Nursing 265 Week 5 EAQ

Which drug is derived from a natural source and may be prescribed for the treatment of osteoporosis?

Calcitonin Rationale Calcitonin is derived from natural sources such as fish; this drug may be prescribed to prevent osteoporosis. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Clomiphene is prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis; this drug is not derived from natural sources.

The nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history?

Partial gastrectomy Rationale Removal of the fundus of the stomach (gastrectomy) destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B 12 preliminary to its absorption in the ileum). Hemorrhaging may cause anemia; however, pernicious anemia occurs when the intrinsic factor is not produced. The beta cells of the pancreas are not involved in secretion of intrinsic factor. Dietary intake does not affect the production of intrinsic factor.

A 17-year-old client is found to have anorexia nervosa. The psychiatrist, in conjunction with the client and the parents, decides to institute a behavior modification program. What does the nurse recall is a major component of behavior modification?

Rewarding positive behavior Rationale In behavior modification[1][2][3], positive behavior is reinforced, and negative behavior is not reinforced or punished. Reducing the number or complexity of necessary restrictions, deconditioning the fear of weight gain, and reducing the number of anxiety-producing situations may all be part of the program, but none is a major component.

A woman comes into the clinic and states that she is thinking about becoming pregnant. What can the woman do to improve the health of her baby before she becomes pregnant?

Start taking prenatal vitamins. Folic acid is important for the pregnant woman; a lack of folic acid can result in neural tube defects, including spina bifida. The time during fetal development when this occurs is very early in the pregnancy, when the woman may not even realize that she is pregnant. Taking prenatal vitamins with adequate folic acid can greatly reduce this birth defect. Although exercise is good for the pregnant woman and infant, it is not necessary to start running 3 miles a day, especially if this is something the client has never done before. Running may not be healthy for the soon-to-be mother and infant if it is a new activity; however, if this is what the woman normally does, she will be encouraged to continue.

A primary healthcare provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide to the client about the need to follow this diet?

"Excessive aldosterone and cortisone cause retention of sodium and loss of potassium" Rationale Clients with Cushing syndrome must limit their intake of salt and increase their intake of potassium. The kidneys are retaining sodium and excreting potassium. An excessive secretion of adrenocortical hormones in Cushing syndrome, not increased or high sodium intake, is the problem. Although sodium retention causes fluid retention and weight gain, the need for increased potassium also must be considered. Because of steroid therapy, excess sodium may be retained, although potassium may be excreted.

The parents of a 6-month-old ask a nurse how to introduce their infant to pureed foods. How should the nurse respond?

"Introduce one food at a time every 4 to 7 days." Rationale The introduction of one new food at a time permits the identification of any food allergies that might be present; intake of multiple new foods makes identification of the causative foods more difficult if there is a reaction. Mixing the food with formula can create feeding problems; if the infant does not like the taste of a food, it may be associated with the formula. Formula intake should be decreased as solid food intake increases, or the infant will be receiving excessive calories. Although pureed foods may be offered by spoon once the formula is finished, solid foods should be given when the infant is hungry to encourage intake.

A 17-year-old adolescent was recently found to have type 2 diabetes mellitus. What information will the nurse include when providing education to the family?

"The most important interventions are good nutrition and portion control." Rationale Most children with type 2 diabetes are overweight or at risk for becoming overweight. With nutritional intervention to promote proper weight, the condition may often be managed with diet and exercise alone. A lifelong insulin regimen; the production of antibodies against the child's own cells; and weight loss with increased appetite, thirst, and urination are all typical of type 1 diabetes.

The mother of a 4-month-old infant weighing 11 lb (5 kg) asks the nurse how much formula is required per day now that her baby has been weaned from the breast. The recommended caloric intake is 108 kcal/kg, and the formula contains 20 kcal/oz (20 kcal/30 mL). How much formula should the nurse tell the mother to give to her infant each day?

27 oz (810 mL) The infant's daily intake should be approximately 27 oz (810 mL). The infant weighs 11 lb (11/2.2 = 5 kg). An infant's daily caloric need is 108 kcal/kg body weight. 108 kcal × 5 kg = 540 kcal/day; because there are 20 kcal/oz, 540 ÷ 20 = 27 oz (20 kcal/30 mL, 540 ÷ 20 X 30 mL = 810 mL) . Twenty-one ounces (630 mL) is inadequate; 33 (990 mL) oz or 39 (1170 mL) oz is excessive. Rationale The infant's daily intake should be approximately 27 oz (810 mL). The infant weighs 11 lb (11/2.2 = 5 kg). An infant's daily caloric need is 108 kcal/kg body weight. 108 kcal × 5 kg = 540 kcal/day; because there are 20 kcal/oz, 540 ÷ 20 = 27 oz (20 kcal/30 mL, 540 ÷ 20 X 30 mL = 810 mL) . Twenty-one ounces (630 mL) is inadequate; 33 (990 mL) oz or 39 (1170 mL) oz is excessive.Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

What is the reason for calculating a body mass index (BMI)-for-age during a health maintenance assessment for school-age clients?

Assessing for obesity or overweight Rationale Due to the increasing number of overweight children in the United States, the BMI charts are a critical component of children's physical assessment. BMI-for-age may be used to identify children and adolescents at the upper end of the distribution who are either overweight (at or above 95th percentile) or at risk for being overweight (at or above the 85th percentile and below the 95th percentile). Assessing for bulimia nervosa and anorexia nervosa is more appropriate for an adolescent versus a school-age child. Assessing for failure to thrive (FTT) is more appropriate for the infant, toddler, and preschool-age child.

A client with systemic lupus erythematosus is taking prednisone. The nurse anticipates that the steroid may cause hypokalemia. What food will the nurse encourage the client to eat?

Broccoli Rationale Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, what is the best recommendation the nurse can make?

Decrease fast food intake. Rationale Eating a variety of healthful foods instead of a fast-food diet that is high in fat and carbohydrates helps decrease excess weight and increase energy with which to engage in physical activities. Joining a gym is expensive and unnecessary. Physical activity can be achieved in the schoolyard or at home. A multivitamin will not promote weight loss. Vitamins and minerals are best obtained in a balanced diet. Diet soft drinks do not contribute to obesity.Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care.

While awaiting surgery, a client with a long history of Crohn disease is receiving total parenteral nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps to prepare for surgery by which process?

Decreasing fecal bulk Rationale By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate gastrointestinal secretions. TPN promotes positive nitrogen balance.

A nurse is planning care for a client with substance-induced persisting dementia resulting from long-term alcohol use. Which nutritional problem, in addition to the effect of alcohol on brain tissue, has contributed to substance-induced persisting dementia?

Deficiency of thiamine Rationale Substance-induced persistent dementia is caused by a prolonged deficiency of vitamin B1(thiamine) and the direct toxic effect of alcohol on brain tissue. Increase in serotonin, reduction in iron intake, and malabsorption of riboflavin are problems that are unrelated to substance-induced persisting dementia caused by alcoholism.STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience.

A client is instructed to avoid straining on defecation postoperatively. Which food item chosen by the client indicates successful learning?

Green vegetables Rationale Green vegetables contain fiber, which promotes defecation. Bananas, milk products, and creamed potatoes have a constipating effect, which results in straining at stool.Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass.

An obese adult develops an abscess after abdominal surgery. The wound is healing by secondary intention and requires repacking and redressing every 4 hours. Which diet should the nurse expect the healthcare provider to prescribe to best meet this client's immediate nutritional needs?

High in protein and vitamin C Rationale Protein and vitamin C promote wound healing; this is a postoperative priority. Although a low-fat diet is preferred for an obese client, vitamin D, as well as other vitamins, should not be limited. A high-calorie diet can increase obesity, and there is no indication that this client is at risk for constipation requiring a high-fiber diet. A low-residue bland diet can cause constipation; the priority is for nutrients to promote healing.

A nurse is preparing a teaching plan for the parents of a child with celiac disease. What information on the basic problem in celiac disease does the nurse include?

Intolerance of gluten Rationale Celiac disease is an immunological small intestine enteropathy characterized by the inability to metabolize the gliadin component of gluten found in grains such as wheat, barley, rye, and oats; this results in excessive glutamine that is toxic to the mucosal cells. The stools are fatty and yellow. The intestinal villi are present but will atrophy if exposed to foods containing gluten. Fluid balance is not the basic problem with celiac disease; however, dehydration may occur in celiac crisis

A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the client's discomfort?

Lactase Rationale Milk and milk products are not tolerated well because they contain lactose, a sugar that is converted to galactose by lactase. Sucrase assists in the digestion of sucrose, which is not a milk sugar. Maltase assists in the digestion of maltose, which is not a milk sugar. Amylase assists in the digestion of starch, which is not a milk sugar.Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.

A nurse in the pediatric clinic is assessing an 11-month-old infant with iron-deficiency anemia. The infant's hemoglobin is 8 g/dL (80 mmol/L). What does the nurse expect to observe when assessing the infant?

Pallor Rationale Paleness occurs because the hemoglobin within the erythrocytes gives them their red color; a low hemoglobin level in the blood results in pallor. Tremors are not a sign of anemia. The skin is usually pale; cyanosis is not typical. Spasticity is not a sign of anemia.

A 6-year-old child treated for acute glomerulonephritis has improved and is soon to be discharged. What should the nurse plan to offer the parents in preparation for the discharge?

Samples of no-salt-added diets for the child to continue at home Rationale Foods high in sodium and salty treats are usually limited to control or prevent edema and hypertension until the child is asymptomatic. The child should not be kept active for long periods because rest is needed; the child usually does not need a long convalescence. Glomerulonephritis usually does not cause such severe kidney damage that a kidney transplant is necessary. The mother should contact the healthcare provider, not the nurse on the unit, for follow-up care.

A client with a history of a pulmonary embolus is to receive 3 mg of warfarin daily. The client has blood drawn twice weekly to ascertain that the international normalized ratio (INR) stays within a therapeutic range. The nurse provides dietary teaching. Which food selected by the client indicates that further teaching is necessary?

Spinach salad Rationale Dark green, leafy vegetables are high in vitamin K. Influencing the level of vitamin K alters the activity of warfarin because vitamin K acts as a catalyst in the liver for the production of blood-clotting factors and prothrombin. The intake of foods containing vitamin K must be consistent to regulate the warfarin dose so that the INR remains within the therapeutic range. Eggs contain protein and are permitted on the diet. Yellow vegetables contain vitamin A and are permitted on the diet. Dairy products containing protein and bread supplying carbohydrates are permitted on the diet.Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.

A nurse is teaching the parents of a school-aged child with celiac disease about the nutrients that must be avoided in a gluten-free diet. What nutrients should the nurse teach the parents to avoid?

Wheat and oat products.Wheat, oats, rye, and barley are major dietary sources of gluten; the gliadin fraction of these grains is not tolerated by individuals with celiac disease. There is no gluten in oils and fats. There is no gluten in cheeses and milk. Corn and rice are used as substitute grains because they do not contain gluten.

A pregnant client with diabetes is referred to the dietitian in the prenatal clinic for nutritional assessment and counseling. What should the nurse emphasize when reinforcing the client's dietary program?

The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessaryIncreased metabolic demands on the body during pregnancy require increased ingestion of calories; appropriate doses of insulin must be provided to permit glucose utilization by the body. The quantities of carbohydrates and fats, as well as of protein, are increased, not decreased, during pregnancy. Simply increasing carbohydrate intake is not sufficient to prevent ketosis. A low-calorie diet is contraindicated; it will not meet the demands of pregnancy on the client's body or the needs of the growing fetus.

A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin and other dietary supplement should the nurse recommend?

Vitamin D and calcium citrate Rationale All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, supplements of calcium and vitamin D are recommended. Vitamin C and glucosamine/chondroitin maintain cartilage and connective tissue integrity but do not help prevent osteoporosis. Vitamins E and B, ginseng, and ginkgo biloba do not help prevent osteoporosis.

A client who has had recurrent infections before and during pregnancy should be instructed to eat a nutrient-rich diet as a means of supporting the body's natural defense mechanisms. What should the nurse encourage the client to include in her diet? Fat-soluble vitamins

Vitamins C and E Rationale Vitamin C plays an important role in tissue formation, and vitamin E is required to protect against the oxidative stress associated with pregnancy. Too much emphasis on fat-soluble vitamins may result in an inadequate intake of important water-soluble vitamins. Dietary fiber and oat bran and low-fat foods with essential fatty acids have no known effect on natural defenses.

A child is found to have celiac disease. When providing education to the family, what food will the nurse advise the family to eliminate from the child's diet?

Wheat-based breads and cereals Rationale Celiac disease, also known as gluten enteropathy, results from an inability to adequately digest grains such as wheat, barley, rye, and oats. Meat, poultry, and eggs; processed sugar products; and milk and other dairy products do not cause problems for clients with celiac disease.