MEDSURG II: Oncology- Saunders Nutrition

A postoperative client has been tolerating a full liquid diet, and the nurse plans to advance the diet to solid food as prescribed. Which assessment is most important for the nurse to make before advancing the diet to solids? 1. Ability to chew 2. Food preferences 3. Cultural preferences 4. Presence of bowel sounds

Correct answer: 1 Rationale: It may be necessary to modify a client's diet of solid food to a soft or chopped (pureed) diet if the client has difficulty chewing. Food and cultural preferences should be ascertained on admission. Bowel sounds should have previously been assessed and present before introducing any diet.

The nurse is providing instructions to a client regarding food items that are high in vitamin D. The client demonstrates understanding of the instructions by stating the need to include which food item in the diet? 1. Milk 2. Meat 3. Oranges 4. Broccoli

Correct answer: 1 Rationale: Milk provides the highest amount of vitamin D. Broccoli and oranges are high in vitamin C, and meat is high in vitamin B complex.

The nurse is providing instructions to a client with osteoporosis regarding appropriate food items to include in the diet to increase her intake of calcium. The nurse determines the need for further instruction when the woman tells the nurse that she will be sure to increase her intake of which food that is lowest in calcium? 1. Pork 2. Seafood 3. Sardines 4. Plain yogurt

Correct answer: 1 Rationale: Of the items listed, pork contains the least amount of calcium. Foods high in calcium include plain yogurt, dairy products, seafood, sardines, green vegetables, calcium-fortified orange juice, and some cereals.

The nurse is providing dietary teaching to a client who is receiving a potassium-retaining diuretic about foods that are low in potassium. Which foods should the nurse include on a list of foods with low potassium content? 1. Apple 2. Carrots 3. Spinach 4. Avocado

Correct answer: 1 Rationale: One medium apple with skin provides approximately 159 mg of potassium per serving, so it has the lowest potassium content of these choices. One large carrot has 341 mg of potassium. Raw spinach (oz) provides 470 mg of potassium. One medium avocado provides the highest potassium content, 700 mg.

The nurse is providing dietary instructions to a client about food items that are high in niacin. Which food item should the nurse recommend as highest in niacin? 1. Poultry 2. Potatoes 3. Tomatoes 4. Strawberries

Correct answer: 1 Rationale: Poultry, eggs, meats, and dairy products are high in niacin. Tomatoes, potatoes, and strawberries are high in ascorbic acid (vitamin C).

The nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse determines that the client understands the instructions given if the client states that which food item(s) are acceptable in the diet? 1. Baked fish 2. Fried chicken 3. Sauces and gravies 4. Fresh whipped cream

Correct answer: 1 Rationale: The client with cholecystitis should decrease overall intake of dietary fat. Foods that should be avoided include sauces and gravies, fatty meats, fried foods, products made with cream, and heavy desserts. The correct option is baked fish, which is low in fat.

The nurse instructs a client with chronic kidney disease who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu? 1. Cream of wheat, blueberries, coffee 2. Sausage and eggs, banana, orange juice 3. Bacon, cantaloupe melon, tomato juice 4. Cured pork, grits, strawberries, orange juice

Correct answer: 1 Rationale: The diet for a client with chronic kidney disease who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids, which is indicated in the correct option. The food items in the remaining options are high in sodium, phosphorus, or potassium.

A child with leukemia is complaining of nausea. The nurse suspects that the nausea is related to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, should offer which item during this episode of nausea? 1. Cool, clear liquids 2. Low-protein foods 3. Low-calorie foods 4. The child's favorite foods

Correct answer: 1 Rationale: When the child is nauseated, offering cool, clear liquids is best because they are soothing and better tolerated. Supportive nutritional measures should include oral supplements with high-protein and high-calorie foods. The nurse should not offer favorite foods when the child is nauseated because foods eaten during times of nausea will be associated with being sick.

A postoperative client has been placed on a clear liquid diet. The nurse should provide the client with which items that are allowed to be consumed on this diet? Select all that apply. 1. Broth 2. Coffee 3. Gelatin 4. Pudding 5. Vegetable juice 6. Pureed vegetables

Correct answer: 1, 2, 3 Rationale: A clear liquid diet consists of foods that are relatively transparent to light and are clear and liquid at room and body temperature. These foods include items such as water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, ice pops, and regular or decaffeinated coffee or tea. The incorrect food items are items that are allowed on a full liquid diet.

Which actions should the nurse include when caring for a client with continuous tube feedings through a nasogastric (NG) tube? Select all that apply. 1. Check the residual every 4 hours. 2. Check for placement every 4 hours. 3. Hang a new feeding bag every 72 hours. 4. Check skin integrity at the site of NG tube insertion. 5. Check for placement before administering medications.

Correct answer: 1, 2, 4, 5 Rationale: A feeding bag and tubing should be changed every 24 hours (or per agency protocol) to reduce risk of bacterial contamination. Placement and residual should be checked at least every 4 hours during administration of continuous tube feedings and prior to giving medications through the tube. Agency policy for technique for assessment of tube placement should be followed. Skin integrity should be assessed at the site of NG tube insertion.

The nurse is caring for a postoperative general surgery foreign-speaking client with a history of poor nutrition. What are some reasonable issues that can impact this client? Select all that apply. 1.Longer hospital stays and increased medical costs 2.Reduced quality of life and increased mortality rate 3.Lack of culturally specific foods related to the client's needs 4.Shortage of qualified nutritional staff in the dietary department 5.Impaired wound healing and increased risk of postoperative infection 6.Impaired functioning of the gastrointestinal (GI) tract, cardiovascular system, respiratory system, and immune system

Correct answer: 1, 2, 5, 6 Rationale: Issues that can impact postoperative general surgery clients with a history of poor nutrition are well documented and include the following: impaired wound healing and increased risk of postoperative infection; impaired functioning of the GI tract, cardiovascular system, respiratory system, and immune system; reduced quality of life and increased mortality rate; and longer hospital stay and increased medical costs. Lack of culturally specific foods related to the client's operative needs and shortage of qualified nutritional staff in the dietary department are not reasonable options and not likely to be an issue in the hospital.

A nursing student is caring for a client who has been admitted to the hospital with malnutrition. The nursing instructor determines that the student has made a correct assessment of malnutrition consequences if the student documents which noted findings? Select all that apply. 1. Cachexic 2. Lethargic 3. Lean extremities 4. Intolerant to heat 5. Dry, flaking skin 6. Poor wound healing

Correct answer: 1, 2, 5, 6 Rationale: Some common findings of severe malnutrition in adults include the following: lethargy; cachexia; dry, flaking skin; and poor wound healing. Edema, not lean extremities, and intolerance to cold, not heat, are also present.

The nurse provides instructions to a client with a low magnesium level about the foods that are high in magnesium. The nurse should tell the client to consume which foods? Select all that apply. 1. Peas 2. Bacon 3. Oranges 4. Cauliflower 5. Peanut butter 6. Canned white tuna

Correct answer: 1, 4, 5, 6 Rationale: The normal magnesium level is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L). Common food sources of magnesium include avocado, canned white tuna, cauliflower, green leafy vegetables such as spinach and broccoli, milk, oatmeal, peanut butter, peas, pork, beef, chicken, potatoes, raisins, and yogurt. Bacon is high in fat and sodium. Oranges are high in potassium.

The nurse instructs a client who is at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines that the client understands the food sources of potassium if the client states that which food items are lowest in potassium, providing less than 200 mg per serving? Select all that apply. 1. Grapes 2. Carrots 3. Spinach 4. Asparagus 5. Avocadoes 6. Applesauce

Correct answer: 1, 4, 6 Rationale: Grapes, asparagus, and applesauce provide from 5 to 150 mg per serving. A large carrot provides 341 mg, spinach (3½ oz) provides 470 mg, and a medium avocado provides 700 mg of potassium.

The nurse is creating a plan of care for a client receiving enteral feedings via a gastrostomy tube (G-tube). The nurse should plan to include which intervention in the plan of care? 1. Provide oral fluids 3 times per day. 2. Check around the stoma site for skin irritation. 3. Medicate with antidiarrheal medications every day. 4. Use sterile technique when administering the tube feedings.

Correct answer: 2 Rationale: A G-tube is a tube inserted directly into the stomach for the purpose of providing direct enteral nutrition. Generally, G-tubes are well tolerated and beneficial to clients on long-term enteral nutrition. Aspiration of stomach contents into the lungs can occur, and the client's head of the bed must be kept elevated. Because of the surgical incision, occasionally gastric contents leak out onto the client's skin. Gastric contents are highly acidic and can cause skin irritation. The skin irritation may lead to infection. The nurse must monitor the insertion site for skin irritation. Oral fluids are not generally a component of the plan of care because the client with a G-tube normally does not have the capability of swallowing. Although diarrhea may be a complication of the feedings, antidiarrheals are not administered daily. Aseptic, not sterile, technique is necessary when administering feedings.

The nurse has given dietary instructions to an older female client to minimize the risk of osteoporosis. The client demonstrates understanding of the dietary teaching by stating that she will increase intake of which food? 1. Rice 2. Milk 3. Broccoli 4. Chicken

Correct answer: 2 Rationale: A client at risk for osteoporosis needs to increase intake of calcium. The major dietary source of calcium is dairy foods, including milk, yogurt, and a variety of cheeses. Calcium also may be added to certain products, such as orange juice, which then is advertised as being fortified with calcium. Calcium supplements are available and recommended for those with typically low calcium intake. Rice, broccoli, and chicken are not food sources that are high in calcium.

A client who was receiving enteral feedings in the hospital has been started on a regular diet and is almost ready for discharge. The client will be self-administering supplemental tube feedings between meals for a short time after discharge. The client expresses concern about performing this procedure at home. What is the nurse's best response? 1. "Maybe a friend will do the feeding for you." 2. "Tell me more about your concerns about going home." 3. "Do you want to stay in the hospital a few more days?" 4. "Have you discussed your feelings with your family and doctor?"

Correct answer: 2 Rationale: A client often has fears about leaving the secure environment of a health care facility. This client has a specific fear about not being able to handle tube feedings at home. An open communication statement such as "Tell me more about . . ." often leads to valuable information about the client and his or her concerns. Options 1 and 4 are nontherapeutic responses because they place the client's issues on hold. Option 3 is beyond the scope of practice for the nurse to implement and may not be necessary.

The nurse is caring for a client with a diagnosis of celiac disease. The nurse recognizes that client teaching has been effective when the client makes which statement? 1. "I can eat whatever I want." 2. "I will eat rice cereal for breakfast." 3. "I will eat beef barley soup for lunch." 4. "I will eat only wheat bread for a snack."

Correct answer: 2 Rationale: A client with celiac disease should be instructed to avoid gluten-containing products such as wheat, barley, oats, and rye.

The nurse is providing instructions to a client with hypophosphatemia. Which food item should the nurse instruct the client to avoid? 1. Fish 2. Cheese 3. Chicken 4. Organ meats

Correct answer: 2 Rationale: Diet therapy for hypophosphatemia consists primarily of an increased intake of phosphorus-rich foods while decreasing the intake of calcium-rich foods. Fish, chicken, and organ meats are food items that are allowed, whereas cheese should be avoided because it is a calcium-rich food.

The nurse should include which item in a list of the most helpful foods for a vegan client wishing to increase foods high in vitamin A? 1. Peas 2. Carrots 3. Potatoes 4. Green beans

Correct answer: 2 Rationale: Foods that are high in vitamin A include carrots, green leafy vegetables, and yellow vegetables. The other vegetables are high in vitamins but do not necessarily have the highest amount of vitamin A.

A client has been given a prescription for gemfibrozil. The nurse should instruct the client to limit which food while taking this medication? 1. Fish 2. Beef 3. Spicy foods 4. Citrus products

Correct answer: 2 Rationale: Gemfibrozil is a lipid-lowering agent. It is given as part of a therapeutic regimen that also includes dietary counseling—specifically, the limitation of saturated and other fats in the diet. Beef contains fat, and its consumption should be limited.

The nurse is talking to the mother of a 2-month-old infant who is being seen in the health care provider's office for a well-child visit. Which statement by the mother would indicate that further teaching is needed about nutrition for this infant? 1."My sister said to start her on a cup, but I think she is too young." 2."I started my daughter on cereal a week ago, and she loves the rice cereal." 3."I remembered that my daughter needs to stay on formula for an entire year." 4."My friend has a 4-month-old child, and I told her that I am not going to start solid food until my daughter is at least 6 months old."

Correct answer: 2 Rationale: Infants are started on rice cereal between the ages of 4 and 6 months. This is the first solid food given to infants, followed by fruits and vegetables. Infants should be maintained on their formula or breast milk for the entire first year. Introducing a cup does not begin until the age of 6 months, when juice is introduced.

The nurse is providing dietary instructions to a client about the food items that are high in vitamin K. Which food item does the nurse recommend as being highest in vitamin K? 1. Fish 2. Spinach 3. Potatoes 4. Strawberries

Correct answer: 2 Rationale: Liver and green leafy vegetables such as spinach are high in vitamin K. Fish contains vitamins A, D, and B12. Potatoes and strawberries are high in vitamin C.

The nurse has conducted dietary teaching with a client diagnosed with iron deficiency anemia. The nurse instructs the client that which food item is a good dietary source of iron? 1. Oranges 2. Apricots 3. Egg whites 4. Refined white bread

Correct answer: 2 Rationale: The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver and other organ meats, blackstrap molasses, and oysters. Other good sources of iron are kidney beans, whole-wheat bread, egg yolk, spinach, kale, turnip tops, beet greens, carrots, raisins, and apricots.

The nurse is monitoring the nutritional status of a client receiving enteral nutrition. Which intervention should the nurse implement to determine the effectiveness of the tube feedings? 1. Use a calorie count. 2. Obtain a daily weight. 3. Evaluate intake and output. 4. Monitor serum protein level.

Correct answer: 2 Rationale: The most accurate measurement of the effectiveness of nutritional management of the client is through the use of daily weighing. These weight checks should be done every day at the same time (preferably early morning), in the same clothes, and using the same scale. Options 1, 3, and 4 assist in measuring nutrition and hydration status. However, the effectiveness of the diet is measured by maintenance of body weight.

The nurse is giving a presentation on good nutrition to a group of teenage mothers. Which level of prevention is the nurse implementing? 1. Basic level 2. Primary level 3. Secondary level 4. Tertiary level

Correct answer: 2 Rationale: The primary level is focused on prevention, and educational classes are a form of prevention. The secondary level is a screening level that entails such procedures as vision screening, mammography, or similar screening tests. The tertiary level is focused on rehabilitation skills. There is no basic level of prevention.

The nurse is conducting a dietary assessment on a client who is on a vegan diet. The nurse provides dietary teaching and should focus on foods high in which vitamin that may be lacking in a vegan diet? 1. Vitamin A 2. Vitamin B12 3. Vitamin C 4. Vitamin E

Correct answer: 2 Rationale: Vegans do not consume any animal products. Vitamin B12 is found in animal products and therefore would most likely be lacking in a vegan diet. Vitamins A, C, and E are found in fresh fruits and vegetables, which are consumed in a vegan diet.

The nurse is explaining the process of bariatric surgery to a severely obese client who has attended a medically supervised weight loss program for approximately 6 months. The client is considering this procedure. What are some conditions that may interfere with a client's commitment to lifelong behavioral changes and that may lead to poor surgical outcomes? Select all that apply. 1. Anxiety 2. Untreated depression 3. Binge eating disorders 4. Drug and alcohol abuse 5. Lack of family resources 6. Inability to comply with nutritional recommendations

Correct answer: 2, 3, 4, 6 Rationale: Conditions that can lead to poor bariatric surgical outcomes include untreated depression, binge eating disorders, drug and alcohol abuse, and an inability to comply with nutritional recommendations. Lack of family resources and anxiety do not affect bariatric surgical outcomes.

A breast-feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. What foods should the nurse tell the mother are acceptable to consume while breast-feeding? Select all that apply. 1. 1% milk 2. Egg yolk 3. Dried beans 4. Hard cheeses 5. Green leafy vegetables

Correct answer: 2, 3, 5 Rationale: Breast-feeding mothers with lactose-intolerant infants need to be encouraged to limit dairy products. Milk and cheese are dairy products. Alternative calcium sources that can be consumed by the mother include egg yolk, dried beans, green leafy vegetables, cauliflower, and molasses.

The nurse is caring for a pregnant client who is iron deficient. What groups are vulnerable to this condition? Select all that apply. 1. Diabetics 2. Alcoholics 3. Vegetarians 4. People with hemochromatosis 5. Women of childbearing years 6. Older people who consume poor diets

Correct answer: 2, 3, 5, 6 Rationale: High-risk groups for iron deficiency anemia include adolescent girls and women in their childbearing years who consume poor diets, people who are food insecure, alcoholics, vegetarians, and older people who consume poor diets. People with diabetes and hemochromatosis are not in this high-risk group.

The home care nurse is conducting a diet history with an older client who lives alone. The nurse finds that the client's typical 24-hour food intake consists of eggs and sausage for breakfast, a fast-food lunch of hamburger and french fries, takeout fried chicken for dinner, and ice cream in the evening. To decrease the risk of cancer, what statement would the nurse make to the client? 1. "You should not eat eggs." 2. "You should not eat sausage." 3. "A high-fat diet increases your risk for colon cancer." 4. "Excessive tobacco use increases the risk of liver cancer."

Correct answer: 3 Rationale: A diet high in fat may be a factor in the development of certain types of cancers. High-fiber diets may reduce the risk of colon cancer. Excessive tobacco use, although not a factor in this client, may increase the risk of cancer of the lung, larynx, throat, esophagus, and bladder.

The nurse is creating a plan of care for a client receiving enteral feedings. Which client problem is the highest priority? 1. Diarrhea 2. Nutrition 3. Aspiration 4. Deficient fluid volume

Correct answer: 3 Rationale: Any condition in which gastrointestinal motility is slowed or esophageal reflux is possible places the client at risk for aspiration. Diarrhea and nutrition may be appropriate problems, but they are not of highest priority. Deficient fluid volume is not likely to occur in this client.

A client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse should offer which full liquid item to the client? 1. Tea 2. Gelatin 3. Custard 4. Ice pop

Correct answer: 3 Rationale: Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, refined cooked cereals, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in the incorrect options are clear liquids.

The nurse has provided dietary instructions to a client regarding food items that are high in vitamin B complex. The client demonstrates understanding of the dietary instructions by stating the importance of including which food item in the diet? 1. Milk 2. Butter 3. Grains 4. Tomatoes

Correct answer: 3 Rationale: Grains contain the highest amount of vitamin B complex. Butter contains vitamin A. Tomatoes are high in vitamin C, whereas milk is high in vitamin D.

The nurse instructs a client about a low-fat diet. Which menu selection indicates that the client understands the nurse's instructions? 1. Shrimp and bacon salad 2. Liver, potato salad, sherbet 3. Turkey breast, boiled rice, and fruit 4. Lean hamburger steak and macaroni and cheese

Correct answer: 3 Rationale: Major sources of fats include meats, salad dressings, eggs, butter, cheese, and bacon. Options 1, 2, and 4 all contain high-fat foods.

The school nurse is providing a nutritional counseling session to a group of adolescents. The school nurse should instruct the adolescents that which item is a good source of vitamin C? 1. Eggs 2. Milk 3. Sweet potatoes 4. Green leafy vegetables

Correct answer: 3 Rationale: Potatoes, especially sweet potatoes, would provide the highest amount of vitamin C. Eggs are high in vitamin B complex. Milk is high in vitamin D. Green leafy vegetables are high in vitamin A.

The nurse is instructing a client with hypertension on the importance of choosing foods low in sodium. The nurse should teach the client to limit intake of which food? 1. Apples 2. Bananas 3. Smoked sausage 4. Steamed vegetables

Correct answer: 3 Rationale: Smoked foods are high in sodium, which is noted in the correct option. The remaining options are fruits and vegetables, which are low in sodium.

The nurse is evaluating a client's ability to select food items for a low-potassium diet. Which food item, if selected by the client, would indicate an understanding of this diet? 1. Spinach 2. Strawberries 3. Cranberry juice 4. Honeydew melon

Correct answer: 3 Rationale: Spinach, strawberries, and honeydew melon are high-potassium foods and average 10 mEq per serving. Cranberry juice is low in potassium and averages 5 mEq per serving.

The nurse has determined that an unconscious client is at risk for nutritional problems. Which outcome indicates to the nurse that the goals have not yet been fully met? 1. Stable weight 2. Intake equaling output 3. Total protein concentration of 4.5 g/dL (45 g/L) 4. Blood urea nitrogen (BUN) level of 20 mg/dL (7.1 mmol/L)

Correct answer: 3 Rationale: The normal total protein level is 6.4 to 8.3 g/dL (64 to 83 g/L). The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Expected outcomes for nutritional problems in an unconscious client include stable weight, intake equaling output, evidence of wound healing, and normal BUN, total protein, and hemoglobin levels. The only abnormal finding in the options is the protein level.

The nurse is consulting with a dietitian to plan a menu for a client who is on a regular diet and is a vegan. Which food item would the nurse and the dietitian select for the client's meal? 1. Scrambled eggs 2. Buttered wheat toast 3. Stir-fried vegetables 4. Chocolate milkshake

Correct answer: 3 Rationale: Vegans exclude animal products from the diet. Stir-fried vegetables are eaten by vegans (as long as they are not fried in butter). Vegans do not eat eggs. Buttered wheat toast also is not acceptable because butter is a dairy product. Milkshakes are not an appropriate choice because dairy products, such as milk, are not eaten on this diet. Foods eaten by a client who is a vegan include grains, fruits, and vegetables.

The nurse is planning to teach a client with malabsorption syndrome about the necessity of following a low-fat diet. The nurse develops a list of high-fat foods to avoid and should include which food items on the list? Select all that apply. 1. Oranges 2. Broccoli 3. Margarine 4. Cream cheese 5. Luncheon meats 6. Broiled haddock

Correct answer: 3, 4, 5 Rationale: Fruits and vegetables tend to be lower in fat because they do not come from animal sources. Broiled haddock is also naturally lower in fat. Margarine, cream cheese, and luncheon meats are high-fat foods.

The nurse is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of which food? 1. Milk 2. Chicken 3. Broccoli 4. Legumes

Correct answer: 4 Important Note: Thiamin is recommended in Wernich's syndrome: Thiamine deficiency in pt with alcohol dependence and causes confusion, ataxia, visual problems. Rationale: The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Legumes are especially rich in this vitamin. Other good food sources include nuts, whole-grain cereals, and pork. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid.

The nurse has instructed a client in the foods that are best to consume on a low-fat diet. The nurse determines that the client understands this diet if the client indicates which food item is lowest in fat? 1. Bran muffin 2. Cheese omelet 3. Bagel with cream cheese 4. Dry toast and strawberry jelly

Correct answer: 4 Rationale: Bread (toast without butter or margarine) contains the least amount of fat among the items in the options provided. Strawberry jelly contains calories but nominal fat. Bran muffins, although they may be high in residue, are high in fat. Cheese contains significant amounts of fat.

The health care provider has prescribed a clear liquid diet for a postoperative client. The nurse prepares to deliver the lunch tray to the client and checks the tray to be sure that which has occurred? 1. Sodium foods are restricted. 2. At least 1 serving of low-fat milk is served. 3. All food items are lukewarm in temperature. 4. All food items are liquid at body temperature.

Correct answer: 4 Rationale: By definition, a clear liquid diet offers foods that are liquid at body temperature. Sodium intake is occasionally restricted if the client is on strict sodium regulation; however, because of the short-term nature of a clear liquid diet for the postoperative client and the limited nutritional content of the diet, electrolytes and minerals generally are lacking. To offer the client some variety and stimulate taste buds, foods of different temperatures should be offered on a clear liquid diet, ranging from frozen (e.g., Popsicles) to warm (e.g., tea). Also, clear liquid diets prohibit milk of any nature because it is not a clear liquid.

The nurse is providing dietary instructions to a client about food items that are high in vitamin C. Which food item does the nurse recommend as being highest in vitamin C? 1. Milk 2. Eggs 3. Liver 4. Cabbage

Correct answer: 4 Rationale: Cabbage, tomatoes, potatoes, and strawberries are some of the foods that are high in vitamin C. Milk contains vitamins A and D and some B vitamins. Eggs contain B vitamins. Liver contains vitamins B6 (pyridoxine), B9 (folic acid), and K.

In planning a low-sodium diet for a client who has recently been diagnosed with heart failure, the nurse should offer the client which food item? 1. Beef bouillon 2. Grilled cheese 3. Cottage cheese 4. Chicken breast

Correct answer: 4 Rationale: Chicken breast has 70 mg of sodium compared with 457 mg for cottage cheese, 700 mg for grilled cheese, and 800 mg for beef bouillon.

A client has been on total parenteral nutrition (TPN) for 8 weeks at home. The health care provider prescribes that the TPN be weaned by 50 mL per hour per day until discontinued. The client asks the nurse why the TPN cannot just be stopped. The nurse explains that unless the TPN infusions are tapered gradually, the client is at risk for developing which complication? 1. Dehydration 2. Hypokalemia 3. Hypernatremia 4. Hypoglycemia

Correct answer: 4 Rationale: Clients receiving TPN are receiving high concentrations of glucose. To give the pancreas time to adjust to decreasing glucose loads, the infusion rate is tapered downward. Before discontinuation of TPN, the body must adjust to the lowered glucose levels. If the TPN is suddenly withdrawn, the client could experience rebound hypoglycemia. Options 1, 2, and 3 are not associated with the discontinuation of the TPN.

The nurse is teaching a client who has iron deficiency anemia about foods she should include in the diet. The nurse determines that the client understands the dietary modifications if which items are selected from the menu? 1. Nuts and milk 2. Coffee and tea 3. Cooked rolled oats and fish 4. Oranges and dark green leafy vegetables

Correct answer: 4 Rationale: Dark green leafy vegetables are a good source of iron and oranges are a good source of vitamin C, which enhances iron absorption. All other options are not food sources that are high in iron and vitamin C.

A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The health care provider prescribes an enteral tube feeding of a standard formula to run at 40 mL/hour. A nursing student is assigned to care for the client, and the nursing instructor asks the student to describe the nursing considerations related to a tube feeding. Which statement, if made by the student, indicates an understanding of this dietary treatment? 1. "Enteral tube feedings frequently cause sepsis." 2. "Enteral feedings should be refrigerated until just before use." 3. "The caloric value of enteral feedings is generally 5 to 10 calories per milliliter." 4. "Enteral feedings require the normal digestive capabilities of the gastrointestinal tract."

Correct answer: 4 Rationale: Enteral nutrition includes offering nutrients by mouth, nasogastric tube, gastrostomy tubes, or percutaneous endoscopic gastrostomy. The common element with these methods of delivery is the fact that the client must have normal gastrointestinal (GI) digestive capabilities. If the client does not have a normal GI tract, other methods of nutrient delivery must be sought, such as parenteral nutrition. Enteral tube feedings may cause aspiration pneumonia from regurgitation of formula into the lungs; however, they generally are not associated with sepsis. Enteral tube feedings should be given at room temperature to avoid problems with diarrhea. The caloric value of most standard enteral feeding formulas is 1 to 2 calories/mL.

A client with hypertension has been prescribed a low-sodium diet. The nurse teaching this client about foods that are allowed should plan to include which food in a list provided to the client? 1. Tomato soup 2. Boiled shrimp 3. Instant oatmeal 4. Summer squash

Correct answer: 4 Rationale: Foods that are lower in sodium are fruits and vegetables (summer squash) because they do not contain physiological saline. Highly processed or refined foods (tomato soup and instant oatmeal) are higher in sodium unless they are specifically noted as low sodium. Saltwater fish and shellfish are higher in sodium.

A client with hypertension has been told to maintain a diet low in sodium. The nurse who is teaching this client about foods that are allowed should include which food item in a list provided to the client? 1. Tomato soup 2. Boiled shrimp 3. Instant oatmeal 4. Summer squash

Correct answer: 4 Rationale: Foods that are lower in sodium include fruits and vegetables (summer squash), because they do not contain physiological saline. Highly processed or refined foods (tomato soup, instant oatmeal) are higher in sodium unless their food labels specifically state "low sodium." Saltwater fish and shellfish are high in sodium.

The nurse is providing a dietary session to a group of clients about the vitamin content of various foods. The nurse should tell the clients that which food item is highest in vitamin A? 1. Eggs 2. Milk 3. Tomatoes 4. Green leafy vegetables

Correct answer: 4 Rationale: Green leafy vegetables are a good source of vitamin A, whereas milk is high in vitamin D content. Eggs are high in vitamin B complex, and tomatoes are high in vitamin C.

The nurse is assessing the skin of a client with a history of malabsorption deficiency and discovers brittle nails. What type of nutritional deficiency should the nurse suspect based on this observation? 1. Iron deficiency 2. Protein deficiency 3. Fatty acid deficiency 4. Vitamin K deficiency

Correct answer: 1 Rationale: Brittle nails result from an iron deficiency. Protein deficiency leads to hair thinning and loss. Fatty acid deficiency can result in dermatitis, and vitamin K deficiency results in bruising.

The breast-feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. The nurse should tell the mother to avoid which food? 1. Milk 2. Egg yolk 3. Dried beans 4. Green leafy vegetables

Correct answer: 1 Rationale: Breast-feeding mothers with lactose-intolerant infants need to be encouraged to limit dairy products. Milk is a dairy product. Alternative calcium sources that can be consumed by the mother include egg yolk, green leafy vegetables, dried beans, cauliflower, and molasses.

A client with heart disease is provided instructions regarding a low-fat diet. The nurse should determine that the client understands the diet if the client states that which food item should be avoided? 1. Apples 2. Oranges 3. Cherries 4. Avocados

Correct answer: 4 Rationale: Fruits and vegetables, except avocados, olives, and coconuts, contain minimal amounts of fat.

A client is recovering from abdominal surgery and has a large abdominal wound. The nurse should encourage the client to eat which food item that is naturally high in vitamin C to promote wound healing? 1. Milk 2. Oranges 3. Bananas 4. Chicken

Correct answer: 2 Rationale: Citrus fruits and juices are especially high in vitamin C. Bananas are high in potassium. Meats and dairy products are two food groups that are high in the B vitamins.

The nurse is providing dietary instructions to a client with a diagnosis of hyperphosphatemia. The nurse determines that the client understands the instructions if the client states the importance of eliminating which item from the diet? 1. Tea 2. Fish 3. Coffee 4. Grape juice

Correct answer: 2 Rationale: Clients with hyperphosphatemia should avoid foods that are naturally high in phosphates. These include fish, eggs, milk products, vegetables, whole grains, and carbonated beverages. Tea, coffee, and grape juice are not high in phosphates.

A client with liver cancer receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter. The nurse should try to limit which food that is most likely to cause this taste for the client? 1. Beef 2. Custard 3. Potatoes 4. Cantaloupe

Correct answer: 1 Rationale: Chemotherapy may cause distortion of taste. Often, beef and pork are reported to taste bitter or metallic. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet. The remaining options are not likely to cause distortion of taste.

The nurse is providing instructions to a client with kidney disease about a low-protein diet. The client demonstrates understanding of the dietary instructions by stating the need to limit which food in the diet? 1. Chicken 2. Whole milk 3. Swiss cheese 4. Peanut butter

Correct answer: 1 Rationale: Chicken (3 ounces) contains 26 g of protein, and peanut butter (2 tablespoons) contains 9 g of protein. Whole milk (1 cup) contains 8 g of protein, and Swiss cheese (1 ounce) contains 7 g of protein.

The nurse is providing dietary instructions to a client regarding a high-protein diet. The nurse should instruct the client to consume which food item that is highest in protein content? 1. 1 cup of cottage cheese 2. 1 ounce of Swiss cheese 3. 2 tablespoons of peanut butter 4. 1 cup of evaporated whole milk

Correct answer: 1 Rationale: Cottage cheese (1 cup) contains approximately 31 g of protein. Swiss cheese (1 ounce) contains 7 g, peanut butter (2 tablespoons) contains 9 g, and evaporated whole milk (1 cup) contains 17 g of protein.

A client is being seen in the clinic for symptoms of hyperinsulinism. The nurse provides information to the client regarding dietary measures for the condition. Which diet would be most appropriate to suggest to the client? 1. Low-fiber, high-fat diet 2. Limiting food intake to 2 meals per day 3. Large amounts of carbohydrates between low-protein meals 4. Small, frequent meals with protein, fat, and carbohydrates at each meal

Correct answer: 4 Rationale: The definition of hyperinsulinism is an excessive insulin secretion in response to consuming carbohydrate-rich foods. This leads to hypoglycemia. It is often treated with a diet that provides for limited stimulation of the pancreas. Carbohydrates can produce a rapid rise in blood glucose levels. However, carbohydrates are necessary in the diet. Proteins do not stimulate insulin secretion. Fats are needed in the diet to provide calories. The best diet for hyperinsulinism will contain proteins and fats whenever carbohydrates are consumed. Diets high in soluble fiber also may be beneficial.

The nurse provides dietary instructions to a client at risk for hypokalemia about which foods are high in potassium and should be included in the daily diet. The nurse should tell the client that which fruit is highest in potassium? 1. Kiwi 2. Apples 3. Peaches 4. Pineapple

Correct answer: 1 Rationale: Foods that are high in potassium include bananas, cantaloupe, kiwi, and oranges. Fruits low in potassium include apples, cherries, grapefruit, peaches, pineapple, and cranberries.

The nurse is providing discharge dietary teaching to a client with a history of irritable bowel syndrome (IBS). What comment made by the client tells the nurse that further instruction is needed? 1. "I'll eat more beans and peas." 2. "I should eliminate caffeine and alcohol." 3. "I'm afraid my son will get this disease." 4. "I know I need to take vitamins and mineral supplements."

Correct answer: 1 Rationale: IBS clients have problems with excess gas formation, with increased distention and bloating that is accompanied by rumbling abdominal sounds, belching, and flatulence, so legumes such as beans and peas should be avoided. Caffeine and alcohol also have to be eliminated. IBS can be inherited. Vitamins and mineral supplements are generally included in the dietary regime.

The home care nurse is visiting a male client who is recovering at home after suffering a brain attack (stroke) 2 weeks ago. The client's wife states that the client has difficulty feeding himself and difficulty with swallowing food and fluids. Which would be the initial nursing action? 1. Observe the client feeding himself. 2. Observe the wife feeding the client. 3. Arrange for a home health aide to assist at mealtimes. 4. Instruct the wife in the use of a feeding syringe to feed the client.

Correct answer: 1 Rationale: It is not uncommon for a client to have difficulty swallowing after experiencing a stroke. Often the client has hemiplegia. The arm on the affected side may be paralyzed, and the client may have to learn to use the opposite arm for self-feeding. Using the nondominant arm may require rehabilitation and retraining. Also, a client may have partial paralysis of the mouth, tongue, or esophagus. To best assist the client, the nurse should first assess the situation by watching the self-feeding process. Perhaps the problem lies in the feeding technique, the type of feeding tool used, the types of foods being served, or a combination. Having someone else feed the client may be necessary if self-feeding is not possible. This approach, however, does not promote independence for the client. A feeding syringe is not recommended for feeding most clients.

A client is diagnosed with a moderate case of acute ulcerative colitis. The nurse doing dietary teaching should give the client examples of foods to eat that represent which therapeutic diet? 1. High fat with milk 2. Low fiber with milk 3. High protein with milk 4. Low fiber without milk

Correct answer: 4 Rationale: The client with a mild to moderate case of acute ulcerative colitis often is prescribed a diet that is low in fiber and does not include milk. This will help to reduce the frequency of diarrhea for this client. The remaining options are incorrect diets and may cause discomfort for the client.

The nurse is teaching a client with tuberculosis about nutrition and foods that should be increased in the diet. The nurse should suggest that the client increase which food items? 1. Potatoes and fish 2. Eggs and spinach 3. Grains and broccoli 4. Meats and citrus fruits

Correct answer: 4 Rationale: The nurse teaches the client with tuberculosis to increase intake of protein, iron, and vitamin C. Foods rich in vitamin C include citrus fruits, berries, melons, pineapple, broccoli, cabbage, green peppers, tomatoes, potatoes, chard, kale, asparagus, and turnip greens. Food sources that are rich in iron include liver and other meats. Less than 10% of iron is absorbed from eggs, and less than 5% is absorbed from grains and vegetables.