Nutrition
• Malnutrition
o Dec albumin (3.5-5g/dL) = dec protein & dec wound heal o 1.5K cal f/ proper wound heal o s/s dry skin, ankle edema (low protein), dec reflex, weak grip, dry eyes
• Child
o Dec choke ∴ peanut butter & celery, whole grapes, pretzels o <2y/o whole milk o >2y/o low fat milk
A nurse is conducting a nutritional class on minerals and electrolytes. The nurse should include that 1/2 cup of which of the following foods is the best source of magnesium? A. Whole almonds B. Chopped tomatoes C. Raw spinach D. Low-fat vanilla yogurt
A. 1/2 cup whole almonds It is the best source b/c it has 193mg of magnesium.
A nurse is planning care for a client who has a new rx for PPN. Which of the following actions should the nurse include in the plan of care? (select all that apply) A. Examine trends in weight loss B. Review preablumin finding C. Administer an IV solution of 20% dextrose D. Add a micron filter to IV tubing E. Use an IV infusion pump
A. Examine trends in weight loss B. Review prealbumin finding D. Add a micron filter to IV tubing E. Use an IV infusion pump
A nurse is providing info to a client who has a new diagnosis of type 1 DM. Which of the following info should the nurse include? (select all that apply) A. A viral infection can trigger the onset of type 1 DM B. Alpha cell in pancreas are damaged in type 1 DM C. Type 1 DM usually occurs before age 30 D. Type 1 DM is treated w/oral antiglycemic medications E. Regular exercise can reduce insulin requirements in type 1 DM
A. A viral infection can trigger the onset of type 1 DM C. Type 1 DM usually occurs before age 30 E. Regular exercise can reduce insulin requirements in type 1 DM It is beta cells in the pancreas that are damaged.
A nurse is caring for a client who is receiving TPN through a central line, but the next bag of solution is not available for administration at this time. Which of the following is an appropriate action by the nurse? A. Administer 20% dextrose in water IV until the next bag is available B. Slow the infusion rate of the current bag until the solution is available C. Monitor for hyperglycemia D. Monitor for hyperosmolar diuresis
A. Administer 20% dextrose in water IV until the next bag is available
A nurse is planning care for a client who is receiving EN through continuous infusion. Which of the following interentions should be included in the plan of care? (select all that apply) A. Administer w/an infusion pump B. Measure residual q8hr C. Flush feeding tube q4hr D. Re-instill residual feeding into the stomach E. Reassess tolerance if residual volume is greater than prescribed amount
A. Administer w/an infusion pump C. Flush feeding tube q4hr E. Reassess tolerance if residual volume is greater than prescribed amount Administering continuous drip EN using an infusion pump ensures the correct volume of feeding is being fused. Flushing the feeding tube q4hr maintains patency. The client's tolerance of the amount and type of formula used should be reassessed if the residual volume is greater than the prescribed amount as this is an indication that the amounts infused are not being digested.
A nurse is teaching a client about his-fiber foods that can assist in lowering LDL. Which of the following foods should the nurse include in the teaching? (select all that apply) A. Beans B. Cheese C. Whole grains D. Broccoli E. Yogurt
A. Beans C. Whole grains D. Broccoli
A nurse is performing a nutritional assessment on a client. Which of the following clinical findings are suggestive of malnutrition? (select all that apply) A. poor wound healing B. dry hair C. BP 130/80 mmHg D. weak hand grips E. impaired coordination
A. poor wound healing B. dry hair D. weak hand grips E. impaired coordination
A nurse is discussing essential nutrients for normal functioning of the nervous system w/a client. Which of the following should the nurse include in the teaching? (select all that apply) A. Ca B. Thiamin C. Vitamin B12 D. Na E. Phosphorus
A. Ca B. Thiamin C. Vitamin B12 D. Na
A nurse in an assistive living facility is caring for an older adult client. The nurse should recognize that older adults have decreased absorption of which of the following? (select all that apply) A. Ca B. Cl C. Folic acid D. Mg E. Phosphorus
A. Calcium C. Folic acid
A nurse is reinforcing dietary teaching to a client who has type 2 DM. Which of the following instructions should the nurse include in the teaching? (select all that apply) A. Carbs should comprise 55% daily caloric intake B. Use hydrogenated oils for cooking C. You can add table sugar to cereals D. You can drink one alcoholic beverage w/a meal E. Use the same portion sizes to exchange carbs
A. Carbs should comprise 55% daily caloric intake C. You can add table sugar to cereals D. You can drink one alcoholic beverage w/a meal E. Use small portion sizes to exchange carbs Client can use table sugar as long as adequate insulin or other agents are provided to cover the sugar intake.
A charge nurse is providing info about fat emulsion added to TPN to a group of nurses. Which of the following statements by the charge nurse are appropriate? (select all that apply) A. Concentration of lipid emulsion can be up to 30% B. Adding lipid emulsion gives the solution a milky appearance C. Check for allergies to soybean oil D. Lipid emulsion prevents essential fatty acid deficiency E. Lipids provide calories by increasing the osmolality of the PN solution
A. Concentration of lipid emulsion can be up to 30% B. Adding lipid emulsion gives the solution a milky appearance C. Check for allergies to soybean oil D. Lipid emulsion prevents essential fatty acid deficiency Lipids provide calories needed w/o increasing osmolality of PN solution
A nurse is planning care for an older adult client who is receiving tx for malnutrition. The client is scheduled for discharge to his home where he lives alone. Which of the following actions should the nurse include in the plan of care? (select all that apply) A. Consult social services to arrange home meal delivery B. Encourage the client to purchase nonperishable boxed meals C. Advise client to purchase frozen fruits and vegetables D. Recommend drinking a supplement between meals E. Educate the client on how to read nutrition labels
A. Consult social services to arrange home meal delivery C. Advise client to purchase frozen fruits and vegetables D. Recommend drinking a supplement between meals E. Educate client on how to read nutrition lables
A nurse is teaching a client about protein needs when on dialysis. Which of the following instructions should the nurse include in the teaching? (select all that apply) A. Consume 35 kcal/kg of body weight to maintain body protein stores B. Take phosphate binders when eating protein-rich foods C. Increase biologic sources of protein such as eggs, milk, and soy D. Increase protein intake by 50% of the recommended dietary allowance (RDA) E. Consume daily protein intake in the morning
A. Consume 35 kcal/kg of body weight to maintain body protein stores B. Take phosphate binders when eating protein-rich foods C. Increase biologic sources of protein such as eggs, milk, and soy D. Increase protein intake by 50% of the recommended dietary allowance (RDA)
A nurse is teaching a community program on nutritional guidelines for cancer prevention. Which of the following instructions should the nurse include? (select all that apply) A. Eat foods high in vitamin A B. Add cruciferous vegetables C. Increase intake of red meats D. Use saturated cooking oil E. Consume refined grains
A. Eat foods high in vitamin A B. Add cruciferous vegetables
A nurse is providing teaching to a client who has vitamin B12 deficiency. Which of the following foods should the nurse instruct the client to consume? (select all that apply) A. Meat B. Flaxseed C. Beans D. Eggs E. Milk
A. Meat D. Eggs E. Milk
A nurse is planning care for a client who has ESKD. Which of the following should the nurse include in the plan of care? (select all that apply) A. Monitor the client's weight daily B. Encourage the client to comply w/fluid restrictions C. Evaluate intake and output D. Instruct the client on restricting calories from carbs E. Monitor for constipation
A. Monitor the client's weight daily B. Encourage the client to comply w/fluid restrictions C. Evaluate intake and output E. Monitor for constipation
A nurse is completing discharge teaching about diet & fluid restrictions to a client who has a calcium oxalate-based kidney stone. Which of the following should the nurse include in the teaching? A. Reduce intake of spinach B. Decrease broccoli intake C. Increase intake of vitamin C supplements D. Limit consumption of purine substances
A. Reduce intake of spinach Foods that contain purine, such as organ meats and red wine, cause uric acid stone formation.
A nurse is teaching a client who has stage 2 CKD about dietary management. Which of the following info should the nurse include in the instructions? A. Restrict protein intake B. Maintain a high-phosphorus diet C. Increase intake of foods high in K D. Limit dairy products to 1 cup/day
A. Restrict protein intake
A nurse is teaching a client who has cancer about ways to increase protein and calories in foods. Which of the following actions should the nurse include? (select all that apply) A. Use PB as a spread on crackers B. Add water in place of milk in soups C. Top fruit w/yogurt D. Dip chicken in eggs before cooking E. Sprinkle cheese on a baked potato
A. Use PB as a spread on crackers C. Top fruit w/yogurt D. Dip chicken in eggs before cooking E. Sprinkle cheese on baked potato
A nurse is administering bolus enteral feedings to a client who has malnutrition. Which of the following are appropriate nursing interventions? (select all that apply) A. Verify the presence of bowel sounds B. Flush the feeding tube with warm water C. Elevate the head of the bed 20 degrees D. Administer feeding at room temperature E. Inspect tube insertion site
A. Verify the presence of bowel sounds B. Flush the feeding tube w/warm water D. Administer feeding at room temperature E. Inspect tube insertion site
A nurse is planning to create dietary guidelines for a client who has type 2 DM. Which of the following info should the nurse incorporate in the dietary plan? (select all that apply) A. Weight management B. Lipid profile C. Cultural needs D. Sleep patterns E. Personal preference
A. Weight management B. Lipid profile C. Cultural needs E. Personal preference
A charge nurse is conducting a nutritional class for a group of newly licensed nurses regarding BMR. The charge nurse should inform the class that which of the following factors increases BMR? (select all that apply) A. lactation B. prolonged stress C. malnutrition D. puberty E. age older than 60 years
A. lactation B. prolonged stress D. puberty
A nurse is performing dietary needs assessments for a group of clients. A blenderized liquid diet is appropriate for which of the following clients? (select all that apply) A. a client who has a wired jaw due to a MVA B. a client who is 24hr postoperative following TMJ repair C. a client who has difficulty chewing due to oral surgery D. a client who has hypercholesterolemia due to CAD E. a client who is scheduled for a colonoscopy the next morning
A. a client who has a wired jaw due to a MVA B. a client who is 24hr postoperative following TMJ repair C. a client who has difficulty chewing due to oral surgery
A nurse is assessing a 6 mo old infant who has a lactose intolerance. Which of the following findings should the nurse expect? (select all that apply) A. abdominal distention B. flatus C. hypoactive bowel sounds D. occasional diarrhea E. visible peristalsis
A. abdominal distention B. flatus D. occasional diarrhea
A nurse is teaching a group of pregnant clients about iron-rich foods. Which of the following foods should the nurse include in the teaching? (select all that apply) A. beans B. fish C. dairy products D. lean red meats E. apples
A. beans B. fish C. dairy products D. lean red meats
A school nurse is teaching a group of teens about healthy snack & food choices. Which of the following foods should the nurse include in the teaching? (select all that apply) A. carrot sticks w/low-fat dip B. cheese & crackers C. unbuttered popcorn D. french fries E. hot dog
A. carrot sticks w/low-fat dip B. cheese & crackers C. unbuttered popcorn
A nurse is caring for a client who has hypothyroidism. Which of the following is associated w/this disorder? A. decreased metabolic demand B. weight loss C. increased HR D. Diarrhea
A. decreased metabolic demand
A nurse is educating parents of a toddler about appropriate snack foods. Which of the following foods should the nurse include in the teaching? (select all that apply) A. graham crackers B. apple slices C. raisins D. jelly beans E. cheese cubes
A. graham crackers B. apple slices E. cheese cubes
A school nurse is teaching a high school health class about the possible causes of a negative nitrogen balance. Which of the following causes should the nurse include in the teaching? (select all that apply) A. illness B. malnutrition C. adolescence D. trauma E. pregnancy
A. illness B. malnutrition D. trauma
A nurse is teaching a group of women about risk factors for developing osteoporosis. Which of the following risk factors should the nurse include? (select all that apply) A. inactivity B. family history C. obesity D. hyperlipidemia E. cigarette smoking
A. inactivity B. family history E. cigarette smoking
A nurse is conducting a nutrition class to a group of women at a local community center. Which of the following info should the nurse include in the teaching? A. progress toward limiting saturated fat to 7% of total daily intake B. good bowel function requires 35 g/day of fiber for women C. limit cholesterol consumption to 400mg/day D. normal functioning cardiac systems depends on B-complex vitamins
A. progress toward limiting saturated fat to 7% of total daily intake
A school nurse is teaching a group of students how to read food labels. Which of the following is a required component of food labels that the nurse should include in the teaching? (select all that apply) A. total carbs B. total fat C. calories D. magnesium E. dietary fiber
A. total carbs B. total fat C. calories E. dietary fiber
A nurse is providing teaching to a client who follows vegan dietary practices. The nurse should instruct the client to ensure he is consuming enough of which of the following nutrients? (select all that apply) A. vitamin D B. fiber C. Ca D. vitamin B12 E. whole grains
A. vitamin D C. Ca D. vitamin B12
• Failure to thrive (toddler)
o Dec distraction during feeding o Cont feed regardless of behavior o Limit fruit juice 4oz/day o Schedule meals @ same time each day o Maintain unhurried meal time 20-30min inc positive eat habit
A nurse is caring for several clients in an extended care facility. Which of the following clients is the highest priority to observe during meals? A. A client who has decreased vision B. A client who has Parkinson's disease C. A client who has poor dentition D. A client who has anorexia
B. A client who has Parkinson's disease This client is at risk for aspiration.
A nurse is collecting data from a client who has PUD. Which of the following findings should the nurse expect? (select all that apply) A. Steatorrhea B. Anemia C. Tarry stools D. Epigastric pain E. Swollen lymph nodes
B. Anemia C. Tarry stools D. Epigastric pain Iron deficiency anemia due to blood loss. Tarry stool due to intestinal bleeding.
A nurse is caring for a client following an appendectomy. The nurse verifies the postoperative rx, which reads, "discontinue NPO status; advance diet as tolerated." Which of the following are appropriate for the nurse to offer the client? (select all that apply) A. Applesauce B. Chicken broth C. Sherbet D. Wheat toast E. Cranberry juice
B. Chicken broth E. Cranberry juice
A nurse educator is teaching a class on culture and food to a group of newly hired nurses. Which of the following statements by a nurse indicates an understanding of the teaching? A. Clients who practice Roman Catholicism do not drink caffeinated beverages B. Clients who practice Orthodox Judaism do not eat meat with dairy products C. Clients who are Mormon eat only the protein of animals that are slaughtered under strict guidelines D. Clients who practice Hinduism do not eat dairy products
B. Clients who practice Orthodox Judaism do not eat meat w/dairy products
A nurse is assessing a client who has hypoglycemia. Which of the following findings should the nurse expect? A. Fruity breath odor B. Diaphoresis C. Ketones in urine D. Polyuria
B. Diaphoresis A client who has hypoglycemia can have diaphoresis and cool, clammy skin.
A nurse is preparing to administer intermittent enteral feeding to a client who has neuromuscular disorder. Which of the following are appropriate nursing interventions? (select all that apply) A. Fill the feeding bag w/24hr worth of formula B. Discard feeding equipment after 24hr C. Leave unused portions of formula at the bedside D. Label the unused portion of the formula E. Elevate the head of the bed for 15min after feeding
B. Discard feeding equipment after 24hr D. Label the unused portion of the formula
A nurse is assessing a client who is postoperative from gastric bypass and who just finished eating a meal. Which of the following findings are manifestations of dumping syndrome? (select all that apply) A. Bradycardia B. Dizziness C. Dry skin D. Hypotension E. Diarrhea
B. Dizziness D. Hypotension E. Diarrhea
A nurse is instructing a client who has celiac disease about foods to avoid. Which of the following foods should the nurse include in the teaching? A. Potatoes B. Graham crackers C. Wild rice D. Canned pears
B. Graham crackers
• Crohn's Disease
o Dec fiber, lactose, fructose o Eat eggs (easily digest & high protein)
A nurse is providing teaching for a client who has a new dx of HTN and a rx for a low-Na diet. Which of the following client statements indicate an understanding of the teaching? (select all that apply) A. I should select organic canned vegetables B. I need to read food labels when grocery shopping C. I will stop eating frozen dinner for lunch at work D. I know that deli meats are usually high in Na E. I can refer to the American Heart Association's website for dietary guidelines
B. I need to read food labels when grocery shopping C. says wrong in but this is an error b/c he states that he will STOP easting frozen dinners D. I know that deli meats are usually high in Na E. I can refer to the American Heart Association's website for dietary guidelines
A nurse is teaching a client who is undergoing cancer tx about interventions to manage stomatitis. Which of the following statements by the client indicates understanding of the teaching? A. I will try chewing larger pieces of food B. I will avoid toasting my bread C. I will consume more food in the morning D. I will add more citrus foods to my diet
B. I will avoid toasting my bread Dry, coarse foods such as toast can worsen the manifestations of stomatitis.
A nurse is reviewing a client health record that includes a report of weight gain in the abdomen and lab findings of elevated blood glucose and elevated triglycerides. The nurse should identify that these findings are manifestations of which of the following conditions? A. Anemia B. Metabolic syndrome C. HF D. HTN
B. Metabolic syndrome
A nurse on an orthopedic unit is reviewing data for a client who sustained trauma in an MVA. Which of the following values indicates the client is in a catabolic state (using protein faster than is being synthesized)? A. Serum albumin 3.5 g/dL B. Negative nitrogen balance C. BMI of 18.5 D. Serum albumin 12mg/dL
B. Negative nitrogen balance A negative nitrogen balance indicates protein is used at a greater rate than it is synthesized as in starvation or a catabolic state following injury or disease
A nurse is teaching a client who is recovering from pancreatitis about following a low-fat diet. Which of the following foods should the nurse recommend? (select all that apply) A. Ribeye steak B. Oatmeal C. Ice cream D. Canned peaches E. Pretzels
B. Oatmeal D. Canned peaches E. Pretzels
A nurse is caring for a client who has DM and is shaky and weak. Which of the following actions should the nurse take? A. Provide subcutaneous insulin for client B. Offer client 120mL (4oz) fruit juice C. Give client IV potassium D. Administer IV sodium bicarbonate
B. Offer client 120mL (4oz) fruit juice The client has manifestations of hypoglycemia. The nurse should offer 10-15g of carbs, which is about how many carbs are in the fruit juice.
A charge nurse is teaching a group of nurses about medication compatibility w/TPN. Which of the following statements should the charge nurse make? A. Use the Y-port on the TPN IV tubing to administer antibiotics B. Regular insulin may be added to the TPN solution C. Administer heparin through a port on the TPN tubing D. Administer vitamin K IV bolus via a Y-port on the TPN tubing
B. Regular insulin may be added to the TPN solution Administering any IV medication through a Y-port on the TPN line is contraindicated. Heparin may be added to the TPN solution to decrease clot formation in the cannula, but it is not injected directly into a port on the TPN tubing. Vitamin K can be added to the TPN solution, but it should not be administered IV bolus through the TPN IV line.
A nurse is discussing health problems associated w/nutrient deficiencies w/a group of adolescents. The nurse should include that which of the following conditions is associated w/a deficiency of vitamin C? A. Dysrhythmias B. Scurvy C. Pernicious anemia D. Megaloblastic anemia
B. Scurvy
A nurse is teaching a client who is starting continuous feedings about the various types of EN formulas. Which of the following should the nurse include in the teaching? A. Formula rich in fiber is recommended when starting EN B. Standard formula contains whole protein C. Hydrolyzed formula is recommended for a full-functioning GI tract D. High-calorie formula has increased water content
B. Standard formula contain whole protein It contains whole protein (milk, meat, eggs) and requires a full-functioning GI tract.
A nurse in an oncology clinic is caring for a client who is undergoing tx for cancer & reports difficulty eating due to inability to taste food. Which of the following interventions should the nurse recommend? A. Avoid citrus juices B. Use plastic utensils to eat C. Eat foods that are warm D. Increase foods high in protein
B. Use plastic utensils to eat
A nurse is educating a client who is taking iron supplements about foods which aid in iron absorption. Which of thefollowing foods is the best choice for the client to make? A. 1 baked potato B. 1/2 cup orange juice C. 1/2 cup low-fat milk D. 2 cups boiled green beans
B. Vitamin C Vitamin C aids in the absorption of iron, and 1/2 cup orange juice has 62mg of vitamin C. This is the best food choice for the client to make.
A nurse is caring for a client who has MS and requires liquids w/honey-like thickness. Which of the following foods can the client consume w/o adding a thickening agent? A. ice cream B. yogurt C. buttermilk D. cream of chicken soup
B. Yogurt
A nurse is assisting a client who has a rx for a mechanical soft diet w/food restrictions. Which of the following are appropriate selections by the client? (select all that apply) A. dried prunes B. ground turkey C. mashed carrots D. fresh strawberries E. cottage cheese
B. ground turkey C. mashed carrots E. cottage cheese
A nurse is caring for a client who is to receive a Level 2 dysphagia diet due to a recent stroke. Which of the following dietary selections is most appropriate? A. turkey sandwich B. poached eggs C. peanut butter crackers D. granola
B. poached eggs A level 2 diet requires foods that are moist and semi-solid.
A nurse in a nutritional clinic is calculating BMI for several clients. The nurse should recognize which of the following client BMIs as overweight? A. 24 B. 30 C. 27 D. 32
C. 27 Overweight BMI = 25-29.9
A nurse is reviewing prescribed medication for a newly admitted client. Which of the following medications decreases the body's rate of metabolism? A. Prednisone B. Levothyroxine C. Amitriptyline D. Epinephrine
C. Amitriptyline Amitriptyline is a tricyclic antidepressant used for treating depression and decreases the body's reat of metabolism.
A nurse is planning care for a client who has mechanical fixation of the jaw following a motorcycle crash. Which of the following actions should the nurse include in the plan of care? (select all that apply) A. Thicken liquids to honey consistency B. Educate the client about the use of nasogastric tube C. Assist client to use a straw to drink liquids D. Ensure that client receives ground meats E. Encourage intake of fluids between meals
C. Assist client to use a straw to drink liquids E. Encourage intake of fluids between meals
A nurse is teaching about diet restrictions to a client who has AKI and is on hemodialysis. Which of the following recommendations should the nurse include in the teaching? A. Limit Ca intake to 2400 mg/day B. Decrease total fat intake to 45% of daily calories C. Decrease K intake to 65 mEq/day D. Limit sodium intake to 4.5 g/day
C. Decrease K intake to 65 mEq/day The client should limit K intake to 60-70 mEq/day. Client on hemodialysis should limit Ca intake to less than 2000 mg/day. The total fat intake should be 35% of daily calories and Na intake should be 1-4 g/day when on dialysis.
A nurse is caring for a client who is transitioning to an oral diet following a partial laryngectomy. Which of the following actions should the nurse take to reduce the client's risk for aspiration? A. Request to have the client's oral medications provided in liquid form B. Instruct the client to follow each bite of food w/a drink of water C. Encourage client to tuck the chin when swallowing D. Consult the dietitian about providing the client with a thin liquid diet
C. Encourage the client to tuck the chin when swallowing
• Gout
o Dec purine foods (organ meats & seafood)
A nurse is caring for an Asian client who has HTN. Which of the traditional Asian dietary patterns places the client at risk for this condition? A. Incorporation of plant-based foods in the diet B. Consumption of raw fruits C. Preparation of foods using sodium D. Focus on shellfish in the diet
C. Preparation of foods using sodium The preparation of foods using sodium places the client at risk for HTN. Many spices in the Asian diet contain sodium, or it is used as a preservative. The client should reduce sodium consumption.
A nurse is assisting a client w/selecting food choices on a menu. Which of the following actions by the nurse demonstrates ethnocentricity? A. asking the client what he likes to eat B. notifying the dietitian to complete the menu C. Recommending one's own favorite foods D. Asking the client's family to fill out the menu
C. Recommending one's own favorite foods
A nurse is collecting data from a client who has suspected HIV-association muscle wasting. Which of the following findings supports this diagnosis? A. BMI 26 B. Fecal impaction C. Report of fever for 30 days D. Report of high alcohol consumption
C. Report of fever for 30 days
A nurse is preparing to administer lipid emulsion and notes a layer of fat floating in the IV solution bag. Which of the following actions should the nurse take? A. Shake the bag to mix the fat B. Turn the bag upside down one time C. Return the bag to the pharmacy D. Administer the bag of solution
C. Return the bag to the pharmacy
A nurse is discussing use of a low-profile gastrostomy device w/the parent of a child who is receiving an enteral feeding. Which of the following is an appropriate statement by the nurse? A. The device can be uncomfortable for children B. Checking residual is much easier with this device C. Tub baths are allowed w/this device D. Mobility of the child is limited w/this device
C. Tub baths are allowed w/this device The low-profile gastrostomy device is fully immersible in water.
A community health nurse is assessing a client who reports numbness of the hands and feet for the past 2 weeks. This finding is associated with which of the following nutritional deficiencies? A. Folic acid B. Potassium C. Vitamin B12 D. Iron
C. Vitamin B12
A nurse is discussing foods that are high in vitamins D with a client who is unable to be out in the sunlight. Which of the following should be included in the teaching? A. 1 cup steamed long-grain brown rice B. 6 medium raw strawberries C. 1/2 cup boiled Brussels sprouts D. 2 large poached eggs
D. 2 large poached eggs The nurse should include eggs as food that is high in vitamin D.
A nurse is teaching a client who has constipation about a high-fiber, low-fat diet. Which of the following food choices by the client indicates understanding of the teaching? A. Peanut butter B. Peeled apples C. Hardboiled egg D. Brown rice
D. Brown rice Unpeeled fruit is a better source of fiber.
A nurse is teaching a client about dietary recommendations to lower high BP. Which of the following statements by the client indicates an understanding of the teaching? A. My daily Na consumption should be 3000mg B. I should consume foods low in potassium C. My limit is 3 cigarettes a day D. I should consume low-fat dairy products
D. I should consume low-fat dairy products
A nurse is caring for a client who is prescribed warfarin. The nurse should teach teh client that which of the following vitamins can interfere with this medication? A. vitamin A B. vitamin D C. vitamin E D. vitamin K
D. Vitamin K Vitamin K assists in blood clotting, is used as an antidote for excess anticoagulants, and can interfere w/warfarin. The nurse should instruct the client to avoid increasing sources of vitamin K through supplements or in the diet.
A nurse is caring for a client who follows a vegan diet. Which of the following foods should the nurse offer the client? A. bagel w/cream cheese B. fried egg C. fruit w/yogurt D. wheat toast w/peanut butter
D. wheat toast w/peanut butter
• Dehydration
o Cont infusion enteral feeding to pv high carb load w/ each IM feed
• Hypermagnesium
o Cx D & cramp
• Hyperkalemia
o Cx V
• Pancreatitis
o Dec Ca o Inc bilirubin o Inc glucose (d/t dec insulin prod by pancreas) o Inc Alk Phos
• Irritable Bowel Syndrome
o Dec High fructose o Inc probiotics o Peppermint oil f/ exacerbations o Glucose is better than fructose (honey)
• DASH diet
o Dec Na to 135-145mEq/L o Glucose 70-110mg/dL o Total cholesterol <200mg/dL
• Solid food w/ 4mo
o 1-2tsp @ each feeding o majority of cal f/ milk o fruit juice starts @ 6mo (limit to 4oz/120mL) o start new food q 4-7days - monitory f/ allergy
• Obese
o 1st tx is 24 diet recall
• Osteomalacia
o 20mcg vit D sup daily o inc antioxidant foods (vit C, E, & beta-carotene) dec free radicals o 15mg vit E f/ antioxidant
• Gastric bypass
o 3 meals & 2 snacks/day - limit portion o begin each meal w/ protein 60-120g/day o eat slowly & stop when feel full
• COPD
o 6 sm meals/day o drinks w/ inc protein/cal between meal o add gravy/sauce to pv dry mouth o soft diet will dec SOB w/ chew
• Hyperlipidemia
o <3g fat f/ cheese o limit egg+yolk to 2-3/wk o 90% lean beef o limit meat to 5oz/day
• Hyperglycemia
o Abd cramps, NV, acetone breath, rapid shallow RR (kussmaul), polydipsia, vomiting, ketonuria
• Calcium
o Almonds highest o Yogurt 315mg o Cheese 214mg o Egg 25mg o Spinach 122mg
• Zinc diet
o BEEF, pinto beans
• Fiber
o Bran cereal 8.8g o Apple w/ skin 3.3g o Banana 3g o Oatmeal 2g o Replace meat entreee w/ main dish peas/beans o Add 2tbs or ¼ cup brain o Leave skin on when eating fruit o Inc fluid intake w/ inc fiber intake
• Nifedipine
o Ca channel blocker o No grapefruit juice d/t inc Rx lvl & inc risk AE
• Electrolyte imbalance
o Dec sodium - confusion, headache, N, dizzy, abd cramp o Inc sodium - confusion, thirst, weakness o Inc phos = dec Ca - numb/tingle, tetany o Dec K - irregular HR, muscle weak, leg cramp, anorexia o Inc K - VD, dysrhythmias, muscle weak o Dec Cl - lack of emotion, anorexia, muscle cramp o Inc Cl - V
• Fluid Overload
o Dilutional hyponatremia <135mEq/dL o Decreased Hct male 42-52% & female 37-47% o Decreased urine specific gravity 1.005-1.030 o Decreased albumin 3.5-5g/dL
• Wt management
o Do not taste food during prep o Portion b4 excluding food o 3-5 meal/day ∴ do not skip o make a list b4 grocery shop o limit sodium to 1500mg/day o lose wt @ ½ to 1lb/week o egg yoly x3/week or < o restric meat to 5oz/day (deck of cards) o cheese <3g fat/serving o butter <2g saturated fat/tbs
• Dumping syndrome
o Drink liquid to slow movement o Complex carbs better than simple o Not associate w/ fat or protein content of food o Lie down after eat to slow food movement via GI o Dec fiber to slow gastric emptying
• Bronchitis
o Enteral feeding - high protein, fat, & calorie; low carbs (breakdown prod CO2)
• Fasting RN ?s
o Exempt f/ fast during illness o Fasting mean no liquids o Fasting certain hours of day o Fasting only apply to certain type(s) food
• Somogyi phenomenon
o Fasting hyperglycemia that occur in morn d/t hypoglycemia @ night o Monitor by check glucose during night
• Cleft lip
o Feed upright o Nipple to side of mouth to pv enter nasal passage
• Lactose intolerance
o Flatulence, bloating, cramping
• Stomatitis
o Food @ room temp to dec irritation o Avoid acidity, citrus, spicy, salty o Drink high cal/protein meal substitutes
• Diabetes mellitus
o Goal HgbA1c <7% - shows avg glucse lvl over past few mo ∴ >7% = not follow diet & avg high sugar lvl
• Inflammatory bowel disease
o Hydrolyzed formula - protein in simplest form for simple digestion o NOT polymeric, milk-based, modular formula
• Constipation
o Inc Ca dec peristalsis
• Cardiovascular
o Inc K to dec risk HTN o Inc fiber to dec cholesterol o Dec trans FA o x2> fatty fish/wk to dec HTN o Limit alcohol & sodium
• Ileostomy
o Inc Na to inc fluid retention to combat fluid loss o Inc pasta/thickening agents o Prep meals on schedule to promote reg BM o B12 necessary to pv anemia
• Mucositis (cancer tx breaks down GI lining)
o Inc fluid intake f/ hydration & peristalsis
• Age-related macular degeneration (AMD) (eyes)
o Inc lutein (carotenoid found in vit A) foods - kale, spinach, collards, mustard greens o Inc antioxidants, vit E & B12
• Parkinson's Disease
o Inc metabolic rate (muscle spasms) ∴ inc cal need o Drooling inc risk dysphagia/aspiration o Levodopa-carbidopa abs dec w/ protein intake ∴ consume w/ low protein (wheat bread) o High protein - yogurt, cheese, peanut butter crackers
• HIV
o Infc s/t HIV tx w/ inc nutrition d/t inc metabolic rate
• Warfarin
o Limit foods rich in vit K (green leafy veggies)
• End-stage kidney disease (ESKD)
o Limit potassium intake d/t dec kidney excretion of K
• Captopril
o Limit potassium rich foods (cantaloupe)
• Cirrhosis + ascites
o Limit sodium intake 2000mg / 2g o Limit fluids to 1.5L o 0.8-1.2g/kg protein pv malnutrition o consume vit K d/t dec prothrombin prod by liver ∴ @ risk clots
• Atorvastatin
o Lipitor (tx high cholesterol) o Okay to take w/ OJ, coffee, milk o Contraindicated w/ grapefruit juice (cx inc serum lvl)
• Folate
o Liver 770 mcg o Chickpeas 141mcg o Orange 47mcg o White bread 47mcg
• Vegetarian
o Low fat cheese f/ protein sup o Low vit b12 d/t lack of animal meat ∴ may req sup o Dec fat rather than cal o Nutrient dense food to avoid protein breakdown f/ energy o x2 servings nuts/flaxseed per day f/ omega 3 FA
• Female dec risk HTN
o Low fat milk o 4-5 servings unsalted nuts o <=1 alcohol/day
• Lipid panel
o Niacin dec LDL & triglycerides o Total cholesterol <200mg/dL o HDL male >45mg/dL & female >55mg/dL o LDL <100mg/dL o Triglycerides <150mg/dL
• Celiac
o No gluten (wheat, barely, rye)
• Kosher
o No pork/shell fish o No combine meat + milk o Can eat meat & milk separate of each other
• Breast feeding
o No water f/ baby ONLY milk o No sup formula d/t nipple confusion o Feed on demand x8-12/day o x5min feed on each breast 1st day after birth o breast milk is all that is needed f/ 1st 6mo (nutritionally complete) o no cow's milk until 1yr o cottage cheese is a complete protein, eat when lactating o incomplete proteins - legumes, peanut butter, & whole grain cereal o storage - discard after feeding (cannot refreeze/use), store f/ 6-12mo, do not thaw in microwave
• Low residue
o No whole gains, fatty meats, high fiber, fruits w/ seeds o Eggs & banana are low residue menu options
• Ramadan
o Only eat during nighttime hours (after sunset) & before dawn o Caffeine prohibited @ any time o Drinks consumed after meals (not with)
• Total parenteral nutrition (banana bag)
o PO must be 60% total cal b4 TPN can be D/C o Must maintain consistent rate o Infuse dextrose 10/20 until next bag arrive d/t high sugar concentration - avoid hypoglycemia o Do not abruptly stop d/t metabolic comp o TPN effective w/ prealbumin 19-38mg/dL o Lipid emulsions made of egg phospholipid ∴ monitor egg allergy
• Dysphagia
o Palpate throat during swallow o High fowler 90 degrees o Assess food pockets o Allow rest b4 meal o Do not hyper extend neck o Neck to chest to pv aspiration o S/s - painful swallow, change in voice o @ risk if drool o do not drink via straw o place food on unaffected side of mouth o limit disruptions during eating o take sm bites o mechanical soft diet - fruits & veggies easy to chew, thickener f/ liquids, altered texture (mashed potatoes)
• Nutrient dense
o Pasta w/ red is better than white o No sweet yogurt o Canned pinto better than refried o Canadian bacon is better than sausage f/ protein
• Enteral (w/in GI) tube feed
o Place in fowlers position o Verify tube placement o Check residual o Flush w/ 30mL water o Admin @ room temp; cold induce cramp/D o Admin @ full strength o Bolus IM feeding over 15-30min o IM feeding over 30-60min o Promote tolerance - inc vol each feeding f/ 1st 4-6hr o Discard open cans in 24hr o Feed in sm, freq o Switch to high cal to pv D o Dec abd distention risk to pv aspiration - ambulate, turn pt on R side (inc GI movement), avoid inc rat, switch to low fat formula (NOT high fat) o If tube clogs switch to less cal dense formula o Tube feeding stops - flush 30-50mL warm water to re-establish flow o Pv aspration w/ monitor gastric residuals q4hr, HOB 30-45 degrees, check tube placement w/ xray once @ beginning o Maintain patency by flushing 30-50mL water b4 & after Rx o Dec D - low fat formula, cont feed, warm b4 admin, dec rate to inc abs
• Glycemic index
o Potato - 90 o Corn - 60 o Macaroni - 45 o Peanuts - 14
• Gero
o Req less cal d/t dec metabolism o Req inc protein d/t inc strength, immune func, heal o Protein intake 20-25% of cal intake o Ca sup w/ meal (inc abs) to maintain healthy bones o Vit D sup d/t dec ability to activate it ∴ @ risk dec Ca level
• Cancer
o Sensitivity to odor ∴ dec aromatic foods to dec NV o Avoid hot foods d/t odor o Sm, freq meals q2hr o Inc citrus food, pickles, & mouth wash to prod more saliva to dec metallic taste o Inc cal & protein but not TOO high cal (cx cancer) o Eat 2.5 cups fruit to maintain wt o Exercise >150min/wk o Limit alcohol male (2) & female (1)/day o Use plastic utensils (dec metallic taste) o Inc fluid & tart f/ taste o Prevention - 4-5 servings (2.5 cups) fruits & veggies/day; limit alcohol; inc whole grain not refined; limit processed meats d/t inc sodium lvl; inc lean cuts w/out skin
• Carbohydrate
o Starchy vs non-starchy veggies o 3-5 carbs/meal (45g) o portion size effects carbs o carb not r/t calorie amt
• Ferrous sulfate (iron)
o Take between meals w/ JUICE o Dec abs w/ eggs, milk, caffeine o Do not take w/ Ca sup d/t dec abs Fe o Inc abs w/ vit C (tomato / orange juice)
• Infec (dec risk w/ chemo)
o Thaw food in fridge, not room temp o Discard leftover after 3-4days o Eat canned goods w/in 1 yr o Cook canned good f/ 10min b4 eat o Heat food >140 degrees
• MAOI Rx
o Tyramine cx HTN crisis (inc BP, headache, sweating) o Cheese has tyramine
• Preggo
o Vegetarian diet okay o Inc protein o Inc iron (30mg sup) o Dec fat/sat fat o Norm wt gain 25-35lb w/ norm BMI o 11-20lb wt gaim w/ abnorm BMI o dec morning sickness - drink/eat separate to dec abd distention, eat carbs to rais sugar quickly & dec N (eat cereal b4 get out of bed), dec fat (inc fat cx delay gastric empty & inc N), no caffeine (l/t heartburn) o Dec constipation - drink 240mL water/day, inc fiber, exercise regularly o Dec NV - eat sm amt food freq
• Braden scale
o Very poor (1) very poor nutrition o Probably inadequate (2) ½ meals & sometimes sup o Adequate (3) >1/2 & refuses sometimes o Excellent (4) eats q meal & between meals
• Vision
o Vit A
• Anorexia nervosa
o Weight pt DAILY @ the same time o Stay w/ pt during and 1hr after meal (pv vomit) o RN sched meals o Privileges based on direct wt gain
• Colostomy
o cx loose stool ∴ thicken w/ pectin o return regular diet 6 wk post op o fiber w/ cx obstruction
• Stress management
o exercise
• Hypoglycemia
o s/s diaphoresis, irritability, tremors, tachycardia, hunger