304 Dudek Chapter 3: protein

The nurse notes that a client has had a substantial loss of muscle mass of both arms and legs over the last two weeks. Which question should the nurse ask to help determine the reason for the client's change in muscle tissue?

"Can you tell me what you've been eating lately?" A loss of muscle mass indicates that protein tissue is being used for energy. The nurse needs to find out what the client's diet or eating habits are to determine if an adequate amount of carbohydrates and fats are being ingested. To "spare" protein from being burned for calories, an adequate supply of energy from carbohydrate and fat is needed. Bed rest could cause muscle wasting however this would not occur over 2 weeks. A change in exercise would not cause a substantial amount of muscle loss over 2 weeks. Water does not affect muscle mass.

The nurse is seeing a client who is not certain why a food is called a complete versus incomplete protein. How might the nurse explain this?

"Complete proteins provide all 9 essential amino acids" Complete proteins provide all nine essential amino acids in adequate amounts and proportions needed by the body for protein synthesis.

A student is asking the nurse for suggestions about the best way to build up muscle mass. The student says that he has been eating a lot of protein but it isn't working. What suggestion should the nurse make?

"resistance training is necessary to build muscle mass" Exercise in the form of resistance training, also called weight or strength training, is necessary to increase muscle mass. Protein eaten in excess of need does not build muscles more quickly. Excess protein is catabolized for energy.

The nurse is assisting a client who has been diagnosed with hepatitis. The client is a vegan and is having difficulties eating a high-protein diet. "I don't want to get fat!" the client insists. How can the nurse respond?

"your body needs the extra protein to heal" Hepatitis is an example of a condition in which extra protein is needed to help the body heal. Protein is metabolized in the liver, and hepatitis interferes with the process. The nurse should validate the client's concerns and never belittle or scold the client. The nurse should also remain nonjudgmental and respect the client's wishes.

When seeing a vegetarian client who requires education regarding the Acceptable Macronutrient Distribution Range, the nurse should direct the client to the see that the recommended range of protein intake is how much?

10%-35% The acceptable Macronutrient Distribution Range for protein for adults is 10% to 35% of total calories.

The nurse is seeing a client for a follow up nutiritonal visit. The client has been following a 1800-calorie MyPlate plan in an attempt to lose weight. She is questioning whether she should decrease her protein intake. The nurse reminds her that the actual protein intake provides what percentage of total calories consumed?

15% For women, the actual protein intake provides 15% of the total calories consumed, according to the U.S. Department of Agriculture.

The nurse is assessing a client newly admitted to the unit with a fractured right femur. The client is 6 feet 3 inches tall and weighs 198 pounds. Which of the following is the client's estimated daily protein requirement?

72 grams To determine the approximate protein requirements per day for a healthy individual, multiply the weight in kilograms by 0.8; to convert pounds to kilograms, divide the weight in pounds by 2.2, so 198/2.2 = 90 kg; 90 x 0.8 = 72.

A client has come in for a follow-up visit after recovering from a serious systemic infection. The client says that he has been making up for not being able to eat for three weeks. The nurse notes that according to the client's food log, his protein intake was 100 grams for the previous day. The laboratory result for his UUN was 9.8 grams. The nurse notes that this client's nitrogen balance is which of the following?

2.2 grams To determine the nitrogen balance, determine nitrogen intake by dividing protein by 6.25 (100 g/6.25 = 16 g); determine total nitrogen output by adding a coefficient of 4 to the UUN (9.8 + 4 = 13.8); calculate the nitrogen balance by subtracting nitrogen output from nitrogen intake (16 - 13.8 = 2.2 g).

The nurse is encouraging a client to obtain his protein from a variety of sources as he follows the MyPlate 2000-calorie pattern. The client is surprised that this plan recommends how much dairy each day?

3 cups The MyPlate 2000-calorie Food Intake Pattern recommends 3 cups of dairy each day.

A 75-year-old client has been brought to the hospital by family members after they found him confused and disoriented at home. Initial assessment indicates malnutrition and muscle wasting. He is found to weigh approximately 50 kilograms. What is the minimum amount of protein that he should receive on a daily basis?

40 grams A healthy individual should ingest 0.8 g/kg of protein daily; therefore a healthy individual weighing 50 kilograms should ingest 40 grams of protein per day. That would be the starting point for this client, and the amount should be adjusted depending on his other symptoms.

A nurse recognizes the client may be surprised to learn that the skeletal muscles contain approximately how much protein?

40% More than 40% of protein in the body is found in the skeletal muscles.

The nurse is teaching a client the MyPlate 2000-calorie plan. The nurse explains that nutrients can be found in more than one group. Approximately what percentage of protein comes from the protein group?

40% More than 40% of the protein in a MyPlate 2000-calorie food pattern comes from the protein food group. The dairy, vegetable, and grains groups also provide proteins.

The client is a healthy 25-year-old athlete who weighs 66 kilograms. What is this client's RDA for protein? Enter the correct number ONLY.

52.8 To calculate the RDA for protein, multiple the person's weight in kilograms by 0.8 g/kg; 66 x 0.8 = 52.8 g.

The nurse is seeing a client who weights 176-pounds and is trying to adopt a healthier diet. When assisting this client to develop a plan, the nurse determines that this client should consume how many grams of protein daily?

64 To determine the approximate protein requirements per day for a healthy individual, multiply the weight in kilograms by 0.8; to convert pounds to kilograms, divide the weight in pounds by 2.2, so 176/2.2 = 80 kg; 80 x 0.8 = 64.

The nurse is reviewing the food log of a client who has been instructed by the health care provider to increase protein intake while recovering from pneumonia. One daily entry from the log shows the following: Breakfast: 1 ounce of granola, 1 cup of yogurt, 1/2 cup of sliced strawberries, and 1 cup of milk Lunch: 1 slice of bread, 2 tablespoons of peanut butter, and 1 cup of milk Dinner: 3 ounces of grilled chicken, 1 hard-boiled egg, 1/2 cup of steamed spinach, and 1/2 cup of brown rice How many grams of protein would the nurse determine the client consumed on this day?

70 Protein content for the food items is as follows: Breakfast: 1 ounce of granola (3 g), 1 cup of yogurt (8 g), 1/2 cup of sliced strawberries (0), and 1 cup of milk (8 g) = 19 g Lunch: 1 slice of bread (3 g), 2 tablespoons of peanut butter (7 g), and 1 cup of milk (8 g) = 18 g Dinner: 3 ounces of grilled chicken (21 g), 1 hard-boiled egg (7 g), 1/2 cup of steamed spinach (2 g), and 1/2 cup of brown rice (3 g) = 33 g The total protein consumption for the day was 70 g. (19 + 18 + 33 = 70)

The nurse is assessing a new client for her nutritional requirements. The client weighs 200 pounds. Approximately how many grams of protein should this client consume on a daily basis?

70 To determine the approximate protein requirements per day for a healthy individual, multiply the weight in kilograms by 0.8; to convert pounds to kilograms, divide the weight in pounds by 2.2, so 200/2.2 = 90.9 kg; 90.9 x 0.8 = 72.72.

The nurse is preparing a diet plan for a client who weighs 200 pounds. If the client is going to start a 1800-calorie MyPlate diet plan, approximately how many grams of protein should he eat each day?

72 grams The number of calories is not important in calculating the RDA for protein. To calculate a healthy adult's RDA for protein, divide the person's weight in pounds by 2.2 to determine weight in kilograms (200 lb/2.2 = 90.9 kg). Multiply by 0.8 g/kg (91 x 0.8 = 72.8 g). The result is the total number of grams per day.

During the assessment of a school aged child, the mother comments that the client has a poor appetite but he will drink milk. The mother is concerned the client is not getting enough protein. The nurse explains that each cup of milk contains how much protein?

8 grams One cup of milk or yogurt contains 8 grams of protein according to the MyPlate guidelines.

The nurse is seeing a client who is considering a vegetarian diet. When the client asks about digestibility of animal proteins, which of the following is the correct response by the nurse? 90-99%

90-99% Protein digestibility is 90% to 99% for animal protein, over 90% for soy and legumes, and 70% to 90% for other plant proteins.

The nurse reviews the care needs for assigned clients. Which client is a priority for the nurse to assess for adequate protein intake?

a client with chronic renal failure beginning hemodialysis treatment Long-term hemodialysis is a condition that can cause excessive protein losses that will need to be replaced. The client with heart failure and atrial fibrillation is not experiencing a hypermetabolic state. Although the client with diabetes is having surgery, the type of surgery does not require an increase in the amount of protein for healing. The client with multiple sclerosis is not experiencing a hypermetabolic state and would not need additional protein for healing.

The nurse recognizes that which protein helps maintain the proper balance among the interstitial compartments of the body?

albumin Circulating proteins, such as albumin, maintain the proper balance of fluid among the intravascular, intracellular, and interstitial compartments of the body.

When providing teaching to a client who would like to learn more about protein, the nurse correctly tells the client which of the following is a nonessential amino acid?

asparagine Asparagine is a nonessential amino acid. Isoleucine, phenylalanine, and lysine are essential amino acids and must be provided by the diet.

The nurse is assessing the food intake a client who has recently taken up a vegan diet. Which of the following foods should the nurse recommend the client include when meal planning to ensure there are complete or complementary proteins in the diet?

black bean and barley soup Black bean and barley soup provides complementary proteins that are suitable for a vegan diet. The cheese enchilada provides complementary proteins, and cheese by itself provides a complete protein; however, cheese is not suitable for a vegan. Peanut butter and rice by themselves both provide incomplete proteins; each must be paired with another incomplete protein.

The client is a 21-year-old male who was in a motorcycle accident, sustaining a fractured femur and closed head injury. The health care provider has requested a nitrogen balance determination. The record indicates a 24-hour protein intake of 70 grams. A 24-hour urinary urea nitrogen collection result was 18.5 grams. The nurse recognizes that this client is in which of the following states?

catabolic protein To determine the nitrogen balance, determine nitrogen intake by dividing protein by 6.25 (70 g/6.25 = 11.2 g); determine total nitrogen output by adding a coefficient of 4 to the UUN (18.5 + 4 = 22.5); calculate the nitrogen balance by subtracting nitrogen output from nitrogen intake (11.2 - 22.5 = -11.3). A negative number indicates that protein breakdown is exceeding protein synthesis. The client is in a catabolic state.

The nurse is assessing a new patient who is being admitted to the unit. The admitting information indicates that this individual is homeless and shows signs of malnutrition. The nurse recognizes that the immediate concern for this patient is which of the following?

correcting electrolyte imbalance Initially correcting fluid and electrolyte imbalances is a priority. Antibiotics can then be started if an infection is identified. Within 48 hours, macronutrients can be started as the patient tolerates. Diet is gradually advanced as tolerated. Amino acid supplements are not recommended.

The nurse recognizes that while fighting an infection a client will require a diet that includes conditionally essential amino acids. Which of the following amino acids are needed?

cysteine Cysteine is a conditionally essential amino acid. Serine is a nonessential amino acid. Threonine and histidine are essential amino acids.

The nurse is aware that proteins carry out many different functions in the body. Some facilitate changes in the body without changing themselves. What are these special proteins called?

enzymes Enzymes are proteins that facilitate specific chemical reactions in the body without undergoing changes themselves.

The nurse notes that a 38-year-old client has +3 pitting edema of both lower extremities. Which information in the client's history would help explain this assessment finding?

follows a vegan eating plan A vegan eating plan typically does not include complete protein sources. Proteins help to regulate fluid balance because they attract water, which creates osmotic pressure. Circulating proteins, such as albumin, maintain the proper balance of fluid among the intravascular, intracellular, and interstitial compartments of the body. A symptom of a low albumin level is edema. Employment and volunteer work would not necessarily encourage the development of edema. Exercise would help prevent the development of lower extremity edema.

The nurse is explaining the role of the liver in processing protein to a nutrition class. As the proteins are broken down, what does the liver do with the nitrogenous wastes?

forms urea The liver forms urea from the nitrogenous wastes when protein and calories are consumed in excess of need. This urea is then excreted from the body.

A client has consistently recorded food intake and protein intake. However, the nurse's calculations do not agree with the client's. When reviewing the log, the nurse notes the discrepancy. Which of the following is NOT correct?

fruit 2 g of protein/ 1 oz serving Fruits have negligible protein content. The other amounts are correct according to the MyPlate guidelines.

The nurse is explaining protein anabolism to a group of students. The nurse explains that this process is determined by which of the following?

individual genetic code Genetic codes that are created at conception hold the instructions for making all the body's proteins.

The nurse is aware that vegans can consume complete protein by consuming two incomplete proteins that complement each other. Which of the following is an example of complementary proteins? Select all that apply.

lentils and curry black beans and rice peanut butter sandwich Lentils and rice curry, peanut butter sandwich, and black beans and rice are complementary proteins. Macaroni and cheese and rice pudding are examples of a complete protein (both contain dairy) and an incomplete protein.

The nurse recognizes that which of the following are essential amino acids? Select all that apply.

leucine lysine tryptophan Leucine, lysine, and tryptophan are essential amino acids. Alanine and aspartic acid are nonessential amino acids, meaning that the body can produce them as needed.

Incomplete proteins differ in limiting missing amino acids. The nurse recognizes that grains are typically low in which of the following amino acids?

lysine Grains are an incomplete protein, typically low in lysine and isoleucine.

The nurse is teaching a group of high school students about protein. After discussing basic facts about protein, the students are able to identify where protein can be found in the body. Protein can be in which of the following? Select all that apply.

muscle fingernails hair Protein is found in every tissue and fluid in the body except for bile and urine.

The nurse is discussing protein with the class. After the class, the students can identify which of the following amino acids is an essential one?

phenylalanine Phenylalanine is one of the nine essential amino acids. Arginine, glycine, and proline are conditionally essential amino acids.

The nurse is aware that after the amino acids have been absorbed in the bloodstream, they are taken to the liver. The nurse understands that before the amino acids are burned for energy, the role of the liver is which of the following?

removes the nitrogen The liver removes the nitrogen from the amino acids so that they can be burned for energy.

The nurse is describing to a group of 8th graders how protein is digested. At the end of the discussion, the students understand that protein digestion begins in the:

stomach Chemical digestion of protein begins in the stomach, with the majority of digestion occurring in the small intestine.

The nurse educator providing nutritional instruction regarding amino acids. When the nurse educator asks the students which of the following the amino acid molecule may contain to give it a distinct identity, which response is correct?

sulfur Some side groups contain sulfur, some are acidic (COOH), and some are basic (NH2).

The nurse understands the importance of assisting clients in maintaining homeostasis. A component of homeostasis is maintaining the proper ratio between protein catabolism and anabolism. Which of the following reflects protein homeostasis?

the balance between catabolism and anabolism Nitrogen balance reflects the state of balance between protein breakdown (catabolism) and protein synthesis (anabolism).

The nurse is explaining how the body uses amino acids and proteins. The nurse explains that which structure in the body determines how amino acids are used?

the liver The liver acts as a clearinghouse for the amino acids it receives. It uses the amino acids it needs, releases those that are needed elsewhere, and handles the extra.

The client is concerned her husband is at risk for developing adverse effects due to his high protein intake. How should the nurse respond?

there are no proven risks Currently, there are no proven risks from eating an excess of protein. Data are conflicting, and a risk might or might not be identified in the future.