Nutrition
The total cholesterol level of which adult female patient indicates the need for health teaching about a low-cholesterol diet? 1. 200 mg/dL 2. 190 mg/dL 3. 150 mg/dL 4. 100 mg/dL
1. CORRECT: A total cholesterol level of 200 mg/dL in a woman is on the high side of the acceptable range. A total cholesterol level should be 200 mg/dL or less. Patients should be taught the foods to avoid that are high in cholesterol to prevent excessive cholesterol levels. 2. 190 mg/dL is an acceptable level of cholesterol for an adult woman. 3. 150 mg/dL is an acceptable level of cholesterol for an adult woman. 4. 100 mg/dL is an acceptable level of cholesterol for an adult woman.
Which nutrient should the nurse encourage a patient to include in the diet to provide vitamin D? 1. Green leafy vegetables 2. Vegetable oils 3. Fortified milk 4. Organ meats
1. Green leafy vegetables are an excellent source of vitamin K, not D. 2. Vegetable oils are an excellent source of vitamin E, not D. 3. CORRECT: Not many foods contain vitamin D; therefore, it should be supplemented with fortified food, such as milk. One quart of fortified milk contains the Recommended Daily Allowance (RDA) of vitamin D for children. 4. Liver is an excellent source of vitamin K, not D.
Why would the nurse provide special instructions to nursing assistive personnel (NAP) before feeding a patient with dysphagia? A. To reduce the risk of aspirating food or fluids B. To ensure that an accurate intake measurement is reported C. To encourage the patient to eat more of the food items on the meal tray D. To ensure that the NAP knows which foods to avoid when feeding the patient
A The nurse gives special instructions before the NAP feeds a patient with dysphagia because such teaching reduces the risk that the patient will aspirate food or fluids.
Which of the following manifestations would be an early sign of silent aspiration? A. Heart rate: 129 B. Blood pressure: 90/60 C. Respiratory rate: 30 D. Temperature: 38.2° C
C Tachypnea (respirations above 26) is an early sign of silent aspiration
A practitioner orders a clear liquid diet for a patient. Which food should the nurse teach the patient to avoid when following this diet? 1. Strawberry gelatin 2. Decaffeinated tea 3. Strong coffee 4. Ice cream
1. Gelatin is a clear liquid that is a solid when refrigerated and a liquid at room temperature. It is permitted in either form on a clear liquid diet. 2. Caffeinated or decaffeinated tea is permitted on a clear liquid diet. 3. Weak or strong and caffeinated or decaffeinated coffee is permitted on a clear liquid diet. 4. CORRECT: Milk and milk products are not included on a clear liquid diet. Ice cream contains a high-solute load, including fat and proteins, which stimulates the digestive process.
Which food item would not be given to a patient on a dysphagia diet? A. Egg salad sandwich on wheat bread B. Biscuits and gravy with scrambled eggs C. Chicken noodle soup D. Rice pudding
C All of the foods listed may be eaten by a patient on a dysphagia diet except the chicken noodle soup. The liquid portion of the soup is not viscous enough to form a soft bolus in the mouth.
A nurse is caring for a patient who is confused and disoriented. What type of food containing chicken is most appropriate for this patient? 1. Soup 2. Salad 3. Fingers 4. Casserole
1. A confused patient may not know how to manipulate a spoon to eat soup. This may result in spilling and frustration. 2. Eating chicken salad requires the use of a utensil that may be beyond the patient's cognitive ability. 3. CORRECT: This is a single food item that usually is familiar to most people in the United States. A single familiar food is an easier symbol to decode cognitively than food mixed together on a plate or in a casserole. In addition, food that the patient can eat with the fingers, rather than a utensil, promotes independence. 4. Eating a casserole requires the use of a utensil that may be beyond the patient's ability. In addition, food mixed together is more confusing than food that is presented individually.
An older adult is admitted to the hospital for multiple health problems. Assessment reveals that the patient has no teeth and is having difficulty eating. Which diet should the nurse encourage the practitioner to order for this patient? 1. Liquid supplements 2. Mechanical soft 3. Pureed 4. Soft
1. A person with few, or no teeth, should be able to meet all daily nutrient requirements without liquid supplements. 2. CORRECT: A mechanical soft diet is modified only in texture. It includes moist foods that require minimal chewing and eliminates most raw fruits and vegetables and foods containing seeds, nuts, and dried fruit. 3. A person with few, or no teeth, can handle a diet with a more solid consistency than pureed foods. A pureed diet is a soft diet processed to a semisolid consistency. 4. A person with few, or no teeth, can handle a diet with a more solid consistency than a soft diet. A soft diet is moderately low in fiber and lightly seasoned. A soft diet usually is ordered for patients who are unable to tolerate a regular diet after surgery as a transition between liquids and a regular diet.
The nurse is evaluating the effectiveness of a nutritional program. Which clinical finding is the best short-term indicator of an improved nutritional status? 1. Weight gain of two pounds daily 2. Increasing transferrin level 3. Decreasing serum albumin 4. Appropriate skin turgor
1. A rapid weight gain indicates fluid retention, not nutritional status. One liter of fluid weighs 2.2 pounds. 2. CORRECT: Serum transferrin is a marker for protein status. Because its half-life is 8 days compared with albumin, which is 20 days, serum transferrin levels will provide earlier objective information concerning a person's increasing or decreasing nutritional status. 3. A decreasing serum albumin level indicates a deteriorating, not improving, nutritional status. A serum albumin level should range between 3.5 and 5.0 g/dL. Mild depletion values range between 2.8 and 3.4 g/dL. Moderate depletion values range between 2.1 and 2.7 g/dL. In severe depletion, values are less than 2.1 g/dL. 4. Appropriate skin turgor, fullness, and elasticity that allow the skin to spring back to its previous state after being pinched reflect an adequate fluid, not nutritional, balance.
A nurse is assessing a patient who is admitted to the hospital with withdrawal from alcohol. The nurse anticipates that excessive alcohol intake will directly contribute to health problems because it: 1. Lengthens passage time of stool through the intestinal tract 2. Decreases the absorption of many important nutrients 3. Accelerates the absorption of medications 4. Interferes with the absorption of glucose
1. Alcohol increases intestinal motility so that it decreases, not increases, the length of time it takes intestinal contents to pass through the body. 2. CORRECT: Alcohol interferes with vitamin intake, absorption, metabolism, and excretion. It specifically interferes with the absorption of vitamins A, D, K, thiamine, folic acid, pyridoxine, and B12. 3. The damaging effects of alcohol decrease, not increase, the efficiency of the process of absorption of medications in the stomach and intestines. However, alcohol can potentiate the action of drugs, such as central nervous system depressants. 4. Alcohol interferes with the absorption of thiamine, which is essential to oxidize, not absorb, glucose.
A patient is anorexic because of stomatitis related to chemotherapy. What should the nurse be most concerned about when planning care for this patient? 1. Aspiration 2. Dehydration 3. Malnutrition 4. Constipation
1. Although in some patients stomatitis may cause difficulty with swallowing (dysphagia), which may contribute to aspiration, a bland diet soft in consistency will help to minimize dysphagia. 2. Fluids promote a softer stool and activity increases peristalsis. Ingesting adequate amounts of fluid generally is not a problem as long as acidic fluids are avoided because they irritate the lesions of the mucous membranes. 3. CORRECT: Stomatitis, inflammation of the mucous membranes of the oral cavity, can be painful. Patients with stomatitis frequently avoid eating to limit discomfort, which can lead to inadequate nutritional intake and malnutrition. 4. Although a loss of appetite may contribute to constipation, an increase in fluid intake and activity can help prevent constipation.
A nurse identifies that a vegetarian understands the importance of eating kidney beans when the patient says, "Kidney beans are essential because they are a great source of: 1. carbohydrates." 2. minerals." 3. protein." 4. fats."
1. Although kidney beans are an excellent source of carbohydrates, a vegetarian diet has many other foods that can be selected to provide this nutrient. 2. Although kidney beans are an excellent source of minerals, especially sodium, potassium, and phosphorus, a vegetarian diet has many other foods that can be selected to provide this nutrient. 3. CORRECT: Kidney beans are high in protein. One cup of kidney beans contains 15 g of protein. Complete proteins come from animal sources, such as meat, poultry, and fish, but they are not included on a vegetarian diet. Kidney beans combined with a grain are a substitute for a complete protein. 4. One cup of kidney beans contains only 1 g of fat.
A patient is diagnosed with iron deficiency anemia. Which major cause of iron deficiency will influence a focused assessment by the nurse? 1. Metabolic problems 2. Inadequate diets 3. Malabsorption 4. Hemorrhage
1. Although the inability to form hemoglobin in the absence of other necessary factors, such as vitamin B12 (pernicious anemia), can result in iron deficiency, it is not the major cause of iron deficiency. 2. CORRECT: The most common nutrient deficiency in the United States is that of iron, which results from an inadequate supply of dietary iron. The major condition indicating iron deficiency is anemia. 3. Malabsorption of iron is not the major cause of iron deficiency, although a lack of gastric hydrochloric acid is necessary to help liberate iron for absorption and the presence of phosphate or phytate, inhibitors of iron absorption, all can precipitate malabsorption of iron. 4. Although hemorrhage can precipitate iron deficiency, it is not the major etiological factor.
Which is the most common independent nursing intervention to help hospitalized older adults maintain body weight? 1. Making meal time a social activity 2. Taking a thorough nutritional history 3. Providing assistance with the intake of meals 4. Encouraging dietary supplements between meals
1. Although this is desirable, it may be impractical or impossible in an acute-care facility. Patient rooms may be private or semiprivate, which limits exposure to other patients, and patients often are too sick to socialize. 2. Although this is done, the information will not necessarily improve intake. 3. CORRECT: Sick older adults often are debilitated, lack energy, and do not feel well. Assistance with meals conserves the patient's energy and demonstrates a caring concern, which may increase the intake of food. 4. This is a dependent function of the nurse and requires a practitioner's order.
A nurse is teaching a patient about the importance of balancing protein, carbohydrates, and fats in the diet. The nurse identifies that the teaching about carbohydrates is understood when the patient states, "Carbohydrates are best known for providing: 1. Electrolytes." 2. Vitamins." 3. Minerals." 4. Energy."
1. An electrolyte is a chemical substance that, in solution, dissociates into electrically charged particles. Electrolytes maintain the chemical balance between cations and anions in the body, which is essential for acid-base balance. 2. Vitamins are organic compounds that do not provide energy but are needed for the metabolism of energy. 3. Minerals are inorganic elements or compounds essential for regulating body functions. The major minerals of the body are calcium, phosphorus, sodium, potassium, magnesium, chloride, and sulfur. 4. CORRECT: Carbohydrates, a group of organic compounds, such as saccharides, starch, cellulose, and gum, are the main fuel sources for energy. Athletes competing in endurance events often adhere to a diet that increases carbohydrates to 70% of the diet for the last 3 days before a race (carbohydrate loading) to maximize muscle glycogen storage.
A school nurse is preparing a health class about vitamins. Which information about vitamins that is based on a scientific principle should the nurse include? 1. Eating a variety of foods prevents the need for supplements 2. Megadoses of vitamins have proved to be most effective in preventing illness 3. Taking a prescribed vitamin supplement is the best way to ensure adequate intake 4. Vitamins that are more expensive are more pure than those that are less expensive
1. CORRECT: A balanced diet with choices in moderation from a variety of foods will provide the recommended daily allowances of essential nutrients without the need for supplements 2. Megadoses of vitamins no longer operate as nutritional agents and excesses are detrimental to the body, particularly to the liver and brain. 3. Vitamins by themselves will not ensure an adequate intake. Their action contributes to chemical reactions (i.e., they act as catalysts), and they must have their substrate material to work on, which are carbohydrates, protein, and fats and their metabolites. 4. This may or may not be true.
A practitioner orders a low-residue diet. Which food should the nurse teach the patient to include in the diet? 1. Scrambled eggs 2. Orange juice 3. Green beans 4. Rye bread
1. CORRECT: All eggs, except fried, are permitted on a low-residue diet. A low-residue diet is easily digested and absorbed and limits bulk in the intestines after digestion. 2. Orange and grapefruit juice contain pulp, a soluble fiber, which is not permitted on a low-residue diet. 3. Green beans contain polysaccharides that provide structure to plants and result in a residual after digestion that is not permitted on a low-residue diet. One cup of green beans contains 4.19 g of dietary fiber. 4. Whole-grain breads, breads with seeds or nuts, and bread made with bran consist of insoluble fibers that are not permitted on a low-residue diet.
A patient is admitted to the hospital with a history of liver dysfunction associated with hepatitis. The nurse anticipates that this patient may have problems with: 1. Emulsifying fats 2. Digesting carbohydrates 3. Manufacturing red blood cells 4. Reabsorbing water in the intestines
1. CORRECT: Bile is produced and concentrated in the liver and stored in the gallbladder. As fat enters the duodenum, it precipitates the release of cholecystokinin, which stimulates the gallbladder to release bile. Bile, an emulsifier, enlarges the surface area of fat particles so that enzymes can digest the fat. 2. The liver is not involved with carbohydrate digestion. Ptyalin (secreted by the parotid glands), amylase (secreted by the pancreas), and sucrase, lactase, and maltase (secreted by the walls of the small intestine) digest carbohydrates. 3. The liver is not involved with red blood cell production. People who are deficient in iron and protein have difficulty with red blood cell production. 4. The large intestine, not the liver, is involved with reabsorbing water. The majority of the water in chyme is reabsorbed in the first half of the colon, leaving the remainder (approximately 100 mL) to form and eliminate feces.
A patient of Latino heritage is to eat a low-fat diet. The patient tells the nurse, "I am going to have a hard time giving up my favorite family recipes." Which food should the nurse recommend that is low in fat and generally is included in the Latino culture? 1. Salsa 2. Pasta 3. Steamed fish 4. Refried beans
1. CORRECT: Salsa predominantly contains tomatoes, onions, and peppers, all which are low in fat. 2. Pasta contains predominantly carbohydrates, not fat. In addition, in the Latino culture, rice and beans are preferred over pasta. Pasta is associated with the Italian culture. 3. Although steamed fish is low in fat, foods in the Latino culture are generally stewed or fried. Vegetables, legumes, and meat usually are preferred over fish. 4. Refried beans are a fried food that should be avoided on a low-fat diet. Frying involves cooking food with a saturated or unsaturated fat solution, which is composed mostly of fatty acids. Fatty acids combine with glycerol to form triglycerides.
A patient without any identified current health problems is having a yearly physical examination. The laboratory results indicate the presence of ketosis. Which rationale explains the presence of ketosis in this otherwise healthy adult? 1. Inadequate intake of carbohydrates 2. Increased intake of protein 3. Excessive intake of starch 4. Decreased intake of fiber
1. CORRECT: When the amount of carbohydrates ingested does not meet the energy requirements of an individual, the body will break down stored fat to meet its energy needs. Ketone bodies are produced during the oxidation of fatty acids. 2. An increased intake of protein helps meet energy demands because when the energy from carbohydrates is depleted, the body converts protein and fatty acids to glucose (gluconeogenesis). 3. Starch is the major source of carbohydrates in the diet and it yields simple sugars on digestion. 4. Fiber is unrelated to ketosis.
An older adult tends to bruise easily and the practitioner recommends that the patient eat foods high in vitamin K. In addition to teaching the patient about foods sources of vitamin K, the nurse should include nutrients that must be ingested for vitamin K to be absorbed. Which foods that increase the absorption of vitamin K should be included in the teaching plan? 1. Carbohydrates 2. Starches 3. Proteins 4. Fats
1. Carbohydrates are not necessary for the absorption of vitamin K. 2. Starch is not necessary for the absorption of vitamin K. 3. Proteins are not necessary for the absorption of vitamin K. 4. CORRECT: Vitamin K is one of the fat-soluble vitamins (A, D, E, and K) that are absorbed in the presence of fat. Vitamin K plays an essential role in the production of the clotting factors II (prothrombin), VII, IX, and X.
A patient of Asian heritage is recommended to follow a low-fat diet to lose weight. Which food low in fat generally is consumed by members of an Asian population? 1. Egg rolls 2. Spareribs 3. Crispy noodles 4. Hot and sour soup
1. Egg rolls are a fried food. Frying involves cooking food in a solution consisting of saturated or unsaturated fat, which is composed mostly of fatty acids. Fatty acids combine with glycerol to form triglycerides. 2. Spareribs are high in saturated fat and cooked with sauces that are high in saturated or unsaturated fat. 3. Crispy noodles are a fried food that should be avoided. Frying involves cooking food with a saturated or unsaturated fat solution, which is composed mostly of fatty acids. Fatty foods on a low-fat diet should be eaten raw or cooked by broiling, baking, or boiling. 4. CORRECT: Hot and sour soup contains less fat than the other food choices listed.
The nurse is caring for a patient receiving bolus enteral feedings several times daily. Which nursing intervention is most important to help prevent diarrhea? 1. Flush the tube after every feeding 2. Check the residual before each feeding 3. Elevate the head of the bed 30 degrees continuously 4. Discard the refrigerated opened cans of formula after 24 hours
1. Flushing the tube after every feeding moves the formula into the stomach and helps maintain tube patency; it does not reduce the risk of diarrhea 2. Checking residual volume informs the nurse about the absorption of the last feeding. This step prevents the addition of more feeding than the patient can digest; it does not prevent diarrhea. Generally feedings are withheld when a certain residual volume is identified. Protocols may include withholding the next feeding when 150 mL is aspirated, when half the volume of the last feeding is aspirated, or may be based on specific instructions prescribed by the practitioner. 3. Elevating the head of the bed 30 degrees at all times helps to keep the formula in the stomach via the principle of gravity and helps to prevent aspiration; it does not prevent diarrhea. 4. CORRECT: Contaminated formula can cause diarrhea. Cans of opened formula support bacterial growth and must be discarded after 24 hours even when refrigerated.
A nurse is reviewing the laboratory findings of a patient to assess the patient's nutritional status. Which laboratory finding is the best indicator of inadequate protein intake? 1. High hemoglobin 2. Low serum albumin 3. Low specific gravity 4. High blood urea nitrogen
1. Hemoglobin concentration of the blood correlates closely with the red blood cell count. Elevated hemoglobin suggests hemoconcentration from increased numbers of red blood cells (polycythemia) or dehydration. 2. CORRECT: Serum proteins, particularly albumin, reflect a person's skeletal muscle and visceral protein status. An expected serum albumin level ranges between 3.5 and 5.0 g/dL. Mild depletion ranges between 2.8 and 3.4 g/dL. Moderate depletion ranges between 2.1 and 2.7 g/dL. Severe depletion is less than 2.1 g/dL. 3. Specific gravity is a urine test that measures the kidney's ability to concentrate urine. A low specific gravity reflects dilute urine that suggests a high urine volume, diabetes insipidus, kidney infections, or severe renal damage with disturbances in concentrating and diluting abilities. 4. Blood urea nitrogen (BUN) measures the nitrogen fraction of urea, a product of protein metabolism. An elevated BUN suggests renal disease, reduced renal perfusion, urinary tract obstruction, and increased protein metabolism.
A patient has multiple fractures from a skiing accident. To best facilitate bone growth the nurse should encourage the patient to eat more foods high in calcium. Which food selected by the patient indicates an understanding of foods that are high in calcium? 1. Orange juice 2. Peanut butter 3. Cottage cheese 4. Baked flounder
1. One cup of orange juice contains only 27 mg of calcium. 2. One tablespoon of peanut butter contains only 5 mg of calcium. 3. CORRECT: Cottage cheese has the highest amount of calcium of all the options and is an excellent source of calcium, which is essential for bone growth. One cup of cottage cheese contains 155 mg of calcium. The NIH Consensus Conference—Optimal Calcium Intake recommends an average intake of 1000 to 1500 mg of calcium daily for an adult depending on various factors. 4. Three ounces of baked flounder contains only 13 mg of calcium.
A patient is diagnosed with a vitamin A deficiency. Which type of pie should the nurse encourage the patient to ingest? 1. Blueberry 2. Pumpkin 3. Cherry 4. Pecan
1. One piece of blueberry pie contains only 14 μgRE (Retinol Equivalents) of vitamin A. 2. CORRECT: Pumpkin is an excellent source of vitamin A. One piece (one-sixth of a 9-inch diameter pie) contains 3750 μgRE (Retinol Equivalents) of vitamin A. 3. One piece of cherry pie contains only 70 μgRE of vitamin A. 4. One piece of pecan pie contains only 115 μgRE of vitamin A.
What is unrelated to the balance of calcium in the body? 1. Osteoporosis 2. Vitamin D 3. Tetany 4. Iron
1. Osteoporosis is a disease characterized by a decrease in total bone mass and deterioration of bone tissue that leads to bone fragility and the risk of fractures. Adequate calcium is necessary for building and strengthening bones and preventing osteoporosis. 2. Vitamin D promotes bone mineralization by producing transport proteins that bind calcium and phosphorus. This increases intestinal absorption, stimulates the kidneys to return calcium to the bloodstream, and stimulates bone cells to use calcium and phosphorus to build and maintain bone tissue. 3. A decrease in calcium in the blood (hypocalcemia) can eventually lead to tetany, which is characterized by muscle spasms, paresthesias, and convulsions. 4. CORRECT: Iron is unrelated to calcium balance. Iron is essential for hemoglobin formation.
A nurse is caring for patients with a variety of nutrition-related problems. Which problem eventually may require a patient to have a nasogastric feeding tube inserted? 1. Malabsorption syndrome 2. Difficulty swallowing 3. Nausea and vomiting 4. Stomatitis
1. This is not an appropriate therapy for a patient with malabsorption syndrome. A gastrostomy tube permits a formula to be instilled into the stomach, which then progresses to the small intestine where absorption takes place. Depending on the etiology, it can cause gastrointestinal irritation, increased intestinal motility, diarrhea, and dehydration. 2. CORRECT: If a patient with difficulty swallowing (dysphagia) does not respond to a dysphagia diet (mechanical soft, soft, blended or pureed liquids) there may be a need for the insertion of a gastrostomy tube. Gastrostomy feedings can be administered to meet nutritional needs and minimize the risk of aspiration. 3. Gastric tube feedings are contraindicated in the presence of vomiting because of the potential for aspiration. The cause of the nausea and vomiting should be identified and treated. 4. This is a drastic measure for stomatitis. Stomatitis, an inflammation of the mouth, usually is a temporary problem that responds to pharmacological therapy and frequent, appropriate oral hygiene.
An occupational nurse is facilitating a weight reduction group discussion. What should the nurse explain is the most common contributing factor of obesity? 1. Sedentary lifestyle 2. Low metabolic rate 3. Hormonal imbalance 4. Excessive caloric intake
1. This is only one theory associated with the cause of obesity. 2. This is only one theory associated with the cause of obesity. 3. This is only one theory associated with the cause of obesity. 4. CORRECT: This is the basis of all weight gain regardless of the etiology. Excess ingested nutrients are stored in adipose tissue (fat) and muscle, which increases body weight. Obesity is body weight 20% or greater than ideal body weight. Glucose is stored as glycogen in the liver and muscle with surplus amounts being converted to fat. Glycerol and fatty acids are stored as triglycerides in adipose tissue. Excess amino acids are used for glucose formation or are stored as fat.
An obese resident of a nursing home who is receiving a 1500-calorie weight reduction diet has not lost weight in the past 2 weeks. What should the nurse do? 1. Inform the primary care practitioner of the patient's lack of progress 2. Instruct the patient to limit intake to 1000 calories per day 3. Schedule a multidisciplinary team conference 4. Keep a log of the oral intake for 3 days
1. This is premature. The nurse is abdicating the responsibility to help the patient. 2. A change in diet requires a practitioner's order. Generally, calories should not be restricted below 1200 cal/day for women or 1500 cal/day for men so that there are adequate amounts of essential nutrients. 3. This may eventually be done, but it is premature at this time. 4. CORRECT: When the expected outcome of an intervention is not attained, the situation must be reassessed to determine the problem and the plan changed appropriately. A record of a dietary intake provides complete objective information about the amounts and types of food consumed. This information provides data about nutrient deficiencies or excesses, eating patterns, behaviors associated with eating, and potential problems and needs.
What are the major concerns for the nurse caring for a patient receiving parenteral nutrition (PN)? A. Infection and hyperglycemia B. Hyponatremia and hypoglycemia C. Diarrhea or constipation D. Hypoxia and dehydration
A Infection and hyperglycemia are major concerns and complications related to PN.
The nurse is teaching a patient about a healthy diet. Which nutrients would the nurse teach the patient to include? A. Protein, carbohydrate, fat, vitamins, and minerals B. Protein, carbohydrate, little or no fat, a water-soluble vitamin, and mineral supplements C. Protein, carbohydrate, trans fats, vitamins, and minerals D. Protein, carbohydrate, saturated fats, a fat-soluble vitamin, and mineral supplements
A Protein, carbohydrate, fat, fat- and water-soluble vitamins, and minerals are all part of a healthy diet. Vitamins and minerals are best obtained from a balanced diet unless deficiencies exist that may require supplementation. Fat intake is necessary to obtain essential fatty acids that have a role in cell membrane structure and hormone production.
When assisting a patient who has self-feeding difficulties, why would the nurse ask the patient to try to self-feed? A. To determine what kind of assistance the patient needs with feeding B. To identify which food item is causing the trouble C. To identify which hand the patient uses for utensils D. To promote the patient's sense of self-confidence
A The nurse would ask the patient to try to self-feed in order to determine what specific assistance or assistive devices the patient needs during meals.
A nurse in a senior center is counseling a group of older adults about their nutritional needs and considerations. Which of the following information should the nurse include? (select all that apply) A. Older adults are more prone to dehydration than younger adults are. B. Older adults need the same amount of most vitamins and minerals as younger adults do. C. Many older men and women need calcium supplementation. D. Older adults need more calories than they did when they were younger. E. Older adults should consume a diet low in carbohydrates.
A, B, C A. Sensations of thirst diminish with age, leaving older adults more prone to dehydration. B. These requirements do not change from middle adulthood to older adulthood. C. They may ingest insufficient calcium in the diet and may need supplements to help prevent bone demineralization (osteoporosis).
Which information should the nurse teach a patient to prevent foodborne illness? (Select all that apply.) A. Refrigerate foods at 40° F within 2 hours of cooking. B. Cook meat, poultry, fish, and eggs until well done (180° F). C. Do not use food past expiration date. D. Foods may be safely thawed on the kitchen counter overnight. E. Oak cutting boards provide a solid surface for chopping foods. F. Wash fresh fruits and vegetables thoroughly.
A, B, C, F Critical interventions for food safety to prevent foodborne illnesses include refrigeration at appropriate temperature; ensuring that meat, poultry, fish, and eggs are thoroughly cooked; discarding expired foods; and washing fresh fruits and vegetables thoroughly to remove potential bacteria.
Which of the following places the patient at risk for aspiration pneumonia? (Select all that apply.) A. Pocketing of food B. Fatigue C. Cough D. Distractions E. Poor oral hygiene
A, B, D, E Pockets of food may be found inside the cheeks when the patient has difficulty moving food from the mouth into the pharynx. The patient is usually unaware of pocketing, which may lead to aspiration. Chewing and sitting up for feeding accelerate the onset of fatigue. Fatigue increases risk for aspiration, and eating may lead to aspiration. Poor oral hygiene can result in decayed teeth, plaque, and periodontal disease and can cause growth of bacteria that can be aspirated. Environmental distractions and conversations during mealtime increase the risk for aspiration.
Which measure should the nurse take to ensure safety while the patient is receiving feeding via a nasally placed gastric feeding tube? A. Administer medications together to reduce the amount of fluid you need to flush the tube. B. Ensure that the tube is well secured and that no more tube is external than when the tube was originally placed and determined to be in good position whenever you are with the patient and at least every 4 hours. C. Listen while a bolus of air is injected to ascertain placement before you administer medication into the tube. D. Consider that the amount of feeding and fluid that are administered for this patient must be adequate to meet his or her needs because they are the same amounts that you have been using for other patients.
B Ensuring that the tube is well secured and monitoring the length that is external are simple but effective interventions that you can implement to ensure that the patient's feeding tube has not become displaced.
While feeding a patient, the nurse puts the fork down on the tray and turns on the suction machine. Why might the nurse perform this action? A. The patient is tilting the head backward while drinking. B. The patient is choking. C. Food has dripped or spilled onto the patient's clothing. D. The nurse determines that this is the wrong diet for the patient.
B The nurse would turn on the suction machine while feeding a patient if the patient appeared to be choking.
A patient is told the home care nurse will be measuring and recording intake and output (I&O) at home. What will the home care nurse do first? A. Supply a urine hat. B. Explain to the patient why I&O has been ordered. C. Assess the patient's ability to self-monitor and record I&O. D. Provide the patient's family with instructions.
B This intervention is most appropriate because it will help the patient understand why I&O is to be measured at home and will improve compliance with the task.
While feeding a patient recovering from a stroke, a nursing assistive personnel (NAP) becomes distracted and does not watch the patient swallow a bite of food. What would the NAP do to ensure that the patient safely swallowed the food? A. Give the patient a drink to wash down the food. B. Check the patient's mouth for pocketing. C. Suction the patient's mouth. D. Give the patient the next bite of food.
B To ensure that a patient with a neurological impairment safely swallowed the food, the NAP would check the patient's mouth for pocketing.
A nurse is caring for a client who is at high risk for aspiration. Which of the following is an appropriate nursing intervention? A. Give the client thin liquids B. Instruct the client to tuck her chin when swallowing. C. Have the client use a straw. D. Encourage the client to lie down and rest after meals.
B Tucking the chin when swallowing allows food to pass down the esophagus more easily.
What is the priority assessment that should be performed before a patient is given food and fluids? A. Auscultating breath sounds B. Determining orientation C. Checking for bowel sounds D. Asking about food preferences
B Use simple orientation questions and single-step commands to determine the potential for both aspiration and safe oral intake before providing dysphagia screening.
Which interventions by the nurse promote nutrition for a patient whose oral intake is less than required? (Select all that apply.) A. Offering antinausea medication after meals B. Suggesting substitutions, such as nutritious snacks, to enhance nutritional value C. Encouraging frequent small meals D. Telling the patient he will need for parenteral nutrition if he doesn't eat better
B, C Oral intake might be enhanced to meet or approximately meet a patient's needs based on suggestions from you or an RD about good nutritional options. Patients who are struggling to eat often tolerate small frequent meals better than large ones.
Which statement reflects the nurse's understanding of the importance of accurate urinary output measurement for a patient with acute renal failure? A. "If the output begins to decrease, I will notify the physician immediately." B. "Increasing his fluid intake both orally and intravenously should boost his urine output." C. "I will use a collection system with an hourly measurement device added." D. "I will explain to the patient and family why the I&O is being measured and recorded."
C A collection system with an hourly measurement device added will improve the accuracy of measuring the urine.
A nurse is caring for a client who is on a low-residue diet. The nurse should expect to see which of the following foods on the client's meal tray? A. Cooked barley B. Pureed broccoli C. Vanilla custard D. Lentil soup
C A low-residue diet consists of foods that are low in fiber and easy to digest. Dairy products and eggs, such as custard and yogurt, are appropriate for a low-residue diet.
What is the most effective way of preventing aspiration? A. Observe the patient closely for coughing, gagging, choking, and voice alteration. B. Monitor oxygen saturation with pulse oximetry. C. Put any at-risk patient on NPO status until a dysphagia evaluation can be conducted by a speech and language pathologist. D. Watch for subtle signs that aspiration may have occurred, such as lack of speech, depressed alertness, wet quality to the voice, difficulty controlling secretions, and absence of a gag reflex.
C All of the choices listed are steps that reduce the risk of aspiration. The most important precaution to prevent aspiration, however, is to put any at-risk patient on NPO status until a dysphagia evaluation can be conducted by a speech and language pathologist.
Why would the nurse want to determine if the patient is passing flatus before giving a meal? A. To ensure that the previous meal has been fully digested B. To ensure that the meal won't make the patient feel uncomfortably full C. To determine whether the GI tract is functioning. D. To determine whether the patient tolerated the foods given during the previous meal
C GI tract obstruction prevents the passage of flatus and may make the patient feel nauseated. To ensure that the GI tract is functioning, the nurse would want to determine whether the patient is passing flatus and is free of nausea.
A patient is admitted to your unit for dehydration. Which of the following assessments would the nurse identify as a possible sign of fluid imbalance? A. Heart rate at 80 beats per minute B. Capillary refill of less than 2 seconds C. Reduced turgor of the skin D. B/P of 118/78 mmHg
C If the patient is well hydrated, the pinched skin will quickly return. If the patient has decreased elasticity or possible dehydration, a reduced turgor of the skin remains suspended, peaked, or "tented" for a few seconds, and then slowly returns to place.
Which factor related to nutrition does the nurse need to consider when planning care of patients in different age-groups and stages of life? A. Pregnant patients have the same nutritional requirements as nonpregnant patients. B. Adolescents no longer need calcium for bone growth. C. Elderly patients may not need as many calories as younger patients. D. Infants should remain on breast milk or formula only for the first year of life.
C Metabolic rates slow with aging, and the elderly need fewer calories; yet they need as many essential nutrients as younger patients, which makes it especially important that their diets are well balanced.
An older-adult patient is admitted with a history of recent weight loss of 20 lbs over the last 6 months. The patient wears dentures, has lactose intolerance, and is allergic to shellfish. Which finding in the medical history indicates the patient is at high risk for poor nutrition? A. Shellfish allergy B. Lactose intolerance C. 20-lb weight loss D. Dentures
C Older adults are at great risk for poor nutrition. Change in weight is a factor to assess during a focused patient assessment. Determine the amount of weight loss and whether the weight loss was planned or unplanned. Weight loss of greater than 6.6 lbs (3 kg) indicates a nutrition problem.
When nutrition support is indicated for your patient, which of the following would be an appropriate factor for the use of parenteral nutrition (PN) instead of enteral tube feeding? A. It has less serious complications. B. It can be started immediately in an existing intravenous line. C. It can be used when the gastrointestinal tract does not function adequately to absorb nutrients. D. It should be used when the patient's advanced directive indicates that no aggressive measures such as a feeding tube are to be used.
C PN is used when the patient cannot receive feedings through the gastrointestinal tract.
Which of the following should be avoided for the patient consuming a dysphagia mechanically altered diet? A. Moist cake B. Canned peaches C. Peanut butter D. Spaghetti
C The basis of the dysphagia mechanically altered diet is that foods are moist and easily form a bolus to facilitate swallowing. Canned fruit and soft noodles are allowed. Sticky foods such as peanut butter are not allowed because it is difficult for the patient to form a bolus that can be easily swallowed.
What output will the nurse direct nursing assistive personnel (NAP) to measure for a hospitalized patient for whom intake and output measurement is prescribed? A. Nasogastric tube drainage B. Chest tube drainage C. Urine collection drainage D. Ileostomy bag drainage
C The nurse may safely delegate the measurement of urine collection drainage to NAP.
Which point is important for the nurse to include in the plan of care to monitor the patient's tolerance to enteral tube feeding? A. Strict guidelines for residual volumes B. Serum albumin level C. Lack of feeding tube misplacement D. Abdominal assessment and monitoring of bowel status
D Nursing assessment plays a key role in helping assess tolerance to feeding.
Which patient is least at risk for dysphagia? A. A 22-year-old patient with a traumatic brain injury (TBI) sustained during combat B. A 40-year-old woman undergoing stroke rehabilitation who had been smoking and taking oral contraceptives C. A 76-year-old patient with dementia D. A 55-year-old patient with pancreatic cancer who is receiving palliative care
D The risk of dysphagia is elevated in any patient with generalized muscle weakness, altered mental status, or neurological impairment of the swallowing mechanism. Pancreatic cancer is not ordinarily associated with such conditions. Chemotherapeutic agents may cause dysphagia; this patient, however, is receiving only palliative care.
A patient has consumed three 100-mL cups of ice chips and 4 ounces of ginger ale. What will nursing assistive personnel (NAP) document as this patient's oral intake? A. 120 mL B. 170 mL C. 220 mL D. 270 mL
D Three 100-mL cups of ice chips would be 150 mL of fluid, and 4 ounces of ginger ale would be 120 mL of fluid. The intake would be documented as 270 mL.
What would the nurse instruct nursing assistive personnel (NAP) to report while feeding any patient on aspiration precautions? A. Amount of food ingested B. Coughing C. Poor appetite D. Food preferences
B The nurse would instruct NAP to report the onset of coughing in any patient on aspiration precautions.
A patient has a high serum cholesterol level. What food should the nurse teach the patient to avoid? 1. Egg yolks 2. Skim milk 3. Turkey burger 4. Sliced bologna
1. CORRECT: Egg yolks are high in cholesterol and should be avoided by people with high cholesterol. One egg contains 225 mg of cholesterol. A healthy diet should not exceed 300 mg of cholesterol daily. 2. One cup of skim milk contains only 18 mg of cholesterol. 3. Three ounces of turkey contain only 45 mg of cholesterol. 4. Two slices of bologna contain only 31 mg of cholesterol.
A patient has a decreased hemoglobin level because of a low intake of dietary iron. Which food should the nurse teach the patient is the best source of iron? 1. Eggs 2. Fruit 3. Meat 4. Bread
1. One egg contains only 1.0 mg of iron. 2. One serving of fruit contains less than 1.0 mg of iron. 3. CORRECT: Meat, especially liver, is an excellent source of iron. Three ounces of meat contains 1.6 to 5.3 mg of iron depending on the type of meat and whether it is a regular or lean cut. 4. One slice of bread contains 0.7 to 1.4 mg of iron depending on the type of bread.
The nurse is teaching the patient who is taking Coumadin about what foods to limit. Teaching has been effective when the patient avoids which of the following from the menu? A. Peas B. Artichokes C. Broccoli D. Cucumbers
C Broccoli should be avoided because vitamin K-rich foods (dark green leafy vegetables) interfere with the action of Coumadin (anticoagulant).
The nurse is obtaining a health history from a patient. Which information best reflects a healthy behavior? 1. Eating foods low in fat 2. Displaying no signs of illness 3. Visiting a practitioner when ill 4. Wanting to lose twenty pounds
1. CORRECT: Eating foods low in fat is a healthy behavior because it is an action that promotes a healthy lifestyle. Implementing health-promotion behaviors is based on the perceived benefits of the actions. 2. This is one aspect of a person's health status, not a healthy behavior. 3. This is a behavior, but it is in response to an illness, not associated with the promotion of health and the prevention of illness. 4. This reflects cognition, not behavior. Desiring something may or may not progress to action
A patient is scheduled for surgery and the nurse is teaching the patient about the importance of vitamin C in wound healing. Which source of vitamin C should the nurse include in the teaching plan? 1. Potatoes 2. Yogurt 3. Beans 4. Milk
1. CORRECT: Potatoes are an excellent source of vitamin C (ascorbic acid). One 1/2-lb potato contains approximately 26 mg of vitamin C. 2. Eight ounces of yogurt contains only 1 mg of vitamin C. 3. Dry beans (legumes) contain no vitamin C. One cup of green beans contains only 12 mg of vitamin C. 4. One cup of milk contains only 2 mg of vitamin C.
A nurse teaches a patient that fat in the diet is unnecessary to absorb: 1. Vitamin C 2. Vitamin A 3. Vitamin E 4. Vitamin D
1. CORRECT: Vitamin C (ascorbic acid) is a watersoluble vitamin. The presence of fat or bile salts is unnecessary for its absorption. 2. Vitamin A is a fat-soluble vitamin that requires fat and bile salts to be absorbed. 3. Vitamin E is a fat-soluble vitamin that requires fat and bile salts to be absorbed. 4. Vitamin D is a fat-soluble vitamin that requires fat and bile salts to be absorbed.
A nurse is caring for a patient who is expending energy that is greater than the caloric intake. Which human response most likely will occur? 1. Fever 2. Anorexia 3. Malnutrition 4. Hypertension
1. During the states of malnutrition and starvation, the basal metabolic rate (BMR) decreases because the lean body mass decreases. Fever is associated with an increased, not decreased, BMR. 2. When energy expended is greater than the caloric intake, an individual will experience hunger, not anorexia. Hunger is a dull or acute pain felt around the epigastric area caused by a lack of food. Anorexia is the loss or lack of appetite. 3. CORRECT: When energy expenditure exceeds caloric intake, eventually body fat and muscle mass breaks down to supply the fuel needed for metabolism. Malnutrition results when the body's cells have a deficiency or excess of one or more nutrients. 4. When a person is malnourished, eventually the serum protein will be low, which may result in a decreased colloid osmotic pressure and then to the movement of fluid from the intravascular compartment into the peritoneal cavity. When the circulating blood volume decreases, the blood pressure decreases, not increases.
A nurse teaches a patient about the prescribed low-fat diet. Which food selected by the patient indicates that the teaching was understood? 1. Eggs 2. Liver 3. Cheese 4. Chicken
1. Eggs should be avoided on a low-fat diet. One egg contains 1.7 g of saturated fat. 2. Liver should be avoided on a low-fat diet. Three ounces of liver contain 2.5 g of saturated fat. 3. Cheese should be avoided on a low-fat diet. Depending on the cheese, one ounce contains 4.4 to 6.2 g of saturated fat. 4. CORRECT: Chicken is permitted on a low-fat diet. Three ounces of chicken contains 0.9 g of saturated fat. A low-fat food should contain less than 1.0 g of saturated fat per serving.
A nurse teaches a postoperative patient about foods high in protein that will promote wound healing. Which food selection by the patient indicates that the teaching was effective? 1. Milk 2. Meat 3. Bread 4. Vegetables
1. One cup of milk contains only 8 g of protein. 2. CORRECT: Food from animal sources (meat, poultry, fish, eggs, and cheese) provides complete proteins and, therefore, is the best sources of protein. Three ounces of meat or poultry contains 19 to 25 g of protein depending on the type of meat or poultry. 3. Although a serving of a grain product contains approximately 2 g of protein, it primarily provides carbohydrates and fiber. 4. The majority of vegetables provide only 1 to 3 g of protein.
The practitioner identifies that a patient may have a fluoride deficiency. What physical characteristic supports this conclusion? 1. Stomatitis 2. Dental caries 3. Bleeding gums 4. Mottling of the teeth
1. Stomatitis, inflammation of the mucous membranes of the mouth, is most often caused by infectious sources (e.g., herpes simplex virus, Candida albicans, and hemolytic streptococci) or chemotherapy, not fluoride deficiency. 2. CORRECT: Fluoride strengthens the ability of the tooth structure to withstand the erosive effects of bacterial acids on the teeth. The recommended daily intake of fluoride for adults is 1.5 to 4.0 mg. 3. Bleeding gums is caused by inflammation of the gums (gingivitis), not fluoride deficiency. 4. This is not specifically caused by fluoride deficiency. Yellow, brown, or black discoloration may indicate problems, such as staining, a partial or total nonviable nerve, or tetracycline administration during the prenatal period or early childhood.
A nurse is counseling a patient with the diagnosis of osteoporosis. Based on the practitioner's prescription, which vitamin should the nurse instruct the patient to include in a daily health regimen? 1. B 2. K 3. D 4. E
1. The B-complex vitamins are related to protein synthesis and cross-linking of collagen fibers, which are essential for integrity of the integumentary system, not strong bones. 2. Vitamin K promotes blood clotting by increasing the synthesis of prothrombin by the liver; it does not promote strong bones. 3. CORRECT: Vitamin D (also regarded as a hormone) promotes bone mineralization by producing transport proteins that bind calcium and phosphorus, which increases intestinal absorption, stimulates the kidneys to return calcium to the bloodstream, and stimulates bone cells to use calcium and phosphorus to build and maintain bone tissue. 4. Vitamin E prevents the oxidation of unsaturated fatty acids and thereby prevents cell damage; it does not promote strong bones.
A patient has been blind in one eye for several years because of the complications associated with diabetes mellitus. The patient is admitted to the hospital with a detached retina and resulting loss of sight in the other eye. What should the nurse do to assist this patient with meals? 1. Feed the patient 2. Order finger foods that are permitted on the patient's diet 3. Encourage eating one food at a time according to the preference of the patient 4. Explain to the patient where items are located on the plate according to the hours of a clock
1. This does not promote independence and may precipitate feelings of low self-esteem. 2. This is unnecessary and limits the patient's food choices. 3. This is unnecessary and may decrease the patient's appetite. 4. CORRECT: The clock system, which identifies where certain foods are on a plate in relation to where numbers are located on a clock, allows the patient to be independent when eating. Independence with activities of daily living supports self-esteem.
A nurse is caring for a client who weighs 80 kg (176 lb) and is 1.6 m (5 ft 3 in) tall. Calculate the BMI and determine whether this client is obese based on her BMI.
BMI = weight (kg) / height (m^2). BMI = 80 / 2.56 = 31.25 A BMI above 30 identifies obesity, so this client is obese.
What would the nurse instruct nursing assistive personnel (NAP) to do to ensure safety when feeding Salisbury steak to a dependent patient? A. Lower the head of the bed to a 30-degree angle. B. Encourage the patient to drink all fluids first. C. Cut the steak into small, bite-size pieces. D. Ensure that the steak is steaming hot.
C To ensure patient safety, the nurse would instruct NAP to cut the steak into small, bite-size pieces.
In reviewing a patient's chart, the nurse notes that the patient's serum albumin level is 2.5 g/dL and the BMI is 35. In analyzing the laboratory values, the nurse identifies which problem for the patient? A. This patient is underweight. B. This patient is malnourished. C. This patient needs a nitrogen balance study. D. This patient is obese.
D A BMI >30 is considered obese. Albumin is not a good indicator of nutritional status and may be affected by inflammation or hydration statistics.
A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following is the body's priority energy source? A. Fat B. Protein C. Glycogen D. Carbohydrates
D Carbohydrates are the body's priority energy source; providing energy for cells is their primary function. They provide glucose, which burns completely and efficiently without end products to excrete, and carbohydrates are a ready source of energy, and spare proteins from depletion.
