NCLEX RN: Nutrition

The nurse is providing dietary instructions to a client regarding a high-protein diet. The nurse should instruct the client to consume which food item that is highest in protein content?

1.1 cup of cottage cheese 2.1 ounce of Swiss cheese 3.2 tablespoons of peanut butter 4.1 cup of evaporated whole milk Rationale: Cottage cheese (1 cup) contains approximately 31 g of protein. Swiss cheese (1 ounce) contains 7 g, peanut butter (2 tablespoons) contains 9 g, and evaporated whole milk (1 cup) contains 17 g of protein.

Which actions should the nurse include when caring for a client with continuous tube feedings through a nasogastric (NG) tube? Select all that apply.

1.Check the residual every 4 hours. 2.Check for placement every 4 hours. 3.Hang a new feeding bag every 72 hours. 4.Check skin integrity at the site of NG tube insertion. 5.Check for placement before administering medications Rationale: A feeding bag and tubing should be changed every 24 hours (or per agency protocol) to reduce risk of bacterial contamination. Placement and residual should be checked at least every 4 hours during administration of continuous tube feedings and prior to giving medications through the tube. Agency policy for technique for assessment of tube placement should be followed. Skin integrity should be assessed at the site of NG tube insertion.

The nurse is assessing the skin of a client with a history of malabsorption deficiency and discovers brittle nails. What type of nutritional deficiency should the nurse suspect based on this observation?

1.Iron deficiency 2.Protein deficiency 3.Fatty acid deficiency 4.Vitamin K deficiency Rationale: Brittle nails result from an iron deficiency. Protein deficiency leads to hair thinning and loss. Fatty acid deficiency can result in dermatitis, and vitamin K deficiency results in bruising.

The nurse provides dietary instructions to a client at risk for hypokalemia about which foods are high in potassium and should be included in the daily diet. The nurse should tell the client that which fruit is highest in potassium?

1.Kiwi 2.Apples 3.Peaches 4.Pineapple Rationale: Foods that are high in potassium include bananas, cantaloupe, kiwi, and oranges. Fruits low in potassium include apples, cherries, grapefruit, peaches, pineapple, and cranberries.

A client is being seen in the clinic for symptoms of hyperinsulinism. The nurse provides information to the client regarding dietary measures for the condition. Which diet would be most appropriate to suggest to the client?

1.Low-fiber, high-fat diet 2.Limiting food intake to 2 meals per day 3.Large amounts of carbohydrates between low-protein meals 4.Small, frequent meals with protein, fat, and carbohydrates at each meal Rationale: The definition of hyperinsulinism is an excessive insulin secretion in response to consuming carbohydrate-rich foods. This leads to hypoglycemia. It is often treated with a diet that provides for limited stimulation of the pancreas. Carbohydrates can produce a rapid rise in blood glucose levels. However, carbohydrates are necessary in the diet. Proteins do not stimulate insulin secretion. Fats are needed in the diet to provide calories. The best diet for hyperinsulinism will contain proteins and fats whenever carbohydrates are consumed. Diets high in soluble fiber also may be beneficial.

The nurse has provided dietary instructions to a client regarding food items that are high in vitamin B complex. The client demonstrates understanding of the dietary instructions by stating the importance of including which food item in the diet?

1.Milk 2.Butter 3.Grains 4.Tomatoes Rationale: Grains contain the highest amount of vitamin B complex. Butter contains vitamin A. Tomatoes are high in vitamin C, whereas milk is high in vitamin D.

The breast-feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. The nurse should tell the mother to avoid which food?

1.Milk 2.Egg yolk 3.Dried beans 4.Green leafy vegetables Rationale: Breast-feeding mothers with lactose-intolerant infants need to be encouraged to limit dairy products. Milk is a dairy product. Alternative calcium sources that can be consumed by the mother include egg yolk, green leafy vegetables, dried beans, cauliflower, and molasses.

The nurse is creating a plan of care for a client receiving enteral feedings via a gastrostomy tube (G-tube). The nurse should plan to include which intervention in the plan of care?

1.Provide oral fluids 3 times per day. 2.Check around the stoma site for skin irritation. 3.Medicate with antidiarrheal medications every day. 4.Use sterile technique when administering the tube feedings Rationale: A G-tube is a tube inserted directly into the stomach for the purpose of providing direct enteral nutrition. Generally, G-tubes are well tolerated and beneficial to clients on long-term enteral nutrition. Aspiration of stomach contents into the lungs can occur, and the client's head of the bed must be kept elevated. Because of the surgical incision, occasionally gastric contents leak out onto the client's skin. Gastric contents are highly acidic and can cause skin irritation. The skin irritation may lead to infection. The nurse must monitor the insertion site for skin irritation. Oral fluids are not generally a component of the plan of care because the client with a G-tube normally does not have the capability of swallowing. Although diarrhea may be a complication of the feedings, antidiarrheals are not administered daily. Aseptic, not sterile, technique is necessary when administering feedings.

A client with hypertension has been prescribed a low-sodium diet. The nurse teaching this client about foods that are allowed should plan to include which food in a list provided to the client?

1.Tomato soup 2.Boiled shrimp 3.Instant oatmeal 4.Summer squash Rationale: Foods that are lower in sodium are fruits and vegetables (summer squash) because they do not contain physiological saline. Highly processed or refined foods (tomato soup and instant oatmeal) are higher in sodium unless they are specifically noted as low sodium. Saltwater fish and shellfish are higher in sodium.

The nurse is conducting a dietary assessment on a client who is on a vegan diet. The nurse provides dietary teaching and should focus on foods high in which vitamin that may be lacking in a vegan diet?

1.Vitamin A 2.Vitamin B12 3.Vitamin C 4.Vitamin E Rationale: Vegans do not consume any animal products. Vitamin B12 is found in animal products and therefore would most likely be lacking in a vegan diet. Vitamins A, C, and E are found in fresh fruits and vegetables, which are consumed in a vegan diet.

The nurse is explaining the process of bariatric surgery to a severely obese client who has attended a medically supervised weight loss program for approximately 6 months. The client is considering this procedure. What are some conditions that may interfere with a client's commitment to lifelong behavioral changes and that may lead to poor surgical outcomes? Select all that apply.

1.Anxiety 2.Untreated depression 3.Binge eating disorders 4.Drug and alcohol abuse 5.Lack of family resources 6.Inability to comply with nutritional recommendations Rationale: Conditions that can lead to poor bariatric surgical outcomes include untreated depression, binge eating disorders, drug and alcohol abuse, and an inability to comply with nutritional recommendations. Lack of family resources and anxiety do not affect bariatric surgical outcomes.

A client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse should offer which full liquid item to the client?

1.Tea 2.Gelatin 3.Custard 4.Ice pop Rationale: Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, refined cooked cereals, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in the incorrect options are clear liquids.

A breast-feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. What foods should the nurse tell the mother are acceptable to consume while breast-feeding? Select all that apply.

1.1% milk 2.Egg yolk 3.Dried beans 4.Hard cheeses 5.Green leafy vegetables Rationale: Breast-feeding mothers with lactose-intolerant infants need to be encouraged to limit dairy products. Milk and cheese are dairy products. Alternative calcium sources that can be consumed by the mother include egg yolk, dried beans, green leafy vegetables, cauliflower, and molasses.

In planning a low-sodium diet for a client who has recently been diagnosed with heart failure, the nurse should offer the client which food item?

1.Beef bouillon 2.Grilled cheese 3.Cottage cheese 4.Chicken breast Rationale: Chicken breast has 70 mg of sodium compared with 457 mg for cottage cheese, 700 mg for grilled cheese, and 800 mg for beef bouillon

A child with leukemia is complaining of nausea. The nurse suspects that the nausea is related to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, should offer which item during this episode of nausea?

1.Cool, clear liquids 2.Low-protein foods 3.Low-calorie foods 4.The child's favorite foods Rationale: When the child is nauseated, offering cool, clear liquids is best because they are soothing and better tolerated. Supportive nutritional measures should include oral supplements with high-protein and high-calorie foods. The nurse should not offer favorite foods when the child is nauseated because foods eaten during times of nausea will be associated with being sick.

The nurse is caring for a pregnant client who is iron deficient. What groups are vulnerable to this condition? Select all that apply.

1.Diabetics 2.Alcoholics 3.Vegetarians 4.People with hemochromatosis 5.Women of childbearing years 6.Older people who consume poor diets Rationale: High-risk groups for iron deficiency anemia include adolescent girls and women in their childbearing years who consume poor diets, people who are food insecure, alcoholics, vegetarians, and older people who consume poor diets. People with diabetes and hemochromatosis are not in this high-risk group.

A client is diagnosed with a moderate case of acute ulcerative colitis. The nurse doing dietary teaching should give the client examples of foods to eat that represent which therapeutic diet?

1.High fat with milk 2.Low fiber with milk 3.High protein with milk 4.Low fiber without milk Rationale: The client with a mild to moderate case of acute ulcerative colitis often is prescribed a diet that is low in fiber and does not include milk. This will help to reduce the frequency of diarrhea for this client. The remaining options are incorrect diets and may cause discomfort for the client.

The nurse has conducted dietary teaching with a client diagnosed with iron deficiency anemia. The nurse instructs the client that which food item is a good dietary source of iron?

1.Oranges 2.Apricots 3.Egg whites 4.Refined white bread Rationale: The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver and other organ meats, blackstrap molasses, and oysters. Other good sources of iron are kidney beans, whole-wheat bread, egg yolk, spinach, kale, turnip tops, beet greens, carrots, raisins, and apricots.

The nurse should include which item in a list of the most helpful foods for a vegan client wishing to increase foods high in vitamin A?

1.Peas 2.Carrots 3.Potatoes 4.Green beans Rationale: Foods that are high in vitamin A include carrots, green leafy vegetables, and yellow vegetables. The other vegetables are high in vitamins but do not necessarily have the highest amount of vitamin A.

The nurse has determined that an unconscious client is at risk for nutritional problems. Which outcome indicates to the nurse that the goals have not yet been fully met?

1.Stable weight 2.Intake equaling output 3.Total protein concentration of 4.5 g/dL (45 g/L) 4.Blood urea nitrogen (BUN) level of 20 mg/dL (7.1 mmol/L) Rationale: The normal total protein level is 6.4 to 8.3 g/dL (64 to 83 g/L). The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Expected outcomes for nutritional problems in an unconscious client include stable weight, intake equaling output, evidence of wound healing, and normal BUN, total protein, and hemoglobin levels. The only abnormal finding in the options is the protein level.

The nurse is talking to the mother of a 2-month-old infant who is being seen in the health care provider's office for a well-child visit. Which statement by the mother would indicate that further teaching is needed about nutrition for this infant?

1."My sister said to start her on a cup, but I think she is too young." 2."I started my daughter on cereal a week ago, and she loves the rice cereal." 3."I remembered that my daughter needs to stay on formula for an entire year." 4."My friend has a 4-month-old child, and I told her that I am not going to start solid food until my daughter is at least 6 months old." Rationale: Infants are started on rice cereal between the ages of 4 and 6 months. This is the first solid food given to infants, followed by fruits and vegetables. Infants should be maintained on their formula or breast milk for the entire first year. Introducing a cup does not begin until the age of 6 months, when juice is introduced.

The nurse is providing dietary teaching to a client who is receiving a potassium-retaining diuretic about foods that are low in potassium. Which foods should the nurse include on a list of foods with low potassium content?

1.Apple 2.Carrots 3.Spinach 4.Avocado Rationale: One medium apple with skin provides approximately 159 mg of potassium per serving, so it has the lowest potassium content of these choices. One large carrot has 341 mg of potassium. Raw spinach (oz) provides 470 mg of potassium. One medium avocado provides the highest potassium content, 700 mg.

The nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse determines that the client understands the instructions given if the client states that which food item(s) are acceptable in the diet?

1.Baked fish 2.Fried chicken 3.Sauces and gravies 4.Fresh whipped cream Rationale: The client with cholecystitis should decrease overall intake of dietary fat. Foods that should be avoided include sauces and gravies, fatty meats, fried foods, products made with cream, and heavy desserts. The correct option is baked fish, which is low in fat.

A nursing student is caring for a client who has been admitted to the hospital with malnutrition. The nursing instructor determines that the student has made a correct assessment of malnutrition consequences if the student documents which noted findings? Select all that apply.

1.Cachexic 2.Lethargic 3.Lean extremities 4.Intolerant to heat 5.Dry, flaking skin 6.Poor wound healing Rationale: Some common findings of severe malnutrition in adults include the following: lethargy; cachexia; dry, flaking skin; and poor wound healing. Edema, not lean extremities, and intolerance to cold, not heat, are also present.