Chapter 37: Nutrition
The nurse is providing education about nutrition and feeding to the parent of a toddler. Which statement by the child's parent indicates understanding of the education?
"Boiled eggs and pieces of cheese are good snacks for my child." Explanation: Toddlers are often independent and insist on feeding themselves. Appropriate "finger foods" include meatballs, hard-boiled eggs, cooked carrots, fruit slices (without skins), cheese pieces, dry cereal, and crackers. Avoid whole grapes, hot dogs, hard candy, and other foods that could cause choking.
A client tells the nurse, "As long as I only eat 2,400 calories per day, it does not matter which foods I eat." Which response by the nurse is best?
"Can you share an example of what you ate yesterday?" Explanation: Healthy adult client on average require 1,800 to 2,400 cal/day. Unless the caloric intake includes an appropriate mix of proteins, carbohydrates, and fats, the person may be marginally nourished or malnourished. In other words, consuming 2,400 calories of chocolate, exclusive of any other food, is not adequate to sustain a healthy state. By asking the client for an example of the foods eaten, the nurse can help the client plan effectively. It is important to teach clients about healthy nutrition, so this response is most appropriate. The other responses from the nurse are not correct.
A client is discussing vitamin and mineral intake with the nurse. Which client statement requires further nursing teaching?
"My husband and I are ordering a product that has megadoses of vitamins." Explanation: Consuming megadoses (amounts exceeding those considered adequate for health) of vitamins and minerals can be dangerous. This statement requires further nursing teaching. The other statements do not require further teaching.
A female client tells the nurse, "I try to consume 2000 calories daily by eating a variety of proteins, carbohydrates, and fats." What is the appropriate nursing response?
"That is a healthy amount of daily caloric intake." Explanation: Healthy adult women on average require 1800 to 2400 cal/day, with a mix of proteins, carbohydrates, and fats. The nurse should affirm the client's dietary choices. Other answers are incorrect and do not counsel the client appropriately.
The nurse is educating a client taking furosemide for heart failure about eating foods that are rich in potassium. Which statement made by the client indicates that education was effective?
"When I take my medication, I will eat a banana or take it with a glass of orange juice." Explanation: The client demonstrates that the teaching was effective by identifying bananas and orange juice as foods rich in potassium. The desired effect of the medication is to excrete sodium to avoid the accumulation of fluid in the lungs. To increase the amount of salt in the diet would be counterproductive. Dairy products such as milk and cheese are not potassium-rich foods. Eating small frequent meals versus three meals per day is irrelevant in increasing potassium level.
A nurse is establishing an ideal body weight for a 5'9" (175 cm) healthy female. Based on the rule-of-thumb method, what would be this client's ideal weight?
145 lb/ 65.7 kg Explanation: A general guideline, often called the rule-of-thumb method, determines ideal weight based on height. This formula is as follows: For adult females: 100 lb/45.3 kg (for height of 5 feet or 152 cm) + 5 lb / 2.2 kg for each additional inch (2.5 cm) over 5 feet. For adult males: 106 lb / 48 kg (for height of 5 feet) + 6 lb / 2.7 kg for each additional inch over 5 feet.
The nurse prepares to provide gastrostomy insertion site care. The gastrostomy tube was placed this week. The client reports pain at the site. Which action does the nurse take next?
Administer pain medication. Explanation: Gastrostomy feeding tubes are uncomfortable for the first days after insertion. The client will tolerate site care better after analgesic administration. While waiting for the medication to take effect, the nurse can prepare the area. After the medication is working, the nurse provides for privacy and begins site care, carefully assessing for other reasons for site pain including excessive erythema or edema.
The nurse has identified the nursing concern of aspiration risk for a client. When preparing to assist this client with eating, how can the nurse best reduce this risk?
Assess the client's level of consciousness. Explanation: Decreased level of consciousness greatly increases a client's risk of aspirating; it is imperative that the nurse assess this prior to the client eating. It is appropriate for the nurse to assess the client's mouth and abdomen and assess for nausea, but none of these actions directly address the client's risk of aspiration.
Prior to allowing a client to eat, which action is most important for the nurse to take?
Assess the client's level of consciousness. Explanation: The most important thing the nurse can do is to ensure the client is alert enough to safely eat without aspirating. Next, ensuring the client is physically able to self-feed and safely swallow is necessary. The client's cultural needs and eyesight are least important.
The nurse is caring for a client who refuses most foods on the dietary tray. Which nursing intervention is appropriate?
Assess when client generally eats meals. Explanation: There are many reasons a client may refuse food that is served. The nurse should assess for food preferences, when the client generally eats, whether the client has digestive concerns, and cultural beliefs about foods. Leaving the client alone to eat, or simply delegating feeding, does not encourage intake. The client does not need an appetite stimulant until a full assessment has been conducted and other interventions have been implemented.
A nurse is teaching a client about diabetes and glucose monitoring. What should the nurse include in the teaching?
Blood from the fingertips shows changes in glucose more quickly than other testing sites. Explanation: With glucose monitoring, blood from the fingertips shows changes in blood glucose more quickly than other testing sites. With signs and symptoms of hypoglycemia, a fingertip site should be used. Calibrate the glucose monitors at least every month. Glucose levels increase with illness and stress to the body.
The client with dysphagia has a regular meal tray delivered at breakfast. Which is the best action for the nurse to take?
Check the medical record for the client's prescribed diet. Explanation: The nurse ensures the client has received the correct meal tray. Often a client on a dysphagia diet will have a special diet that includes softer or pureed foods and thickened liquids that aren't available on the regular diet tray. The other actions are not incorrect, but the client may not be on a chopped food diet. Sometimes the client with dysphagia just requires sips between bites, and there is no reason to use foods from the unit's kitchen area. The best action the nurse can take is to ensure the client get the correct meal tray.
Which nursing action associated with successful tube feedings follows recommended guidelines?
Check the residual before each feeding or every 4 to 6 hours during a continuous feeding. Explanation: The nurse should check the residual before each feeding or every 4 to 6 hours during a continuous feeding. High gastric residual volumes (200 to 250 mL or greater) can be associated with high risk for aspiration and aspiration-related pneumonia. A closed system is the best way to prevent contamination during enteral feedings. The bowel sounds do not have to be assessed as often as 4 times per shift. Once a shift is sufficient. Food dye should not be added as a means to assess tube placement or potential aspiration of fluid.
A nurse is working with a 46-year-old woman who is working to lose weight. Based on recommendations from the USDA regarding diet modification, which is not appropriate advice for this client?
Drink juice for majority of fluid intake. Explanation: Water should comprise the majority of fluid intake. The remainder should come from food sources such as fruit or 100% fruit juices.
A nurse is managing a client's continuous tube feeding via an NG tube. How often should the nurse check for residual?
Every 4 to 6 hours Explanation: Checking for residual before each feeding or every 4 to 6 hours during a continuous feeding according to institutional policy is implemented to identify delayed gastric emptying. Residuals are not measured immediately after a flush.
A nurse is caring for a client in a long-term care facility. The nurse is reviewing the laboratory data for this client. The nurse should notify the primary care provider if which laboratory result is observed?
Hematocrit 35% Explanation: The hematocrit level of this client is low. Normal hematocrit is 40%-50%. The normal value for hemoglobin is 12-18 mg/dL. The normal value for transferrin is 240-480 mg/dL. The normal blood urea nitrogen is 17-18 mg/dL.
The nurse is caring for a client receiving continuous tube feeding. The client has a gastric residual of 550 mL. The previous residual was 200 mL. What action should the nurse take?
Hold the enteral nutrition and notify the primary care provider. Explanation: When the residual is greater than 500 mL, the enteral feeding should be held and the primary care provider (PCP) needs to be called for further instructions. If there had been two consecutive residuals >250 mL, the PCP would consider ordering a promotility agent. The PCP will consider decreasing the rate of the tube feeding and may or may not want the residual returned since it is so large. The nurse would not discard or replace the residual and merely chart the amount of the residual and continue the tube feeding at the ordered current rate. The excessive large residuals will increase the client's risk for aspiration.
A nurse is delivering meal trays to clients on the unit. One client has a fractured dominant arm which is in a sling. What is the first nursing action when bringing the tray into the client's room?
Identify the name of the client. Explanation: When serving meal trays, the nurse first identifies the name of the client to ensure the client receives the correct meal tray. The nurse will then assist this client, who has limited mobility of the arm, in preparing the food by removing lids from the food items, opening cartons of fluids, and cutting food into bite-sized pieces.
Which nursing action is performed according to guidelines for aspirating fluid from a small-bore feeding tube?
If fluid is obtained when aspirating, measure its volume and pH and flush the tube with water. Explanation: The nurse would measure the volume and pH of the aspirated fluid, then flush the tube with water. The nurse would not place the client in Trendelenburg position as this could lead to reflux of the feeding from the stomach and possibly cause aspiration of the solution into the lungs. The nurse would not use a small syringe or continue to instill air until fluid is aspirated.
A nurse is caring for a client with a gastrostomy tube in place. Which is an accurate guideline for care of the insertion site?
If the gastric tube insertion site has healed and the sutures are removed, use soap and water to clean the site. Explanation: If the gastric tube insertion site has healed and the sutures are removed, wet a washcloth and apply a small amount of soap onto it. Gently cleanse around the insertion site, removing any crust or drainage. If the gastrostomy tube is new and still has sutures holding it in place, dip a cotton-tipped applicator into sterile saline solution and gently clean around the insertion site, removing any crust or drainage. Avoid adjusting or lifting the external disk for the first few days after placement, except to clean the area.
What is an appropriate intervention when unexpected situations occur during the administration of a tube feeding?
If the tube becomes clogged when aspirating contents, use warm water and gentle pressure to remove the clog. Explanation: Warm water and gentle pressure should be used to unclog a tube. If a large amount of residue is accidentally aspirated, the health care provider should be notified. If the client is nauseated, the head of the bed should remain elevated and an antiemetic administered as prescribed. The tube should be in the stomach, not the esophagus.
The nurse is reviewing a client's most recent laboratory results, which reveal increases in hematocrit, creatinine, and blood urea nitrogen (BUN). After collaborating with the interdisciplinary team, what intervention is most appropriate?
Increase the client's fluid intake. Explanation: Dehydration can cause increases in hematocrit, BUN, and creatinine. Calorie restriction, increased protein intake, and TPN are not indicated by these laboratory data.
A client who is recovering from a stroke has begun tube feedings. Which principle should the nurse follow when administering the tube feeding?
Intermittent feedings use gravity for instillation or a feeding pump to administer the formula over a set period of time. Explanation: Intermittent feedings are delivered at regular intervals, using gravity for instillation or a feeding pump to administer the formula over a set period of time. The steps for administering feedings are similar regardless of the tube used. Intermittent feedings are the preferred method of introducing the formula over a set period of time via gravity or pump. Feeding intolerance is less likely to occur with smaller volumes. Feeds are not warmed prior to instillation.
The nurse is caring for a client with an enlarged thyroid. What nutritional deficiency is linked to an enlarged thyroid?
Iodine Explanation: A chronic deficiency of iodine can lead to endemic goiter. The major initial symptom is an enlarged thyroid gland.
The nurse is caring for a client with an enlarged thyroid gland. Which nutritional deficiency will the nurse suspect is linked to the client's condition?
Iodine Explanation: A chronic deficiency of iodine can lead to goiter, which manifests as an enlargement of the thyroid gland.
What should the nurse consider when teaching a man with well-defined muscle mass about meal planning?
Men have a higher need for proteins. Explanation: Due to the higher percentage in muscle mass in men, they have a higher need for proteins in their diet. Men do not have a higher or lower need for carbohydrates, minerals, or vitamins.
During a visit to the pediatrician's office, a parent inquires about adding solid foods to the diet of a 6-month-old infant. What does the nurse inform the parent?
New foods should be introduced one at a time for a period of 2 to 3 days. Explanation: Solid foods are generally introduced between 4 and 6 months of age. New foods should be introduced one at a time for a period of 2 to 3 days so that any allergic reaction can be identified. Iron-fortified foods are recommended.
A nurse is caring for a client who is not able to take food orally for 10 days and who will be on IV therapy during that period. The nurse knows that the client will likely receive which type of nutrition?
Peripheral parenteral nutrition Explanation: The client requires peripheral parenteral nutrition. Peripheral parenteral nutrition provides temporary nutritional support of approximately 2000 to 2500 calories daily. It can meet a client's metabolic needs when oral intake is interrupted for 7 to 10 days, or it can be used as a supplement during a transitional period as a client begins to resume eating. Total parenteral nutrition (TPN) is preferred for clients who are severely malnourished or may not be able to consume food or liquids for a long period. Metabolizing nutrition is a way to replenish and supply water to the body. A nasogastric feed is administered through narrow tubing that is inserted through the client's nose into the stomach.
The nurse is performing a nutritional assessment of an obese client who visits a weight control clinic. What information should the nurse take into consideration when planning a weight reduction plan for this client?
Psychological reasons for overeating should be explored, such as eating as a release for boredom. Explanation: The nurse would need to take into consideration that psychological reasons for overeating should be explored. One pound of body fat is equal to approximately 3,500 calories. To lose 1 pound/week, the daily intake should be decreased by 500 calories per day. Obesity can be difficult to treat due to various factors.
The average dietary nutrient intake level that meets the nutritional requirement of almost all healthy people in a selected age and gender group is the:
RDA level Explanation: The RDA level is the average dietary intake level that meets the nutritional requirement of almost all healthy people in a selected age and gender group.
A nurse is reviewing a client's laboratory values. Which laboratory value would be indicative of a client's level of malnutrition?
Serum albumin Explanation: Serum albumin levels can help measure protein levels in the body and are good indicators for nutrition status. Hemoglobin levels maintain red blood cells that carry oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs. Creatinine is a laboratory value that assesses kidney function. Oxygen saturation is the fraction of oxygen-saturated hemoglobin relative to total hemoglobin in the blood. It is best used to determine how well a client is oxygenating.
A nurse is caring for a client who has a malabsorption disease. The nurse should understand that which structure in the gastrointestinal system absorbs the majority of digested food and minerals?
Small intestine Explanation: Most absorption of digested food and minerals occurs in the small intestines. The stomach is responsible for storing food, secreting digestive enzymes, and digestion. The large intestine forms feces and absorbs water to regulate the consistency of stool. The digestive function of the liver is the production of bile.
A client is receiving continuous tube feeding via a nasogastric (NG) tube. What should the nurse use to determine that the NG is in correct placement? Select all that apply.
Stop tube feedings for 1 hour after medication before testing the pH of the gastric fluid. Visually assess aspirate that it differs from the color and consistency of the tube feeding. Measure the exposed length of feeding tube and compare it to the baseline measurement. Explanation: The tube feeding and medications can alter the pH, so stop the tube feeding for 1 hour before testing the pH of the aspirate. The aspirate from the stomach should be different from the tube feeding: green with particles of off-white or brown may be present and the aspirate should be clear in consistency. The feeding tube has radiographic markings and the same marking present at the nare should be the same as charted in the baseline when the tube was confirmed initially by chest x-ray. Chest x-rays are not repeated to confirm placement of a feeding tube because they would expose the client to unnecessary radiation. The aspirate in the stomach should have a pH range of 4 to 6, and is usually <5.5.
A health care provider orders nutritional therapy administered via a central vein for a client who cannot take foods orally. What is the term for this type of nutrition?
Total parenteral nutrition (TPN) Explanation: TPN is nutritional therapy that bypasses the gastrointestinal tract and is administered through a central vein. PPN is nutritional therapy used for clients who have an inadequate oral intake and require supplementation of nutrients through a peripheral vein. A PEG is a surgically placed gastrostomy tube. A PEJ is a surgically placed jejunostomy tube.
An older adult client informs the nurse that foods don't taste or smell the same and eating is a chore. What suggestion can the nurse provide to the client to address this age-related change?
Try eating foods that are attractive and at the proper temperature. Explanation: The nurse should suggest eating foods that are attractive and at the proper temperature. Other suggestions include eating one food at a time rather than mixing foods and eating foods with different textures and aromas. The nurse should refrain from suggesting spicy foods, which may not be well tolerated by a client or may not be part of the client's flavor profile.
The nurse has observed that a client's food intake has diminished in recent days. What intervention should the nurse perform in order to stimulate the client's appetite?
Try to ensure that the client's food is attractive and sufficiently warm. Explanation: Food in the health care setting can often be unattractive and cool. Ensuring that it is appealing to the eyes and presented at the correct temperature can stimulate the client's appetite. Meals should be small and more frequent, not less frequent and larger. Supplements may be nutritionally necessary, but these do not act to increase the client's appetite.
The client reports to the nurse that she feels as if her eyes are persistently dry. This symptom is consistent with a deficiency in which dietary element?
Vitamin A Explanation: Dryness of the eyes (xerophthalmia) is associated with a deficiency of vitamin A.
A client is prescribed warfarin, an anticoagulant. When educating this client about potential diet and drug interactions, the nurse would caution the client about foods containing which nutrient?
Vitamin K Explanation: Specific foods may interact with medications, altering the effectiveness of the drug. Vegetables high in vitamin K decrease the effectiveness of the commonly used anticoagulant warfarin. Calcium, potassium, and Vitamin C do not interact with warfarin.
The nurse is assessing clients for basal metabolic rate (BMR). Which client would the nurse suspect would have an increased BMR?
a client who has a fever Explanation: A client who has a fever would have an increased BMR. The energy needs of the body are increased due to the client's fever. The BMR is decreased in an older adult client, a client who is fasting, and a client who is asleep.
The nurse is teaching four clients in a community health center. Which client does the nurse identify as needing more servings per day of milk?
adolescent who is in the second trimester of pregnancy Explanation: Children, adolescents, pregnant women, and breast-feeding mothers require more servings per day of certain food groups, particularly the milk group. Therefore, the adolescent who is pregnant will require more milk servings. The other clients do not require more servings of milk.
The nurse is teaching an older adult client about different types of proteins that can be eaten. Which foods will the nurse identify as containing dietary protein? Select all that apply.
beans nuts poultry fish Explanation: Dietary proteins are obtained from animal and plant food sources, which include milk, meat, fish, poultry, eggs, soy, legumes (peas, beans, and peanuts), nuts, and components of grains. Butter is a fat and not a source of protein.
A client has been found to be deficient in vitamin K. For what complication will the nurse closely assess, because it is related to this deficiency?
bleeding tendencies Explanation: A deficiency in vitamin K will cause bleeding tendencies related to the inability for the blood to clot appropriately. Visual disturbances may indicate a deficiency in vitamin A. Alterations in calcium levels may indicate a deficiency in vitamin D. Cardiac arrhythmias may be caused by potassium, calcium, magnesium deficiency.
The nurse is teaching a client about ways in which to reduce sodium in the diet. Which foods will the nurse recommend that the client avoid? Select all that apply.
cured ham table salt bacon Explanation: Sodium is found in higher concentrations in table salt, bacon, and processed meats. The other choices do not have a high concentration of sodium.
A woman consumes pasta, grains, and other carbohydrates for which purpose?
energy Explanation: The main function of carbohydrates is to provide energy.
A client is receiving total parenteral nutrition (TPN). The nurse will assess for complications related to:
fluid and electrolyte levels. Explanation: Total parenteral nutrition (TPN) is nutrition administered through a central venous access and is high in nutrients and electrolytes. It is important to assess fluid and electrolyte levels with TPN infusions. Falls are a risk associated with ability to reposition and not TPN. There is no pain associated with TPN infusions as the medication is administered via a central venous access line. Nausea or vomiting are not adverse effects associated with TPN as the medication is administered via a central line and not by a feeding tube in the stomach.
A client has developed an abscess following abdominal surgery, and the client's food intake has been decreasing over the past 2 weeks. Which laboratory finding may suggest the need for nutritional support?
low prealbumin levels Explanation: Prealbumin levels are a good indicator of a client's short-term nutritional status; decreased levels are suggestive of malnutrition. Protein in the client's urine, low blood sugars, and increased white blood cells are not necessarily indicative of malnutrition. Proteinuria is urine having an abnormal amount of protein. The condition is often a sign of kidney disease. Random blood sugar can be affected by food intake. White blood cells are indicative of infection.
A client with influenza is prescribed a diet that is rich in fiber and carbohydrates. Which would the nurse incorporate into the education plan as a major reason for the high fiber diet?
maintenance of normal bowel elimination Explanation: Dietary fiber is a minimal source of energy but plays an essential role in stimulating peristalsis and maintaining normal bowel elimination. Proteins have specific functions of producing hemoglobin for carrying oxygen to tissues, insulin for blood glucose regulations, and albumin for regulating osmotic pressure in the blood. Fats perform the important functions of energy storage of adipose tissue, vitamin absorption, and transport of fat-soluble vitamins A, D, E, and K.
A client with protein deficiency is encouraged to eat a protein-rich snack. The client requests a peanut butter sandwich. What other food can the nurse provide that will provide the client with complete protein?
milk Explanation: Complete proteins, such as milk, typically come from animal sources. Proteins from plant sources, such as soybeans, are usually incomplete. Carrots and bread are not significant protein sources.
An older adult client has a decubitus ulcer with drainage, dysphagia, and immobility. She consumes less than 300 calories per day and has a large amount of interstitial fluid. The client is in a state of:
negative nitrogen balance. Explanation: A negative nitrogen balance exists when excretion of nitrogen exceeds the intake.
A client who is taking supplements reports severe flushing and itching an hour after ingestion. The nurse is aware that the supplement is most likely:
niacin. Explanation: Niacin, part of the B vitamins, has a known side effect of flushing and itching after ingestion. The other vitamins that make up the B complex vitamin are B1 thiamin, B2 riboflavin, B3 niacin, B5 pantothenic acid, B6 pyridoxine, B7 biotin, B9 folic acid, and B12 cobalamin. Other adverse effects of the B complex vitamins include nausea, vomiting, constipation, abdominal pain, and black stools.
A nurse is caring for a client who has a body mass index (BMI) of 26.5. Which category should the nurse understand this client would be placed in?
overweight Explanation: A client with a BMI below 18.5 should be considered underweight. A client with a BMI of 18.5 to 24.9 is considered to be at a healthy weight. A client with a BMI of 25 to 29.9 is considered overweight; a client with a BMI of 30 or greater indicates obesity. A BMI greater than 40 is considered extreme obesity.
Which client(s), at risk for poor nutritional intake, would benefit from nutritional counseling from the nurse? Select all that apply.
pregnant adolescents people with substance use problems older adults living on fixed incomes Explanation: Examples of those in the United States at risk for an inadequate nutritional intake include older adults who are socially isolated or living on fixed income, homeless people, children of economically deprived parents, pregnant adolescents, people with substance use problems, and clients with eating disorders. Children of middle-income parents and individuals who prefer to purchase food from local farmers are not necessarily at risk.
A nurse teaches a student nurse about the role fats play in the human body. What is the major storage form of fat?
triglycerides Explanation: Triglycerides are the predominant form of fat in food and the major storage form of fat in the body, composed of one glyceride molecule and three fatty acids. Trans fat is a product that results when liquid oils are partially hydrogenated. These oils then become more stable and solid. Trans fats raise serum cholesterol levels. Cholesterol is a fat-like substance, found only in animal tissues, which is important for cell membrane structure, a precursor of steroid hormones and a constituent of bile. Lipid is a group name for fatty substances, including fats, oils, waxes, and related compounds.
A nurse is learning about religious dietary restrictions at a nursing conference. Which religious meal selection should the nurse understand is appropriate?
vegetable plate for a client who practice Hinduism Explanation: Dietary restrictions associated with religions are extremely important to provide culturally competent nursing care. Clients who practice Hinduism do not consume beef, because cows are considered a sacred creature. They are typically vegetarians; therefore, a vegetable plate is appropriate for this client. Clients who practice Orthodox Judaism eat have kosher foods. Shrimp and pork are prohibited in a kosher diet. Members of The Church of Jesus Christ of Latter-day Saints do not drink coffee, tea, or alcohol and they limit their meat consumption.
Which vitamin is found only in animal foods?
vitamin B12 Explanation: Vitamin B12 functions in the formation of mature red blood cells and in synthesis of DNA and RNA. This vitamin is only found in animal foods (meats, fish, poultry, milk, and eggs).
A nurse in a rural health center meets a new client, age 4. The nurse notices as the client enters the clinic that his legs appear to be bowed. When he smiles, the nurse also notes that his dentition is quite malformed for a child his age. What vitamin deficiency would the nurse most suspect?
vitamin D Explanation: Severe vitamin D deficiency manifests as rickets, osteomalacia, poor dentition, and tetany.
Which of the following is a fat-soluble vitamin?
vitamin E Explanation: Vitamin E is a fat-soluble vitamin.