Nutrition

A postoperative client has been tolerating a full liquid diet, and the nurse plans to advance the diet to solid food as prescribed. Which assessment is most important for the nurse to make before advancing the diet to solids?

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

The nurse has a prescription to give 30 mL of an antacid to a client through a feeding tube. Which is the priority nursing action?

1 Assess tube placement. Although each of the actions in the options is important, evaluation of tube placement is the priority to prevent aspiration and to ensure that medication delivery will be in the stomach.

A client has been given a prescription for gemfibrozil. The nurse should instruct the client to limit which food while taking this medication?

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

The nurse is evaluating a client's ability to select food items for a low-potassium diet. Which food item, if selected by the client, would indicate an understanding of this diet?

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

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

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

The home care nurse is visiting a male client who is recovering at home after suffering a brain attack (stroke) 2 weeks ago. The client's wife states that the client has difficulty feeding himself and difficulty with swallowing food and fluids. Which would be the initial nursing action?

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

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

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

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

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

The breast-feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. The nurse should tell the mother to avoid which food?

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

The nurse is providing instructions to a client regarding food items that are high in vitamin D. The client demonstrates understanding of the instructions by stating the need to include which food item in the diet?

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

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

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

The nurse is providing dietary instructions to a client with a diagnosis of hyperphosphatemia. The nurse determines that the client understands the instructions if the client states the importance of eliminating which item from the diet?

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

The nurse is giving a presentation on good nutrition to a group of teenage mothers. Which level of prevention is the nurse implementing?

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

A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The primary health care provider prescribes an enteral tube feeding of a standard formula to run at 40 mL/hr. A nursing student is assigned to care for the client, and the nursing instructor asks the student to describe the nursing considerations related to a tube feeding. Which statement, if made by the student, indicates an understanding of this dietary treatment?

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

A client is diagnosed with a moderate case of acute ulcerative colitis. The nurse doing dietary teaching should give the client examples of foods to eat that represent which therapeutic diet?

4.Low fiber without milk The client with a mild to moderate case of acute ulcerative colitis often is prescribed a diet that is low in fiber and does not include milk. This will help to reduce the frequency of diarrhea for this client. The remaining options are incorrect diets and may cause discomfort for the client.

The nurse is teaching a client with tuberculosis about nutrition and foods that should be increased in the diet. The nurse should suggest that the client increase which food items?

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

The nurse is providing dietary instructions to a client about the food items that are high in vitamin K. Which food item does the nurse recommend as being highest in vitamin K?

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

The nurse is administering a bolus feeding through nasogastric (NG) tube. Which position should the nurse use for the client after the tube feeding?

3 Fowler's on the right side Following a tube feeding, the head of the bed should be elevated for 30 to 60 minutes to prevent vomiting and aspiration, a complication of a tube feeding. The right lateral position uses gravity to facilitate gastric emptying, which also will reduce the risk of vomiting. The flat supine position should be avoided after a tube feeding.

The nurse is instructing a client with hypertension on the importance of choosing foods low in sodium. The nurse should teach the client to limit intake of which food?

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

The nurse is planning to teach a client with malabsorption syndrome about the necessity of following a low-fat diet. The nurse develops a list of high-fat foods to avoid and should include which food items on the list? Select all that apply.

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

The nurse instructs a client with chronic kidney disease who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu?

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

The nurse is providing dietary instructions to a client regarding a high-protein diet. The nurse should instruct the client to consume which food item that is highest in protein content?

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

The nurse is teaching a client who has iron deficiency anemia about foods she should include in the diet. The nurse determines that the client understands the dietary modifications if which items are selected from the menu?

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

Which actions should the nurse include when caring for a client with continuous tube feedings through a nasogastric (NG) tube? Select all that apply.

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

The nurse provides instructions to a client with a low magnesium level about the foods that are high in magnesium. The nurse should tell the client to consume which foods? Select all that apply.

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

The nurse instructs a client who is at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines that the client understands the food sources of potassium if the client states that which food items are lowest in potassium, providing less than 200 mg per serving? Select all that apply.

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

The nurse is providing discharge dietary teaching to a client with a history of irritable bowel syndrome (IBS). What comment made by the client tells the nurse that further instruction is needed?

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

The nurse is providing dietary instructions to a client about food items that are high in niacin. Which food item should the nurse recommend as highest in niacin?

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

The nurse has conducted dietary teaching with a client diagnosed with iron deficiency anemia. The nurse instructs the client that which food item is a good dietary source of iron?

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

The nurse should include which item in a list of the most helpful foods for a vegan client wishing to increase foods high in vitamin A?

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

The nurse is providing instructions to a client with hypophosphatemia. Which food item should the nurse instruct the client to avoid?

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

The nurse is monitoring the nutritional status of a client receiving enteral nutrition. Which intervention should the nurse implement to determine the effectiveness of the tube feedings?

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

The school nurse is providing a nutritional counseling session to a group of adolescents. The school nurse should instruct the adolescents that which item is a good source of vitamin C?

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

A client with hypertension has been prescribed a low-sodium diet. The nurse teaching this client about foods that are allowed should plan to include which food in a list provided to the client?

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

The nurse is providing dietary instructions to a client about food items that are high in vitamin C. Which food item does the nurse recommend as being highest in vitamin C?

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

The nurse is providing instructions to a client with kidney disease about a low-protein diet. The client demonstrates understanding of the dietary instructions by stating the need to limit which food in the diet?

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

A client who was receiving enteral feedings in the hospital has been started on a regular diet and is almost ready for discharge. The client will be self-administering supplemental tube feedings between meals for a short time after discharge. The client expresses concern about performing this procedure at home. What is the nurse's best response?

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

A breast-feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. What foods should the nurse tell the mother are acceptable to consume while breast-feeding? Select all that apply.

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

A breast-feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. What foods should the nurse tell the mother are acceptable to consume while breast-feeding? Select all that apply.

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

The nurse has given dietary instructions to an older female client to minimize the risk of osteoporosis. The client demonstrates understanding of the dietary teaching by stating that she will increase intake of which food?

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

The home care nurse is conducting a diet history with an older client who lives alone. The nurse finds that the client's typical 24-hour food intake consists of eggs and sausage for breakfast, a fast-food lunch of hamburger and french fries, takeout fried chicken for dinner, and ice cream in the evening. To decrease the risk of cancer, what statement would the nurse make to the client?

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

The nurse has instructed a client in the foods that are best to consume on a low-fat diet. The nurse determines that the client understands this diet if the client indicates which food item is lowest in fat?

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

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

4 Legumes The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Legumes are especially rich in this vitamin. Other good food sources include nuts, whole-grain cereals, and pork. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid.

A client with hypertension has been told to maintain a diet low in sodium. The nurse who is teaching this client about foods that are allowed should include which food item in a list provided to the client?

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

The nurse is providing a dietary session to a group of clients about the vitamin content of various foods. The nurse should tell the clients that which food item is highest in vitamin A?

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