Nclex-PN Nutrition

An abdominal postoperative client has been tolerating a full liquid diet, and the nurse plans to advance the diet to solid food as prescribed. The nurse collects data regarding which important item before advancing the diet to solids? 1.Food preferences 2.Cultural preferences 3.Presence of bowel sounds 4.Dentition and ability to chew

4.Dentition and ability to chew Rationale: It may be necessary to modify a client's diet to a soft or mechanical chopped diet if the client has difficulty chewing. Food and cultural preferences should have been determined on admission. Bowel sounds should be present before introducing any diet to a postoperative client.

The nurse has conducted dietary teaching with the client diagnosed with iron deficiency anemia. The nurse determines that the client understands the information if the client states the intention to increase intake of which foods? *Select all that apply.* 1.Oysters 2.Spinach 3.Pineapple 4.Egg whites 5.Kidney beans 6.Refined white bread

1.Oysters 2.Spinach 5.Kidney beans 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, 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. Pineapple, egg whites, and refined white bread are not rich sources of iron.

The nurse is providing dietary instructions to a client with a diagnosis of ulcerative colitis. The client is prescribed to follow a low residue diet during episodes of diarrhea. Which food should the nurse instruct the client to avoid? 1.Fresh corn on the cob 2.Broiled chicken breast 3.Gelatin with canned fruit 4.Bagels with cream cheese

1.Fresh corn on the cob Rationale: Ulcerative colitis is a chronic inflammatory bowel disease in which the colon becomes edematous, develops ulcerated areas, and results in bloody diarrhea that occurs with exacerbations. A low-residue (low-fiber) diet is prescribed for some clients during exacerbations because this places less strain on the intestines and is easier to digest. The item that contains high residue and thus would place strain on the intestines is the fresh corn on the cob.

The nurse is asked to assist with preparing a client who will be receiving a continuous total parenteral nutrition (TPN) solution via a central line. The nurse plans to institute which interventions for this client related to the TPN? *Select all that apply.* 1. Central line dressing changes per protocol 2. Blood glucose monitoring around the clock 3. Monitoring central venous pressure every shift 4. Using an electronic infusion pump with the infusion 5. Applying sequential compression devices (SCD) to the legs 6. Reviewing prescribed blood laboratory values including electrolytes

1. Central line dressing changes per protocol 2. Blood glucose monitoring around the clock 4. Using an electronic infusion pump with the infusion 6. Reviewing prescribed blood laboratory values including electrolytes Rationale: The client receiving TPN is at an increased risk for fluid and electrolyte imbalance, hyperglycemia, and infection. The central line dressing is changed according to protocols set up to prevent infection. The TPN rate of infusion needs to be closely regulated with use of an electron infusion pump. The TPN contains increased concentration of glucose, so the blood glucose levels are monitored around the clock. Blood laboratory values are monitored often (3 times per week) because the electrolyte balance is totally dependent on the prescribed TPN solution. The TPN formula is adjusted and prescribed according to the client's laboratory results. Administration of TPN does not involve monitoring central venous pressure although that is possible through a central intravenous line. The client will be able to ambulate and so SCD are not required but may be prescribed for other reasons.

The nurse is preparing to administer an intermittent tube feeding to a client. The nurse aspirates and is unable to obtain any residual tube feeding. Which action should the nurse take *next*? 1. Administer the tube feeding slowly. 2.Contact the primary health care provider. 3.Turn the client to the side and attempt to aspirate again. 4.Auscultate bowel sounds and check for abdominal tenderness.

3.Turn the client to the side and attempt to aspirate again. Rationale: The nurse aspirates before administering an intermittent tube feeding to determine how well the formula is being absorbed. All of the tube feeding may have been absorbed, but the end of the tube may be up against the stomach wall. In this case the nurse has the client turn to move the tube and attempts to aspirate again to check for residual. Depending on the type of tube (such as a gastrostomy tube), the nurse may be able to safely administer the tube feeding without obtaining aspirated residual to note characteristics or pH to verify correct placement of the tube. The next action is not to notify the primary health care provider, administer the tube feeding slowly, or auscultate bowel sounds. These actions may be reasonable, but none of them is the next action of the nurse.

A client states that he has removed all dairy foods from his diet because he is lactose intolerant. The nurse plans care for the client knowing which information? 1. Leafy green vegetables will provide all of the necessary calcium. 2. Calcium supplements only will be needed to supplement for dairy products. 3. Lactose enzymes must be taken to eliminate the effects of lactose intolerance. 4. Calcium and protein are valuable nutrients and need to be supplemented in some form.

4. Calcium and protein are valuable nutrients and need to be supplemented in some form. Rationale: Clients who are lactose intolerant experience symptoms of bloating, cramping, and diarrhea. Calcium and protein need to be supplemented in some form in the diet of the client with lactose intolerance. Lactose enzymes may help clients with lactose intolerance, but they may not eliminate the client's problems. An individual generally does not consume enough leafy green vegetables daily to obtain sufficient calcium.

A hospitalized client is a lacto-vegetarian. Which food item should the nurse remove from the meal tray? 1.Eggs 2.Milk 3.Cheese 4.Broccoli

1. Eggs (Rationale: Lacto-vegetarians eat milk, cheese, and dairy foods but avoid meat, fish, poultry, and eggs.)

The nurse needs to increase the calcium in the diet of a client who is lactose intolerant. Which food items should the nurse encourage? *Select all that apply.* 1.Milk 2.Tofu 3.Cheese 4.Broccoli 5.Sardines 6.Mustard greens

2. Tofu 4. Broccoli 5. Sardines 6. Mustard greens Rationale: Lactose-intolerant clients should not eat dairy products. Therefore, these clients need high-calcium foods from nondairy sources. Tofu, broccoli, mustard greens, and sardines are foods that are high in calcium that do not come from dairy sources. Although milk and cheese are high in calcium, they are dairy products, which lactose-intolerant clients need to avoid.

A child with leukemia is experiencing nausea related to medication therapy. The nurse, concerned about the child's nutritional status, should offer which items during an episode of nausea? 1.Low-calorie foods 2.Cool, clear liquids 3.Low-protein foods 4.The child's favorite foods

2.Cool, clear liquids

he nurse is developing a nutritional plan for an assigned client. Which is the *most* critical piece of data to collect before formulating the plan? 1.A dietary diary 2.Food preferences 3.The presence of food allergies 4.Medical history of conditions related to nutritional deficits

3.The presence of food allergies Rationale: The presence of food allergies is critical to know before developing a nutritional plan. Dietary diary results, food preferences, and medical history provide good information but are not as crucial as the presence of food allergies.

A low-sodium diet has been prescribed for a client with hypertension. Which food selected from the menu by the client indicates an understanding of this diet? 1.Baked turkey 2.Tomato soup 3.Boiled shrimp 4.Chicken gumbo

1.Baked turkey Rationale: Regular soup (1 cup) contains 900 mg of sodium. Fresh shellfish (1 oz) contains 50 mg of sodium. Poultry (1 oz) contains 25 mg of sodium.

The nurse is reinforcing instructions to a client about complete/high quality protein foods. Which food choices would indicate the client understood the teaching? *Select all that apply.* 1.Eggs 2.Beans 3.Cereal 4.Oranges 5.Chicken 6.Broccoli

1.Eggs 5.Chicken Rationale: Complete/high-quality proteins are proteins that contain all essential amino acids and are found in a variety of meats, eggs, and dairy products. Beans are incomplete/lower-quality proteins as are some cereals. Oranges and broccoli contain vitamins and minerals and minimal protein.

The nurse reinforces dietary instructions to a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines the client has understood if the client plans to include which foods in the diet? *Select all that apply.* 1. Apples 2. Raisins 3. Kiwifruit 4. Bananas 5. Pineapple 6. Canned peaches

2. Raisins 3. Kiwifruit 4. Bananas Rationale: Foods that are high in potassium include bananas, cantaloupe, kiwifruit, oranges, and dried fruits such as raisins. Fruits low in potassium include apples, cherries, grapefruit, canned peaches, pineapple, and cranberries.

The nurse has given dietary instructions to a client to minimize the risk of osteoporosis. The nurse determines that the client understands the recommended changes if the client verbalizes the intention to increase intake of which foods? *Select all that apply.* 1. Fish 2. Yogurt 3. Potatoes 4. Chicken 5. White bread 6. Cottage cheese

2. Yogurt 6. Cottage cheese Rationale: Osteoporosis is a chronic metabolic disease in which there is bone loss resulting in decreased bone density and increased risk for fracture. Calcium intake is important to minimize the risk of osteoporosis. The major dietary source of calcium is from dairy foods, including milk, yogurt, and a variety of cheeses. Calcium also may be added to certain products, such as orange juice, which are then advertised as being "fortified" with calcium. Calcium supplements are also recommended to minimize the risk of osteoporosis. Fish, potatoes, chicken, and white bread are foods that are not high in calcium.

The nurse who is assisting in a weight loss program prepares to monitor a client's weight. The client receives education about caloric intake and weight reduction. In order to lose 2 pounds per week the caloric intake should be decreased by how many calories per day? 1. 100 calories 2. 500 calories 3. 1000 calories 4. 1500 calories

3. 1000 calories Rationale: The amount of weight loss in a client in a weight loss program is based on food intake, energy expenditure, and fluid loss. To obtain a weight loss of 1 pound per week the client needs a decrease in daily caloric intake of 500 calories. To lose 2 pounds per week the client needs to decrease intake by 1000 calories per day.

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week, yet is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern about not being able to continue the tube feedings at home with family caregivers. Which nursing response would be appropriate at this time? 1."Your primary health care provider thinks you are ready and so do I." 2."Try to eat more foods and maybe the tube feedings can be stopped." 3."You are afraid to leave but once you are home things will be just fine." 4."Tell me more about your concerns with your feedings after going home."

4."Tell me more about your concerns with your feedings after going home." Rationale: A client often has fears about leaving the secure, cared-for environment of the health care facility. This client has a fear about not being able to provide self-care at home and not being able to handle the tube feedings at home. An open communication statement such as, "Tell me more about..." often leads to valuable information about the client and the client's concerns. Giving false assurance, giving advice, and dismissing client feelings are nontherapeutic statements.

A client is having problems with blood clotting. Which food item should the nurse encourage the client to eat? 1.Legumes 2.Citrus fruits 3.Vegetable oils 4.Green, leafy vegetables

4.Green, leafy vegetables Rationale: Green, leafy vegetables are high in vitamin K, which acts as a catalyst for facilitating blood-clotting factors. Legumes are high in folic acid and thiamine. Citrus fruits are high in vitamin C, which helps with wound healing. Vegetable oil is high in vitamin E, which acts as an antioxidant.

The nurse is providing dietary instructions to a client with gout. The nurse should tell the client to avoid which food item? 1.Scallops 2.Chocolate 3.Cornbread 4.Macaroni products

(1) 1.Scallops Rationale: Scallops should be omitted from the diet of a client who has gout because of the high purine content. The food items identified in the remaining options have negligible purine content and may be consumed by the client with gout.

A newly pregnant client is asking how to prevent neural-tube birth defects. The nurse reinforces which food choices to include in the diet? *Select all that apply.* 1.Milk 2.Peanuts 3.Oranges 4.Broccoli 5.Egg yolks 6.Grapefruit

(3,4 & 6) 3.Oranges 4.Broccoli 6.Grapefruit Rationale: *Folic acid (folate) helps prevent neural tube birth defects; it is found in green, leafy vegetables; liver, beef, and fish; legumes; and grapefruit and oranges.* Peanuts are high in protein and niacin. Milk is high in calcium and vitamin D. Egg yolks are high in vitamin A, iron, and cholesterol.

The nurse employed in a well-baby clinic is reinforcing nutrition instructions to the mother of a 1-month-old infant. Which instruction should the nurse provide the mother? 1.Introduce strained fruits one at a time. 2.Introduce strained vegetables one at a time. 3.Offer breast milk or formula as the main food. 4.Offer rice cereal mixed with breast milk or formula.

3.Offer breast milk or formula as the main food. Rationale: Breast milk or formula is the main food throughout infancy. Rice cereal mixed with breast milk or formula is introduced at 4 months of age. Strained vegetables, fruits, and meats, are introduced one at a time and can begin at 6 months of age.

A client has been diagnosed with pernicious anemia. In planning care for the client, the nurse anticipates that the client will be treated with which vitamin or mineral? 1.Iron 2.Folic acid 3.Thiamine 4.Vitamin B12

4.Vitamin B12 Rationale: Pernicious anemia is caused by a deficiency of the intrinsic factor, which results in the inability to absorb vitamin B12 in the intestine. Treatment consists of weekly at first and then monthly injections of vitamin B12. Thiamine is most often prescribed for the client with alcoholism. Iron is administered for iron deficiency anemia, and folic acid is prescribed for folic acid deficiency.

A 17-year-old pregnant client is being seen at the obstetric clinic. The nurse is reviewing the following laboratory results, which were obtained 2 hours after breakfast: hemoglobin 10 g/dL (100 mmol/L), sodium 140 mEq (140 mmol/L), glucose 110 mg/dL (6 mmol/L), potassium 4.1 mEq (4.1 mmol/L). Which dietary instruction should the nurse reinforce for this client? 1.Increase the amount of red meats. 2.Increase the intake of milk products. 3.Limit the number of bananas per day. 4.Decrease the amounts of heavily sugared items.

1.Increase the amount of red meats. Rationale: This client's hemoglobin level is low; red meats are a good source of iron. The normal hemoglobin for a female is 12 to 16 g/dL (120 to 160 mmol/L). The normal sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). normal serum glucose fasting is 70 to 110 mg/dL (4 to 6 mmol/L), and a 2-hour postprandial is less than 140 mg/dL (8 mmol/L). Based on the laboratory results, there is no reason for the client to increase her milk intake or limit the number of bananas consumed daily. The normal potassium for an adult is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L).

A client with heart disease is instructed regarding a low-fat diet. The nurse determines that the client understands the diet if the client states to avoid which food item? 1.Apples 2.Cheese 3.Oranges 4.Skim milk

2. Cheese Rationale: Fruits, vegetables, and skim milk contain minimal amounts of fat. Cheese is high in fat.

The nurse has completed diet teaching for a client who has been prescribed a low-sodium diet to treat hypertension. The nurse determines that there is a *need for further teaching* when the client makes which statement? 1."This diet will help lower my blood pressure." 2."Fresh foods such as fruits and vegetables are high in sodium." 3."This diet is not a replacement for my anti-hypertensive medications." 4."The reason I need to lower my salt intake is to reduce fluid retention."

2."Fresh foods such as fruits and vegetables are high in sodium." Rationale: A low-sodium diet is used as an adjunct to antihypertensive medications for the treatment of hypertension. Sodium retains fluid, which leads to hypertension secondary to increased fluid volume. Fresh foods such as fruits and vegetables are low in sodium.

A clear liquid diet has been prescribed for a client with gastroenteritis. Which item is appropriate to offer to the client? 1.Soft custard 2.Orange juice 3.Clam chowder 4.Fat-free beef broth

4. Fat-free beef broth (Rationale: A clear liquid diet consists of foods that are relatively transparent. Soft custard and orange juice would be included in a full liquid diet because they are opaque, not clear. Clam chowder is opaque and also includes pieces of clams, thus eliminating it from a full liquid diet.)

When reinforcing dietary instructions to a client with irritable bowel syndrome whose primary symptom is alternating constipation and diarrhea, the nurse should tell the client that which foods are best to include in the diet for this disorder? *Select all that apply.* 1.Beans 2.Apples 3.Cabbage 4.Brussels sprouts 5.Whole-grain bread

(2 & 5) 2.Apples 5.Whole-grain bread Rationale: A high-fiber, high-residue diet is used for constipation, irritable bowel syndrome when the primary symptom is alternating constipation and diarrhea, and asymptomatic diverticular disease. High-fiber foods include fruits and vegetables and whole-grain products. Gas-forming foods such as beans, cabbage, and Brussels sprouts should be limited

The nurse is preparing to administer a continuous tube feeding to a client with a nasogastric tube. The primary health care provider has prescribed an amount of 100 mL/hr. The tube feeding setup is an open system, a bag that has formula added at intervals. How much formula should the nurse plan to add to fill the feeding bag? 1. 400 mL of formula 2.600 mL of formula 3. 800 mL of formula 4. Enough formula to last for 8 hours

1. 400 mL of formula Rationale: Feeding can be hung at room temperature for a period of 4 hours. If 100 mL/hr is prescribed, the nurse should fill the feeding bag with a maximum amount of 400 mL. Feeding hung longer than 4 hours at room temperature creates the risk of bacterial invasion in the formula.

The nurse reviews a client's serum sodium level and notes that the level is 150 mEq/L (150 mmol/L). The primary health care provider prescribes dietary instructions for the client based on the sodium level. Which food items should the nurse instruct the client to avoid? *Select all that apply.* 1. Bacon 2. Salami 3. Tomatoes 4. Summer squash 5. Processed oat cereals

1. Bacon 2. Salami 5. Processed oat cereals Rationale: The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). A serum sodium level of 150 mEq/L (150 mmol/L) is indicative of hypernatremia. Based on this finding, the nurse should instruct the client to avoid foods high in sodium, such as processed foods including cereals and meats (bacon and salami). Summer squash and tomatoes are low in sodium.

The nurse teaches the family of an infant with spina bifida that the infant should not be given which baby foods that may trigger a latex-type food allergy? Select all that apply. 1. Kiwi 2. Prunes 3. Apples 4. Bananas 5. Avocados

1. Kiwi 4. Bananas 5. Avocados Rationale: Infants with spina bifida develop a latex allergy due to repeated exposure to latex in surgery and having urinary catheters and should be in a latex-free environment. Parents should be informed about food sensitivities that are common to children with latex allergies. Foods that can cause a cross allergy to latex and should be avoided are bananas, avocados, and kiwi. Prunes and apples will not cause a latex-type reaction.

The nurse reinforces instructions to a client to increase the amount of riboflavin in the diet. The nurse should tell the client to select which food item that is high in riboflavin? 1.Milk 2.Tomatoes 3.Citrus fruits 4.Green, leafy vegetables

1.Milk Rationale: Food sources of riboflavin include milk, lean meats, fish, and grains. Tomatoes and citrus fruits are high in vitamin C. Green leafy vegetables are high in folic acid.

The nurse is reinforcing instructions to a client regarding how to decrease the intake of phosphorus in the diet. The nurse should tell the client that which food items are allowed with few restrictions in a phosphorus-restricted diet? *Select all that apply.* 1. Fish 2. Apples 3. Almonds 4. White bread 5. Egg whites 6. Whole-grain pasta

2. Apples 4. White bread 5. Egg whites Rationale: Phosphorus is in many foods, especially meats, dairy, and whole grains. Foods low in phosphorus include apples, white bread, and egg whites. Fish, almonds, and whole grain pasta have significant amounts of phosphorus.

A client with a burn injury is transferred to the nursing unit, and a regular diet has been prescribed. The nurse encourages the client to eat which dietary items to promote wound healing? 1. Veal, potatoes, gelatin, and orange juice 2. Chicken breast, broccoli, strawberries, and milk 3. Peanut butter and jelly sandwich, cantaloupe, and tea 4. Spaghetti with tomato sauce, garlic bread, and ginger ale

2. Chicken breast, broccoli, strawberries, and milk Rationale: Protein and vitamin C are necessary for wound healing. Poultry and milk are good sources of protein. Broccoli and strawberries are good sources of vitamin C. Peanut butter is a source of niacin. Gelatin and jelly have no nutrient value. Spaghetti is a complex carbohydrate.

A client who has recently been started on enteral feedings begins to complain of abdominal cramping, followed by passage of two liquid stools. The nurse notes that the client has abdominal distention as well. The nurse reviews the nutritional content on the label of the can to see if it contains which ingredient? 1. Maltose 2. Lactose 3. Sucrose 4. Fructose

2. Lactose Rationale: Several tube feeding formulas contain lactose. A client with an unreported history of lactose intolerance would develop symptoms such as these in response to nutritional therapy with these formulas. If the client is diagnosed as lactose intolerant, a lactose-free formula should be prescribed by the primary health care provider. This will resolve the client's symptoms and promote adequate nutrition for the client.

A client who has calcium phosphate kidney stones tells the nurse, "Tell me what I can do, so that I never have this pain again." Which instructions should the nurse plan to include in the reinforcement of dietary instructions? *Select all that apply.* 1.Avoid spinach. 2.Decrease sodium intake. 3.Limit the intake of organ meats. 4.Limit the intake of whole grains. 5.Limit protein to 5 to 7 servings per week.

2.Decrease sodium intake. 4.Limit the intake of whole grains. 5.Limit protein to 5 to 7 servings per week. Rationale: The client should decrease sodium intake because sodium decreases the kidney tubular calcium reabsorption, which will result in increased phosphorus. Limiting whole grains can aid in the reduction of urinary phosphate. Limiting proteins can decrease the acidity of urine, which prevents calcium precipitation. Spinach should be limited in clients with calcium oxalate calculi, not calcium phosphate calculi. Organ meat should be limited in clients with uric acid calculi stones because of purine content.

A client has a diagnosis of hyperphosphatemia. The nurse reinforces instructions by telling the client to eliminate which items from the diet? *Select all that apply.* 1.Tea 2.Fish 3.Cocoa 4.Coffee 5.Chicken

2.Fish 5.Chicken Rationale: Foods naturally high in phosphates should be avoided with hyperphosphatemia. These include fish, chicken, eggs, milk products, vegetables, whole grains, and carbonated beverages. Coffee, tea, and cocoa are not high in phosphates.

A client is receiving an enteral feeding that delivers 1.5 calories/mL. The feeding is infusing at 30 mL/hr via a feeding pump. What is the maximal amount of calories the client should receive in an 8-hour period if the tube feeding is not interrupted? *Fill in the blank.* ____ Calories

360 calories Rationale: Multiply the milliliters per hour by the calories per milliliter. Then, using the ratio/proportion method, determine the maximal number of calories the client should receive in an 8-hour period.

The nurse is reinforcing instructions to a client on how to decrease the intake of potassium in the diet. The nurse determines the need for further teaching if the client selects which foods to include in the diet? *Select all that apply.* 1.Eggs 2.Bread 3.Lettuce 4.Potatoes 5.Avocados 6.Salt substitute

4. Potatoes 5. Avocados 6. Salt substitute Rationale: Potatoes and avocados are potassium-containing foods and should be avoided if on a potassium-restricted diet. Salt substitute, often potassium chloride used in place of regular salt (sodium chloride), is a source of potassium. Eggs, bread, and lettuce are all foods low in potassium and are allowed in a potassium-restricted diet.

A postoperative client has been placed on a clear liquid diet. Which items is the client allowed to consume? *Select all that apply.* 1. Broth 2. Coffee 3. Gelatin 4. Pudding 5. Ice cream 6. Vegetable juice

1. Broth 2. Coffee 3. Gelatin 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 water, bouillon, clear broth, carbonated beverages, gelatin, lemonade, Popsicles, and regular or decaffeinated coffee or tea. Pudding, ice cream, and vegetable juices are allowed on a full liquid diet.

A client with hypertension has been prescribed a low-sodium diet. The nurse reinforcing instructions about foods that are allowed should include which foods in a list provided to the client? *Select all that apply.* 1. Fresh tomato 2. Tomato soup 3. Boiled shrimp 4. Instant oatmeal 5. Summer squash

1. Fresh tomato 5. Summer squash Rationale: Foods that are lower in sodium are fruits and vegetables, such as fresh tomato and summer squash, because they do not contain physiological saline. Highly processed or refined foods, such as prepared soups and cereal, are higher in sodium unless they are noted specifically to be "low sodium." Saltwater fish and shellfish (shrimp) are high in sodium.

The nurse caring for a client with a neurological disorder is assisting in planning care to maintain nutritional status. The client has had a swallowing study done that shows the client is at risk for aspiration and is able to feed self. The nurse should review which interventions with the unlicensed assistive personnel (UAP)? *Select all that apply.* 1. Add the prescribed thickener to liquids. 2. Have the client sitting up at 45 degrees. 3. Follow each swallow of food with a sip of water. 4. Observe client for episodes of coughing or choking. 5. Take the client for a walk before the meal to provide stimulation.

1. Add the prescribed thickener to liquids. 4. Observe client for episodes of coughing or choking. Rationale: A client, with suspected dysphagia, usually has a swallow study done to verify and detail the dysphagia problem. The client has specific prescribed interventions to deal with the problem and aspiration precautions are initiated. Thin fluids are easier to aspirate so prescribed thickeners are added to liquid foods. The client should be observed eating so a caregiver can intervene if choking or coughing occurs. This is also a good opportunity to teach family members about the interventions. The client should be sitting upright at a 90-degree angle. The client should eat small amounts in an unrushed manner. Clients should not take a sip of water after each swallow but double swallowing (swallowing twice after each bite) may be effective in clearing food from the mouth. The client should be well rested before meals because fatigue is a risk factor for aspiration.

The nurse reinforces instructions regarding diet for a client at risk for hypokalemia. The nurse determines there is a *need for further teaching* when the client selects which foods as sources high in potassium? *Select all that apply.* 1. Bread and butter 2. Carrots and peas 3. Peppers and onions 4. Beef and potato salad 5. Avocados and mushrooms

1. Bread and butter 2. Carrots and peas 3. Peppers and onions Rationale: Clients taking thiazide or loop diuretics need to have adequate potassium intake and benefit from dietary teaching about the potassium values of foods. Bread and butter, carrots and peas, and peppers and onions are relatively low sources of potassium. Meats and certain fruits and vegetables are high in potassium and include beef and potato salad and avocados and mushrooms.

The nurse is preparing to administer an intermittent tube feeding to a client. The nurse aspirates 90 mL of residual from the tube. What should the nurse do? *Select all that apply.* 1.Hold the feeding. 2.Document the amount of residual. 3.Place it into a container for laboratory analysis. 4.Reinstill the residual and administer the feeding. 5.Deduct the amount of the residual from the new feeding before administering.

2.Document the amount of residual. 4.Reinstill the residual and administer the feeding. Rationale: Unless otherwise instructed or if the residual contents appear abnormal, an amount of less than 100 mL is reinstilled; then a normal amount of prescribed tube feeding is administered. The amount of residual should be documented. It is important to return the contents to the stomach to prevent electrolyte imbalances. The feeding is not held, and the residual is not sent to the laboratory. The tube feeding should continue at the prescribed rate.

A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The primary health care provider inserts a nasogastric tube and prescribes a tube feeding of a standard formula feeding to run at 50 mL/hr. The nurse plans care, knowing that which is true regarding enteral feedings? 1.Enteral feedings are a frequent cause of sepsis. 2.Tube feedings should be refrigerated until just before use. 3.The caloric value of enteral feedings is generally 5 to 10 kcal/mL. 4.Enteral feedings require the normal digestive capabilities of the gastrointestinal (GI) tract.

4. Enteral feedings require the normal digestive capabilities of the gastrointestinal (GI) tract. Rationale: Enteral nutrition can include providing nutrients by mouth, nasogastric tube, gastrostomy tubes, or a percutaneous endoscopic gastrostomy (PEG) tube. The common element in each of these methods of delivery is that the client must have normal 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 feedings may cause aspiration pneumonia because of regurgitation of formula into the lungs; however, they are not generally associated with sepsis. 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 kcal/mL.

A client receiving enteral feedings develops abdominal distention and diarrhea shortly after initiation of the feedings. Which is the appropriate intervention for the nurse to implement? 1.Encourage ambulation to stimulate peristalsis. 2.Administer prescribed antidiarrheal medications. 3.Make the client NPO and put the tube feeding on hold. 4.Notify the primary health care provider (PHCP) of the client's signs and symptoms.

4.Notify the primary health care provider (PHCP) of the client's signs and symptoms. Rationale: Clients receiving tube feedings can develop distention and diarrhea due to hyperosmolarity of the formula, malabsorption, or contamination. The nurse should notify the PHCP about the problems of the client not tolerating the tube feeding. Encouraging ambulation may improve peristalsis, but this will not improve toleration of the tube feeding. Administering antidiarrheal medication or stopping the tube feeding should not be done without approval of the PHCP. If the client was made NPO without the tube feeding, the client would be at risk for dehydration.

The nurse instructs a client at risk for hypokalemia from thiazide diuretic therapy about foods that are high in potassium. The nurse determines that there is a *need for further teaching* if the client states that which foods are high in potassium and should be included in the diet plan? *Select all that apply.* 1. Eggs 2.Beef 3.Pork 4.Raisins 5.White bread with butter

1. Eggs 5.White bread with butter Rationale: The client was incorrect to state that eggs and bread and butter are good sources of potassium. One large egg provides 66 mg of potassium. White bread and butter is approximately 120 mg. One-half cup of raisins contains 700 mg of potassium. Four ounces of beef contains 420 mg, and 4 ounces of pork contains 525 mg of potassium.

A client has a serum sodium level of 151 mEq/L (151 mmol/L), and the nurse reinforces dietary teaching about the types of foods to avoid. The nurse determines that there is a *need for further teaching* if the client states that which food choices are good? *Select all that apply.* 1.Fish 2.Rhubarb 3.Spinach 4.Cabbage 5.Sauerkraut 6.American cheese

5.Sauerkraut 6.American cheese Rationale: The client's laboratory value reflects hypernatremia because the normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). Based on this finding, the nurse should instruct the client to avoid foods high in sodium. Sauerkraut and American cheese are high in sodium content. These should include foods from animal sources, which contain physiological saline, and highly processed meats and other foods that often have sodium added as a preservative. Spinach and rhubarb are good food sources of calcium. Cabbage is low calorie and a good source of vitamin C. Fish is high in phosphorus.

A client has a prescription to take sodium polystyrene sulfonate for several days. The client also needs to make some dietary changes. Which foods should the client avoid? *Select all that apply.* 1. Cabbage 2. Peaches 3. Soybeans 4. Mushrooms 5. Strawberries

1. Cabbage 4. Mushrooms 5. Strawberries Rationale: Sodium polystyrene sulfonate is a cationic exchange resin used as treatment for hyperkalemia (potassium level greater than 5.0 mEq/L [5.0 mmol/L]) Besides taking the medication, the client should avoid foods that are high in potassium content, including cabbage, mushrooms, and strawberries. Foods low in potassium are peaches and soybeans.

A client is recovering from abdominal surgery and has a large abdominal wound. The nurse encourages the client to eat foods from which nutrient categories to promote wound healing? *Select all that apply.* 1. Protein 2. Calcium 3. Vitamin C 4. Vitamin K 5. Unsaturated fats

1. Protein 3. Vitamin C Rationale: Protein is needed to build new tissues and vitamin C is active in the body in many enzyme processes and with collagen synthesis. A client with a large abdominal wound will require adequate protein and vitamin C intake to heal. Protein is found in meats, poultry, fish, milk, and beans and lentils. Citrus fruits and juices are especially high in vitamin C. Other sources are potatoes, tomatoes, and other fruits and vegetables. Calcium and vitamin K are necessary nutrients but are not specific to wound healing. Unsaturated fats are those fats thought not to contribute to atherosclerosis.

The nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which foods? *Select all that apply.* 1. Milk and yogurt 2. Clams and mussels 3. Apples and mangos 4. Potatoes and carrots 5. Lean beef and chicken liver

2. Clams and mussels 5. Lean beef and chicken liver 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, clams, mussels, and oysters. Milk products are lowest in iron of all of the food sources listed. Potatoes, carrots, apples, and mangos are not rich sources of iron.

An older client complains of chronic constipation. Which instructions should the nurse reinforce with the client? *Select all that apply.* 1.Include rice and bananas in the diet. 2.Increase the intake of sugar-free products. 3.Increase fluids to at least eight glasses a day. 4.Increase various potassium-rich foods in the diet. 5.Respond in a timely manner to the urge to defecate

3.Increase fluids to at least eight glasses a day. 5.Respond in a timely manner to the urge to defecate Rationale: Increase of fluid intake and dietary fiber will help change the consistency of the stool and make it easier for the client to pass. Clients should respond to the feeling of peristalsis involved with urge to defecate. Some older clients with mobility issues may not respond to the urge. Increasing the intake of rice and bananas will increase constipation. Increasing sugar-free products and potassium in the diet will not be beneficial to the client.

The nurse is assigned to assist in caring for a client who is receiving parenteral nutrition with fat emulsion. The nurse is instructed to monitor the client for signs of fat overload. The nurse monitors for which signs and symptoms of this complication? 1.Fever and pruritic urticaria 2.Bradycardia and altered taste 3.Hypothermia and muscle weakness 4.Hypertension and decreased urine output

1.Fever and pruritic urticaria Rationale: IV fat emulsions are sometimes administered with parenteral nutrition to supply needed calories and essential fatty acids. This fat emulsion must be infused by pump at a set rate, usually over 10 to 12 hours. Signs and symptoms of fat overload include fever, leukocytosis, hyperlipidemia, and pruritic urticaria, and focal seizures are possible. Hepatosplenomegaly also may be present. Bradycardia, altered taste, muscle weakness, hypertension, and decreased urine output are not signs of this complication.

The nurse is instructing a client with osteomalacia about appropriate food items to include in the diet. Which food items should be included in the client's diet? *Select all that apply.* 1.Milk 2.Citrus fruits 3.Bread products 4.Wild caught salmon 5.Green, leafy vegetables

1.Milk 4.Wild caught salmon Rationale: Osteomalacia is the softening of bone tissue characterized by inadequate mineralization of osteoid. It is the adult equivalent of rickets and vitamin D deficiency in children. Of the food items presented, milk, which has vitamin D added, provides the best source of vitamin D. Oily fish, especially wild caught such as salmon and mackerel, are also rich in vitamin D. Citrus fruits are high in vitamin C. Bread products are high in niacin. Green, leafy vegetables are high in folic acid.