Nutrition Final

Malnutrition associated with deficient protein intake can cause a variety of symptoms. Which symptom might cause a nurse to suspect a patient has malnutrition associated with deficient protein intake?

Moon face Third spacing of fluid from decreased oncotic pressure can be because of low albumin and other proteins in the blood from protein malnutrition. Remember this effect can happen with diseases that cause decreased synthesis of proteins by the liver or increased excretion of protein from the blood. Cirrhosis is an example. We need to look at many parameters when we assess patients because symptoms can occur for more than one reason and we don't want to pick the wrong one!

Guidelines and diet texture alterations for dysphagia are individualized according to the patient's ability to swallow. In general, some textures and consistencies are more difficult to swallow or have a higher risk of aspiration than do others. Which liquid consistency is associated with the highest risk of aspiration compared with other liquid consistencies?

Thin liquids - consistency of water In general, thin liquids are most easily aspirated compared with other liquids because of how they are handled in the mouth during the ingestion and swallowing processes

Intake of fish should be avoided during pregnancy because of the negative risk of high intake of mercury on fetal brain development. true/false

false Following the guidelines for safe intake of fish during pregnancy is advised - not the avoidance of fish. Intake of low mercury fish provides a good source of DHA (docosahaexanoic acid) that is needed for brain/ retinal development in the fetus and infant.

If an athlete complains to you about muscle cramping following intense exercise during a hot, humid day, which mineral should you first suspect as the cause of this symptom?

Sodium

A patient with protein calorie malnutrition can experience altered drug effects (potential for drug toxicity) as a result of their poor protein status. Explain why.

Some drugs bind with protein for transport in the blood. A poor protein status leads to diminished blood proteins, such as albumin and globulin, to bind with these drugs. The result could be an increase in unbound (or free) drug that may lead to toxic drug effects.

A patient presents to the emergency department with an elevated blood alcohol concentration (BAC), hypoglycemia, and is suspected of abusing alcohol. Which micronutrient will automatically be prescribed to this patient to avoid precipitating a nutrient deficiency when IV dextrose (glucose) is given?

Thiamine Used in the metabolism of both alcohol and carbohydrates- abuse of alcohol can cause diminished thiamin status, which would slip into a thiamin deficiency when carbohydrate in the form of IV dextrose is given. Wernicke-korsakoff syndrome could result with permanent cognitive deficits due to thiamin deficiency

Using the protein swap system, calculate how many grams of protein are in this meal. 5 oz turkey burger with 1 oz cheese melted on top one hamburger bun 2 TBSP catsup 1-1/2 cups of French fries 1 cup milk one orange

49 grams Burnger (6 swaps, 42 gn) Bun (0) Catscup (0) Fries (0) Milk (1 swap, 7 gm) Orange (0)

Anabolism examples

Adolescent growth spurt Pregnancy Body building

One function of carbohydrate is to 'spare protein'. Explain what this term means in your own words. How would you explain it to a patient?

Spare protein means that carbohydrate keeps protein from being sacrificed as a fuel source. Carbohydrate provides 4 calories/ gm and a source of glucose, which many cells in the body require for fuel. If there is insufficient carbohydrate intake, protein from the diet (and eventually the body if there is not enough in the diet) gets broken down to make glucose, getting sacrificed as fuel instead of used as the building block that it should be in the body. Think about what might happen to a patient with a large wound that needs lots of protein to heal if their protein is getting sacrificed as fuel...would the wound heal as it should? Imagine how you would explain the importance of adequate carbohydrate to a patient in this situation.

Sarcopenia, or loss of muscle associated with aging, is a concern with the older adult. Which of the following statements is true regarding the older adult and sarcopenia

Spreading protein servings over the day in ~20 gram increments can trigger muscle protein synthesis

When conducting a patient assessment, the nurse should assess for risk factors for poor nutrition. Poor calcium status can occur for many reasons. All of the following statements except one reflect a risk factor for poor calcium status. Choose the statement that is not a risk factor for poor calcium status.

Substitution of fortified almond milk in place of cow's milk in the diet

Elevated blood cholesterol can be lowered with dietary management. Which of the following recommendations is NOT part of the recommendations to lower serum cholesterol?

Switching to snack foods that contain palm oil instead of corn Oils liquid at room temperature (expection of tropical oils because they are high in saturated fat) fats that are solid or semi-solid at room temperature indicate saturated fat

Minerals can chelate several drugs and cause them to not be absorbed. List one drug or class of drug that is an example of this effect

Tetracyclines Levothyroxine Thyroxine Fluoroquinolones Tetracycline

An expectant mom, who is planning on breastfeeding her baby, has been avoiding fish because of mercury concerns. She read online that a special fat in fish called DHA helps with brain development in babies and now is confused about what to do. What advice can you offer to her?

Assure her that she can enjoy up to two to three servings of low mercury fish a week

Sweat rate calculation helps in making a plan to maintain fluid balance in the athlete. Which answer describes how sweat rate is calculated?

Athlete is weighed in dry clothing after voiding both before and after exercise

A client has had two rounds of chemotherapy and experienced severe nausea with the second round. What action could the nurse suggest to minimize nausea with the next round of treatment?

Avoid foods with a strong odor They trigger nausea

It is not always convenient or quick to measure a patient's height when conducting a nutrition assessment. And, sometimes a patient is not able to stand to have height measured. Which of the following techniques is an acceptable and valid method to use in adults for gathering information under these circumstances?

Recumbent length can be measured be sure to note in your documentation that recumbent length and not standing height was used. Recumbent length is typically greater than standing height because of the relaxation of the spine while lying flat.

List one nursing intervention that you could practice when feeding a cognitively impaired older adult.

Place the food in front of the patient so that they know it is presented to them. Offer a calming setting with music, or something to help the patient relax. Follow the correct feeding techniques.

Read the section in your textbook Chapter 20: Weight Management that outlines assessment, including the boxes and tables. Answer the CT? (critical thinking question) in Table 20-1 here.

Please know that as nurses you have a huge responsibility to not contribute to weight bias/stigma. From research, we know that people who are obese often encounter weight bias and stigma by clinicians and in turn, this experience can lead to avoidance of healthcare/lack of follow-up and create a vicious cycle that perpetuates the problem.

In addition to educating school-age children about healthy eating, list one more action the school nurse can take to help prevent the development of eating disorders.

Be a role model by not exhibiting weight bias Be a role model by not discussing dieting or weight around children Discuss how the 'thin ideal' (meaning thinking the thinner the better) is not conducive with health Educated students on media literacy topics so they learn to critically evaluate the images they view

Which of the following is NOT a good source of protein -Skin milk -tofu -lentils -peanut butter -brown rice

Brown rice

The Recommended Dietary Allowance (RDA) for iron during pregnancy is 27 mg/ day, an increase from 18 mg/ day for women of childbearing age. Which reason is the best explanation a nurse should give to a woman who wonders why she needs to consume more iron than usual?

Poor iron status in the mother can contribute to risk of delivery a low birth weight baby An increase in vascular volume during pregnancy and the iron requirements/ stores for the developing fetus are additional reasons. Adequate intake of iron by the expectant mom helps babies to be born with sufficient iron stores to last up to 6 months. A low iron intake by the expectant mom can result in an infant with low iron status.

Fetal alcohol syndrome can occur in a child due to alcohol consumption by the mother during pregnancy. What is the daily number of 'standard drinks' that is felt to be safe during pregnancy to avoid this condition?

None

A patient tells the nurse that they are taking red yeast rice to help with their elevated cholesterol after they had some side effects from the traditional statin drugs used to treat hypercholesterolemia. What would be an appropriate response by the nurse?

Red yeast rice has the same side effects as statin drugs

How many "carbohydrate choices" are in this meal? Grilled cheese sandwich made with two pieces of sliced whole wheat bread, 1 cup plain yogurt with 1 cup of raspberries stirred in. Vitamin Water 16 oz. poured from large bottle < label says it has 15 gm carbohydrate in 8 oz.>?

seven two slices of bread (2) yogurt (1) fruit (2) Vitamin water (2)

Choose which scenario is an appropriate application of the Recommended Dietary Allowance recommendation. This example is for vitamin B-12

the new vegan who no longer consumes animal foods RDA is for healthy people with no deficiencies or nutrient risks due to health conditions

The US Dietary Guidelines together with the MyPlate icon outline healthy eating recommendations. All of the following are recommendations contained in these guidelines except one. Which statement is incorrect?

our plates should be 1/3 veggies Veggies + fruits should be 1/4

Some minerals can cause altered heart rhythm if blood levels of the mineral are low. Name two.

magnesium potassium Potassium K Ca calcium Magnesium Calcium Mg

A five-year-old patient and their parent are meeting with the nurse following the child's diagnosis one month ago with multiple food allergies. Allergies to milk, seafood, soy, and peanuts were discovered. The parent reports considerable worry because the child seems to be eating less than usual since milk, yogurt, cheese, and peanut butter were consumed daily in their diet and it has been hard to find safe foods to replace them. The nurse weighs the child and finds a weight loss of three pounds in one month. Which response by the nurse is the most appropriate reply to the parent and addresses the concerns presented here?

"I can tell you are worried. Let's brainstorm some ideas today and also consider a referral to our dietitian"

Using the carbohydrate counting system, calculate the number of grams of carbohydrate in this entire meal. A pasta salad with 2 cups pasta 1 cup cooked broccoli 1/2 cup cooked peppers 4 oz of cubed cheese 2 TBSP of oil and vinegar dressing A small pear 8 oz of 100% fruit juice

120 2 pasta (4 choices, 60 gm) veggies (1 choice, 15 gm) Pear (1 choice, 15 gm) Juice (2 choices, 30 gm)

A nurse is discussing alcohol intake and heart health with a female patient who has a low HDL-cholesterol and is trying to manage both her weight and elevated blood triglycerides. Which statement by the nurse fits current recommendations for alcohol for this specific patient?

Alcohol can boost your blood triglyceride level, just like sugars do

Antiretroviral treatment (ART) is a central part of the treatment of HIV infection and includes protease inhibitors. Which of the following statements is NOT true regarding these medications and nutrition?

All classes of antiretroviral medications need be taken on an empty stomach and this recommendation causes many clients to skip meals Drugs vary in their requirements of whether they are taken with or without food.

A patient who cannot swallow is on a tube feeding and their oral medications will have to be adjusted as a result. Which of the following scenarios presents a problematic example of why the nurse may need to consult with a pharmacist regarding drug administration when caring for a patient being tube fed?

All examples are problematic Fushing the feeding tube with water following the administration of a fluoroquinolone antibiotic and then restarting the feeding Crushing an extended-release form of a drug and mixing it with water to administer via the feeding tube Administering an enteric coated drug orally to maintain its enteric coating property Administering phenytoin (Dilantin) via a jejunostomy tube (J-Tube)

Which volume represents the total daily recommended intake of fluid for the average female adult?

Almost three liters /day

Which of the following statements is true regarding the use of dietary supplements during cancer treatment?

Antioxidants, like vitamin C, may interfere with the effects of radiation treatment

Gastric bypass surgery, also known as Roux-en-Y or Billroth II, has the potential to cause poor nutritional status of some micronutrients. Patients who have had this surgery require life-long monitoring or supplementation of several micronutrients. Name one nutrient deficiency that these patients at risk of developing.

B12 calcium Iron vitamin d

New parents or caregivers might ask the nurse for advice about introducing solid food into an infant's diet. Which of the following statements is evidence-informed advice that the nurse can offer?

Babies can be offered a rotation of cereals made from different grains as their initial solid food

A patient on a clear liquid diet needs to understand what is considered a clear liquid and what is not a clear liquid. The nurse would need to re-educate the patient who is found consuming one of the following items. Which item is not part of clear liquid diet?

Black tea with a teaspoon of milk Milk is not a clear liquid - you cannot see through it - and is not part of a clear liquid diet. Black tea with milk would not be included on this diet. The care team should be notified if the patient was prescribed a clear liquid diet as part of a bowel preparation in case the milk consumption affects an upcoming procedure.

A blood albumin level is a common laboratory test in the clinical setting. Which statement about using this lab test in a nutrition assessment is FALSE?

Blood albumin is an excellent way to assess a patient's current protein nutrition status The half-life of albumin is about three weeks so it does not give a current picture of nutrition status. Plus, albumin levels can be affected by non-nutrition factors, such as liver disease.

A patient with cirrhosis asks the nurse about using an herbal supplement that they read about online as having healing properties for liver disease. Briefly explain an appropriate response by the nurse that addresses the question and provides education to the patient.

Buyer beware! Because there is no pre-market safety testing for dietary supplements and because there have been too many case reports of adulteration and contamination of supplements, there is no way to assure that it is safe to take a dietary supplement. And, because many dietary supplements are metabolized in the liver, just as drugs are, the risk is high that a supplement could affect hepatic health. On top of that, there is research showing that some supplements are associated with risk of liver failure - see p 536 in textbook and the Livertox link in Canvas resource page.

You are educating a patient who has hypertension about sodium and blood pressure. Pretend you only have two minutes to give some general advice that the patient can use to make future dietary decisions. In only one or two sentences, explain to the patient (in a general, overarching way) how they can reduce their sodium intake.

Choosing foods close to their original form, such as plain meats/poultry, fish; fruits and vegetables; whole grains; milk and yogurt; healthy oils can keep sodium intake below 2,300 mg/ day. Check and compare food labels for sodium content when making choices to help minimize intake of sodium from processed foods (convenience/ canned) and pickled foods.

Mixing energy drinks and alcohol is a health risk. Which answer explains the reason this practice of mixing the two together is not recommended?

Caffeine gives the drinker a false sense of unimpaired motor skill ability Blood alcohol concentration (BAC) is unaffected by mixing alcohol and energy drinks together - the BAC will be the same compared with the same amount of alcohol and no energy drink. However, the person who consumed the mix will have a false sense that their BAC is lower because they also will perceive the central nervous stimulant effect of the caffeine.

During adulthood, the daily recommended intake for some nutrients increases after age 50 years. Fill in the blanks and list two nutrients that fit this description. After age 50 years, the daily recommended intake for _____ and _____ increases.

Calcium and vitamin D

A thorough nutrition assessment is crucial at the pregnant female's first prenatal visit, with follow up assessments done over the course of the pregnancy. When caring for a 15-year-old pregnant female, which of the following statements is NOT accurate information to consider when doing the nutrition/ nursing assessment?

Calcium needs in the pregnant teen are not increased compared with those of a 25 year old pregnant female

You are providing a patient with nutrition education and explaining the importance of consuming whole grains. The patient asks you how to know if a food is considered a whole grain. Which suggestion would be an accurate response?

Check the ingredient listing for grains with the word "whole" or a grain closest to its original form

Why is a low-fat diet not recommended for very young children?

Children are still undergoing brain development up to age 2 years and require a full fat diet for both brain and central nervous system components. Children can slowly phase into the recommendations on reduced intake of saturated fat after the age of two years in accordance with the US Dietary Guidelines.

Your post-operative patient is eating poorly, picking at pudding and jello and otherwise drinking the Ensure nutrition drink delivered with their meals. Given what you know about wound healing and nutrition, what is the best advice you could offer to this patient? (Your answer need not be too long)

Consuming the proper amount of protein is essential to heal the wound. You need protein for your bodies structure and support systems. Also, proteins help with antibodies to prevent infection. Carbohydrates are your fuel for your body. If you do not have enough, your body will not have the energy to get better and heal your incision, causing the potential for complications.

Health promotion and disease prevention are important nutritional health goals in adulthood. List the name of one dietary pattern or diet that is associated with a decreased risk of chronic diseases.

DASH/Mediterranean/plant based/vegan We know from research that a more plant-based type of dietary pattern is associated with decreased risk of many chronic diseases, including cardiovascular disease, hypertension, type 2 diabetes, obesity, and some cancers

Diarrhea is a common complaint in patients and can occur from several conditions, such as inflammatory bowel disease, treatment with chemotherapy, radiation to the abdominal area or enteropathy from HIV-AIDs. What dietary manipulations may help with this symptom?

Decreasing intake of lactose-containing foods A short-term trial can be done to see if this manipulation is helpful. If it does not work, no need to continue w restriction.

A client with HIV infection is taking antiretroviral medications, including a protease inhibitor. The client now expresses concern about body image and the central fat accumulation from lipodystrophy that is occurring. The patient wants to know what dietary interventions are effective in alleviating this problem. What advice can the nurse offer?

Dietary interventions have not been shown to significantly alter the fat distribution found in this condition

Name the three broad risk factors for poor nutrition status the nurse should consider with every nutrition assessment. What three questions do you ask yourself about the patient when determining if a patient is potentially at risk for poor nutrition? (The answer to this question is in your micronutrient lecture slides).

Does the patient have: 1) decreased intake for any reason? 2) altered absorption or excretion of any nutrient for any reason? 3) a condition that causes increased nutrient needs that are not be met?

Many different nutrition screening tools exist. Which statement about these tools is accurate?

Each nutrition screening tool is developed for use with a set population Be sure to use a tool that was developed for the population you are screening. Tools are not valid for use in other populations.

An elderly patient with end-stage chronic obstructive pulmonary disease (COPD) has been transferred to the medical floor from critical care. What strategy can the nurse suggest to this client who is experiencing dyspnea, fatigue, and early satiety?

Eat small, frequent meals to minimize effort and energy expended during eating

Prevention or treatment of overweight and obesity in children is important since excess weight can lead to health consequences into adulthood. Which of the following is an appropriate intervention for the nurse to suggest to a concerned parent of an overweight child?

Encourage the parent to follow a healthy eating pattern even though they are at a healthy weight

The gold standard for determining energy expenditure is indirect calorimetry, but that technology is expensive and not always available in every setting. There are multiple equations that are used to determine energy expenditure. Online apps and tools use some of these formula as do clinicians who do not have access to indirect calorimetry. Which of the following is a limitation or drawback to using these equations?

Equations have a high margin of error because they were developed for a set population but are used on the general population Research was limited to set populations - such as fit, healthy weight people - and then the formula are used in populations such as the critically ill or the obese where there has been limited validation of the equations.

The Recommended Dietary Allowance (RDA) for carbohydrate is 130 gm/ day for non-pregnant/lactating adults and children because this amount of intake provides sufficient carbohydrate for muscle activity and other body functions that require glucose.

False That is the minimum needed for brain function, need more than that for other functions depending on activity level.

Which of the following is true about mineral status in the body?

Excess intake of some minerals can lead to a deficiency of other minerals because some minerals compete with each other for absorption Minerals do compete for absorption - especially the divalent cations (2+ charged). The effect is magnified with supplements vs foods because of the high dose of a nutrient in a supplement. And, the effect is of more consequence in the patient already at risk for low mineral status. For example: poor iron intake or a diagnosis associated with altered absorption/excretion of iron.

A preoperative nutrition assessment reveals that a client is taking various vitamins and minerals in dietary supplement form that were recommended by their healthcare provider. Which supplement explanation should the nurse use to explain why a particular supplement should be discontinued prior to surgery?

Excessive vitamin E causes altered blood clotting EFG supplement that interferes with blood clotting and causes a surgical complication

A patient tells you that 'carbohydrates are bad' and they are trying to consume no carbohydrate in their diet. In your own words, explain the importance of carbohydrate to the patient

Explain the functions carbohydrates have, especially in providing fuel to the brain and sparing protein. Also explain what happens when the diet lacks carbohydrate - how protein is broken down and sacrificed as fuel and how that can affect muscle building or healing if there is not enough protein left over for those functions.

Research has proven that any caffeine intake during pregnancy is associated with an increased risk of delivering a low birth weight baby. For this reason, it is recommended that pregnant women completely avoid caffeine intake during pregnancy. true/false

False The recommendation for caffeine intake during pregnancy is to consume less than 200 mg/ day. Higher intakes are associated with lower birth weight, but difficulties in accurately assessing caffeine intake and genetic differences in caffeine metabolism make research on this topic difficult to interpret.

Dieting during adolescence is linked with improved body image and lowered risk of overweight in adulthood. true/false

False

The body is capable of adjusting mineral absorption rate when someone has a mineral deficiency and this adjustment corrects the deficiency true/false

False Body can adjust absorption rate to some degree, but not enough to eliminate the risk of deficiency. For example, the body does boost the absorption rate of iron when there is a deficiency state, yet iron deficiency is still a prevalent issue across the lifespan.

Fructose in a piece of fruit is a simple sugar and the amount of fruit consumed per day should fall within the recommendation for added sugar intake. true/false

False Fructose is a natural sugar, there is no recommendation for intake of natural sugars because this is present in foods with abundant nutrients

A clear liquid diet contains adequate calories to meet the needs of most hospitalized adults and can be prescribed for up to one week without concern true/false

False A clear liquid diet provides fluid for hydration and some carbohydrate to keep the patient out of ketosis. It is nutritionally deficient and should not be prescribed for a week without seeking a nutrition consult in the interim.

Claims on the front of a package such as "rich in vitamins" or "made with less sodium" indicate that the food is a healthy option true/false

False Claims on the front of the package do not give a clear picture. Read the Nutrition Fact Panel and the ingredients instead. Foods that claim they are "rich in vitamins" can still be high in added sugar, saturated fat, and sodium. The vitamins could have been added as ingredients and not naturally found in the product, which could be a processed food. "Made with less sodium" is meaningless - less sodium that what? The Nutrition Fact Panel is the place to look to learn how much sodium is in a product.

An essential amino acid is an amino acid that the body can synthesize using metabolic byproducts found in the body's amino acid pool True/false

False Essential amino acids are essential to the diet because the body cannot synthesize them

Administration of a 15% intravenous dextrose solution (D15W) via a peripheral vein is an advisable way to provide carbohydrate calories to the patient who on PPN (peripheral parenteral nutrition). true/false

False Intravenous dextrose solutions above a 10% concentration (D10W) will cause an influx of fluid into a peripheral vein and 'blow the vein' as it is called - leading to phlebitis. In some patients, even the 10% solution is problematic

The Food and Drug Administration (FDA) requires a warning on dietary supplements that lists possible side effects or safety concerns for pregnant females or children. True/false

False NO warnings are required even when side effects are known about a dietary supplement

Wearing heavy clothing to increase sweating during exercise is a helpful way to burn more calories and lose fat. true/false

False, it can contribute to increased sweat losses, but these losses are only water and NOT fat

The requirement for daily iron intake remains unchanged for males from age five years through adulthood. true/false

False- Iron requirements increase during adolescence to 11 mg/ day to compensate for the development of increased muscle mass and blood volume. From age 19 years on, the iron requirement in males decreases to only 8 mg/ day.

A low blood calcium level is an early warning sign of a calcium deficiency true/false

False- low blood calcium is seldom indicative of nutrition status and instead indicative of a medical concern that is affecting calcium homeostasis/regulation in the body

Why might an older female patient experience a higher blood alcohol level than a younger male who consumed the same amount of alcohol?

Females produce less alcohol dehydrogenase Females do produce less alcohol dehydrogenase - plus with age, older women have less total body water - which would affect the concentration of alcohol in the body.

Clogged enteral feeding tubes are a nuisance and can happen easily. Which of the following practices by the nurse will help to decrease the risk of a feeding tube becoming clogged?

Flushing the feeding tube with water before and after administration of medications This practice is important. If residual feeding formula is in the tube, it can form a precipitate with medications. The opposite is also true - if residual medication is in the tube and feedings are resumed, a precipitate can form. Flushing with water reduces the chance of a precipitate forming and clogging the tube

"Nutrients of concern" exist with each lifespan population and should be a focus when conducting a nutritional assessment. When conducting a nursing assessment of a woman of childbearing age who hopes to have a child soon, what is one vitamin or mineral that is a "nutrient of concern" that you should be sure to address in the nutrition portion of your assessment?

Folate Folic acid iron Calcium

A patient, who is trying to avoid catching a cold from family members, purchases a bottle of orange juice that states it "supports a healthy immune system" and tells the nurse that this claim is because vitamin C prevents a cold. Which answer is the best response for the nurse to offer to the patient?

Food and supplement labels can make claims about a healthy structure or function in the body. This type of claim does not mean the product can prevent or treat a disease

The family of a client with a Stage IV exudative pressure ulcer asks the nurse for some ideas about foods that they could bring in to offer to the patient. Which ideas are the best ones for the nurse to suggest to the family?

Foods with high protein content, such as pudding or custard, because protein is being lost through the wound and is needed for healing

Adequate folic acid intake during pregnancy is crucial and plays a role in decreasing the risk of neural tube defects. Which of the following statements is accurate information for the nurse to relay to a patient who shares that they hope to become pregnant sometime soon.

Gluten-free products often lack fortification with folic acid In the US, products made from white flour are mandated to contain folic acid fortification - specifically for the purposes of providing a source of the vitamin to women of child-bearing age in hopes of decreasing the incidence of neural tube defects. This fortification mandate has been successful in that goal. Gluten-free products contain no wheat and are not mandated to be fortified in any way.

Gastroparesis is a condition that results in slowed gastric emptying. List one dietary interventions that the nurse should suggest to a patient who has been diagnosed with this condition.

Good glycemic control in patients who have diabetes Small frequent meals - a smaller volume will take less time to empty than a larger volume Low fat - fat causes slowed gastric emptying Low fiber - fiber increases the risk of bezoars, an undigested food mass that can lead to an intestinal blockage Solid food may be tolerated earlier in the day and a switch to more liquid meals later in the day- this advice is reserved for more extreme symptoms where gastric emptying is very prolonged. Some patients tolerate solid foods at the start of the day and then gastric emptying slows later in the day. Liquids empty more quickly from the stomach than do solids Liquid or pureed food items - this advice is reserved for more extreme symptoms where gastric emptying is very prolonged. Liquids empty more quickly from the stomach than do solids Oral liquid nutrition supplements or a tube feeding in more extreme cases- in some circumstances a feeding tube is placed that extends into the duodenum to bypass the stomach to avoid the issue of delayed gastric emptying

A client has gastroesophageal reflux (GERD) and is complaining of increased symptoms at night when going to bed despite acid reduction medications. The nurse suspects that one of the following new habits is responsible for the symptoms. Which habit should the nurse advise the patient to stop?

Having a beer after dinner each night while watching television Alcohol and carbonation both increase GERD

A father is asking the nurse when he can introduce solid foods into the diet of his baby. How should the nurse respond? Briefly explain two things: 1) the timing you would suggest and 2) why this timing is appropriate.

I would suggest starting solid foods no earlier than four months and no later than six months, depending on your child's development. They should be able to sit up, grasp things, and have tongue and jaw control as signs of readiness for solid foods. If they are premature, use the date of full term to determine when four to six months would be. This is important because they need to be able to have the skills developed to chew and not choke on the food, as well as to make sure they are getting proper nutrients and introduction to foods.

List one example of a risk factor for iatrogenic malnutrition - either list something that you can think of based on your reading or have seen occur in the clinical setting.

Iatrogenic malnutrition means 'caused by medicine' - so it is malnutrition that happens because of a stay in the hospital, medical treatment or poor clinical practices. Examples include missed meals for procedures or because of interruptions, tube feedings that are held, prolonged NPO status, a diet that does not meet the patient's personal preferences and results in diminished intake, side effects from a drug or treatment that impact nutritional intake

A patient is scheduled to have an assessment of their energy expenditure using indirect calorimetry. Which of the following statements by the nurse is NOT accurate advice to give the patient as they prepare for this assessment?

If you are going to smoke, have your last cigarette no closer than one hour before the assessment Nicotine elevates basal metabolic rate and it is recommended that the patient not smoke/ use nicotine patch or other form of nicotine for at least 140 minutes before the test.

Thermal or burn injuries are among the most nutritionally demanding physiological stressor to the body, meaning nutritional requirements are very elevated. What is the reason for this metabolic effect?

Inflammation, heat loss, and tissue destruction cause hypermetabolism All these factors are present with a thermal injury and each one causes an increase in nutritional needs

Picky eating and food jags are common in young children and are developmentally appropriate behaviors. List one idea you could offer a concerned caregiver who is worried about this concern and wants their child's intake to improve.

Involve the child in shopping and meal preparation Give the child a choice between two foods that are both good choices Continue to offer small portions of new foods for the child to try Ignore the food jags as long as the child is growing healthfully Notice whether the picky eating is due to the food texture and offer the food in another form Notice whether the picky eating is due to any physical complaints - but don't ask the child directly about a particular symptom. Instead you can say "tell me how you feel when you eat xyz"

If a patient has lowered gastric acid production from medications, aging, or gastric resection, it could cause reduced absorption of two minerals. List the two minerals affected by this situation.

Iron calcium iron Calcium Calcium + iron benefit from acidic pH in the stomach

Many nutrients are required for a wound to heal properly. Which of the following is true regarding nutrition and wound healing?

Iron is required to delivery oxygen to the wound site

A client who had gastric bypass surgery to treat morbid obesity is experiencing Dumping Syndrome. What suggestion can the nurse make to the patient to help lessen symptoms?

Lie down after eating Lying down helps to combat the effects of gravity on gastric emptying.

What is the recommendation by the Dietary Guidelines for Americans and the World Health Organization (WHO) regarding intake of added sugars in the diet?

Limit intake to less than 10% of total calories per day

The nurse working in a HIV clinic is asked for information on food safety by a patient who is planning to travel to an all-inclusive tropical resort. Which advice is accurate for the HIV infected patient?

Local fruits are safe as long as you wash and peel them yourself Key point here is doing the washing and peeling yourself with clean hands.

Waist circumference measurement is a part of the nursing nutrition assessment for metabolic syndrome. How can the nurse obtain this information?

Locate the patient's iliac crests and use them as a guide to measure the waist circumference at those points

Malnutrition is an important concern that can impact patient outcomes. Which of the following statements is untrue about the effects of malnutrition in the hospitalized adult?

Malnutrition is linked with an altered BMI-for age While malnutrition can affect weight and therefore BMI, BMI-for-age is not a parameter used in the assessment of adults. BMI-for-age is used only in pediatrics - because children are still growing.

The Recommended Dietary Allowance (RDA) for protein is the daily amount of protein recommended for which person?

Middle-aged adult who is very sedentary No stated medical or nutriton condition that would warrant a recommendation other than the RDA meant for healthy people to maintain nutrient status

You are working in a pediatric practice and are asked to speak with the parents of a toddler newly diagnosed with a milk allergy. The family has an appointment with a dietitian in two weeks and is worried about what to do in the meantime. What advice is the most important for the nurse to give this family at this time?

Milk can be a hidden ingredient in food so every food label must be checked, even flavorings

1) What effect would it have on nitrogen balance calculations if a patient mistakenly did not use the collection jug even once while urinating over 24-hour the collection period? 2) How could the nurse emphasize the importance of adhering to accurate urine collection? (meaning: what would you say to the patient?)

Missing any urine in the 24 hr collection would yield a falsely lower value of protein in the urine. Lower protein in the collection would alter the math equation for nitrogen balance making it falsely look like more protein was retained for anabolism. The mistake would mistakenly make the healthcare team think the patient had a better nutrition status than they actually did The nurse could emphasize to the patient the importance of an accurate collection so that the team would know whether the patient was getting adequate protein to improve their health/ heal a wound/ recover from a trauma or illness/ build muscle (or whatever the nutrition goal is for the patient related to protein intake)

Energy drinks are popular, especially with teens and young adults. Which statement about energy drinks is accurate information that the nurse can share with a patient?

Mixing energy drinks with alcohol is associated with an increased risk of binge drinking

A breastfeeding mom who is living in a homeless shelter is concerned that her infant is not consuming adequate breastmilk. What can the nurse advise the mother easily track each day to best assess whether or not the baby's daily intake has diminished? Fill in the blank: The mother can track _______________ each day.

Number of wet diapers

Over-nutrition and under-nutrition are not mutually exclusive conditions. Both of these conditions can exist together in a patient and we should not assume that just because a patient exhibits signs of over-nutrition that they are not at risk of undernutrition. In two words, list the term used to describe the presence of both over-nutrition in the form of obesity along with nutritional deficiencies or under-nutrition in the same patient?

Obesity paradox or double burden

Older adults in general are at a higher risk of dehydration than are younger adults. Which answer best describes the main reason for this risk in the older adult population?

Older adults have lower total body water because of reduced muscle mass

Early satiety in the older adult can have a negative impact on nutrition status. List one nursing intervention to improve dietary intake that you could suggest to a patient who is experiencing this symptom.

Oral nutrition supplements as well as nutrient dense foods with more calories per bite. Cream soup instead of clear and ice cream instead of jello.

**Not important Read "Interaction Action: Why ask about dietary supplements?" feature box on page 208 in the textbook. List one new thing you learned from this reading.

Over half of organ donation recipients use one or more supplements despite the risk that is has on them. This is something that I never knew, I assumed people would adhere to the protocol very strictly. I would assume this would be talked about more as there is such a big risk of rejection and toxicity to the patient/recipient.

Despite the fact that fiber is not absorbed by the body, it is essential in the diet for several purposes. Which of the following is a function of fiber in the diet?

Promotes laxation

If someone consumes adequate protein intake, but lacks intake of adequate calories, what metabolic consequence could occur as a result?

Protein form the diet will be sacrificed to be used as energy *the body uses carbs first, protein second Used for fuel instead of as a building block

Which statement about protein digestion and absorption is accurate?

Protein is absorbed in the small intestine after bring broken down to peptides and amino acids We do not absorb whole proteins and instead need protein broken down to di/tri peptides and amino acids

A patient with hepatitis read online that high protein intake can lead to hepatic encephalopathy and so has cut back on consumption of protein-containing foods. When the patient shares this information with the nurse, what is the best response for the nurse to give?

Reduced protein intake will lead to breakdown of skeletal muscle and other proteins in the body, which can impair the repair of inflamed hepatocytes in this patient Any condition with 'itis' means inflammation - and an inflamed liver requires healing in order to help prevent the development of scar tissue (which is what cirrhosis is - scar tissue in place of healthy hepatocytes). So, a patient who has hepatitis needs a high protein/ calorie diet to meet the needs for healing. Plus, it will compromise all the other important functions of protein in wellness.

List one suggestion that the nurse can offer to help improve nutrition intake using oral liquid nutrition supplements (such as Ensure or Boost).

Serve liquid supplements cold - not a room temperature Serve liquid supplements at least an hour away from any meal time Use liquid supplements in place of other fluids when passing medications - as long as there is not a drug-supplement interaction (careful!) Vary flavors of liquid supplements to avoid taste fatigue

"If the gut work, use it!" is a statement that describes the advice to use the gastrointestinal (GI) tract to feed a patient when possible instead of parenteral (intravenous) nutrition. What is the rationale for this advice?

The intestinal barrier becomes permeable when the gut is not used and bacteria can travel from the GI tract to the peritoneal cavity Bacterial translocation is when bacteria move from the gut to the peritoneal cavity or to organs and can cause inflammation and infection. Not using the GI tract causes the gut wall to be 'leaky' and allow the bacteria to travel

What is sarcopenia

The loss of muscle mass associated with aging Body does not react as well to protein and they are not able to create protein molecules as well as they once were

The majority of probiotics are regulated as dietary supplements - not medications - and are touted in the popular press as treatment for many conditions. Which of the following is a true statement about the scientific evidence available for probiotic use?

The majority of research findings on probiotics are in agreement that probiotics are effective in treating diarrhea associated with antibiotic use Alert: If a patient is on tetracycline or a fluoroquinolone antibiotic and chooses to get their probiotics from fermented dairy - like yogurt - be sure that you educate them about chelation and the correct spacing of timing of the dose of the antibiotic from the timing of the ingestion of yogurt.

In general, older adults are at increased risk of dehydration compared to younger adults. Which of the following describes a primary reason for this risk in the older adult population?

The older adult has lowered total body water because of sarcopenia Less muscle mass results in less total body water. The older adult has less total body water than a younger counterpart and therefore more easily can slip into dehydration when any increase fluid losses or lowered intake occurs - such as with GI losses, extreme heat and increased sweating, or diminished intake.

You are a nurse working in an obstetrics practice and during your nursing assessment learn that your patient who is six months pregnant is following a very low carbohydrate diet. You know that the Recommended Dietary Allowance (RDA) for carbohydrate is increased during pregnancy. What information should you share with the patient?

The pregnant female needs increased carbohydrate intake to provide needed glucose for the fetus

Health recommendations about alcohol intake use the terminology of a "standard drink". Why are recommendations given in terms of a "standard drink"?

The total grams of alcohol is the same for each standard drink The "standard drink" allows for comparison of actual grams of alcohol consumed since health effects are linked to the 'dose' of alcohol consumed (meaning grams of alcohol). Drinks vary in alcohol content/ percentage/ portion and this method allows for comparison between different types of drinks while keeping in mind their actual alcohol content in a set serving

A family is visiting the pediatrician for a well-visit for their 2.5 year-old and 6 year-old children. While the nurse is doing an assessment, the family shares that they think the 2.5 year-old child is not eating enough and that meal time is a battle to get the child to eat more. The 6 year-old eats plenty and their intake is not a concern to the family. The adults serve meals portioned out on each person's plate and then brings the plate to the table. The two children are served the same portions as one another. Which response is the most appropriate for the nurse to offer to the family?

The younger child only needs a portion of about two to three tablespoons of each food to be considered a serving In young children, a TBSP per year of age is an appropriate portion for any food. So a 2.5 year old and a six year old can be served different portions - and then the child can decide how much to eat or if they want more.

What is the American Academy of Pediatrics recommendation regarding offering children fruit juice?

Too much can fill them up and displace more nutritious foods in the diet, and extra calories

Catabolism examples

Trauma Burn injury Surgery

Glucose is the simple sugar that circulates in our blood stream. In the hospital, glucose is given in the intravenous form called dextrose true/false

True Dextrose is a form of glucose, the simple sugar that all carbohydrates are broken down into for use in the body

Joking around about weight and making weight comments to a child or adolescent can contribute to later risk of disordered eating and eating disorders in the person. true/false

True- A weight focused environment - whether presented as jokes, teasing or even lots of body talk/ diet talk - sets the stage for risk of all types of disordered eating/eating disorders.

Even with adequate intake by the mother, the vitamin D content of breastmilk is insufficient to meet the needs of the infant. true/false

True- Infants require a vitamin D supplement right from birth. If the baby is being formula-fed, the formula will contain vitamin D. If the baby is breastfed, the baby should be given a liquid vitamin D supplement that contains the recommended amount.

You are a nurse working in a gastroenterology practice. A new patient reports feeling sick after drinking a glass of milk and thinks they better give up on having any dairy foods in the future. What is the best first advice to give this patient who gets diagnosed with lactose intolerance during the office visit?

Try a small amount of yogut instead of milk Smaller portions or fermented dairy

Lactose intolerance is a common condition. What is the best initial dietary advice the nurse can offer to the patient who complains of feeling sick after drinking a glass of milk?

Try consuming a small amount of yogurt instead of milk Since lactase enzyme activity is use-it-or-lose it, consuming a small amount of food that is a fermented food with lactose is an often well-tolerated way to maintain some level of lactose tolerance

Dietary supplements may interact with medications. Some cause increased or decreased drug effect. Others have similar effects to a medication, which potentiates the medication effect. Which dietary supplements alter platelet aggregation and could have negative consequences when taken in large doses or along with medications that already affect blood clotting?

Vitamin E, fish oil, gingko, garlic

A teenager suspected of having an eating disorder reports that the slight bowing of her legs just occurred in the last week and must be from the vegan diet she started the prior week. When documenting in the medical record, which statement by the nurse is the best assessment of the findings?

Vitamin deficiencies do not manifest symptoms quickly in cells that turn over slowly in the body, such as bone. Fat soluble vitamin deficiencies, such as vitamin D, take months and months to manifest themselves usually. And, bone turns over slowly. The combination of these two factors makes it unlikely that the deficiency symptoms sprouted up in a week.

Body Mass Index (BMI) is used to screen patients for overweight, obesity, and underweight. What other anthropomorphic tool is useful to use along with a BMI to better assess the patient than BMI alone?

Waist circumference or body composition

Weight gain recommendations during pregnancy differ among women. List one reason that weight gain recommendations might be higher for one woman compared with another woman?

Weight gain recommendations are based on pre-pregnancy weight. Females who are underweight need to gain more weight compared with those at a healthy weight or overweight. Additionally, females at higher risk of delivering a low birth weight baby are recommended to gain more than women of low risk. High risk categories include teens and Black women.

Assessing cultural, including religious, influences on nutrition is an important step in every nutrition assessment. In assessing a patient newly diagnosed with hypertension, which statement best reflects a way to begin this portion of the assessment?

What would you like me to know about your dietary practices? Start the conversation broad and no assumptions

Some patients require varying levels of feeding assistance during meals. Which of the following practices should be avoided when providing feeding assistance?

When hand feeding a cognitively impaired individuals, sit at eye level and mix together the pureed peas and mashed potatoes to facilitate intake Never mix together foods when feeding a patient unless a patient has let you know that is their preference. Consider the visual appeal of a food and how mixing together foods - especially on a pureed diet - creates a very unappealing meal.

A gluten-free diet is the only treatment for celiac disease. Which of the following foods is allowed on a gluten-free diet?

Winter squash baked with quinoa quinoa does not contain gluten and is a good option for a gluten-free diet Barely, malt, and wheat germ all contain gluten

Which explanation below correctly describes why symptoms of poor protein nutrition include ascites and pedal edema?

alters oncotic pressure

You are a nurse working in a college health clinic. A 21-year-old student who has type 1 diabetes asks you about what the recommendation is for drinking alcohol with diabetes. Which response is the appropriate answer?

consume alcohol only with food and when blood glucose is controlled

Offer two ideas to a patient who consumes very little fiber on how to improve fiber intake. Be specific (meaning: do not write 'consume more fiber at breakfast' or similar general statement - list specific ideas that a patient could follow and not be left with questions about what you mean)

consume fruit with skin or seeds, like apple or berries choose a whole grain breakfast cereal have half the dinner plate filled with vegetables keep edible skin on any fruits or vegetables (like apple, pear, baked potato, zucchini) snack on whole grain crackers or popcorn choose some bean-based dishes, such as black bean or lentil soup or add chickpeas to a salad try to have five servings total of fruits and vegetables per day

Sarcopenic obesity is considered a nutritional challenge in the older adult. Any older adult with sarcopenic obesity should receive nutrition education about how to lose weight. true/false

false Each patient should be individually assesses to determine whether or not the benefits to losing weight are greater than any associated risks. In the older adult, too much or too quick of a weight loss could result in loss of muscle and worsened sarcopenia that could lead to functional decline. Additionally, a restrictive diet could lead to diminished nutrient intake.

Someone's basal metabolic rate (BMR) is influenced by many factors. What factor influences BMR more than any other factor?

fat. free body mass / lean body mass/ muscle mass Muscle or lean body mass is what contributes the most to our basal metabolic rate. Someone's body size may indirectly influence BMR for this reason but not all people of the same size have the same amount of muscle. Energy expenditure or physical activity are not part of BMR since basal metabolic rate is defined as the energy expended for body functions/ organ functions while at complete rest.

It is suggested that the daily recommended intake for vitamin B12 in the adult over age 50 years be met by consuming a synthetic form of vitamin B12, such as is found in a dietary supplement or fortified food. What is the rationale for recommending a synthetic form of this vitamin?

gastric acid production diminishes with age and synthetic vitamin B-12 absorption does not require an aciditic gastric environment Gastric acid product does diminish with age. And, an acid stomach is needed to cleave the B12-protein bond found in natural sources of vitamin B12. Synthetic sources do not have this bond.

Adequate protein in the diet is essential for muscle-building. Name one other function of protein in the body.

healing pH balance energy enzymes hormones immune function growth and development fluid balance calories blood components

You are a school nurse teaching a high school health class about added sugar. Which of the following statements is NOT true about added sugars?

honey contains essential B-vitamins and is great to use in baking because it is not considered added sugar

The 24-hour recall is often used as part of a nutrition assessment. List one criticism of this tool.

subjective - subject to the patient's ability to recall and to accurate portion-telling subject to social/reporting bias - patient's want us to like them, not judge them and so may give us a perceived 'right' answer vs the real answer to a question. Research tells us that some folks over-report healthful foods like fruits and vegetables and under-report alcohol. a one day snapshot that may not reflect usual intake

You are teaching a patient how to spot added sugar on a food label. In addition to watching for the word 'sugar' on the ingredient label, list one other ingredient that is considered an added sugar.

sucrose honey high fructose corn syrup anything ending in ose brown sugar syrup