HESI quiz week 3

The nurse is teaching health promotion tips to the mother of a 2-year-old child. During the follow-up visit, the nurse observes that the child has diarrhea and dental caries. Which action of the parent is responsible for this condition?

Providing 4 to 6 oz of 100% fruit juice per day is recommended for toddlers. Consumption of high amounts of fruit juice can contribute to diarrhea, overnutrition, and dental caries.

A nurse is performing the initial history and physical examination of a client with a diagnosis of duodenal ulcer. Which type of pain does the nurse expect the client to describe?

Duodenal ulcer pain is relieved with food and antacids and often awakens the client at night when sleeping. Gastric ulcer pain is worse with eating or one hour after eating.

A pregnant woman tells the nurse in the prenatal clinic that she knows that folic acid is very important during pregnancy and that she is taking a prescribed supplement. She asks the nurse which foods contain folic acid (folate) so she may add them to her diet in its natural form. Which foods should the nurse recommend? Select all that apply.

Legumes contain large amounts of folate, as do enriched grain products.

The nurse determines that dietary teaching for a client with mild preeclampsia has been effective when the client makes which statement?

One of the many factors believed to contribute to the development of preeclampsia is inadequate nutrition. Therefore recommendations call for a nutritious diet that includes unrestricted sodium, high protein, and a sufficient number of calories. Additional intake of 340 calories/day is required during the third trimester of pregnancy.

The nurse teaches a mother about the dietary measures to be followed for her 5-month-old infant. During the follow-up visit, the nurse finds that the child has indigestion. Which action by the mother is responsible for this situation?

The enzyme amylase is needed for the digestion of complex carbohydrates. A 4- to 6-month-old infant is deficient in amylase. Sweet potatoes are rich in complex carbohydrates; therefore the 5-month-old infant can have indigestion from eating sweet potatoes. Almond milk, vegetable juice, and bottle milk do not contain complex carbohydrates; therefore, they do not result in indigestion.

During the initial prenatal visit of a woman at 23 weeks' gestation, the nurse discovers that she has a history of pica. What is the most appropriate nursing action?

The primary concern for a pregnant women who practices pica is that her diet is nutritionally inadequate. Nutritional guidance may be necessary, depending on the findings of this assessment. Pica does not indicate a psychologic/emotional disturbance; frequently it is influenced by the client's culture. If a substance is not toxic to the mother, it is generally not fetotoxic. Iron is routinely prescribed during pregnancy; this does not specifically address the practice of pica.

A 12-month-old infant is to receive ferrous sulfate for iron-deficiency anemia. How will the nurse administer the medication?

Very young children should receive ferrous sulfate elixir through a syringe or medicine dropper placed in the back of the mouth; this limits staining of teeth by the ferrous sulfate.

A client is receiving warfarin. The nurse explains the need for careful regulation of dietary intake of vitamin K. What is the rationale for the nurse's teaching?

Vitamin K promotes the liver's synthesis of prothrombin, an important blood clotting factor, and will reverse the effects of warfarin. Platelet aggregation and fibrinogen formation by the liver are not promoted by vitamin K. Vitamin K does not affect calcium ionization.

A pale, lethargic 1-year-old infant weighs 28 lb (12.7 kg) and has a hemoglobin level of 9 g/dL (90 mmol/L). The parent tells the nurse that the infant refuses solid food when it is offered by spoon and drinks between four and six full bottles of milk per day. What should the nurse recommend?

A diet of only milk is not sufficient to meet the infant's iron needs. Meat and fortified cereals are high in iron. Finger foods are appropriate for older infants. At this age, weaning from the bottle is not the issue; supplementary iron intake is. Although health care and monitoring will be required, the metabolic clinic is not the appropriate referral. Although adding pureed baby foods to the milk would increase iron intake, a large hole in the nipple of the bottle is not desirable at this point.

A nurse is caring for an underweight adolescent girl with a diagnosis of anorexia nervosa. What common characteristics of girls with this disorder should the nurse recognize when obtaining a health history and performing a physical assessment? Select all that apply.

Fatigue results because inadequate nutritional intake results in electrolyte imbalances and a decreased red blood cell count. Many of these clients have lowered body temperature and are intolerant of cold. Anorexic clients have bradycardia. Amenorrhea occurs because of endocrine imbalances resulting from starvation; it is thought that severe starvation damages the hypothalamus.

A nurse is caring for an adolescent who has anorexia nervosa. The nutritional treatment of anorexia is composed of several guidelines. Which guidelines should the nurse emphasize? Select all that apply.

Food intake should be increased by approximately 200 calories weekly. A gradual increase allows the client to adapt emotionally and physically to the increased volume. Thirty minutes is sufficient time for eating. Extended mealtimes place excessive attention on eating and increase anxiety and conflict. Goals should be set per week. Behaviors that result in achievement of goals should be rewarded. Goals provide structure, and rewards motivate additional positive behaviors while promoting self-esteem. Consumption of high-fiber foods does not have to be increased. A variety of foods and textures should be eaten. Small, frequent meals should be offered.

A nurse is teaching the mother of an 18-month-old toddler with iron-deficiency anemia about her child's dietary needs. What foods should the nurse suggest for inclusion in the child's diet?

Gingerbread cookies made with molasses are an excellent source of iron. They may be eaten as a finger food, which toddlers prefer. Pumpkin pie provides some protein and iron but has a spicy taste that is generally not a favorite of toddlers. Although grapes contain iron, a cup is an excessive amount for an 18-month-old child to ingest. Apples, although nutritious, are low in protein and iron.

What kind of health service does the nurse offer in a health promotion or primary care program?

Health promotion or primary care focuses on improved health outcomes for the entire population. It includes nutrition counseling and health education.

To reduce the risk of recurrent painful gout attacks, the nurse teaches the client to avoid which foods? Select all that apply.

Like other organ meats, liver is a high-purine food (range of 150 to 1000 mg/100 g) and should be avoided. Shellfish (e.g., shrimp, lobster) are also high-purine foods and should be avoided. Eggs and cheese have insignificant amounts of purine and are unrestricted. Foods that contain a moderate amount of purine (50 to 150 mg/dL), such as salmon, may be eaten four times a week.

After tolerating an oral rehydration solution (Pedialyte) being given because of dehydration resulting from diarrhea, a 20-month-old toddler's condition improves and a regular diet is started. What foods should the nurse suggest that the parents offer their child? Select all that apply.

Poached eggs are nutritious and are easily digested. Carrots help replace the sodium lost in diarrhea. Animal crackers are not irritating to the gastrointestinal tract. Creamed foods and puddings contain milk, which may irritate the gastrointestinal tract in some children.

A nurse notices that a diabetic client is consuming chocolate brought by a family member. Which nursing action should a nurse perform to adhere to the principle of autonomy?

The nurse adheres to the principle of autonomy by collaborating with other healthcare providers to pursue the best treatment plan for the client. In this case, the nurse should collaborate with a dietician to obtain a special diet chart for a diabetic client.

A client who recently immigrated to the United States (Canada) has a chronic vitamin A deficiency. What information about vitamin A should the nurse consider when assessing this client for clinical indicators of this deficiency?

Vitamin A is used in the formation of retinol, a component of the light-sensitive rhodopsin (visual purple) molecule.

Which feelings should a nurse anticipate a client with bulimia nervosa to report experiencing during the time following an episode of binge eating? Select all that apply.

When clients feel powerless and helpless, they often lose hope. They feel desperate, despondent, and dejected. Clients with bulimia nervosa have a sense of being out of control that accompanies the excessive or compulsive consumption of large amounts of food, resulting in feelings of powerlessness, helplessness, and hopelessness.

To prepare a client for discharge, the nurse is providing dietary instructions to a client who had a pancreaticoduodenectomy (Whipple procedure). What should the nurse include in the instructions?

A whipple leads to malabsorption because of impaired delivery of bile to the intestine; fat metabolism is interfered with, causing dyspepsia. These clients are anorexic, require small, frequent meals, and should eat a high-calorie, high-protein, low-fat diet. High-calorie meals are needed for energy and to promote use of protein for tissue repair. High protein is required for tissue building;

Which information should the nurse include when teaching a client with heart disease about cholesterol?

Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats and can be decreased with unsaturated fats. Only animal foods furnish dietary cholesterol. Exercise, not cholesterol, increases HDL levels and helps decrease the risk of heart disease.

The nurse interviews a young client with anorexia nervosa to obtain information for the nursing history. What will the client's history most likely reveal? Select all that apply.

Clients with anorexia nervosa typically have a history of ritualistic behaviors, rigidity, and meticulousness, reflecting a need for control. Clients with anorexia nervosa have a disturbed self-image and always see themselves as fat and needing further weight loss.

When a Schilling test is prescribed for a client suspected of having cobalamin deficiency because of pernicious anemia, what should the nurse plan to do?

A 24-hour to 48-hour urine specimen assesses parietal cell function. After radioactive cobalamin is administered, its excretion is measured; if cobalamin cannot be absorbed, as in pernicious anemia, very little is excreted in the urine. This test is not affected by medications. The results of this test are not affected by food; with pernicious anemia there is a deficiency of intrinsic factor, which is necessary for vitamin B 12 use. Intake and output records are not necessary with a Schilling test.

A 78-year-old client comes to the health clinic presenting with fatigue. The client's laboratory results indicate a hematocrit of 32.1% and a hemoglobin of 10.5 g/dL (105 mmol/L). Which is the most appropriate nursing intervention in response to these laboratory results?

A nutritional assessment starts the investigation for a cause of the client's anemia and is an independent function of the nurse. These are not expected values; an intervention is indicated.

A nurse discusses the implications of diet and fluid intake with a client who is receiving lithium therapy. What will the nurse teach the client and family about nutrition?

A regular diet should be maintained.

A nurse discusses dietary instructions with the parents of a toddler with acute glomerulonephritis. What nutrients does the nurse list that are restricted? Select all that apply.

Sodium is restricted, in that salt is not added to foods, and processed meat and salty snacks are avoided. Potassium is always restricted in the presence of oliguria to prevent cardiac dysrhythmias associated with hyperkalemia. Potassium is found in fruits such as bananas, oranges, and apples and in white potatoes. Lipids are not restricted; usually fats are a prime source of calories. Glucose is not restricted; it is also a prime source of calories.

A client comes to the clinic reporting weight loss, fatigue, and a low-grade fever. Physical examination reveals a slight enlargement of the cervical lymph nodes. Which question is most appropriate for the nurse to ask initially?

The length of time a low-grade fever is present, together with a history of night sweats and other physical findings, is valuable information in assisting the nurse with care planning and helping the primary healthcare provider determine a diagnosis.

A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse consider to be a high priority for the client?

A shiny tongue, paresthesias of the limbs, ataxia, and cobalamin of 125 pg/mL (normal: 200- 835 pg/mL) are the manifestations of pernicious anemia. The client has pernicious anemia due to a vitamin B 12 deficiency and should be given vitamin B 12 injections. Vitamin B 12 cannot be given orally to a client with pernicious anemia because the client does not produce the intrinsic factors needed to absorb Vitamin B 12.

After gastrointestinal surgery, a client's condition improves, and a regular diet is prescribed. Which food, included on a regular diet, should the nurse encourage the client to consume to decrease discomfort?

Baked fish is a low-residue, low-fat, high-protein, and non-gas-producing food that usually is tolerated well.

A client with cholecystitis is placed on a low-fat, high-protein diet. Which nutrient should the nurse teach the client to include in this diet?

During acute cholecystitis, low-fat liquids are permitted; skim milk is low in fat and contains protein, which will promote healing. Beef, even if it is lean, contains fat. Egg yolks contain fat. Although low in fat and contains protein; broccoli is a gas-producing vegetable that should be avoided at this time.