Chapter 27 TB

neural tube defects

malformations of the brain, spinal cord, or both during embryonic development that often result in lifelong disability or death

Kwashiorkor

protein deficiency

Which statement made by a client whose body mass index (BMI) is 34 and is attempting to lose weight would indicate the need for further teaching?

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

While the nurse is performing a nutritional assessment, the patient states, "I am on a vegan diet. I have been a vegan for 10 years." What is the best response by the nurse?

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

After instructing a mother about nutrition for a preschool-age child, which statement by the mother indicates correct understanding of the topic?

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

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?

"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 can't use the excess glucose."

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?

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

The nurse is caring for a 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?

"Smokers use vitamin C faster than do nonsmokers, and this is linked to iron deficiency. You can either eat more foods containing vitamin C and iron or take dietary supplements."

Which portion of a nutritional assessment must the registered nurse complete?

Analyzing the data

A patient who was prescribed furosemide is deficient in potassium. Which nutritional goal is appropriate for this patient? The patient will increase consumption of:

Avocados, peaches, molasses, and potatoes

A middle-aged patient with a history of alcohol abuse is admitted with acute pancreatitis. Which nutrient level will most likely be the lowest?

B vitamins Patients who regularly abuse alcohol may be deficient in many nutrients; however, they are commonly deficient in the B vitamins and folic acid.

Which class of nutrients is the body's primary source of energy?

Carbohydrates

The nurse completes the nutrition assessment for a 14-year-old female with a body mass index (BMI) of 15. Which physical assessment finding would cause the nurse to suspect an eating disorder?

Cold intolerance It is a physical sign of an eating disorder.

A patient with trigeminal neuralgia is prescribed a mechanical soft diet. This diet places the patient at risk for which complication?

Constipation Because of its lack of fiber, a mechanical soft diet places the patient at risk for constipation.

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?

Folic acid

An elderly female, adequately nourished, was admitted to the skilled nursing facility 3 months ago. Since then, she has had a significant weight loss and has become weak. Her appetite and activity level are reduced, and she has lost interest in interacting with other patients. What would the nurse suspect the reason for her condition to be?

Frail elderly syndrome With advancing age, older adults face many losses. As a result, depression and social isolation are common. Both negatively affect appetite. Frail elderly syndrome is a complex disorder characterized by weight loss, lessened activity and interaction, and increasing frailty.

Which substance is stored in the liver?

Glycogen Humans store glucose in liver and skeletal muscle tissue as glycogen. Glycogen can then be converted back into glucose to meet energy needs through a process known as glycogenolysis.

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?

Grape juice 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.

A patient's parenteral nutrition (PN) container infuses before the pharmacy prepares the next container. This places the patient at risk for which complication?

Hypoglycemia

A 52-year-old man has a body mass index of 28.9, and his weight exceeds the ideal body weight for height by 23%. Which nursing diagnosis should the nurse identify for this patient?

Imbalanced Nutrition: More Than Body Requirements

Which intervention would help to prevent or relieve persistent nausea?

Immediately remove any food that the patient cannot eat.

Which patient is most likely experiencing positive nitrogen balance? A patient admitted:

In the sixth month of a healthy pregnancy A positive nitrogen balance typically exists during pregnancy when new tissues are being formed and nitrogen intake exceeds output.

During the day shift, a patient's temperature measures 97°F (36.1°C) orally. At 2000, the patient's temperature measures 102°F (38.9°C). What effect does this rise in temperature have on the patient's basal metabolic rate?

Increases the rate by 35% Basal metabolic rate increases by 7% for each degree Fahrenheit (0.56°C); therefore, this patient's temperature rise is an increase of 35%: 102 - 97 = 5 ´ 7 = 35.

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 nutrient?

Iron

In a patient with type 1 diabetes mellitus admitted with hyperglycemia, fats are being broken down for energy. Which alternative fuel does the breakdown of fats produce?

Ketones When fats are used for energy, they are converted directly into an alternative fuel called ketone

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?

Lipoproteins, such as low-density and high-density lipoproteins (LDLs and HDLs) 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." 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 and is often known as the "good cholesterol."

After inserting a nasogastric feeding tube, what would be the nurse's priority action prior to starting the first tube feeding?

Obtain radiographic verification (x-ray). Radiographic (x-ray) verification is the only reliable method for confirming tube placement; it must be performed before the first feeding is administered.

Which laboratory test result most accurately reflects a patient's nutritional status?

Prealbumin It levels fluctuate daily, and is considered a better marker of acute change than albumin.

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?

Protein

Which nutrient deficiency increases the risk for tissue breakdown?

Protein

Which nutritional goal is appropriate for a patient newly diagnosed with hypertension? The patient will:

Restrict use of sodium

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?

Serum albumin of 3.2 g/dL Serum albumin is a blood protein and marker for nutritional status. The value should be between 3.4 and 4.8 g/dL. This situation is consistent with undernutrition due to low nutritional intake.

The patient is irritable, temperature is elevated, and mucous membranes are dry. Based on these findings, the patient most likely has excess levels of which mineral?

Sodium

The nurse is checking the aspirate for the patient receiving gastric tube feedings. The nurse notes the 200 mL of pale yellow and cloudy fluid with a pH of 7.3. Which action should the nurse take?

Stop the feeding immediately; then notify the prescribing provider. Normal gastric fluid should be greenish brown or white, and acidic (pH 1 to 5.5). If the gastric aspirate has 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.

While addressing a community group, the nurse explains the importance of replacing saturated fats in the diet with mono- and polyunsaturated fats. The nurse emphasizes that doing so greatly reduces the risk of which complication?

Stroke

Which food item provides the body with no usable glucose?

Wheat germ Humans do not have the enzymes to digest fiber; thus, it provides no usable glucose

trigeminal neuralgia

a condition characterized by sudden, intense, severe lightning-like pain due to an inflammation of the fifth cranial nerve

Prealbumin

a thyroxin-binding protein measured to evaluate the nutrition status of critically ill patients who are at high risk for malnutrition

type 1 diabetes mellitus

diabetes caused by a total lack of insulin production; usually develops in childhood, and patients require insulin replacement therapy to control the disorder