fruit juice and a lollipop are fast-acting sugars, and neither of them will provide a sustained response. The fat content of chocolate candy decreases the rate of absorption of glucose. Neither peanut butter crackers nor a glass of milk is a fast-acting sugar; peanut butter crackers and milk can be used to maintain the glucose level after it is raised.

The parents of a 6-year-old child with celiac disease tell the school nurse that their child becomes dejected because she is not able to eat snack foods like the rest of her class and friends. What snack can the nurse recommend that is safe for the child to eat

tortilla chips Products composed of corn, rice, and millet do not contain gluten and are permitted on a low-gluten diet; tortilla chips are made from corn flour. Pretzels contain wheat flour, which is not permitted on a low-gluten diet; products containing rye, oats, and barley are also restricted. Oatmeal cookies contain oats, which are not permitted on a low-gluten diet. Peanut butter crackers contain wheat flour, which is not permitted on a low-gluten diet.

The nurse provides teaching to a client who will begin to receive tube feedings after a total laryngectomy. The nurse concludes that the teaching was understood when the client makes which statement about tube feedings?

tube feeding till incision is fixed Food should be avoided until the area is healed completely; this will keep the area from becoming irritated and contaminated. Because of the alterations in structure, the gag reflex is no longer present. The ability to belch has no bearing on the decision to resume oral feedings. The ability to tolerate oral feedings is not lost; such feedings are withheld to prevent irritation to the surgical site until healing has taken place.

A client with osteoporosis has been receiving dietary information from the nurse. Which food selection by the client indicates that the nurse's dietary instruction was effective?

turnip greens Turnip greens are high in calcium and vitamins. A high level of nitrogen from protein breakdown may increase the release of calcium from bone to serve as a buffer of the nitrogen. Soft drinks that are high in phosphorus may interfere with calcium absorption from the gastrointestinal (GI) tract. Enriched grains that are high in phosphorus may interfere with calcium absorption from the GI tract.

Which recommendation is most important for the nurse to include in a teaching program for a client who has been placed on a 2-gram sodium diet?

use lemon juice to flavor meat Lemon juice adds flavor and is low in sodium. Condiments (e.g., mustard, ketchup) are high in sodium and should be avoided. Canned vegetables contain a large amount of sodium; fresh vegetables should be encouraged. Carbonated beverages generally contain sodium; coffee, even if it is decaffeinated, does not contain sodium.

A client will be taking cholestyramine, a bile acid sequestrant, as treatment for type II hyperlipoproteinemia. What vitamin does the nurse anticipate may become deficient because of this drug therapy?

vitamin D Bile acid sequestrants (also known as bile acid-binding resins) bind with bile acids to form an insoluble compound that is then excreted in the bowel movements. These drugs decrease the absorption of fat-soluble vitamins (A, D, E, K). Vitamins B3, C, and B12 are water-soluble vitamins and therefore are not affected by the administration of this drug.

A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery?

whole bran Whole bran provides bulk that promotes intestinal motility and a regular bowel movement. Vitamins are not related to normalizing bowel function. Cod liver oil is not related to regulating bowel function. Amino acids are not related to regulating bowel function.