Chapter 27. Nutrition

The nurse completes the nutrition assessment for a 14-year-old female with a BMI of 15. What physical assessment finding might suggest bulimia nervosa? a)Loss of enamel on teeth b)Low level of interest in exercise c)Slightly elevated temperature d)Skin excoriation in skinfolds

A A BMI of less than 18.5 is considered underweight. Eating disorders are a concern for adolescents, girls more commonly than boys. Signs of anorexia nervosa may include dry, brittle hair and nails, generalized fatigue, constipation, low blood pressure, feeling cold with a lower than normal temperature, amenorrhea, and low BMI. Bulimia is self-induced vomiting (purging) after episodes of binging. In bulimia, the BMI might be low (less than 18.5), normal, or even high (greater than 25). Dental decay and erosion of tooth enamel occur with repeated purging. Most people with an eating disorder, especially those with bulimia nervosa, are preoccupied with exercise. Skin rash and excoriation in skin creases is more common in people with obesity.

Which food provides the body with no usable glucose? a)Wheat germ b)Apple c)White bread d)White rice

A Dietary fiber, such as wheat germ, contains no usable glucose. Apples, white bread, and white rice all contain carbohydrates, which provide usable glucose.

A patient who was prescribed furosemide (Lasix) is deficient in potassium. Which of the following is an appropriate nutritional goal for this patient? The patient will increase his consumption of: a)Bananas, peaches, molasses, and potatoes b)Eggs, baking soda, and baking powder c)Wheat bran, chocolate, eggs, and sardines d)Egg yolks, nuts, and sardines

A Foods rich in potassium include bananas, peaches, molasses, meats, avocados, milk, shellfish, dates, figs, and potatoes. Eggs, baking soda, and baking powder have high sodium content. Dairy products, beef, pork, beans, sardines, eggs, chicken, wheat bran, and chocolate are rich in phosphorus. Egg yolks, nuts, sardines, dairy products, broccoli, and legumes are rich in calcium.

The nurse is caring for a patient with a significant history of hypertension and cardiovascular disease. The nurse would be most interested in the findings of which laboratory results? a)Low-density lipoproteins (LDL) and high-density lipoproteins (HDL) b)Fatty acids such as alpha-linolenic acid (omega-3) c)B-complex vitamins d)Vitamin K

A Low-density lipoproteins (LDLs) transport cholesterol to body cells. Diets high in saturated fats increase LDL circulation in the bloodstream and may result in fatty deposits on vessel walls, causing cardiovascular disease. As a result, LDL is often known as the "bad cholesterol." High-density lipoproteins (HDLs) remove cholesterol from the bloodstream, returning it to the liver, where it is used to produce bile; thus, a high HDL is considered protective against cardiovascular disease. It is often known as the "good cholesterol." Vitamin K is involved in blood clotting. B-complex vitamins' primary function is cellular metabolism. Linolenic acid (omega-3) helps to protect against heart disease but does not indicate cardiovascular disease.

The nurse is checking the gastric aspirate for the patient receiving tube feedings. She notes the 200 mL of pale yellow and cloudy fluid with a pH of 7.3. Which action should she take? a)Stop the feeding immediately; then notify the prescribing provider. b)Hold the tube feeding for 2 hours; continue if residual is less than 200 mL. c)Flush tube with 30 mL of sterile water; resume tube feeding at prescribed rate. d)Administer a promotility agent as prescribed; resume feeding in 1 hour.

A Normal gastric fluid should be clear, green, and acidic (pH 5.0). If the gastric aspirate is pale yellow and cloudy with a pH of 7.3 (alkaline), the nurse must stop the tube feeding immediately and notify the prescriber of the feedings. This finding might indicate the feeding tube has migrated to the lungs, which could lead to aspiration pneumonia and become a medical emergency. Holding the feeding for 2 hours and continuing after that could lead to aspiration pneumonia because the quality of the fluid indicates the placement of the tube is in the lungs. Flushing the tube and resuming feedings when the feeding tube is in the lungs could lead to a medical emergency. A promotility agent (e.g., metoclopramide) would be given if the patient has gastric residual volume (GRV) of 250 mL or more for two consecutive checks. However, if the GVR is more than 500 mL, the nurse would stop the feeding and reassess the patient.

The nurse notices that a patient has spoon-shaped, brittle nails. This suggests that the patient is experiencing Imbalanced Nutrition: Less Than Body Requirements related to deficiency of which of the following nutrients? a)Iron b)Vitamin A c)Protein d)Vitamin C

A Patients with iron deficiency may have spoon-shaped, brittle nails. Other abnormal nail findings include dull nails with transverse ridge (protein deficiency); pale, poor blanching, or mottled nails (vitamin A or C deficiency); splinter hemorrhages (vitamin C deficiency); and bruising or bleeding beneath nails (protein or caloric deficiency).

A patient is brought to the emergency department experiencing leg cramps. He is irritable, his temperature is elevated, and his mucous membranes are dry. Based on these findings, the patient most likely has excess levels of which mineral? a)Sodium b)Potassium c)Phosphorus d)Magnesium

A Signs and symptoms associated with sodium excess include thirst, fever, dry and sticky tongue and mucous membranes, restlessness, irritability, and seizures. Findings associated with potassium excess include cardiac arrhythmias, weakness, abdominal cramps, diarrhea, anxiety, and paresthesia. Phosphorus excess leads to tetany and seizures. Magnesium excess causes weakness, nausea, and malaise.

The nurse is providing nutrition counseling for a patient planning pregnancy. The nurse should emphasize the importance of consuming which nutrient to prevent neural tube defects? a)Folic acid b)Calcium c)Protein d)Vitamin D

A The nurse should emphasize the importance of consuming folic acid even before conception to prevent neural tube defects from developing. Calcium and protein needs also increase during pregnancy; however, their consumption does not prevent neural tube defects. Vitamin D consumption does not prevent neural tube defects.

A mother brings her 4-month-old infant for a well-baby checkup. The mother tells the nurse that she would like to start bottle feeding her baby because she cannot keep up with the demands of breastfeeding since returning to work. Which response by the nurse is appropriate? a)"Make sure you give your baby an iron-fortified formula to supplement any stored breast milk you have." b)"You really need to continue breastfeeding your baby." c)"Give your baby formula until he is 6 months old; then you can introduce whole milk." d)"Your baby weighs 14 pounds, so he will require about 36 ounces of formula a day."

A The nurse should not make the mother feel guilty about her decision to begin bottle feeding to supplement breastfeeding. Instead, she should educate the mother about best practices for bottle feeding. She can give it to supplement any stored breast milk she might have in supply. She should emphasize the importance of giving the baby iron-fortified formula because fetal iron stores become depleted by 4 to 6 months of age. Infants younger than 1 year of age should not receive regular cow's milk because it may place a strain on the immature kidneys. Because the baby weighs 14 pounds, he will require about 21 ounces of formula a day (not 36 ounces), based on the nutritional recommendations that infants require 80 to 100 mL of formula or breast milk per kilogram of body weight per day.

Which portion of a nutritional assessment must the registered nurse complete? a)Analyzing the data b)Obtaining intake and output c)Weighing the patient d)Obtaining the history

A The registered nurse should review and interpret (analyze) the data collected as part of a nutritional assessment. The registered nurse can delegate height, weight, and intake and output to nursing assistive personnel. History taking can be safely delegated to the licensed practical nurse.

A 52-year-old man has a triceps skinfold thickness of 18 mm, and his weight exceeds the ideal body weight for his height by 23%. Which nursing diagnosis should the nurse identify for this patient? a)Imbalanced Nutrition: More Than Body Requirements b)Risk for Imbalanced Nutrition: More Than Body Requirements c)Imbalanced Nutrition: Less Than Body Requirements d)Readiness for Enhanced Nutrition

A This patient has defining characteristics for the nursing diagnosis Imbalanced Nutrition: More Than Body Requirements: triceps skinfold thickness more than 15 mm in men and weight that is 20% over ideal for height and frame. The patient does not have defining characteristics for the other nursing diagnoses.

1. To promote wound healing, the nurse is teaching a patient about choosing foods containing protein. The nurse will evaluate that learning has occurred if the patient recognizes which food(s) is an incomplete protein that should be consumed with a complementary protein? Select all that apply. a)Whole grain rice b)Lentils c)Soybeans d)Egg whites e)Quinoa

A, B Incomplete protein foods do not provide all of the essential amino acids necessary for protein synthesis. By combining two or more incomplete proteins, a complete (whole) protein may be formed. The amino acids missing from one source can be made whole by adding another protein that contains that missing amino acid. For example, legumes (lentils) and grains (rice) with yellow peppers make a healthy meal using complementary proteins. Other examples are nuts (peanut) with legumes (black beans) in a salad. Dairy (yogurt) and seeds (sunflower and flax seeds) also work this way. Egg whites, soybeans, and quinoa are examples of complete proteins.

The nurse is teaching a patient about the importance of reducing saturated fats in his diet. The nurse will recognize that learning has occurred if, upon questioning, the patient replies that he should read product labels to eliminate the intake of which saturated fats? Select all that apply. a)Palm oil b)Coconut oil c)Canola oil d)Peanut oil e)Safflower oil

A, B Palm and coconut oils are sources of saturated fat that are contained in many processed foods. The patient should be encouraged to read product labels to eliminate them from his diet. Olive, canola, and peanut oils are monounsaturated fats that tend to lower LDL cholesterol (the "bad" cholesterol). These should be substituted for saturated fats in the diet. Polyunsaturated fats that also tend to lower blood cholesterol are found in plant sources, such as sunflower, safflower, soybean, corn, and cottonseed.

The nurse assigned to an oncology unit reports that three of the patients with cancer do not have an appetite and have eaten little during the shift. What strategies can the nurse on the next shift use to increase her patients' appetites? Select all that apply. a)Offer frequent, smaller meals. b)Keep the patients' rooms neat and clean. c)Provide or assist with frequent oral hygiene. d)Increase liquid intake with meals. e)Serve foods with little aroma.

A, B, C Illness, with any accompanying pain, anxiety, and medications, often causes appetite loss. To improve appetite and intake and, subsequently, nutritional status, the nurse would offer frequent and smaller meals; keep the patient's environment neat and clean and free of unpleasant sights, odors, and medical equipment; order a late food tray or warm the food; provide or assist with frequent oral hygiene; provide a pleasant eating environment; serve foods attractively; control pain; encourage meals with family and friends; and position the person comfortably for mealtime. Fluids are usually not increased with meals to prevent gastric distention and feeling full before the patient consumes sufficient nutrients.

A nurse on a medical-surgical unit asks a licensed practical nurse (LPN) to help with nutritional assessments for newly admitted patients. What part of the nutritional assessment can be delegated to the LPN? Select all that apply. a)Height and weight b)Intake and output c)Nutritional history d)Interpreting laboratory findings e)Body fat measurement

A, B, C The registered nurse can safely delegate to the licensed practical nurse (LPN/LVN) the measurement of weight, height, body fat, hip-waist ratio, and other anthropometric measures. The LPN/LVN can document intake and output and obtain the patient's nutritional history. However, the registered nurse is responsible for reviewing and interpreting the findings of the nutritional assessment, including laboratory values.

The pediatric nurse is preparing a teaching plan about vitamins for parents of school-age children. What vital information will the nurse include in the plan? Select all that apply. a)Vitamins are needed for cellular metabolism. b)Vitamins are necessary for preventing particular deficiency diseases. c)Because the body does not make vitamins, they must be supplied by the foods we eat. d)The most important vitamin for children is vitamin C. e)Vitamin C toxicity occurs in people with liver dysfunction.

A, B, C Vitamins are organic substances that are necessary for metabolism or preventing a particular deficiency disease. Because the body cannot make vitamins, they must be supplied by the foods we eat. Vitamins are critical in building and maintaining body tissue, supporting our immune system so we can fight disease, and ensuring healthy vision. There is no reference that children need any other specific vitamin, such as vitamin C, more than others; all are important for healthy bodily functions. Because vitamin C is soluble in water, any excessive amount is regularly excreted by the kidneys into the urine. Thus, toxicity is rare except in people with renal disease—not liver disease.

The nurse admitting a new patient to the medical-surgical unit is conducting a dietary history. What information should the nurse include? Select all that apply. a)Basic eating habits b)Food preferences c)Attitude toward food d)A body mass index (BMI) e)Cultural dietary restrictions

A, B, C, D A nurse can obtain a dietary history during any routine assessment. The purpose is to collect baseline information about the patient's basic eating habits, food attitudes and preferences, cultural factors, and use of dietary supplements. A dietary history creates a picture of the patient's food habits and eating behaviors. A body mass index (BMI) is not part of the dietary history, although it is sometimes a part of a total nutritional assessment.

What should you include in a plan for teaching adults about dietary trans-fatty acids? Select all that apply. a)Trans fat increases the shelf-life of foods. b)Trans fat decreases blood cholesterol levels and LDL levels. c)The FDA mandates that trans fat content be listed on all food labels. d)Check for hydrogenated vegetable oils on food labels. e)Vegetable oil sprays used for cooking are high in trans fats.

A, C, D Trans-fatty acids are saturated fats created when food manufacturers add hydrogen to polyunsaturated plant oils, such as corn oil. This process solidifies the fat, improves texture and flavor, and extends the shelf-life of the food. Trans fats increase (not decrease) blood cholesterol levels. Additionally, they raise LDL levels. The FDA mandates that trans fat content be listed on all food labels. Intake of saturated and trans fat should be limited. Vegetable oil sprays are not high in trans fats. The CDC recommends cooking and baking with vegetable oils (liquid or spray) instead of solid fats (e.g., solid shortenings, butter, lard).

Which instructions should the nurse give to the patient complaining of constipation? Select all that apply. a)Drink at least eight glasses of water or fluid per day. b)Include a minimum of four servings of meat per day. c)Gradually increase your fiber intake to 25 grams per day. d)Exercise at least 60 minutes per day as you feel necessary. e)Use the restroom when you feel the urge to defecate.

A, C, E To prevent constipation, the nurse should instruct the patient to consume a high-fiber diet, drink at least eight glasses of water or fluid per day, exercise regularly, and eat meals on a regular schedule. It is best to gradually increase fiber in the diet to approximately 20 to 35 grams a day. Eating a large amount of fiber when the body is not used to it can cause stomach cramping, bloating, and discomfort. Foods that worsen constipation include ice cream, cheese, and processed foods, particularly those high in refined sugars. Exercise improves digestive function and is best done in moderate amounts on most days of the week. When holding a bowel movement, the body can absorb the water in the stool, making it harder to pass.

For a patient with Risk for Imbalanced Nutrition: Less Than Body Requirements related to Impaired Swallowing, which nursing interventions are appropriate? Select all that apply. a)Check inside the mouth for pocketing of food after eating. b)Provide a full liquid diet that is easy to swallow. c)Remind the patient to raise the chin slightly to prepare for swallowing. d)Keep the head of the bed elevated for 30 to 45 minutes after feeding.

A, D The nurse should check for pocketing of food (storing food in cheeks) that the patient has not been able to swallow, and should keep the head of the bed elevated for 30 to 45 minutes after feeding. Liquids should be avoided unless thickeners are added. The patient should flex the head forward (tuck the chin) in preparation for swallowing.

Which patient is most likely experiencing positive nitrogen balance? A patient admitted: a)With third-degree burns of his legs b)In the sixth month of a healthy pregnancy c)From a nursing home who has been refusing to eat d)With acute pancreatitis

B A positive nitrogen balance typically exists during pregnancy when new tissues are being formed. Patients with burns, malnutrition, and serious illness commonly experience negative nitrogen balance because tissues are lost.

A patient with trigeminal neuralgia is prescribed a mechanical soft diet. This diet places the patient at risk for which complication? a)Dehydration b)Constipation c)Hyperglycemia d)Diarrhea

B Because of its lack of fiber, a mechanical soft diet places the patient at risk for constipation. It does not place the patient at risk for dehydration, hyperglycemia, or diarrhea.

The nurse is caring for a male patient who states, "I have been smoking two packs of cigarettes a day for 20 years and now my nurse practitioner wants me to take vitamins. Do you think I need to take vitamins?" What is the most appropriate response by the nurse? a)"Smoking is bad for your health. I believe if you stop smoking you would certainly be better off and not have to take vitamins." b)"Smokers use vitamin C faster than do nonsmokers, and is linked to iron deficiency. You can either eat more foods containing vitamin C and iron or take dietary supplements." c)"It is probably a good idea. With your history of tobacco use, I'm sure you are lacking in vitamins and nutrients." d)"I really cannot answer this question. You will need to speak with your nurse practitioner to find out more about this."

B Because vitamin C is an antioxidant, smokers metabolize vitamin C faster than do nonsmokers. The more a person uses tobacco, the more vitamin C is lost, yet, the body needs more vitamin C to counteract the damage smoking causes to cells. Additionally, because vitamin C aids in absorption of iron, a low level of vitamin C is also linked to iron deficiency. If a person cannot quit smoking, vitamin C and iron supplementation may help compensate. This is the best explanation to give to the patient. It is informative and nonjudgmental. Nurses can answer these questions without having to refer the patient to the nurse practitioner. Telling a patient he would be better off not smoking may be true, but it reflects a judgmental attitude on the part of the nurse. Telling the patient that he is lacking in many vitamins is too broad and not helpful.

Which class of nutrients is the body's primary source of energy? a)Proteins b)Carbohydrates c)Lipids d)Vitamins

B Carbohydrates are the primary energy source for the body. Carbohydrates perform several functions. They supply energy for muscle and organ function, spare protein, and enhance insulin secretion. Carbohydrates are more easily and quickly digested than are proteins and lipids, fuel strenuous short-term skeletal muscle activity, and provide nearly all the energy for the brain. If carbohydrates are not available, proteins and lipids (fats) can also be used for energy. Proteins primarily perform the following functions: build tissue and maintain metabolism, immune systems functions, fluid balance, and acid-base balance. They are a secondary energy source. The primary functions of lipids include supplying the body with essential nutrients, acting as an energy source, providing flavor and satiety, and providing insulation. Although vitamins provide no energy, they are critical in regulating a variety of body functions.

A 30-year-old patient newly diagnosed with type 2 diabetes states to the nurse, "If glucose is so important, then I think as long as my blood sugar is high I must be doing well." What is the most appropriate response by the nurse? a)"It depends on what you mean by high blood sugar. You will need to obtain more information from your provider as diabetes is a very complicated disease process." b)"I understand how you are thinking; however, a high glucose level does not mean that there is more fuel available for your body's cells. Because you have diabetes, your body cells will allow only a limited amount to enter. The cells can't use the excess glucose." c)"I will be able to explain this to you a little better later when we talk about diabetes. For now, I have to finish my assessment and then we can get back to your question." d)"I will teach you how to perform glucose testing when I finish your assessment. As long as your blood sugar remains somewhere in the 120 to 140 range, you will be doing well."

B Diabetes, an endocrine problem, may develop as a result of either insufficient insulin production or resistance to the existing supply of insulin. A high blood glucose level does not mean that there is more fuel available for cellular energy. A characteristic of diabetes is that although there is more than enough glucose in the blood, it cannot enter and be used by the cells. Putting the patient off by telling her to ask the provider indicates either her own poor understanding of the disease, or an unwillingness to provide patient teaching. The nurse should clarify, explain, and teach this information to her patient in a timely way. Glucose testing is important; however, a random blood sugar range of 120 to 140 mg/dL is too high for diabetic patients.

A group of pediatric nurses accepts an international assignment in an underdeveloped country. The nurses are informed that they will be caring for many children with kwashiorkor. The nurses will create a care plan focusing on which primary nutrient for these children? a)Calories b)Protein c)Lipids d)Glucose

B Malnutrition is most common in underdeveloped nations and among children, older adults, and people with chronic illness such as cancer, HIV, and COPD. Malnutrition caused by deficiency of protein in a diet that is primarily starches is called kwashiorkor. When protein sources in food are scarce and overall caloric intake is low, marasmus occurs, particularly in young children. Kwashiorkor is not a disease of low calorie, lipid, or glucose intake.

A middle-aged patient with a history of alcohol abuse is admitted with acute pancreatitis. This patient will most likely be deficient in which nutrients? a)Iron b)B vitamins c)Calcium d)Phosphorus

B Patients who regularly abuse alcohol may be deficient in many nutrients; however, they are commonly deficient in the B vitamins and folic acid. Vitamin A deficiency can be associated with night blindness in heavy drinkers; vitamin D deficiency leads to softening of the bones. Because some alcoholics are deficient in vitamins A, C, D, E, and K and the B vitamins, they experience delayed wound healing. In particular, because vitamin K, the vitamin needed for blood clotting, is commonly deficient in those who regularly abuse alcohol, those patients can have delayed clotting, resulting in excess bleeding. Deficiencies of other vitamins involved in brain function can cause severe neurological damage.

Which laboratory test result most accurately reflects a patient's nutritional status? a)Albumin b)Prealbumin c)Transferrin d)Hemoglobin

B Prealbumin levels fluctuate daily and give the best indication of the patient's immediate nutritional status. Albumin level is not as accurate because the half-life of albumin is 18 to 21 days, causing a delay in detection of nutritional problems. Transferrin, a protein that binds to iron, has a half-life of 8 to 9 days; therefore, it allows for faster detection of protein deficiency than does albumin. However, transferrin is not as fast as prealbumin. Hemoglobin level reflects iron intake or blood loss.

Which nutrient deficiency increases the risk for pressure ulcers? a)Carbohydrate b)Protein c)Fat d)Vitamin K

B Protein is necessary for growth and maintenance of body tissues. Protein deficiency places the patient at risk for skin breakdown and pressure ulcer formation. Carbohydrates are the primary fuel of the body. Fat is a source of energy and contains essential nutrients. Vitamin K aids blood clotting.

For an elderly client who is experiencing chronic nausea and weight loss, which laboratory result would the nurse recognize as being most consistent with a diagnosis of Imbalanced Nutrition: Less Than Body Requirements? a)Serum glucose of 78 mg/dL b)Serum albumin of 3.2 g/dL c)Creatinine of 1.0 mg/dL d)Potassium of 4.1 g/dL

B Serum albumin is a blood protein and marker for nutritional status. The value should be between 3.5 and 5.0 g/dL. This situation is consistent with undernutrition due to low nutritional intake. As there is no indication that the woman has been vomiting, the potassium level should be within normal limits (3.4 to 4.8 mEq/L). However, if she had been vomiting over a period of days or longer, you would anticipate her to have low potassium, sodium, and other electrolyte levels. Serum glucose is normal (70 to 100 mg/dL) in this scenario. The serum creatinine is within normal limits for women (0.5 to 1.0 mg/dL).

Where in the body is glucose stored? Select all that apply. a)Brain b)Liver c)Skeletal muscles d)Smooth muscles e)Bone marrow

B, C Human beings store glucose in liver and skeletal muscle tissue as glycogen. Glycogen is converted back into glucose to meet energy needs. Blood is produced in the bone marrow (not glucose). The brain requires glucose to function but does not store glucose.

A patient who underwent surgery 24 hours ago is prescribed a clear liquid diet. The patient asks for something to drink. Which item may the nurse provide for the patient? a)Tea with milk b)Orange juice c)Gelatin d)Skim milk

C A clear liquid diet consists of water; tea (without dairy); coffee; broth; clear juices, such as apple, grape, or cranberry; popsicles; carbonated beverages; and gelatin. Skim milk, tea with milk, and orange juice are included in a full liquid diet.

During the day shift, a patient's temperature measures 97°F (36.1°C) orally. At 2000, the patient's temperature measures 102°F (38.9°C). What effect does this rise in temperature have on the patient's basal metabolic rate? a)Increases the rate by 7% b)Decreases the rate by 14% c)Increases the rate by 35% d)Decreases the rate by 28%

C Basal metabolic rate increases 7% for each degree Fahrenheit (0.56°C); therefore, this patient's temperature rise is an increase of 35%.

A patient's 2:1 parenteral nutrition container infuses before the pharmacy prepares the next container. This places the patient at risk for which complication? a)Sepsis b)Pneumothorax c)Hypoglycemia d)Thrombophlebitis

C Because of the high glucose content of 2:1 parenteral nutrition, any interruption in therapy places the patient at risk for hypoglycemia. A PN of this type should not be discontinued abruptly, but rather over several (as many as 48) hours to prevent a sudden drop in blood sugar. Hypoglycemia is unlikely to occur with a 3:1 solution (containing lipids), as the final concentration of glucose is less than 10%. Sepsis is a complication that can occur if a break in aseptic technique occurs during therapy. Pneumothorax can occur as a result of central venous catheter insertion. Central venous catheters are typically employed for parenteral nutrition. Thrombophlebitis is a complication of central venous catheter use.

Which polysaccharide is stored in the liver? a)Insulin b)Ketones c)Glycogen d)Glucose

C Humans store glucose in the liver as polysaccharides, known as glycogen. Glycogen can then be converted back into glucose to meet energy needs through a process known as glycogenolysis. If fats must be used for energy, they are converted directly into ketones. Insulin is a pancreatic hormone that promotes the movement of glucose into cells.

Which of these statements made by a client whose BMI is 34 and is attempting to lose weight would indicate the need for further teaching? a)"I should limit the number of fruit juices that I drink every day." b)"I need to tell my family and friends about my commitment to lose weight." c)"An online food diary is unlikely to help me to improve my food intake." d)"I should limit the amount of time that I spend in front of my computer and TV."

C Keeping a food diary (either traditional or online), reviewing nutritional intake (both food selections and serving size), and patterns of consumption have all been shown to assist clients in decreasing dietary intake. Sugar-sweetened beverages (e.g., soda, fruit juices, fruit drinks, and energy drinks) have a high concentration of empty calories and minimal micronutrients. Setting realistic, measurable goals that are shared with family members (accountability) increases the likelihood of success. Increased exercise and reduced sedentary activities (e.g., screen time), coupled with reduced dietary intake with improved food quality, tend to result in weight loss.

Which nutritional goal is appropriate for a patient newly diagnosed with hypertension? The patient will: a)Limit his intake of protein b)Avoid foods containing gluten c)Restrict his use of sodium d)Limit his intake of potassium-rich foods

C Patients with hypertension should limit their intake of sodium. Those with liver disease should control their protein intake. Patients with renal disease must limit their intake of potassium-rich foods. Patients with celiac disease should avoid foods containing gluten.

After inserting a nasogastric tube, what would be the nurse's priority action prior to starting the first tube feeding? a)Auscultate bowel sounds over the abdomen. b)Aspirate gastric contents and obtain a pH reading. c)Obtain radiographic verification (x-ray). d)Mix the feeding with water for the first feeding only.

C Radiographic (x-ray) verification is the only reliable method for confirming tube placement; it must be performed before the first feeding is administered. All feeding tubes contain markings that can be detected by radiographic films. Reliable bedside assessment is necessary following the initial x-ray verification and is used prior to feedings because even when the tube is initially placed correctly in the stomach/intestines and verified by x-ray, it may move upward. However, no bedside method alone is reliable. Feeding tube placement can be checked by testing the pH of the aspirate in combination with other methods; however, this is not the most reliable indication of proper placement prior to a first feeding. Auscultating bowel sounds does not provide any reliable information related to tube placement, although it is an indicator of intestinal motility. For an initial feeding, the prescriber may order the feeding to be mixed with water to assess the patient's tolerance of the feeding. Nevertheless, tube placement must be verified prior to feeding.

While addressing a community group, the nurse explains the importance of replacing saturated fats in the diet with mono- and polyunsaturated fats. She emphasizes that doing so greatly reduces the risk of which complication? a)Kidney failure b)Liver failure c)Stroke d)Lung cancer

C Replacing saturated fats in the diet with mono- and polyunsaturated fats reduces the risk of heart disease, atherosclerosis, and stroke, not kidney failure, liver failure, or lung cancer.

While the nurse is performing a nutritional assessment her patient states, "I am on a vegan diet. I have been a vegan for 10 years. What do think?" What is the best response by the nurse? a)"Is this a religious or cultural requirement for you?" b)"It is fine; however, you may not be getting all the nutrients you need." c)"Can you tell me about the foods you eat along with any other supplements you take?" d)"I think it is your right to be on whatever diet you would like to be on."

C The most appropriate response by the nurse is to first assess what the patient is eating and what supplements the patient uses. This will assist the nurse in identifying the patient's knowledge level of the diet and in identifying proper supplements. The nurse cannot assume that although the patient is following a specific diet, she is obtaining the proper nutrition. Asking the patient whether this is a religious or cultural requirement may be judgmental, is a closed question, and will not elicit information regarding specific dietary intake. All vegetarian diets exclude red meat and poultry, but beyond this distinction is a wide spectrum of vegetarian diets. Vegans eat only foods of plant origin. When choosing a vegetarian diet, one cannot use animal products, such as eggs and milk, to supply necessary nutrients. For example, vegans must eat foods fortified with B12 or take B12 supplements because a deficiency can result in severe and irreversible neurological impairment. Other nutrients that may be inadequately supplied in vegan diets include vitamin D, calcium, iron, and zinc. It is certainly an individual's right to make his or her own choices regarding diet; however, this response again will not assist the nurse in conducting a thorough nutritional assessment.

A patient with type 1 diabetes mellitus is admitted with hyperglycemia and associated acidosis. The presence of which alternative fuel in the body is responsible for the acidosis? a)Glycogen b)Insulin c)Ketones d)Proteins

C When fats are converted to ketones for use as alternative fuel, as in diabetic ketoacidosis when glucose cannot by used by the cells, the acidity of the blood rises, leading to the acidosis. Glycogen is converted to glucose to meet energy needs. Insulin, a pancreatic hormone, promotes the movement of glucose into cells for use. Proteins would not be used for fuel as long as fats were available.

An elderly female, adequately nourished, was admitted to the skilled nursing facility 3 months ago. Since then, she has had a significant weight loss and become frail. Her appetite and activity level are reduced and she has lost interest in interacting with other patients. What would the nurse suspect the reason for her condition to be? a)Need for teaching about nutrition b)Anxiety c)Distaste for the food served d)Adult failure to thrive

D Adult failure to thrive is a complex disorder seen in many institutionalized older adults. It is characterized by weight loss, decreased activity and interactions, and increasing frailty. The overall description presented by the nurse is consistent with adult failure to thrive. The resident's poor appetite is not a result of not understanding nutrition or the need to eat. Teaching would not be helpful in this instance. In this situation, the resident's poor appetite is more likely related to depression and social withdrawal or even dementia than to anxiety. Most skilled nursing facilities could individualize the dietary selection to some degree to provide residents with adequate nutrition.

Which of the following interventions would help to prevent or relieve persistent nausea? a)Assess for signs of dehydration. b)Provide dietary supplements. c)Have the patient sit in an upright position for 30 minutes after eating. d)Immediately remove any food that the patient cannot eat.

D Dehydration can occur as a result of continued nausea and vomiting, so the nurse should assess for it. However, this intervention does not prevent nausea. Dietary supplements might help to prevent malnutrition. However, they do not prevent nausea; in fact, they often cause nausea. Having the patient sit upright helps to prevent respiratory aspiration should the patient vomit; it does not prevent or relieve nausea. Odors (even pleasant ones) and even the sight of food can cause nausea, so any uneaten food should be removed immediately from the room.

After instructing a mother about nutrition for a preschool-age child, which statement by the mother indicates correct understanding of the topic? a)"I usually use dessert only as a reward for eating other foods." b)"I will hide vegetables in casseroles and stews to get my child to eat them." c)"I do not give my child snacks; they simply spoil his appetite for meals." d)"I know that lifelong food habits are developed during this stage of life."

D Lifelong food habits are developed during the preschool stage of life. Therefore, the mother should widen the variety of foods she introduces to her child. Desserts should not be used as rewards for eating other foods. This practice can shape an attitude about food that can lead to eating disorders later in life. Preschool-age children often refuse combined foods such as casseroles and stews. Because they are active, preschoolers require nutritious between-meal snacks.