Chapter 36 nutrition

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

"According to research, vegetarians have a higher incidence of obesity than others."

The nurse is providing care for an older adult client who is recovering from pneumonia on the hospital's medical unit. The nurse sets up the client's dinner tray on his overbed table. The client then states, "I won't be having any of this." What is the nurse's most appropriate response?

"Can you tell me why you don't want to have dinner tonight?"

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

"My favorite drink is coffee with sugar."

A client is discussing vitamin and mineral intake with the nurse. Which client statement requires further nursing teaching?

"My husband and I are ordering a product that has megadoses of vitamins."

A nursing student is teaching healthy nutrition to a client who is vegetarian. Which statement by the nursing student requires the nursing instructor to intervene?

"Obesity is closely linked with vegetarianism."

A female client tells the nurse, "I try to consume 2000 calories daily by eating a variety of proteins, carbohydrates, and fats." What is the appropriate nursing response?

"That is a healthy amount of daily caloric intake."

A woman is 6 weeks pregnant and is in a clinic for her first prenatal exam. She asks a nurse how her nutritional needs have changed now that she is pregnant. Which is the nurse's best response?

"You will need additional nutrients such as calcium, folic acid, and protein."

what is the basal metabolic rate for women?

0.9 cal/kg/hr

what is the basal metabolic rate for men?

1 cal/kg/hr

3500 calories is equal to

1 pound

A 40-year-old man has consumed a breakfast consisting of cereal, milk, orange juice, and coffee. His blood sugar in 2 hours is likely to be in what range?

140-180 mg/dL

A nurse is establishing an ideal body weight for a 5'9" (175 cm) healthy female. Based on the rule-of-thumb method, what would be this client's ideal weight?

145 lb/ 65.7 kg

What is the body mass index (BMI) of a client who is 1.68 meters tall and weighs 70 kg?

24.8

The nurse is caring for four clients. Which does the nurse identify as highest risk for development of cardiometabolic syndrome?

36-year old with obesity who smokes

what are the ABCDE's of assessing nutritional status?

A- Anthropometric data (BMI, waist circumference) B- Biochemical Data C- Clinical data D-dietary data E- economic, social, and medical data

A nurse is discussing vitamin supplementation. Which groups are more prone to mild vitamin deficiencies? Select all that apply.

Adolescents Pregnant or lactating women Strict vegetarians

A nurse documents a client's hemoglobin as 80 g/L. What nutritional condition does this biochemical data signify?

Anemia

The nurse is attempting to insert an NG tube and, as the tube is passing through the pharynx, the client begins to retch and gag. What nursing interventions are appropriate in this situation?

Ask the client if he needs to pause before continuing insertion. Continue to advance tube when the client relates that he is ready. Have the emesis basin nearby in case client begins to vomit.

The nurse has obtained a client's capillary blood glucose sample and the results are significantly lower than reference range. What is the nurse's priority action?

Assess the client for signs and symptoms of hypoglycemia.

A nurse is caring for a client who has a nursing diagnosis of Risk for Aspiration. When preparing to assist this client with eating, how can the nurse best reduce this risk?

Assess the client's level of consciousness.

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

Assess when client generally eats meals.

A client who is bedridden and dependent has been ordered to resume an oral diet. When feeding the client, the nurse should perform what action?

Assist the client into a high-Fowler's position.

A nurse is caring for a client who has a decrease in appetite. Which actions by the nurse would be appropriate?

Assist with oral hygiene before serving the meal tray.

what are water soluble vitamins?

B vitamins and vitamin C; absorbed through intestinal wall into bloodstream, not stored.

A nurse is teaching a client about diabetes and glucose monitoring. What should the nurse include in the teaching?

Blood from the fingertips shows changes in glucose more quickly than other testing sites.

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

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

A nurse is caring for a client who reports frequent nausea. Which food should the nurse recommend to the client when the nausea is relieved?

Clear fruit juices

A nurse is working with a 46-year-old woman who is working to lose weight. Based on recommendations from the USDA regarding diet modification, which is not appropriate advice for this client?

Drink juice for majority of fluid intake.

what is basal metabolism?

Energy required to carry on involuntary activities of the body at rest. -- the energy needed to sustain the metabolic activities of cells and tissues

A nurse is caring for a client with a nasogastric tube. The nurse enters the room to flush the nasogastric tube and check gastric residual. Which action should the nurse perform first?

Ensure the head of the bed is elevated.

A nurse is managing a client's continuous tube feeding via an NG tube. How often should the nurse check for residual?

Every 4 to 6 hours

Which task may be safely delegated to unlicensed assistive personnel (UAP)?

Feeding a client who is at risk for aspiration

A nurse is assessing a client's nutritional status. Which findings should lead the nurse to suspect poor nutritional status?

Flaky facial skin, facial edema, and pale skin color

A client has had a stroke and will require long-term tube feeding. Which type of feeding tubes would be most appropriate for this client's needs?

Gastrostomy tube

What is anthropometric data?

Height, weight, skin fold measurements, waist circumference, BMI

The nurse is caring for a client receiving continuous tube feeding. The client has a gastric residual of 550 mL. The previous residual was 200 mL. What action should the nurse take?

Hold the enteral nutrition and notify the primary care provider.

A nurse is preparing to obtain a client's capillary blood sample for glucose testing. The nurse should perform which action?

Hold the lancet perpendicular to the skin and prick the site.

Which nursing action is performed according to guidelines for aspirating fluid from a small-bore feeding tube?

If fluid is obtained when aspirating, measure its volume and pH and flush the tube with water.

A nurse is caring for a client with a gastrostomy tube in place. Which is an accurate guideline for care of the insertion site?

If the gastric tube insertion site has healed and the sutures are removed, use soap and water to clean the site.

What is an appropriate intervention when unexpected situations occur during the administration of a tube feeding?

If the tube becomes clogged when aspirating contents, use warm water and gentle pressure to remove the clog.

A client has been on a clear liquid diet for 5 days. What is an appropriate nursing diagnosis for this client?

Imbalanced nutrition, less than body requirements

The nurse is reviewing a client's most recent laboratory results, which reveal increases in hematocrit, creatinine, and blood urea nitrogen (BUN). After collaborating with the interdisciplinary team, what intervention is most appropriate?

Increase the client's fluid intake.

A client who is recovering from a stroke has begun tube feedings. Which principle should the nurse follow when administering the tube feeding?

Intermittent feedings use gravity for instillation or a feeding pump to administer the formula over a set period of time.

The nurse is caring for a client with an enlarged thyroid. What nutritional deficiency is linked to an enlarged thyroid?

Iodine

A female client has developed an abscess following abdominal surgery, and her food intake has been decreasing over the past 2 weeks. Which laboratory finding may suggest the need for nutritional support?

Low serum albumin levels

What are macronutrients and micronutrients?

Macronutrients essential nutrients that supply energy and build tissue Micronutrients- vitamins and minerals

The nurse is caring for a client who is pregnant. Which nutrition education will the nurse provide?

More servings of milk daily will be required.

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

New foods should be introduced one at a time for a period of 5 to 7 days.

The nurse is performing a nutritional assessment of an obese client who visits a weight control clinic. What information should the nurse take into consideration when planning a weight reduction plan for this client?

Psychological reasons for overeating should be explored, such as eating as a release for boredom

A nurse has just inserted a nasogastric tube in a client. Which method is most reliable for verifying the correct placement of the tube?

Radiographic confirmation of position

A nurse is caring for a client who has a malabsorption disease. The nurse should understand that which structure in the gastrointestinal system absorbs the majority of digested food and minerals?

Small intestine

The nurse is caring for a client who has dysphagia and is unable to eat independently. The nurse is preparing to assist the client in eating a meal. Which action is appropriate?

Speak to the client but limit the need for the client to respond verbally while chewing and swallowing.

A nurse is caring for a client receiving total parenteral nutrition (TPN). Which should the nurse educate the client about regarding TPN therapy? Select all that apply.

TPN has three primary components: proteins, carbohydrates, and fats. TPN has a high glucose concentration. TPN requires a PICC line or central venous access.

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

The new nurse places the client in the left lateral recumbent position.

The nurse has observed that a client's food intake has diminished in recent days. What intervention should the nurse perform in order to stimulate the client's appetite?

Try to ensure that the client's food is attractive and sufficiently warm.

BMI standards

Underweight - <18.5 Normal - 18.5-24.9 Overweight - 25-29.9 Obese class 1 and class 2- 30-39.9 morbidly obese- 40 and above

The client reports to the nurse that she feels as if her eyes are persistently dry. This symptom is consistent with a deficiency in which dietary element?

Vitamin A

A client has a history of long-term alcohol use. Which nutrient would need to be required in increased amounts?

Vitamin B

Which vitamin is found only in animal foods?

Vitamin B12

Which of the following is a fat-soluble vitamin?

Vitamin E

A client is prescribed warfarin, an anticoagulant. When educating this client about potential diet and drug interactions, the nurse would caution the client about foods containing which nutrient?

Vitamin K

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

Vitamin K

what are fat soluble vitamins?

Vitamins A, D, E, K; absorbed with fat into the lymphatic system, excess stored in liver and adipose tissue; must be transported attached to a protein through blood.

The nurse is assessing clients for basal metabolic rate (BMR). Which client would the nurse suspect would have an increased BMR?

a client who has a fever

Body Mass Index (BMI)

a measure of body weight relative to height

A client has developed dysphagia secondary to a cerebrovascular accident. The nurse is aware that the client is at risk for:

aspiration.

The nurse is teaching a client about ways in which to reduce sodium in the diet. Which foods will the nurse recommend that the client avoid?

bacon table salt cured ham

The nurse is teaching an older adult client about different types of proteins that can be eaten. Which foods will the nurse identify as containing dietary protein?

beans nuts poultry fish

The nurse is providing education about nutrition and feeding to the parent of a toddler. Which statement by the child's parent indicates understanding of the education?

boiled eggs and pieces of cheese are good snacks for my child

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

bread

macrominerals

calcium, phosphorus, magnesium, sodium, potassium, chloride, sulfur need to consume >100mg

What are essential nutrients?

carbohydrates, protein, fat, vitamins, minerals, water. not synthesized in the body or are made in insufficient amounts.

A nurse is caring for a client who has been ordered a clear liquid diet. Which liquid can be included in the client's diet?

cranberry juice

A woman consumes pasta, grains, and other carbohydrates for which purpose?

energy

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

extremely obese.

what is water soluble fiber?

fiber that dissolves in water; causes slow gastric emptying, decreases serum cholesterol levels. foods such as oat bran, oatmeal, beans, veggies, prunes

what is water insoluble fiber?

fiber that does not dissolve in water

A client is receiving total parenteral nutrition (TPN). The nurse will assess for complications related to:

fluid and electrolyte levels.

what are some factors affecting food choices?

illiteracy, language barriers, knowledge of nutrition, lack of caregiver or social support, social isolation, limited ability to purchase food

The nurse is caring for a client with an enlarged thyroid gland. Which nutritional deficiency will the nurse suspect is linked to the client's condition?

iodine

microminerals

iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, iodine, need to consume <100 mg

What is biochemical data?

laboratory tests: Hct, Hgb, Albumin, Prealbumin, blood glucose, blood cholesterol, blood triglycerides, BUM, creatinine.

An older adult client has a decubitus ulcer with drainage, dysphagia, and immobility. She consumes less than 300 calories per day and has a large amount of interstitial fluid. The client is in a state of:

negative nitrogen balance.

A client who is taking supplements reports severe flushing and itching an hour after ingestion. The nurse is aware that the supplement is most likely:

niacin.

what is a positive nitrogen balance?

nitrogen intake exceeds losses

what is a negative nitrogen balance?

nitrogen losses exceed intake

A 45-year-old client on the inpatient unit has just resumed eating a normal diet. The nurse checks a blood sugar with the morning labs and the result is 99.10 mg/dL (5.5 mmol/L). How would the nurse interpret this blood glucose?

normal

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

older adults living on a fixed income

A nurse is caring for a client who has a body mass index (BMI) of 26.5. Which category should the nurse understand this client would be placed in?

overweight

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

overweight

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

people with substance use problems pregnant teenagers older adults living on fixed incomes

A nurse is caring for a client with chronic anemia. What should be included in the diet of this client?

red meat

Which laboratory test is the best indicator of a client in need of TPN?

serum albumin

what are nonessential nutrients?

synthesized in adequate amounts not required for body functioning; not supplied through dietary sources

The nurse is teaching four clients in a community health center. Which client does the nurse identify as needing more servings per day of milk?

teenager who is in the second trimester of pregnancy

A nurse is conducting client education with a woman who meets the diagnostic criteria for metabolic syndrome. The nurse is teaching the client about the MyPlate tool for promoting healthy food intake. According to MyPlate, the highest proportion of food in each meal should consist of what?

vegetables

The nurse is caring for a client who has been experiencing prolonged wound healing from a surgical procedure. A deficiency in which nutrient would be associated with this condition?

vitamin C

A nurse in a rural health center meets a new client, age 4. The nurse notices as the client enters the clinic that his legs appear to be bowed. When he smiles, the nurse also notes that his dentition is quite malformed for a child his age. What vitamin deficiency would the nurse most suspect?

vitamin D

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

vitamin D

When planning interventions in the immediate hours after birth the nurse recognizes the need to provide an injection of which vitamin (to manage a lack of it), due to lack of bacteria in the intestinal tract?

vitamin K