Nutrition Exam III Review

D. 0.6-1.3 mg/dL

Which of the following illustrate normal lab findings for creatinine? A. 0.9-2.1 mg/dL B. 3.5-6.5 mg/dL C. 9.5-13.5 mg/dL D. 0.6-1.3 mg/dL

A. Males [39-50%]; Females [35-47%]

Which of the following illustrate normal lab findings for hematocrit? A. Males [39-50%]; Females [35-47%] B. Males [40-60%]; Females [50-70%] C. Males [50-70%]; Females [40-60%] D. Males [35-47%]; Females [39-50%]

C. 1.5-2.5 mEq/L Rationale: Aids thyroid hormone secretion Activates enzymes for carb/protein metabolism Nerve and muscle function (cardiac)

Which of the following illustrate normal lab findings for magnesium? A. 8.5-10.2 mEq/L B. 3.5-6.5 mEq/L C. 1.5-2.5 mEq/L D. 4.5-7 mEq/L

A. 2.5-4.5 mg/dL Rationale: Bone, teeth strength Acid base balance

Which of the following illustrate normal lab findings for phosphorus? A. 2.5-4.5 mg/dL B. 3.5-6.5 mg/dL C. 9.5-13.5 mg/dL D. 4.5-7 mg/dL

D. 3.5-5 mEq/L Rationale: ICF control Acid base balance Nerve transmission Muscle contraction BP regulation

Which of the following illustrate normal lab findings for potassium? A. 8.5-10.2 mEq/L B. 1.002-1.030 mEq/L C. 7.2-11.5 mEq/L D. 3.5-5 mEq/L

B. 1.003-1.030 g/mL

Which of the following illustrate normal lab findings for specific gravity? A. 1.000-1.001 g/mL B. 1.003-1.030 g/mL C. 1.005-1.060 g/mL D. 0.001-1.020 g/mL

A. 8.5-10.2 mg/dL Rationale: Calcium helps with bone/teeth formation, blood clotting, nerve conduction, & muscle contraction

Which of the following illustrate normal lab findings of calcium? A. 8.5-10.2 mg/dL B. 3.5-6.5 mg/dL C. 9.5-13.5 mg/dL D. 4.5-7 mg/dL

B. 135-145 mEq/L Rationale: Sodium helps with water balance (volume and BP), acid base balance, muscle action, & nerve transmission

Which of the following illustrate normal lab findings of sodium? A. 80-130 mEq/L B. 135-145 mEq/L C.140-165 mEq/L D. 150-180 mEq/L

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." Rationale: 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 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."

A. Imbalanced Nutrition: More Than Body Requirements Rationale: 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.

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. The body converts food into complex forms of chemical energy and then into usable energy; therefore, extra food intake must have equal energy exertion in order to not gain weight. Rationale: In order for weight to be managed, there must be an equal amount of chemical energy and useable energy so that BMR can be maintained.

A client blames recent weight gain on his or her metabolism. Which is the best information that the nurse can provide to the client about how metabolism works? A. The body converts food into complex forms of chemical energy and then into usable energy; therefore, extra food intake must have equal energy exertion in order to not gain weight. B. Metabolism encompasses all the ways in which the body changes and uses nutrients for vital processes and bodily functions, so metabolism is unable to cause weight gain. C. The metabolic process involves exerting energy from foods to provide basal metabolic rate, or energy needed for the body to sustain function at all times. D. The body uses metabolism to release energy, allowing us to engage in bodily functions that do not cause weight gain.

A, D, & E

A client reports that he follows a strict vegetarian diet. What recommendations should the nurse give? Select all that apply. A. Increase intake of food fortified with vitamin B12 and B12 supplements. B. The client should add meat to the diet; a vegetarian diet is not advised. C. The client should use nonstick cookware to prepare food. D. Sun exposure can help compensate for lack of dietary vitamin D. E. Eat foods containing vitamin C to improve iron absorption.

B. Ongoing infections Rationale: If a patient is seen at the clinic with an infected foot wound, the nurse should realize this is a risk for ongoing infection if the appropriate plan of care is not implemented.

A client who is undernourished is seen in the clinic for an infected foot wound. The nurse realizes this client is at continued risk for: A. Elevated iron level B. Ongoing infections C. Elevated albumin level D. The development of type 2 diabetes

D. D Rationale: Vitamin D is a fat-soluble vitamin responsible for regulating the rate of deposit and reabsorption of calcium and bones.

A client with a calcium deficiency also should be tested for a deficiency in which vitamin? A. A B. B C. C D. D

B. Protein Rationale: 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 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. B vitamins Rationale: 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.

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

A. "Make sure you give your baby an iron-fortified formula to supplement any stored breast milk you have." Rationale: 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.

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, B, & C Rationale: A. CORRECT: Sensations of thirst diminish with age, leaving older adults more prone to dehydration. B. CORRECT: These requirements do not change from middle adulthood to older adulthood. C. CORRECT: They may ingest insufficient calcium in the diet and may need supplements to help prevent bone demineralization (osteoporosis).

A nurse in a senior center is counseling a group of older adults about their nutritional needs and considerations. Which of the following information should the nurse include? (Select all that apply.) A. Older adults are more prone to dehydration than younger adults are. B. Older adults need the same amount of most vitamins and minerals as younger adults do. C. Many older men and women need calcium supplementation. D. Older adults need more calories than they did when they were younger. E. Older adults should consume a diet low in carbohydrates.

C. Determine the client's intention to change current eating habits Rationale: When using the nursing process, the nurse should first assess the client's readiness to commit to a change in behavior

A nurse is caring for a client who has a BMI of 29 and expresses a desire to lose weight. Which of the following actions should the nurse take first? A. Refer the client to a nutritionist B. Discuss eating strategies with the client C. Determine the client's intention to change current eating habits D. Instruct the client to perform 30 min of vigorous exercise daily.

C. Elevate the head of the client's bed at 45 degrees before the feeding Rationale: The nurse should elevate the head of the. client's bed between 30 and 45 degrees before feeding to prevent aspiration.

A nurse is caring for a client who has an NG tube for intermittent enteral feedings. Which of the following actions should the nurse take? A. Auscultate bowel sounds after each feeding B. Ensure the formula is cold before administering C. Elevate the head of the client's bed at 45 degrees before the feeding D. Flush the tubing with 15 mL of water after the enteral feeding

B. Instruct the client to tuck her chin when swallowing. Rationale: Tucking the chin when swallowing allows food to pass down the esophagus more easily.

A nurse is caring for a client who is at high risk for aspiration. Which of the following is an appropriate nursing intervention? A. Give the client thin liquids. B. Instruct the client to tuck her chin when swallowing. C. Have the client use a straw. D. Encourage the client to lie down and rest after meals.

C. Vanilla custard Rationale: A low-residue diet consists of foods that are low in fiber and easy to digest. Dairy products and eggs, such as custard and yogurt, are appropriate for a low-residue diet.

A nurse is caring for a client who is on a low-residue diet. The nurse should expect to see which of the following foods on the client's meal tray? A. Cooked barley B. Pureed broccoli C. Vanilla custard D. Lentil soup

D. Carbohydrates Rationale: Carbohydrates are the body's priority energy source; providing energy for cells is their primary function. They provide glucose, which burns completely and efficiently without end products to excrete, and carbohydrates are a ready source of energy, and spare proteins from depletion.

A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following is the body's priority energy source? A. Fat B. Protein C. Glycogen D. Carbohydrates

D. "Older adults need an increased amount of calcium." Rationale: Older adults need an increased amount of calcium as well as vitamins D, B12, and A

A nurse is providing teaching about nutrition to an older adult client. The client asks "Don't I need the same amount of nutrients that I did when I was younger?" Which of the following responses should the nurse make? A. "Older adults need less protein." B. "Older adults need an increased amount of carbohydrates." C. "Older adults need an increased amount of iron." D. "Older adults need an increased amount of calcium."

A. Decreased albumin Rationale: A decrease in albumin level can be an indication of long-term protein depletion. Other potential conditions that result in decreased albumin levels include burns, wound drainage, and impaired hepatic function.

A nurse is reviewing the laboratory findings of a client who has protein-calorie malnutrition. Which of the following findings should the nurse expect? A. Decreased albumin B. Elevated hemoglobin C. Elevated lymphocytes D. Decreased cortisol

A, B, C, & E Rationale: 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.

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

C. Gelatin Rationale: 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.

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

B. Constipation Rationale: 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.

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

A, B, C, & D Rationale: A: They refuel strenuous, short-term skeletal muscle activity and provide nearly all the energy for the brain B: When the body has to use protein, ketosis occurs, causing an acid imbalance in the body leading to muscle wasting C: Sodium absorption and calcium excretion are enhanced by complex carbs, which tend to be fibrous in nature and carry nutrients throughout the body D: Insulin is a hormone produced in the pancreas that is used to move glucose into the cells for use.

A young female client reports fatigue, feeling foggy, muscle cramps, constipation, and headaches, and states that her heart feels like it is "fluttering." During assessment, she states she has been on a high-protein, no-carb diet. Which information should the nurse give the client to educate her about the importance of eating healthy carbohydrates? Select all that apply. A. Complex carbohydrates supply energy to muscles, organs, and the brain. B. Without carbohydrates, the body has to resort to using protein for energy, which then cannot rebuild tissue or maintain/repair body tissue. C. Healthy carbohydrates aid in the absorption of sodium and the excretion of calcium. D. Healthy carbohydrates enhance insulin secretion, which is needed for cellular use of glucose. E. Healthy carbohydrates regulate fluid balance so the body does not become dehydrated.

D. "I know that lifelong food habits are developed during this stage of life." Rationale: 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.

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."

B. 3.5-5.0 g/dL

Which of the following illustrate normal lab findings for albumin? A. 8.5-10.2 g/dL B. 3.5-5 g/dL C. 9.5-13.5 g/dL D. 4.5-7 g/dL

A & D Rationale: 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.

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.

B. Serum albumin of 3.2 g/dL Rationale: 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).

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

D. Reassess client outcomes during treatment and adjust as needed

In measuring the effectiveness of nutritional interventions, the nurse should? A. Expect results to occur rapidly. B. Not be concerned with physical measures such as weight. C. Rely solely on lab results to measure effectiveness D. Reassess client outcomes during treatment and adjust as needed

C. Healthy dieting Rationale: Healthy dieting (1) describe food selection and preparation tips and other behavior modifications that can lead to slow, sustained weight loss, (2) promote a diet that includes a variety of food choices and a balance of nutrients, (3) encourage physical activity as a cornerstone of weight loss, & (4) emphasize self-monitoring, cognitive strategies, and behavior modification.

The Dietary Approaches to Stop Hypertension (DASH) diet and the American Heart Association (AHA) diet are examples of which type of diet? A. Cultural B. "Fad" dieting C. Healthy dieting D. Traditional dieting

A, C & D

The basal metabolic rate is impacted by which factors? Select all that apply. A. Body temperature B. Disease process C. Muscle mass D. Environmental temperature E. Sleep patterns

B. A recently widowed 76-year-old woman recovering from a mild stroke Rationale: Older adults who are homebound and have a chronic illness have additional nutritional risks. Frequently this group lives alone with few or no social or financial resources to assist in obtaining or preparing nutritionally sound meals. This contributes to a risk for food insecurity caused by low income and poverty. In addition, the mild stroke might cause dysphagia.

The home care nurse is seeing the following patients. Which patient is at greatest risk for experiencing inadequate nutrition? A. A 55-year-old obese man recently diagnosed with diabetes mellitus B. A recently widowed 76-year-old woman recovering from a mild stroke C. A 22-year-old mother with a 3-year-old toddler who had tonsillectomy surgery D. A 46-year-old man recovering at home following coronary artery bypass surgery

A. Mechanical Soft Rationale: The mechanical soft diet is the diet of choice for people with chewing difficulties resulting from missing teeth, jaw problems, or extensive fatigue. This diet can supply a full range of nutrients but is low in fiber. As a result, constipation is a risk. Foods Included: Add to the full liquid diet: soft vegetables and fruits; chopped, ground, or shredded meat; and breads, pastries, eggs, and cheese.

The item illustrated is an example of what type of diet? A. Mechanical Soft B. Pureed C. Clear Liquid D. Sodium Restricted E. Full Liquid

E. Full Liquid Rationale: Contains all the liquids included in the clear liquid diet plus any food items that are liquid at room temperature. Difficult to obtain a balanced diet on a full liquid plan; use for a short time only. Foods Included: Add to clear liquid diet: soups, milk, milk shakes, puddings, custards, juices, some hot cereals, and yogurt. If needed for a longer time, a professional dietitian should be involved in planning the diet.

The item illustrated is an example of what type of diet? A. Mechanical Soft B. Pureed C. Clear Liquid D. Sodium Restricted E. Full Liquid

C. Clear Liquid Rationale: Clear liquid diets provide fluids to prevent dehydration and supplies some simple carbohydrates to help meet energy needs. They do not supply adequate calories, protein, and other nutrients, so timely progression to more nutritious diets is recommended. Foods Included: Water, tea, coffee, broth, clear juice (usually apple, grape, or cranberry juice), popsicles, carbonated beverages, and gelatin.

The items illustrated are an example of what type of diet? A. Mechanical Soft B. Pureed C. Clear Liquid D. Sodium Restricted E. Full Liquid

A, B, C, & E Rationale: 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.

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 Rationale: 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.

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. Loss of enamel on teeth Rationale: 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.

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

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." Rationale: 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.

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."

A, C & E Rationale: Patients with dysphagia are at risk for aspiration and need more assistance with feeding and swallowing. Feed the patient with dysphagia slowly, providing smaller-size bites, and allow the patient to chew thoroughly and swallow the bite before taking another. Position the patient in an upright, seated position in a chair or raise the head of the bed to 90 degrees. If the patient has unilateral weakness, teach him or her and caregiver to place food in the stronger side of the mouth. Additional interventions include providing a 30-minute rest period before eating. Have the patient slightly flex the head to a chin-down position to help prevent aspiration. Determine the viscosity of foods that the patient tolerates best through the use of trials of different consistencies of foods and fluids. Thicker fluids are generally easier to swallow. More frequent chewing and swallowing assessments throughout the meal are necessary. Allow the patient time to empty the mouth after each spoonful, matching the speed of feeding to the patient's readiness. If the patient begins to cough or choke, remove the food immediately.

The nurse is caring for a patient experiencing dysphagia. Which interventions help decrease the risk of aspiration during feeding? (Select all that apply.) A. Sit the patient upright in a chair. B. Give liquids at the end of the meal. C. Place food in the strong side of the mouth. D. Provide thin foods to make it easier to swallow. E. Feed the patient slowly, allowing time to chew and swallow. F. Encourage patient to lie down to rest for 30 minutes after eating.

A. Low-density lipoproteins (LDL) and high-density lipoproteins (HDL) Rationale: 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 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. Stop the feeding immediately; then notify the prescribing provider. Rationale: 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 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.

B. Sodium 470 mg Rationale: For clients with hypertension or fluid balance problems, sodium intake should be limited. Consuming > 2500 mg/day of sodium increases the risk for high blood pressure, heart attacks, and stroke

The nurse is performing discharge teaching for a client newly diagnosed with hypertension. Select the area of this nutritional label showing the ingredient(s) that the client should be instructed to limit in his diet. A. Iron B. Sodium 470 mg C. Protein 5g D. Vitamin A E. Dietary fiber 0g

A. Folic acid Rationale: 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.

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, C & D Rationale: Caution older adults to avoid grapefruit and grapefruit juice because these impair absorption of many drugs. Thirst sensation diminishes, leading to inadequate fluid intake or dehydration; thus older adults should be encouraged to ingest adequate fluids. Some older adults avoid meats because of cost or because they are difficult to chew. Cream soups and meat-based vegetable soups are nutrient-dense sources of protein. Cheese, eggs, and peanut butter are also useful high-protein alternatives. Milk continues to be an important food for older women and men who need adequate calcium to protect against osteoporosis (a decrease of bone mass density). Screening and treatment are necessary for both older men and women. Vitamin D supplements are important for improving strength and balance, strengthening bone health, and preventing bone fractures.

The nurse is teaching a program on healthy nutrition at the senior community center. Which points should be included in the program for older adults? (Select all that apply.) A. Avoid grapefruit and grapefruit juice, which impair drug absorption. B. Increase the amount of carbohydrates for energy. C. Take a multivitamin that includes vitamin D for bone health. D. Cheese and eggs are good sources of protein. E. Limit fluids to decrease the risk of edema.

A. iron Rationale: 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).

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

B. Places the patient supine while giving a bath. Rationale: Patients receiving enteral feedings should have the head of the bed elevated a minimum of 30 degrees, preferably 45 degrees, unless medically contraindicated. Laying the patient supine increases the risk of aspiration of the feeding and should be avoided. This needs to be addressed to maintain patient safety.

The nurse sees the unlicensed assistive personnel (UAP) perform the following for a patient receiving continuous enteral feedings. What intervention does the nurse need to address immediately with the UAP? The UAP: A. Fastens the tube to the gown with tape. B. Places the patient supine while giving a bath. C. Performs oral care for the patient. D. Elevates the head of the bed 45 degrees.

B. Turn patient to left lateral decubitus position Rationale: An air embolus possibly occurs during insertion of the catheter or when changing the tubing or cap. Have the patient assume a left lateral decubitus position first. Then have the patient perform a Valsalva maneuver -holding the breath and "bearing down"-. The increased venous pressure created by the maneuver prevents air from entering the bloodstream during catheter insertion. Maintaining integrity of the closed intravenous system also helps prevent air embolus.

The nurse suspects that the patient receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What action does the nurse need to take first? A. Raise head of bed to 90 degrees B. Turn patient to left lateral decubitus position C. Notify health care provider immediately D. Have patient perform the Valsalva maneuver

A. TPN can cause hyperglycemia, and it is important to keep your blood glucose level in an acceptable range. Rationale: The TPN formula is a combination of crystalline amino acids, hypertonic dextrose, electrolytes, vitamins, and trace elements. Administration of concentrated glucose is accompanied by increases in endogenous insulin production, which causes cations (potassium, magnesium, and phosphorus) to move intracellularly. Blood glucose levels should be monitored every 6 hours to assess for hyperglycemia. Maintaining blood glucose within acceptable limits helps prevent complications from the TPN.

The patient receiving total parenteral nutrition (TPN) asks the nurse why his blood glucose is being checked since he does not have diabetes. What is the best response by the nurse? A. TPN can cause hyperglycemia, and it is important to keep your blood glucose level in an acceptable range. B. The high concentration of dextrose in the TPN can give you diabetes; thus you need to be monitored closely. C. Monitoring your blood glucose level helps to determine the dose of insulin that you need to absorb the TPN. D. Checking your blood glucose level regularly helps to determine if the TPN is effective as a nutrition intervention.

A, B, & C Rationale: 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 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. Toxicity Rationale: As vitamins A, D, E, & K are fat-soluble, they are stored longer in the body; thus, daily supplements are not always needed and toxicity can occur.

What could potentially occur if a client takes Vitamin A, D, E, and K supplements daily? A. Toxicity B. Dehydration C. Impaired iron absorption D. Impaired metabolism

A, C, & D Rationale: 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).

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.

B. Place client's head of bed (HOB) to above 30 degrees Rationale: Patients should have the head of the bed elevated a minimum of 30 degrees, preferably 45 degrees or greater, unless medically contraindicated. Laying the patient supine increases the risk of aspiration and should be avoided. This needs to be addressed to maintain patient safety.

When caring for a client on aspiration precautions which of the following can be delegated to the UAP? A. Provide client's family education about aspiration risks B. Place client's head of bed (HOB) to above 30 degrees C. Determine client's ability to swallow food during meals D. Assess client's skin turgor to measure hydration status

B. Carbohydrates Rationale: 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.

Which class of nutrients is the body's primary source of energy? A. Proteins B. Carbohydrates C. Lipids D. Vitamins

A, C, & E Rationale: 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.

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.

B. Protein Rationale: 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.

Which nutrient deficiency increases the risk for pressure ulcers? A. Carbohydrates B. Protein C. Fat D. Vitamin K

C. Restrict his use of sodium Rationale: 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.

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

A, B, C, E

Which of the following are considered fat-soluble vitamins? Select all that apply: A. A B. D C. K D. C E. E

A, B, D, E, & G Rationale: Complex carbohydrates, which consist of long chains of saccharides called polysaccharides, are absorbed and metabolized more slowly than simple sugars, making them a better nutritional choice. Because carbohydrate ingestion enhances insulin secretion, they increase the feeling of fullness and satisfaction. Carbohydrates are not considered "bad," but must be balanced with protein and fat consumption.

Which of the following are included in Sources of Complex Carbohydrates? Select all that apply: A. Whole wheat bread B. Spaghetti C. Sugar D. Corn E. Potatoes F. Honey G. Beans

B & E Rationale: Simple carbohydrates, commonly called sugars, are a primary source of energy and quickly increase blood glucose, but burn quickly and provide little nutritional support. However, they can be helpful when clients are hypoglycemic and need to raise their blood glucose quickly. Additional foods include corn syrup, honey, molasses, sugar cane, sugar beets, and fruits.

Which of the following are included in Sources of Simple Carbohydrates? Select all that apply: A. Bread B. Milk C. Eggs D. Legumes E. Sugar F. Grains

B, C, D, F, & G Rationale: According to the U.S. Department of Agriculture's Dietary Guidelines for Americans (2015), a nutritious diet should include a varied, balanced diet that is high in fiber-rich fruits, vegetables, and whole grains. The diet should be low in trans-fats and saturated fats, with most fats coming from foods such as fish, nuts, and vegetable oils. Intake of salt, sugar, and alcohol, which can lead to hypertension, diabetes, and chronic kidney disease, respectively, should be monitored. A person should engage in daily physical activity and maintain a healthy weight. Food should be properly cooked, chilled, and stored. Cleaning hands, cooking surfaces, and fruits and vegetables will prevent food-borne illness.

Which of the following are included in the Dietary Guide for Americans? Select all that apply: A. Recommend fat intake below 50% of total caloric intake B. Recommend achieving and maintaining healthy weight C. Limit intake of sugar salt, and alcohol D. Meet USDA food guideline recommendations E. Detail weekly intake of nutrient-rich foods F. Limit the consumption of saturated fats G. Recommend choosing fiber-rich foods H. State whole grains should make up 10% of grain intake

A, B, C, D, & G Rationale: The U.S. Food and Drug Administration mandates that certain nutrition facts be stated on all food labels, including serving size and calories and information about fat, electrolytes, vitamins, carbohydrates, and proteins. This label is a great way to educate clients about monitoring their nutritional intake.

Which of the following are included in the Nutrition Facts Label? Select all that apply: A. Total fat B. Sodium C. Protein D. Serving size E. Fat soluble & water soluble vitamins F. Recommended dietary intake G. Calories from fat H. % of daily values based on a 1,500 calorie diet

C. 6-20 mg/dL

Which of the following illustrate normal lab findings for BUN? A. 22-35 mg/dL B. 3.5-6.5 mg/dL C. 6-20 mg/dL D. 4.5-7 mg/dL

D. Immediately remove any food that the patient cannot eat. Rationale: 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.

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.

A. 1, 3, 4, 2

Which of the following is the correct order for providing education on nutrition to a client and his spouse: 1)Assess client's readiness to learn 2)Document education in client's chart 3)Decrease environmental stimulation 4)Educate client and spouse about nutrition A. 1, 3, 4, 2 B. 1, 2, 3, 4 C. 2, 4, 3, 1 D. 2, 1, 4, 3

C. Phosphorus (2.5-4.5 mg/dL) Rationale: Phosphorus is the second most abundant mineral in the body, second to calcium. About 85% of the body's phosphorus is stored in bones and teeth. It helps to activate enzymes, and keeps blood pH within a normal range. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Over time this can lead to increased risk of heart attack, stroke or death.

Which of the following minerals exhibit the effects and symptoms below: Effects of Deficiency Bone loss, poor growth Symptoms of Excess Tetany, convulsions A. Iron B. Calcium C. Phosphorus D. Magnesium

B. Calcium (8.5-10.5 mg/dL) Rationale: Calcium is a mineral most often associated with healthy bones and teeth, although it also plays an important role in blood clotting, helping muscles to contract, and regulating normal heart rhythms and nerve functions. Hypercalcemia is a condition in which the calcium level in your blood is above normal. Too much calcium in your blood can weaken your bones, create kidney stones, and interfere with how your heart and brain work. Hypercalcemia is usually a result of overactive parathyroid glands

Which of the following minerals exhibit the effects and symptoms below: Effects of Deficiency Bone loss, tetany, rickets, osteoporosis Symptoms of Excess Kidney stones, constipation, intestinal gas A. Iron B. Calcium C. Sodium D. Magnesium

C. Sodium (135-145 mEq/L) Rationale: The human body requires a small amount of sodium to conduct nerve impulses, contract and relax muscles, and maintain the proper balance of water and minerals. It is estimated that we need about 500 mg of sodium daily for these vital functions. Too much sodium in the diet can lead to high blood pressure, heart disease, and stroke. It can also cause calcium losses, some of which may be pulled from bone.

Which of the following minerals exhibit the effects and symptoms below: Effects of Deficiency Dizziness, abdominal cramping, nausea, vomiting, diarrhea, tachycardia, convulsions, coma. (Rarely occurs except in heavy exercise and sweating.) Symptoms of Excess Thirst, fever, dry and sticky tongue and mucous membranes, restlessness, irritability, convulsion A. Iron B. Calcium C. Sodium D. Magnesium

A. Iron Rationale: Iron is a mineral that the body needs for growth and development. Your body uses iron to make hemoglobin, a protein in red blood cells that carries oxygen from the lungs to all parts of the body, and myoglobin, a protein that provides oxygen to muscles.

Which of the following minerals exhibit the effects and symptoms below: Effects of Deficiency Small, pale red blood cells, anemia Symptoms of Excess Hemochromatosis -- disorder in which the body can build up too much ______ in the skin, heart, liver, pancreas, pituitary gland, and joints A. Iron B. Calcium C. Phosphorus D. Magnesium

D. Magnesium (1.5-2.5 mEq/L) Rationale: Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation [1-3]. Magnesium is required for energy production, oxidative phosphorylation, and glycolysis. High doses of magnesium from supplements or medications can cause nausea, abdominal cramping and diarrhea.

Which of the following minerals exhibit the effects and symptoms below: Effects of Deficiency Tremor, spasm, convulsions, weakness, muscle pain, poor cardiac function Symptoms of Excess Weakness, nausea, malaise A. Iron B. Calcium C. Sodium D. Magnesium

D. Vitamin C Rationale: Vitamin C is an antioxidant that helps protect your cells against the effects of free radicals — molecules produced when your body breaks down food or is exposed to tobacco smoke and radiation from the sun, X-rays or other sources. Free radicals might play a role in heart disease, cancer and other diseases. Although too much dietary vitamin C is unlikely to be harmful, large doses of vitamin C supplements might cause: Diarrhea. Nausea. Vomiting. Symptoms for deficiency include fatigue, depression, and connective tissue defects (eg, gingivitis, petechiae, rash, internal bleeding, impaired wound healing).

Which of the following vitamins exhibit the effects and symptoms below: Effects of Deficiency Anemia, tissue bleeding, easy bone fracture, gingivitis, petechiae, poor wound healing, joint pain, scurvy Symptoms of Excess Stomach inflammation, diarrhea, oxalate kidney stones A. Vitamin A B. Vitamin B12 C. Folic Acid D. Vitamin C E. Vitamin D F. Vitamin K G. Vitamin E

E. Vitamin D Rationale: It is a fat-soluble vitamin that has long been known to help the body absorb and retain calcium and phosphorus; both are critical for building bone. Also, laboratory studies show that vitamin D can reduce cancer cell growth, help control infections and reduce inflammation.

Which of the following vitamins exhibit the effects and symptoms below: Effects of Deficiency Bone and muscle pain, weakness, softening of bone, fractures, rickets Symptoms of Excess Fatigue, weakness, loss of appetite, headache, mental confusion, mental retardation in infants A. Vitamin A B. Vitamin B12 C. Folic Acid D. Vitamin C E. Vitamin D F. Vitamin K G. Vitamin E

B. Vitamin B12 Rationale: Vitamin B-12 (cobalamin) plays an essential role in red blood cell formation, cell metabolism, nerve function and the production of DNA, the molecules inside cells that carry genetic information. Food sources of vitamin B-12 include poultry, meat, fish and dairy products. Key points about vitamin B12 deficiency anemia. Without enough oxygen, your body can't work as well. Symptoms include weak muscles, numbness, trouble walking, nausea, weight loss, irritability, fatigue, and increased heart rate.

Which of the following vitamins exhibit the effects and symptoms below: Effects of Deficiency Classic triad of glossitis (inflamed tongue), weakness, and ascending paresthesia; pernicious anemia, irreversible nerve damage, memory loss, dementia Symptoms of Excess Unlikely - they are readily excreted A. Vitamin A B. Vitamin B12 C. Folic Acid D. Vitamin C E. Vitamin D F. Vitamin K G. Vitamin E

G. Vitamin E Rationale: Vitamin E is a nutrient that's important to vision, reproduction, and the health of your blood, brain and skin. Vitamin E also has antioxidant properties. Vitamin E toxicity is rare, but occasionally high doses cause a risk of bleeding, as well as muscle weakness, fatigue, nausea, and diarrhea. The greatest risk from vitamin E toxicity is bleeding. Diagnosis is based on a person's symptoms.

Which of the following vitamins exhibit the effects and symptoms below: Effects of Deficiency Hyporeflexia, ataxia, hemolytic anemia, myopathy Symptoms of Excess Insufficient blood clotting, impaired immune system A. Vitamin A B. Vitamin B12 C. Folic Acid D. Vitamin C E. Vitamin D F. Vitamin K G. Vitamin E

F. Vitamin K Rationale: Vitamin K helps to make various proteins that are needed for blood clotting and the building of bones. Prothrombin is a vitamin K-dependent protein directly involved with blood clotting. Osteocalcin is another protein that requires vitamin K to produce healthy bone tissue. Vitamin K toxicity is extremely rare. The only reported toxicity comes from menadione, which has no use in humans. Its toxicity is thought to be associated with its water-soluble properties. When toxicity does occur, it manifests with signs of jaundice, hyperbilirubinemia, hemolytic anemia, and kernicterus in infants.

Which of the following vitamins exhibit the effects and symptoms below: Effects of Deficiency Increased bleeding Symptoms of Excess Jaundice and hemolytic anemia in infants A. Vitamin A B. Vitamin B12 C. Folic Acid D. Vitamin C E. Vitamin D F. Vitamin K G. Vitamin E

C. Folic Acid Rationale: Folate (vitamin B-9) is important in red blood cell formation and for healthy cell growth and function. The nutrient is crucial during early pregnancy to reduce the risk of birth defects of the brain and spine. Taking doses of folic acid higher than 1mg can mask the symptoms of vitamin B12 deficiency, which can eventually damage the nervous system if it's not spotted and treated.

Which of the following vitamins exhibit the effects and symptoms below: Effects of Deficiency Megaloblastic anemia, neural tube defects Symptoms of Excess Increased seizure activity, hives, respiratory distress, itching, rash A. Vitamin A B. Vitamin B12 C. Folic Acid D. Vitamin C E. Vitamin D F. Vitamin K G. Vitamin E

A. Vitamin A Rationale: Vitamin A is a nutrient important to vision, growth, cell division, reproduction and immunity. Vitamin A also has antioxidant properties.

Which of the following vitamins exhibit the effects and symptoms below: Effects of Deficiency Night blindness, xerosis, xerophthalmia, keratomalacia, skin lesions Symptoms of Excess Gastrointestinal upset, headache, blurred vision, poor muscle coordination, fetal defects A. Vitamin A B. Vitamin B12 C. Folic Acid D. Vitamin C E. Vitamin D F. Vitamin K G. Vitamin E

C. "An online food diary is unlikely to help me to improve my food intake." Rationale: 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 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."

A. Analyzing the data Rationale: 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.

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

B. Lipid Rationale: Butter is an example of a lipid. Lipids are organic substances that are insoluble in water.

Which source of energy is butter? A. Simple carbohydrate B. Lipid C. Complete protein D. Incomplete protein

C. "I will make sure that I eat a balanced diet and exercise regularly." Rationale: Obesity is an epidemic in the United States. Proposed contributing factors are sedentary lifestyle and poor meal choices. Healthy eating and participation in exercise or other activities of healthy living promote good health.

Which statement made by an adult patient demonstrates understanding of healthy nutrition teaching? A. "I need to stop eating red meat." B. "I will increase the servings of fruit juice to four a day." C. "I will make sure that I eat a balanced diet and exercise regularly." D. "I will not eat so many dark green vegetables and eat more yellow vegetables."

A. High-density lipids (HDLs) Rationale: HDLs work to remove cholesterol from the blood stream and return it to the liver, so it can be converted into bile.

Which type of lipid removes cholesterol from the bloodstream? A. High-density lipids (HDLs) B. Low-density lipids (LDLs) C. Glycerides D. Sterols

C. "Can you tell me about the foods you eat along with any other supplements you take?" Rationale: 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.

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."