Nutrition

The nurse is caring for four older adult clients. Which does the nurse identify at highest risk for cardiometabolic syndrome?

59-year old with bust, abdomen, and hips of similar proportion Waist circumference and obesity are linked with cardiometabolic syndrome. The client with an abdomen that mirrors bust and hip circumference is at highest risk. The other clients are not at as high of a risk.

A nurse is inserting a nasogastric tube in a client with an ileus. Which actions would be appropriate for the nurse to use to confirm correct placement of the tube? Select all that apply.

Aspirate stomach contents to check pH level. Do a radiographic examination. Measure tube length and tube marking. The correct methods to check placement of the nasogastric tube include aspiration of stomach contents to check pH level, measurement of tube length and tube marking, and radiographic examination. Auscultation of injected air over the epigastric space is no longer an accepted or reliable way to check placement of the nasogastric tube. Listening for gurgling at the end of the nasogastric tube is not a way to ensure correct placement.

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. 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.

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. 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.

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. 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 nurse is reviewing a client's laboratory report. The report indicates the client's albumin level is 2.89 g/L (4.19 mmol/L). Which inference can the nurse make about the laboratory result?

The client may be overhydrated. Serum albumin values reflect protein intake or absorption. Values of less than 3.5 g/dL (5 mmol/L) may indicate nutritional deficits. Such protein changes take more than 2 weeks to appear in serum albumin values because the half-life of albumin is about 18 days. A low albumin level also can be related to overhydration and may not necessarily indicate malnutrition.

The charge nurse is observing a new nurse care for a client who is receiving a continuous feeding through a nasogastric feeding tube. Which actions by the new nurse would require intervention by the charge nurse?

The new nurse places the client in the left lateral recumbent position. This action is incorrect. The client should be assisted to a high-Fowler's position (45 degrees).

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. 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 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 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.

A nurse is working with a 54-year-old with a history of constipation. The client asks if there is anything he could add to his diet to ease defecation. The nurses best response would be what?

fiber Fiber promotes peristalsis to maintain normal bowel elimination.

A nurse in a clinic is caring for a female client who is of childbearing age. Which vitamins or minerals should the nurse recommend to prevent neural tube defects during pregnancy?

folic acid Folic acid has significantly decreased the number of children born with neural tube defects. Vitamin C or ascorbic acid helps with wound healing. Vitamin E helps maintain strong immunity, healthy eyes, and skin. Vitamin D helps prevent osteoporosis by keeping bones strong.

Which nursing student statement regarding vegetarian diets requires further teaching from the nursing instructor?

"According to research, vegetarians have a higher incidence of obesity than others." Vegetarians have a lower incidence of colorectal cancer and fewer problems with obesity and diseases associated with a high-fat diet. Protein complementation helps a client get amino acids needed. Vegans rely solely on plant sources for protein; semi-vegetarians exclude only red meat from their diet.

A client with diabetes mellitus must monitor carbohydrate intake. Which client statement requires nursing intervention?

"My favorite drink is coffee with sugar." Foods containing added sugar as a major ingredient tend to supply calories but few, if any, other nutrients. A client monitoring carbohydrate intake should be mindful of the intake of extra sugar. The other answer choices are appropriate for a client diagnosed with diabetes mellitus who is monitoring carbohydrate intake.

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." 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 client is discussing vitamin and mineral intake with the nurse. Which client statement requires nursing intervention?

"Taking megadoses of vitamins will help me increase muscle mass quickly." Consuming megadoses of vitamins and minerals can be dangerous, so this statement requires intervention. The nurse should find out the type and dose of vitamins that the client takes. The other statements do not require intervention.

After reviewing the client's chart, the nurse notes that the client has been ordered a clear liquid diet. Which meal tray would the client be allowed to eat?

Bouillon, apple juice, and gelatin Clear liquid diets contain foods that are clear liquids at room temperature or body temperature, such as gelatin, fat-free broth, bouillon, ice pops, clear juices, carbonated beverages, regular and decaffeinated coffee, and tea. Full liquid diets contain all the items on a clear liquid diet, but also include milk and milk drinks, custards, puddings, plain frozen desserts, pasteurized eggs, cereal gruels, vegetable juices, and milk and egg substitutes.

Which nursing action associated with successful tube feedings follows recommended guidelines?

Check the residual before each feeding or every 4 to 8 hours during a continuous feeding. The nurse should check the residual before each feeding or every 4 to 8 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.

Which vitamin is found only in animal foods?

vitamin B12 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 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. Water should comprise the majority of fluid intake. The remainder should come from food sources such as fruit or 100% fruit juices.

Which of the following is a fat-soluble vitamin?

vitamin E

A client who has bleeding tendencies has a deficiency in which vitamin?

vitamin K Vitamin K deficiencies are manifested in two ways: an increased tendency to hemorrhage and hemorrhagic disease of the newborn, which is common in premature or anoxic newborns.

A nurse is learning about religious dietary restrictions at a nursing conference. Which of the following religious meal selections should the nurse understand is appropriate?

Hindus: vegetable plate Dietary restrictions associated with religions are extremely important to provide culturally competent nursing care. Hindus do not consume beef because cows are considered a sacred creature. They are typically vegetarians; therefore, a vegetable plate is appropriate for this client. Orthodox Jews must have Kosher foods. Shrimp and pork are prohibited in this religion. Mormons do not use coffee, tea, or alcohol and they limit their meat consumption.

During a visit to the pediatrician's office, a mother inquires about adding solid foods to the diet of her infant age 6 months. What does the nurse inform the mother?

New foods should be introduced one at a time for a period of five to seven days. 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 five to seven days so that any allergic reaction can be identified. Iron-fortified foods are recommended.

The nurse is caring for a client who refuses most foods on the dietary tray. Which nursing intervention is appropriate?

assess when the client generally eats meals 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.

The nurse is teaching a client who wishes to try a vegetarian diet about different types of proteins that can be eaten. Which food will the nurse identify that contain appropriate dietary protein? (Select all that apply.)

beans nuts eggs tofu 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. For the client who wishes to try a vegetarian diet, the nurse will recommend beans, nuts, eggs, and tofu. Carrots do not contain protein.

An athlete wants to increase her intake of complex carbohydrates and asks the nurse about potential sources. Which food is considered a complex carbohydrate?

bread Bread, cereal, potatoes, rice, pasta, crackers, flour products, and legumes contain complex carbohydrates.

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 Severe vitamin D deficiency manifests as rickets, osteomalacia, poor dentition, and tetany.

The nurse is helping a client who eats a normal diet of 2000 calories daily to read a nutritional label on a box of cereal. Which nutrient does the nurse identify as appropriate for this client?

cholesterol less than 300mg The nurse is helping a client who eats a normal diet of 2000 calories daily to read a nutritional label on a box of cereal. Which nutrient does the nurse identify as appropriate for this client?

The nurse is providing education to a client with high triglyceride and cholesterol levels. Which food should the client be cautioned to avoid?

coconut Coconut oil, palm oil, and palm kernel oil are highly saturated fats.

A client resides in a long-term care facility. Which nursing intervention would promote increased dietary intake?

encourage the client to eat in the dining room Encouraging the client to eat in the dining room will allow for socialization during meal time. This will have a positive effect on the amount of food consumed and provide enjoyment.

Upon assessment, the nurse determines the client has a body mass index (BMI) of 45. This finding indicates the client is:

extremely obese A person with a BMI below 18.5 is underweight, a BMI of 25 to 29.9 indicates an overweight individual, a BMI of 30 or greater indicates obesity, and a BMI of 40 or greater indicates extreme obesity.

A woman age 20 years has announced her intention to implement a zero-fat diet in order to lose weight and maximize her health. What is a potential consequence of completely eliminating fat sources from the woman's diet?

impaired vitamin absorption In addition to providing caloric needs, fats are necessary for the absorption of fat-soluble vitamins. It would be inadvisable to wholly eliminate fats from the diet in an effort to limit calorie intake. Fat does not directly contribute to tissue growth, water absorption in the bowel, or antibody production.

You are the nurse caring for a client with an enlarged thyroid gland. You anticipate which nutritional deficiency is linked to the client's condition?

iodine A chronic deficiency of iodine can lead to goiter, which manifests as an enlargement of the thyroid gland.

The nurse is teaching a new mother who is not breast-feeding her infant. What nutrient must be supplemented by the mother?

iron Breast-fed infants receive all the nutrients from their mother; those who are bottle fed need iron supplements in the form of formula or cereal. Vitamin C, calcium and protein do not need to be supplemented.

A nurse is educating a group of adolescent girls on bone and teeth growth. Which fat-soluble vitamin assists to build bone and teeth?

vitamin d Vitamin D stimulates the absorption of calcium, which is an essential component for building strong, healthy bones bones and teeth. Vitamin A is essential in maintaining visual acuity, cell growth, and the immune system. Vitamin E is an antioxidant and also functions in promoting healing and healthy skin (cell growth). Vitamin K is essential in clotting.

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 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 postmenopausal client wishes to increase the amount of vitamin D that she consumes to help keep her bones strong. Which food will the nurse recommend?

milk Milk contains vitamin D, which helps with the absorption of calcium and phosphorous. The other choices do not.

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 A negative nitrogen balance exists when excretion of nitrogen exceeds the intake.

The community nurse is educating client groups about nutrition. Which group does the nurse identify that will benefit most from nutritional counseling and intervention?

older adults living on a fixed income Older adults who are socially isolated or living on fixed incomes will benefit most from nutritional counseling and intervention. Other individuals are not at the same level of risk.

A nurse is working with a 45-year-old construction worker. The nurse obtains his height and weight and calculates that his BMI is 28. How would the nurse best classify James?

overweight A body mass index (BMI) between 25 and 29.9 is considered overweight.

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 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 clients, at risk for poor nutritional intake, would benefit from nutritional counseling from the nurse? (Select all that apply.)

pregnant teenagers people with substance abuse problems older adults living on fixed incomes 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 teenagers, people with substance abuse 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.

The nurse is helping a client who wishes to increase Omega-3 fatty acids order breakfast. Which food will the nurse recommend?

salmon Omega-3 fatty acids are found in fish such as salmon, halibut, sardines, olive oil, flaxseed, walnuts, and certain types of legumes. The other food choices do not contain Omega-3 fatty acids.

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 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.

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?

teenager who is in the second trimester of pregnancy Children, adolescents, pregnant women, and breast-feeding mothers require more servings per day of certain food groups, particularly the milk group. Therefore, the teen (adolescent) who is pregnant will require more milk servings. The other clients do not require more servings of milk.

When checking the placement of a gastrostomy or jejunostomy tube, the nurse must make regular comparisons of:

tube length The nurse would regularly make comparisons of the length of the tube to be sure it is still correctly in place. The nurse would not continue to regularly compare gastric fluid, pH, or air pressure.

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 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.