Ch. 19 Nutrition

The nurse has assessed a patient's body mass index (BMI) to be 19.6. This assessment of weight versus height indicates that this patient's weight category is in which category? a. Low health risk b. Overweight c. Obese d. Morbidly obese

A A BMI between 18.5 and 24.9 is associated with the lowest health risk. Those with BMIs between 25 and 29.9 are considered overweight, and those with BMIs of 30 or greater are considered obese. A BMI of less than 18.5 is considered underweight and is also associated with health risks.

The body uses 22 common amino acids, but 9 of them must be obtained from protein in the diet. What are these proteins considered? a. Essential b. Basic c. Fundamental d. Primary

A Essential amino acids must be consumed in the diet, because the body cannot make them.

The nurse is counseling a patient about the difference between type 1 and type 2 diabetes. What should the nurse stress that patients with type 2 diabetes are required to receive on a daily basis? a. Regular carbohydrate-controlled meals b. Oral hyperglycemic agents c. Insulin injections d. Stringent low-calorie diets

A People with type 2 diabetes must take daily regulated meals with controlled carbohydrate content. Type 1 diabetics must have insulin injections.

A patient who has hypertension is complaining about the lack of taste with the low-sodium diet that has been prescribed. What should the nurse emphasize that sodium may do? a. Contribute to hypertension. b. Interfere with blood clotting. c. Produce stomach ulcers. d. Decrease calcium in the bones.

A Sodium may contribute to hypertension.

A patient diagnosed with renal failure is unable to excrete protein waste products and develops a condition that requires a protein-restricted diet. The nurse instructs the patient that azotemia can be diminished by substituting other food groups for protein. What is an example of a food that this patient can substitute for protein? a. Potatoes b. Beans c. Cheese d. Soy products

A The foods that a patient with renal disease can substitute for energy are in the carbohydrate group. Potatoes are the only carbohydrate listed.

The patient who had a gastrostomy complains to the nurse about frequent episodes of dumping syndrome. What can the nurse recommend to this patient to decrease this problem? a. Eat small, frequent meals. b. Include more fiber in meals. c. Increase seasoning on food. d. Limit intake to semiliquids.

A The symptoms of dumping syndrome can be reduced by consuming small frequent meals of mildly seasoned food; extra fiber is not essential.

Which are the energy-providing food groups? (Select all that apply.) a. Carbohydrates b. Fats c. Proteins d. Vitamins e. Minerals

A, B, C The food groups that provide energy are carbohydrates, fats, and proteins.

At approximately 4 to 6 months of age, solid food is introduced to a baby. What foods with high iron content should be recommended by the nurse? a. Pureed fruit b. Fortified cereals c. Fruit juice d. Rice

B At approximately 4 to 6 months, iron-rich foods, such as fortified cereal and pureed meat, are introduced to a baby.

The nurse is educating a patient on a vegan diet. What supplement will the nurse encourage this patient to take to avoid a deficiency? a. B6 b. B12 c. K d. D

B B12 is almost exclusively found in animal products, but it can be supplemented with fortified cereals or vitamins.

A patient taking a diuretic is assessed by the nurse as having an erratic pulse and muscle weakness. What electrolyte should the nurse suspect is deficient? a. Sodium b. Potassium c. Chloride d. Iron

B Diuretics can deplete potassium through urine excretion and lead to muscle weakness and cardiac arrhythmias.

What is the term for stored fat that insulates the body and serves as a cushion to protect organs? a. Subcutaneous tissue b. Adipose tissue c. Cohesive tissue d. Lipid tissue

B Fat is stored in the body as adipose tissue.

The nurse teaches a patient who has a nonfunctioning or dysfunctional GI tract that total parenteral nutrition (TPN) will be infused. Where will the infusion occur? a. Through the carotid artery b. Through the superior vena cava c. Through the femoral vein d. Through the inferior vena cave

B TPN solution is usually infused through the superior vena cava.

A fit, young woman was at zero nitrogen balance. The nurse discovers that this patient is now pregnant with her first child. For what is this patient at risk? a. Embolism b. Anabolism c. Catabolism d. Metabolism

B When more nitrogen is consumed than is excreted, anabolism occurs. This is also called a positive nitrogen balance.

A nurse caring for a patient who is prescribed a full-liquid diet recognizes that this diet lacks some nutrients. What nutrients are lacking? a. Fat-soluble vitamins b. Potassium c. Iron and fiber d. Water-soluble vitamins

C A full-liquid diet is deficient in iron and fiber.

When discussing the digestion and metabolism of fat, the nurse tells the patient who has a history of cholecystitis and who is on a low-fat diet that fat must be emulsified to be digested. What is the substance necessary for emulsification? a. Sugar b. Cholesterol c. Bile d. Protein

C Bile is necessary to emulsify fat

Careful attention to carbohydrate consumption can improve metabolic control of diabetes. The nurse teaches a meal planning approach that focuses on the total amount of carbohydrates eaten at a meal. What is this meal planning approach called? a. Carbohydrate splitting b. Reduced caloric intake c. Carbohydrate counting d. Carbohydrate balancing

C Carbohydrate counting is a meal planning approach that focuses on the total amount of carbohydrates eaten.

When reviewing a patient's dietary intake, the nurse recommends that sugar consumption be reduced to the recommended daily level. What is this level? a. No more than 24% of total daily kilocalories b. No more than 16% of total daily kilocalories c. No more than 8% of total daily kilocalories d. No more than 4% of total daily kilocalories

C DRIs relating to carbohydrates indicate that 45% to 65% of an adult's total calorie intake should be in the form of carbohydrates and that added sugars should be limited to no more than 8% (approximately 40 g) of the total number of calories consumed daily.

A school nurse is teaching a group of adolescents about adequate nutrition. What increased intake should the nurse encourage? a. Potassium and sodium b. Chloride and magnesium c. Iron and calcium d. Vitamins and minerals

C Dietary inadequacies in adolescence include iron and calcium.

What are some elements found in food that are necessary for good health but the body cannot make? a. Important nutrients b. Lifesaving nutrients c. Essential nutrients d. Necessary nutrients

C Elements found in food that our bodies cannot make are essential nutrients.

The nurse reminds the male patient with lactose intolerance that he can avoid the unpleasant symptoms of nausea, bloating, flatulence, and diarrhea, if he will avoid certain foods. What product should the patient be instructed to avoid? a. Soy beans b. Rice c. Milk d. High fiber

C Lactose intolerance occurs as a result of a lack of lactase that makes it impossible to break down milk sugar.

The nurse is explaining the activity recommendations from the USDA's new MyPlate plan. What is the minimum amount of moderate weekly exercise needed to balance nutritional intake? a. 15 minutes b. 1 hour and 15 minutes c. 2 hours and 30 minutes d. 60 minutes

C My Plate recommends a minimum of 2 hours and 30 minutes of moderate aerobic physical activity a week to balance nutritional intake and 1 hour and 15 minutes of vigorous physical activity a week.

The home health nurse is caring for a patient that has undergone removal of a part of the stomach. What condition associated with partial stomach removal should the nurse look for when assessing the patient? a. A stomach ulcer b. Digestive problems c. Pernicious anemia d. Malabsorption

C Pernicious anemia results when the intrinsic factor is missing due to surgery on the stomach.

The nurse is providing information about high cholesterol levels. What is the rationale for avoiding saturated fats? a. They block absorption of nutrients. b. They interfere with metabolism. c. They increase blood cholesterol. d. They must be hydrogenated.

C Saturated fats tend to increase blood cholesterol.

The nurse explains that a patient with a heart problem should follow a decreased sodium diet. What will a decreased sodium diet prevent or help reduce? a. Stroke b. Fluid excretion c. Heart attacks d. Obesity

C Sodium attracts water and causes fluid retention. Hypervolemia increases the heart's workload, which can lead to a heart attack.

What is a nursing intervention to decrease the thirst of a patient who is on a fluid restriction? a. Rinsing the mouth with warm water b. Sipping carbonated drinks c. Sucking on occasional ice chips d. Limiting tooth brushing to once per day

C Sucking on occasional ice chips is a way to decrease thirst without adding a large amount of fluid. Rinsing the mouth with cool water and frequent tooth brushing are helpful also. Carbonated drinks contain sodium and will enhance fluid retention.

What has replaced the USDA's Recommended Dietary Allowance (RDA)? a. Nutrition Recommended Allowance (NRA) b. National Bionutritional Allowance (NBA) c. Dietary Reference Intake (DRI) d. Dietary Guidelines for Americans (DGA)

C The Dietary Reference Intake (DRI) has replaced the Recommended Dietary Allowance (RDA).

The nurse recognizes that when a patient is unable to consume adequate nutrition by mouth, an alternative route such as a feeding ostomy may be used. What is the proper term for feeding a patient by this method? a. Total parenteral nutrition (TPN) b. Nasogastric c. Enteral d. Parenteral

C The administration of nutritionally balanced liquid foods through a feeding ostomy is called enteral nutrition.

The patient complains to the nurse that he feels terrible since he has been taking several different kinds of vitamin preparations. What should the nurse assess for indications of vitamin toxicity?a. Edema b. Hypertension c. Fatigue d. Diarrhea

C Toxicity usually occurs from the use of large supplemental doses of vitamins and minerals and presents as fatigue, nausea, vomiting, and headache.

How many kcal/g does 1 g of alcohol provide? a. 4 kcal/g b. 5 kcal/g c. 6 kcal/g d. 7 kcal/g

D Alcohol provides 7 kcal/g of energy.

To demonstrate the energy-producing potential of different foods, the nurse explains that 3 g of lean meat produces 12 kcal/g. How many kcal/g does 3 g of fish oil produce? a. 6 kcal/g b. 15 kcal/g c. 21 kcal/g d. 27 kcal/g

D Fat provides 9 kcal/g.

What carbohydrate is not usually consumed and is stored in the liver and in some muscles? a. Sugar b. Glucose c. Lipids d. Glycogen

D Glycogen is not generally consumed in the diet but is the body's storage form of carbohydrate. It is found mainly in the liver, with some storage in the muscles.

The nurse makes nutrition a focus in the care plan. Where does nutrition play the most important role? a. Weight control b. Sustained appetite c. Building strong bones d. Health maintenance

D Nutrition is the total of all processes involved in taking in and using food substances for proper growth, functioning, and maintenance of health.

The young woman who is breastfeeding will need an increase of calories and protein. What foods should the nurse suggest as sources of protein? a. Green, leafy vegetables b. Citrus fruits d. Asparagus d. Nuts

D Nuts are a safe source of protein for lactating women.

The nurse cautions a patient with a pancreatic disorder that the disorder will interfere with the digestion of fats and may lead to a clotting disorder. What is the cause of these potential problems? a. Inability to use vitamin B b. Inability to use vitamin C c. Inability to use vitamin D d. Inability to use vitamin K

D Vitamins A, D, E, and K are fat-soluble. Difficulty with fat metabolism will result in the inability to use fat-soluble vitamins. Vitamin K plays a role in blood clotting. It is important in maintaining four of the eleven clotting factors found in the blood.

A middle-aged pt received a diagnosis of type2 diabetes & is receiving a diabetic diet. The patient's spouse expresses concern bc there are cookies on the lunch tray. Which response is the best? a. "Sugars & sweets are permitted in moderation. The important thing is that the total carb content of the meal is controlled & balanced with your medication & nutrient needs." b. "I can understand your concern. Sugars are rapidly absorbed & have capacity to raise blood glucose lvls more quickly than other carbs. I will check with the kitchen & see if your spouse received the wrong tray." c. "I am sure that if the cookies were on the meal tray, they must be allowed in the diet. They are probably low in sugar. There is likely no need for concern." d. "Sugar is used to treat hypoglycemia. Perhaps your spouse had low blood sugar reading before breakfast, & the dietitian sent up the cookies to give extra sugar on the meal tray."

a

A patient planning for pregnancy has heard that some experts recommend folic acid supplements for women of childbearing age. The patient understands the need for this recommendation by making which statement? a. "Folic acid may help prevent neural tube defects in my baby." b. "Folic acid provides me with extra calories to make new cells." c. "It is impossible for me to receive adequate amounts of folic acid in my diet." d. "Folic acid will help me to increase iron absorption in my diet."

a

An adolescent trauma patient has just been started on nasogastric tube feedings. Shortly after the formula begins, the patient complains of nausea and abdominal cramps. What is the appropriate nursing action? a. Check the formula rate, strength, or volume; any of these could possibly be too high. b. Nothing; these are normal symptoms with tube feedings. c. Stop the infusion immediately; these are symptoms of aspiration. d. Stop the infusion because the feeding tube is emptying into the lung rather than the stomach.

a

The nurse routinely participates in long distance endurance sports, such as running, swimming, and cycling. Which foods would the nurse eat to have energy over a longer period of time? a. Corn and potatoes b. Milk and citrus fruits c. Honey and table sugar d. Chocolate and electrolyte drinks

a Corn and potatoes are complex carbohydrates that break down more slowly and provide energy for a longer time. Milk, fruits, honey, table sugar, and chocolate are simple sugars that supply quick energy because they require less digestion. Electrolyte drinks would be important on hot days during prolonged periods of exercise

Which laboratory result is the nurse most likely to examine to determine if the treatment for iron deficiency anemia is effective? a. Hemoglobin level b. Electrolyte values c. Blood clotting factors d. Albumin level

a Iron is important in the formation of hemoglobin. The treatment for iron deficiency anemia would be diet modification and iron supplements as needed.

A 69-year-old patient reports frequently taking antacids. Why does this patient have an increased risk for developing pernicious anemia? a. Low stomach acidity blocks the absorption of vitamin B, from foods. b. Antacids interfere with the body's ability to use heme iron. c. Older people who take antacids are less likely to produce intrinsic factor. d. Antacids inhibit the digestion of foods that supply vitamin C.

a Stomach acidity decreases with age and with antacid use. This decreased acidity blocks the absorption of vitamin B12 from foods. Intrinsic factor is required for vitamin B12 absorption, and may be missing after stomach surgery. Both vitamin B12 and intrinsic factor are required to prevent pernicious anemia. Heme iron prevents iron deficiency anemia. Antacids do interfere with the absorption of many medications and nutrients; advise patients to follow directions of provider.

The patient has just ordered lunch at a restaurant. According to the USDA My Plate recommendations, which food item would the patient plan to divide and take a portion home in a carry-out box? a. 10 ounces grilled skinless chicken breast b. 1 cup of steamed vegetables c. ¾ cup of mixed fruit salad d. ¾ cup of brown rice pilaf

a Ten ounces of chicken breast is an excessively large portion according to MyPlate. The other portions are appropriate.

A patient with ascites has fluid restrictions of1000 mL/ 24 hours. The nurse observes that the patient frequently asks visitors and staff to give him extra fluids. What would the nurse do first to improve the patient's compliance? a. Assess the patient's understanding of the fluid restrictions. b. Offer suggestions to decrease sensation of thirst (e.g., chew gum). c. Post a sign over the bed that indicates fluid limits. d. Instruct family, friends, and staff that fluids are limited and measured.

a The nurse must first assess the patient's understanding of the therapy. If the patient understands the purpose, method, and goals, but needs additional support to comply, then strategies such as teaching, posting notices, and offering suggestions to decrease thirst are appropriate. If the patient understands, but is unable or unwilling to comply, then the RN, HCP, and nutritionist should be consulted.

A woman is in the first trimester of pregnancy.She reports several episodes of nausea and vomiting, a headache, and irritability. The nurse observes shallow breathing and perspi-ration, and the woman appears shaky and ner-vous. What would the nurse do first? a. Check blood glucose level. b. Take the temperature. c. Check pulse oximeter reading. d. Attach electrocardiogram monitor.

a The nurse suspects hypoglycemia, which is not uncommon in the first trimester; therefore, the first action would be to check the blood glucose level. If the blood sugar is low, 15 g of carbohydrates or a glass of milk (has lactose and protein) could be administered.

A patient reports routinely taking high doses of vitamin supplements. Which vitamin has the greatest potential for toxic effects related to high dosage? a. A b. B1 (thiamine) c. B2 (riboflavin) d. C

a Vitamin A is a fat-soluble vitamin and can be stored in the body; potentially it can cause death. The others are water-soluble. Vitamin C could cause diarrhea and abdominal cramping.

The patient is going to be discharged with a prescription for an anticoagulant medication. Which question would the nurse ask? a. "How many servings of leafy green vegetables would you normally eat in a week?" b. "Do you drink at least 8 glasses of fluid every day?" c. "What would you typically eat for breakfast every morning?" d. "Are you having any problems with constipation or adequate fiber intake?"

a Vitamin K can affect clotting times; thus, the patient should be assessed for ingestion of typical amounts of vitamin K sources and be advised to keep consumption at a consistent rate so that the medication can be adjusted accordingly

A patient in the early stages of pregnancy is experiencing some nausea and vomiting. Which suggestions would be appropriate for the nurse to recommend? (Select all that apply.) a. Limit foods with strong odors, and avoid food odors that bother you. b. Avoid foods with a high fat content. c. Try consuming five or six smaller meals each day, and include a source of protein in each meal. d. Try not to let your stomach get completely empty. Eat before you are overly hungry. e. Increase carbonated beverage intake.

a, b, c, d

Which admission assessments would be performed for long-term care residents in relation to potential nutritional problems? Select all that apply. a. Problems with fine motor movements b. Ability to chew and swallow different textures of foods c. Typical daily fluid intake d. Ability to obtain and prepare own food e. Dietary restrictions related to chronic health problems f. Food preferences or rituals related to cultural background

a, b, c, e, f Ability to chew, swallow, and take fluids should be assessed. Dietary intake related to health problems or culture should also be assessed. Ability to obtain and prepare own food would be relevant for a community-dwelling patient, but meals are typically prepared in long-term care facilities.

Which patients have conditions that would prompt the nurse to monitor serum sodium levels? Select all that apply. a. The patient is having a prolonged high fever. b. The patient has severe diarrhea and vomiting. c. The patient has iron deficiency anemia. d. The patient has chronic kidney disease. e. The patient has cystic fibrosis.

a, b, d, e Patients with fluid imbalances, sweating, diarrhea and vomiting, or renal disorders are more likely to lose sodium. Cystic fibrosis is a genetic condition and salt and water do not move in and out of the cells in a normal pattern

The nurse is working with a patient who requires an increase in complete proteins in the diet. Which foods will the nurse recommend? Select all that apply. a. Soy b. Eggs c. Peanuts d. Beans e. Fish f. Yogurt

a, b, e, f Soy supplies complete protein. Animal products such as eggs, meat, fish, and milk supply complete proteins. Peanuts and beans are good sources of incomplete proteins.

What are nursing responsibilities in promoting nutrition for patients? Select all that apply. a. Assisting patients to eat or drink b. Designing diet plans for patients with chronic health problems c. Recording the patient's fluid and food intake d. Observing the patient for signs of poor nutrition e. Communicating dietary concerns to other members of the health care team f. Monitoring laboratory values that are related to nutritional intake

a, c, d, e, f Assisting, recording, observing, communicating, and monitoring are nursing responsibilities related to nutrition. Designing dietary plans for chronic health problems would be done by a dietician who would consider the disease diagnosis, specific nutritional needs and patient preference.

A nurse is caring for a patient recently diagnosed with type 2 diabetes. The patient asks the nurse to tell her about the dietary changes she will need to make. Which actions are appropriate and within the scope of practice for a nurse? a. Review the patients chart and recommend a calorie and carbohydrate intake that is based on blood glucose and lipid values. b. Discuss the rationale for and the general principles of the diabetic diet with the patient, and then communicate the patient's concerns to the registered dietitian and health care provider. c. Locate the health care provider's diet order in the medical chart, and then obtain a preprinted diet sheet showing the exchange lists for meal planning and a menu pattern based on the prescribed calorie level. d. Decline to comment on the diet because the nurse is not a trained professional in the area of nutrition; refer all questions to a registered dietitian.

b

A patient with cancer has anorexia and weight loss. Which suggestion is most likely to help him increase intake and prevent weight loss? a. Encourage the patient to eat double portions at each b. Suggest that the patient snack often on high-calorie c. Encourage the patient to eat the low calorie first. d. Suggest to the patient that he decrease his amount of exercise.

b

The health care provider has recommended that a patient increase the amount of fiber in her diet to help control her blood cholesterol levels. Which guidelines are most appropriate for increasing water-soluble fiber in the diet? a. Choose a daily fiber supplement that contains no artificial additives and preservatives; follow the instructions on the container, and be sure to drink plenty of water. b. Choose foods that are closer to their whole state rather than refined or processed, including more fruits, oats, and legumes to increase soluble fiber; and drink plenty of water. c. Choose more vegetables, vegetable juices, whole wheat, and whole wheat products to increase soluble fiber; and drink plenty of water. d. Choose more fruit juices to provide fluid and fiber, and include iron-fortified breakfast cereals to enhance the absorption of fiber from the fruit juice.

b

The nurse determines that a hypertensive patient understands the DASH diet when the patient chooses which items from a sample menu used in dietary teaching? a. Caesar salad, bread sticks, and frozen yogurt. b. Grilled chicken sandwich, strawberries, and lettuce salad. c. Grilled cheese sandwich, canned pineapple, and brownie. d. Chicken and vegetable stir fry, rice, and egg roll.

b

The home health nurse sees that the patient's potassium level is 3.6 mmol/L. There is nothing in the patients medication or health history that should affect the potassium levels. What will the nurse do? a. Tell the patient to make an appointment to see the HCP as soon as possible. b. Suggest that the patient eat sweet potatoes, fruits, vegetables, fresh meat, legumes, and milk. c. Take vital signs and assess the patient for signs/symptoms of hyperkalemia. d. Instruct the patient to have a potassium 4. test repeated every 12-18 months.

b A potassium level of 3.6 mmol/L is on the low end of normal, so the nurse could suggest that the patient eat foods that supply potassium. A moderate potassium deficiency (in the absence of hypokalemia) may lead to increased blood pressure, increased risk of kidney stones, and increased bone loss.

Which laboratory value would the nurse check to evaluate the protein status of a patient who has been receiving medical nutrition therapy? a. Hemoglobin b. Albumin c. White blood cell count d. Electrolyte values

b Albumin is a plasma protein. Albumin level is lowered in poor nutritional states and should improve with nutritional therapy. Hemoglobin and electrolyte values are also associated with nutritional status of various minerals. White blood cell counts reflect immune system reaction.

Which item is allowed on a clear liquid diet? a. Orange juice b. Gelatin c. Sherbet d. Cream soup

b Any liquid that can be seen through is considered okay for a clear liquid diet.

The mother asks the nurse about giving strained fruits to her infant. When would this food be introduced? a. 2 months b. 5 months c. 8 months d. 12 months

b At approximately 4-6 months of age, depending on the infant's development, it is possible to introduce solid foods into the diet. The child is usually started on iron-fortified rice cereal. Fruits are added next, then vegetables, and then meats

The patient reports noticing that his gums bleed very easily. If the bleeding is caused by a nutritional deficiency, which types of food will correct the problem? a. Milk, egg yolks, and liver b. Broccoli, peppers, and tomatoes c. Cereals, legumes, and nuts d. Poultry, fish, and brown rice

b Bleeding gums is one sign of vitamin C deficiency; citrus fruits, broccoli, tomatoes, and peppers are some sources for vitamin C. Milk, egg yolks, and liver supply vitamins A, D, and K. Cereals, legumes, and nuts supply vitamin B1 (thiamine). Poultry, fish, and brown rice supply vitamin B6 . See Table 19.4 for additional information.

hich patient is most likely to benefit from an increase in dietary fiber? a. Has chronic obstructive pulmonary disease b. Has a high risk for metabolic syndrome c. Has a high risk for osteoporosis d. Has a recent diagnosis of hepatitis

b Dietary fiber can lower cholesterol and blood glucose levels and assist in weight loss. Risk factors for metabolic syndrome include abdominal obesity, dyslipidemia, elevated blood pressure, and insulin resistance.

A patient is interested in adding antioxidants to the diet. What is the best advice? a. Take vitamin supplements, especially A, C, and E. b. Eat a wide variety of fruits and vegetables. c. Eat dairy products such as cheese, yogurt, and milk. d. Take a multi-vitamin and mineral supplement.

b Fruits and vegetables are the best source of antioxidants

The patient was advised by the HCP to "watch intake of cholesterol." Which question is the most useful in assessing the likelihood of the patient's adherence to the provider's advice? a. "Do you understand what 'watch your intake of cholesterol' means?" b. "How do you plan to manage your intake of cholesterol?" c. "Would you like a list of foods that contain high amounts of cholesterol?" d. "What do you normally eat in a 24-hourPeriod?"

b If the patient is able to describe a plan of self-management, it means that he/she understands the sources of cholesterol and is ready for self-care; thus, the nurse can reinforce the plan. Asking the patient to describe a typical 24-hour period is the second best option, because it provides assessment data as to areas the patient needs to "watch." Offering a food list is a good option if the patient is unsure how to proceed. "Do you understand?" is a closed question. The patient may be embarrassed about being unsure and just say yes.

The patient tells the nurse that he has problems with his cholesterol so a friend told him to eat avocadoes. What is the best response? a. "Avocadoes are very high in fat so the total cholesterol will increase." b. "Avocadoes are a source of monounsaturated fats, which are thought to lower bad cholesterol." c. "Avocadoes are yellow fruits, and fruits generally do not affect cholesterol levels." d. "Avocadoes are a source of trans-fatty acids, which will increase the good cholesterol."

b Monounsaturated fats are thought to lower low-density lipids (bad) cholesterol. Avocadoes are high in fat, so the nurse should remind the patient to limit total fat intake to 20% to 35%.

The nurse is evaluating the performance of an unlicensed assistive personnel (UAP) who is feeding a patient. Which action indicates a need for correction? a. Offering the patient the bedpan before the meal. b. Placing the patient in a recumbent position. c. Providing opportunity for hand hygiene before the meal. d. Talking with the patient during the feeding.

b Patients should be assisted to a sitting or high Fowler's position to prevent aspiration. The other actions are correct. (Note to student: Socially engaging the patient is usually encouraged; however, if talking is distracting [e.g., manic phase of bipolar disorder] or if there is risk for aspiration [e.g., stroke], then the UAP should be instructed accordingly.)

The patient reports sensations of bloating, gas, and constipation after adding lots of fruits, vegetables, and whole grains to her diet. So she has decided to go back to her former dietary pattern and exclude these foods. What is the best advice that the nurse can give the patient? a. "Resume former dietary patterns and contact your HCP." b. "Slowly increase intake of fiber foods and drink at least 8 glasses of water each day." c. "Start with a fiber supplement instead of fruits, vegetables, and whole grains." d. Excessive fiber intake can lead to osteoporosis and anemia in women."

b Sudden increase in dietary fiber can cause bloating, gas, and constipation, so patients should be advised to add fiber foods slowly and to drink a lot of water. Contacting the HCP is always good advice when starting a new dietary change but returning to old dietary habits should not be encouraged in this case. Osteoporosis and anemia can be caused by excessive fiber, but there are many benefits of a reasonable fiber intake, so the nurse should not negatively influence the patient by making statements that do not necessarily apply to the patient's situation

The patient is trying to understand the difference between dietary reference intakes (DRIs) and recommended dietary allowances (RDs).Which patient statement best indicates an understanding of DRIs? a. "DRis replace the RDAs but are similar, so I could use either one to monitor my cholesterol." b. "Using DRIs, I could decrease my risk for diabetes and monitor my sugar consumption." c. "RDAs apply to healthy adult Americans; but I should rely on DRIs because I am overweight. " d. "DRIs are based on disease states; so I can use them as a guideline to control my thyroid problem."

b The purpose of dietary reference intake (DRIs) is to help individuals optimize their health, prevent disease, and avoid consuming too much of a nutrient. Helping the patient understand the application of the DRIs to personal health is a strategy to help him remember the information. DRIs do replace recommended dietary allowance (RDAs), but are not exactly the same because DRIs combine RDAs, adequate intake, tolerable upper intake, and the estimated average requirement of each nutrient. RDAs did target the adult American; however, RDAs were also made for other age groups (e.g., children and older adults) and for pregnant/lactating women.

A patient with a family history of osteoporosis is taking calcium supplements to help reduce her risk of developing osteoporosis.What recommendations can be made to prevent the development of reduced calcium balance? (Select all that apply.) a. Taking small doses of calcium throughout the day rather than one large dose. b. Choosing plenty of milk products, and avoiding excess caffeine intake. c. Consuming a high-protein diet. d. Consuming a diet that has moderate levels of sodium. e. Increasing potassium intake.

b, c

A healthy 35-year-old patient wishes to lose weight because herBMI is 27. Which suggestion would be most appropriate for her? a. This BMI is too low for good health; the patient needs to supplement the diet to increase weight. b. This is an acceptable BMI, and it is best to maintain weight at this level for continued good health. c. Appropriate weight loss is possible with a healthy, reduced-calorie diet and incorporating at least 30 minutes of physical activity into each day. d. This BMI is elevated to the point that treatments, such as surgery, are necessary.

c

A patient is controlling his blood cholesterol through diet. He is familiar with food sources of saturated fat and cholesterol but is confused about trans fatty acids. The nurse should explain that which group of foods contributes the most trans fatty acids? a. Butter, cream, fats in meats, and tropical oils such as palm and coconut oils. b. Fish oils, nuts and seeds, and vegetable oils such as olive oil and canola oil. c. Stick margarines, shortening, deep-fried restaurant foods, and commercially prepared baked goods. d. Liquid margarines, vegetable oil spreads, and vegetable oils such as corn, soybean, and cottonseed.

c

A patient takes medication for hypertension and asks whether there is anything else he can do to help to reduce his blood pressure. What is the best nursing response? a. "A low-fat, low-cholesterol diet with only a limited amount of simple sugars will have the greatest effect on your blood pressure." b. "A salt-free diet will have the greatest effect on your blood pressure. Do not add salt in your cooking or at the table." c. "Adequate calcium and potassium intake, as well as lower sodium intake, offers some possibility of helping your blood pressure. Eat plenty of fruits, vegetables, and low-fat milk products." d. "Limit the use of processed foods, in your diet. That way, you will have less sodium in your diet."

c

A patient with iron-deficiency anemia started taking iron supplements. What recommendation can the nurse give the patient to increase iron absorption? a. Drink milk or take calcium supplements at the same time as eating iron-rich foods. b. Take iron supplements with coffee, tea, or red wine. c. Consume vitamin C-rich foods at the same meal with iron-containing foods. d. Take iron supplements with a high-fiber bran cereal.

c

The nurse is reviewing a patient's dietary intake. Which patient behavior reflects compliance with a 2-g sodium-restricted diet? a. Using only the two packets of salt found on the mealtray. b. Limiting milk to 1 cup per day. c. Avoiding use of salt in cooking. d. Using salt-free butter with meals.

c

Which patient comment indicates to the nurse that more teaching is needed for the patient experiencing dumping syndrome after gastric surgery? a. "I should eat six small meals per day." b. "I should not drink fluids with my meals." c. "I should use honey or jelly instead of butter." d. "I should lie down for 30 to 60 minutes after eating."

c

A parent tells the nurse, "The school nutritionist advised parents to send packed lunches that include complete proteins, but I'm not exactly sure what that means." Which is the best response? a. "What would you normally send in a packed lunch?" b. "Just pack a variety of foods that you know your child will eat." c. "Complete proteins are generally of animal origin, like eggs or meat, but a complete protein can also be made of a combination of plant-based foods." d. "Does your child have any dietary restrictions or food allergies?"

c Animal origins is an easy way for the parent to understand what is meant by complete proteins. It is important to also instruct the mother on combinations of plant based proteins that can create a complete protein. Questions about eating patterns, allergies, and dietary restrictions are appropriate if the parent appears to need more guidance

The patient reports a habit of smoking at least one pack of cigarettes every day. Which foods would the nurse encourage the patient to eat, because of the heavy smoking habit? a. Fish and poultry b. Milk products c. Citrus fruits d. Whole grains

c Citrus fruits supply vitamin C and an additional 35 mg/day of vitamin C is encouraged because smoking increases oxidative stress.

Following bariatric surgery, a patient experiences nausea, cramping, diarrhea, sweating, lightheadedness, and palpitations after eating.What is the most important self-care measure for the nurse to reinforce? a. Immediately report the symptoms to the surgeon; surgical intervention may be necessary. b. Be patient and live with the symptoms; they are expected and temporary. c. Avoid concentrated sweets and drink fluids 30-60 minutes before and after meals. d. When symptoms occur, replace the next meal with extra fluids such as diluted juices.

c Dumping syndrome is usually associated with the consumption of too much refined sugar. Slowing gastric emptying and small frequent meals that are higher in protein and fat with less carbohydrates help to correct the problem

Which parental action encourages good dietary habits in the child? a. Allow the chine to eat whenever he is hungry and skip meals if he is not hungry. b. Give the child whatever the rest of the family is eating; do not cater to special requests. c. Encourage the child to help with food preparation and create a positive environment. d. Give everyone the same serving size and quietly remove leftover food.

c If the child helps prepare the food it gives him a role and helps him increase feelings of control. Keeping a positive atmosphere around mealtime makes the meal less stressful for all. Meal and snack times should be set times. Children's servings should be smaller than adult servings. Offering the family food is not a bad strategy, but if every meal is a struggle, then offering nutritious foods that the child likes will meet nutritional needs and make mealtimes more pleasant. In addition, children often have a very narrow range of preferences and introducing new foods should be done slowly

The nurse is talking to a 17-year-old female whose parents have reluctantly allowed her to start a vegan diet if she agrees to talk to anHCP before beginning the diet. The HCP is most likely to monitor her for which nutrition-related condition? a. Anorexia nervosa b. Rickets c. Iron deficiency anemia d. Marasmus

c Iron deficiency anemia is the most prevalent nutrition problem in the world. In addition, adolescence, menstruation, and a lack of animal products in the diet will increase the risk for iron deficiency anemia. There is a higher incidence of anorexia nervosa among teenage girls; however, choosing a vegan diet is considered a healthy choice, whereas anorexia nervosa is a mental health disorder. Rickets is caused by a vitamin D deficiency. Marasmus is a protein deficiency.

The mother reports that her child took a few extra chewable vitamins, because he thought they were gummy candies. Which question is the most important to assess for potential toxicity? a. "Does the product contain vitamin C?" b. "How much does the child weigh?" c. "Is iron listed as one of the ingredients?" d. "Did you induce vomiting?"

c Iron poisoning can be fatal and many children's supplements will contain iron. Vitamin C can cause some gastrointestinal disturbances. Poison Control will ask the child's weight, amount ingested, time, and product name. Inducing vomiting in this case is not harmful, but probably not helpful either, because the chewable form is readily digested and absorbed.

The nurse is educating a group of high school students regarding nutrition. How should the nurse respond when the students ask what occurs when protein, mineral, iron, and fat combine? a. Body processes are regulated. b. Energy is provided. c. Tissue is built and repaired. d. Body function is restored.

c Many nutrients are necessary to build and repair tissue, including protein, minerals, iron, and fat.

The nurse is teaching a patient who has heart failure to read nutrition labels on food products. Which nutritional fact is the most important for this patient to pay attention to? a. The total number of kilocalories of fat per serving b. The % daily value of fiber provided in a serving c. The number of milligrams of sodium per serving d. The number of grams of protein per serving

c Patients with heart failure have risk for fluid volume overload, so this patient needs to be mindful of sodium intake. If the patient is overweight, the nurse would also suggest that the patient look at the calories per serving

Which patient is at the greatest risk for a negative nitrogen balance that will lead to atrophy of muscles? a. The patient gets nothing by mouth for several days due to intractable nausea and vomiting b. The patient is in the first trimester of a normal pregnancy. c. The patient sustained severe burns to 50% of the body surface. d. The patient has been fasting for several days for a religious ritual.

c Patients with severe illness or injury or with prolonged starvation will have negative nitrogen balance and manifest muscle atrophy. Having nothing by mouth (NPO) and fasting do create a negative nitrogen balance state, but temporary protein deficiency should not cause obvious physical changes. Pregnancy creates a positive nitrogen balance as tissues are built.

The nurse sees an order for "clear liquid diet, advance as tolerated to regular diet." What does the nurse do to get the best food selection for the patient? a. Contact the HCP for clarification of the b. Ask the patient if he is hungry and what he prefers to eat. c. Assess the patient's overall response to the clear liquid diet. d. Call the nutritionist and ask for an individualized diet plan.

c The nurse must assess how the patient is tolerating the liquid diet before offering soft foods. This would include assessing bowel function and subjective sensations. The patient is likely to be hungry for something besides liquids, but desire for food does not necessarily correlate with what the bowel can tolerate. Assessments should be made before calling the HCP or the nutritionist

An Asian American patient reports experiencing nausea, a bloated feeling, and flatulence after eating. Which question is the most relevant? a. "Do you have any food allergies?" b. "Are you following the MyPlate guidelines?" c. "What did you eat just before the onset of the symptoms?" d. "Is anyone who ate the same food having the same symptoms?"

c The patient is describing symptoms of lactose intolerance and there is a higher incidence among Asian-, African-, Native-, and Hispanic-Americans. Food allergies are more likely to cause itching or swelling of the mucous membranes. MyPlate guidelines generally direct people to eat a variety of foods in modest portions. Asking if others are having similar symptoms is a good question if food poisoning is suspected.

The nurse is assessing an older resident at a long-term care center. The resident appears flushed, skin turgor is poor, mucous membranes are dry, and resident seems unusually irritable. What would the nurse do first? a. Test for gag reflex; then offer oral fluids. b. Obtain an order for electrolyte values. c. Take vital signs and check urine specific gravity. d. Check blood sugar and offer a popsicle.

c The resident is showing signs of dehydration. A urine specific gravity test can be used to check for dehydration. If the vital signs are abnormal, the nurse would use clinical judgment about notifying the HCP. Blood sugar level and response to oral fluids would be additional data to give to the HCP

Which dietary recommendation should the nurse include in the discharge instructions for a client who has been diagnosed with coronary artery disease? a. Limit intake of whole grains. b. Limit intake of tuna. c. Limit intake of soybean products. d. Limit intake of egg yolks.

d

While the nurse is completing discharge teaching for a patient with elevated cholesterol levels, the patient asks how to distinguish between an unsaturated fat and a saturated fat. Which statement is most accurate? a. Saturated fats are generally from plant sources and are solid at room temperature. b. In unsaturated fats the hydrogen bonds are full. c. Saturated fats are missing hydrogen at points of unsaturation. d. Unsaturated fats are generally from plant sources and are liquid at room temperature.

d

Which patient would not be offered low-fat milk? a. 15-year-old female with type 1 diabetes b. 26-year-old female who is in the third trimester of pregnancy c. 68-year-old female who has hip fracture related to osteoporosis d. 18-month-old female who is transitioning to cow's milk

d Children younger than age 2 should not be given low-fat milk because they need the fat content. For the other patients, low-fat milk would be preferred over whole milk

The patient is taking a diuretic medication every day. Which electrolyte value is the most important to monitor? a. Chloride b. Sodium c. Phosphorus d. Potassium

d Diuretics, such as furosemide, chlorothiazide, and hydrochlorothiazide can contribute to depletion of potassium, magnesium, and calcium.

Which patient is most likely to be prescribed a carbohydrate-modified diet? a. Has heart failure b. Has hypertension c. Has cirrhosis of the liver d. Has diabetes mellitus

d In diabetes, the body does not produce or properly use insulin. Insulin is a hormone needed to convert sugar, starches, and other carbohydrates into the energy for daily life. Fat and sodium restrictions are frequently used for patients who are at risk for cardiovascular disorders. Protein restrictions are used mostly for patients with kidney or liver problems.

During a trip to a developing country, the nurse observes that many of the toddlers appear very fat with enlarged abdomens and swollen extremities. Which nutritional deficiency is associated with these symptoms? a. Carbohydrates b. Fats c. Vitamins d. Protein

d Kwashiorkor is a severe protein deficiency. The swelling is caused by fluid shifting related to hypoalbuminemia. It is likely that the children have many other nutritional deficiencies

According to the Nationa ns, whof Health's Office of Dietary Supplements, which patient would be advised to have an additional 35 mg/day of vitamin C beyond the usual recommended adult dose? a. A patient who was recently diagnosed with cancer. b. A patient who has recent onset of cold symptoms. c. A patient who drinks alcohol daily. d. A patient who smokes cigarettes every day.

d Patients who smoke should be advised that higher levels of vitamin C are recommended because smoking creates oxidative stress. There is no evidence that vitamin C alleviates cold symptoms or cancer. Patients who drink excessive alcohol may need thiamine.

The patient has sustained severe injuries in an accident. Which food sources supply the nutrient that plays the biggest role in helping the patient to build and repair injured tissue? a. Green vegetables and bright-colored fruits b. Pasta and breads made from whole grains c. Beans, legumes, and soy products d. Lean meats, poultry, and fish

d Protein is the single most important nutrient for building and repairing tissue; however, the patient will need a well-balanced diet to recover.

The patient expresses a strong preference for beef that is marbled with fat at every meal, because of the flavor and the feeling of fullness and satisfaction. Nurse would advise that this eating habit is likely to increase risk for which health condition? a. Osteoporosis b. Cirrhosis of the liver c. Diabetes mellitus d. Atherosclerosis

d Saturated fats increase the risk for atherosclerosis. However, none of these chronic health problems is improved by eating too much fat.

A patient has symptoms of steatorrhea and flatulence. Which diet is the HCP most likely to recommend? a. Carbohydrate-modified diet b. Protein-restricted diet c. Sodium-restricted diet d. Fat-controlled diet

d Steatorrhea is fat in the stool and occurs when there is incomplete digestion of fats. Carbohydrate-modified diets are prescribed for patients with diabetes. Protein-restricted diets are used for patients with kidney or liver problems. Sodium-restricted diets are used for heart failure or hypertension

Patients with nasogastric (NG) tubes may develop otitis media. What will the nurse do to prevent this occurrence? a. Increase fluid intake. b. Remove and reinsert the tube every 24 hours. c. Suction the nose and mouth. d. Turn the patient side to side every 2 hours.

d The nasogastric tube pressing against the eustachian tube causes obstruction and edema. It is best prevented by turning the patient from side to side frequently, at least every 2 hours.

The patient has risk for osteoporosis. Which foods is the nurse most likely to suggest? a. Eggs, raw fruits and vegetables b. Whole-grain breads and pasta, and poultry c. Green leafy vegetables and citrus fruits d. Sardines, tofu, cheese, and broccoli

d The patient with osteoporosis needs foods that are high in calcium. See Table 19.7 for additional information.

Which patient is at risk for pernicious anemia and is most likely to be prescribed a vitaminB, supplement?a. Frequently tries different weight-loss plans b. Eats small amounts of a variety of foods c. Prefers meat and potatoes, with very few vegetables d. Adheres to a strict vegan diet

d Vitamin B12 is primarily found in foods of animal origin; therefore, the person eating the vegan diet is most likely to need vitamin B12 supplements. The patient who is trying weight loss plans should be assessed for weight loss goals and advised to see the provider. The patient who eats very few fruits and vegetables needs counseling about healthy diet. Eating small amounts of a wide variety of foods is a good strategy to meet nutritional needs without taking supplements.

The nurse is talking to a patient who has high cholesterol and a family history of cardiovascular disease. Which foods are most likely to counteract the high cholesterol? a. Wheat bran and celery b. Orange juice and white rice c. Lettuce and pears d. Oats and barley

d Water-soluble fiber foods (fruit, oats, barley, legumes) help to bind the cholesterol in the digestive tract. Insoluble fiber found in wheat bran, celery, lettuce, and pears helps to soften stool and speed transit of foods through the digestive tract. Oranges provide more fiber than orange juice. White rice will slow movement of solid material through the digestive tract.

The patient is interested in lowering his cholesterol levels and reducing the risk of cardiovascular disease. Which breakfast tray offers the most water-soluble fiber to help the patient meet his goals? a. Half a grapefruit with hard-boiled egg b. Hash-browned potatoes with sausage patty c. Yogurt with honey, granola, and fresh strawberries d. Oatmeal topped with cinnamon and raw apple slices

d Water-soluble fiber sources include fruits, oats, barley, and legumes.