Nutrition Mastery Quiz RNSG 1324

After teaching the parents of a child with lactose intolerance about the disorder, the nurse determines that the teaching was effective when the mother used which statement to describe the condition? 1. "The lack of an enzyme to break down lactose." 2. "Inability to digest fats completely." 3. "An allergy to lactose found in milk." 4. "Inability to digest proteins completely."

1. "The lack of an enzyme to break down lactose." Lactose intolerance is not an allergy. Rather, it is caused by the lack of the digestive enzyme lactase. This enzyme, found in the intestines, is necessary for the digestion of lactose, the primary carbohydrate in cow's milk. Protein and fat digestion are not affected.

During a prenatal visit, a pregnant client with cardiac disease and slight functional limitations reports increased fatigue. The nurse knows that the client understands the management of the disorder when the client says which of the following? 1. "I will eat my evening meal an hour before bedtime so that digestion can occur while I am resting." 2. "I will eat five or six small meals each day and have some protein with each meal." 3. "I will eat five or six small, nutritious meals each day but with mostly carbohydrates for more energy." 4. "I will eat three meals each day, but will avoid all simple carbohydrates in my diet."

2. "I will eat five or six small meals each day and have some protein with each meal." Digestion of a large meal shunts blood to the gastrointestinal tract, increasing fatigue levels. Clients with this disorder should ingest small, frequent, and nutritious meals five or six times per day. It is not necessary to completely avoid simple carbohydrates. Eating immediately before bedtime can disturb sleep patterns. A pregnant woman with cardiac issues benefits from sound sleep.

A client with chronic renal failure is undergoing hemodialysis. Postdialysis, the client weighs 59 kg. The nurse should teach the client to: 1. control the amount of protein intake to 59 to 70 g/day. 2. increase fluid intake to 3,000 mL each day. 3. increase sodium in the diet to 4 g/day. 4. limit total calories consumed each day to 1,000.

1. control the amount of protein intake to 59 to 70 g/day. Hemodialysis clients have their protein requirements individually tailored according to their postdialysis weight. The protein requirement is 1.0 to 1.2 g/kg body weight per day. Hence, for a 59-kg weight, the amount of protein will be 59 to 70 g/day. Sodium should be restricted to 3 g/day. The client should obtain sufficient calories; if calories are not supplied in adequate amount, the body will use tissue protein for energy, which will lead to a negative nitrogen balance and malnutrition. Fluid intake needs to be restricted. The fluid amount is restricted to 500 to 700 mL plus the urine output.

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client decreases the intake of which foods? 1. fats 2. high-calcium foods 3. high-sodium foods 4. carbohydrates

1. fats Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux.

TPN is ordered for a client with Crohn's disease. The TPN solution is having an intended outcome when: 1. the client's nutritional needs are met. 2. the client does not have metabolic acidosis. 3. the client is in a negative nitrogen balance. 4. the client is hydrated.

1. the client's nutritional needs are met. The goal of TPN is to meet the client's nutritional needs. TPN is not used to treat metabolic acidosis; ketoacidosis can actually develop as a result of administering TPN. TPN is a hypertonic solution containing carbohydrates, amino acids, electrolytes, trace elements, and vitamins. It is not used to meet the hydration needs of clients. TPN is administered to provide a positive nitrogen balance.

The breastfeeding mother of a 1-month-old diagnosed with cow's milk sensitivity asks the nurse what she should do about feeding her infant. Which recommendation would be most appropriate? 1. Limit breastfeeding to once per day, and begin feeding an iron-fortified formula. 2. Continue to breastfeed, but eliminate all milk products from your own diet. 3. Change to a soy-based formula exclusively, and begin solid foods. 4. Discontinue breastfeeding, and start using a predigested formula.

2. Continue to breastfeed, but eliminate all milk products from your own diet. Mothers of infants with a cow's milk allergy can continue to breastfeed if they eliminate cow's milk from their diet. It is important to encourage mothers to continue to breastfeed because breast milk is usually the least allergenic and most easily digested food for an infant. In addition, the infant is able to obtain protein through the mother's milk. If the mother stops breastfeeding, then a predigested protein hydrolysate formula would be the first choice. An iron-fortified formula is a cow's milk-based formula. A soy-based formula is not used because approximately 20% of infants with cow's milk sensitivity are also sensitive to soy. Solid foods are not introduced until the infant is 4 to 6 months of age.

A primiparous client is on a regular diet 24 hours postpartum. She is from Guatemala and speaks only Spanish. The client's mother asks the nurse if she can bring her daughter some "special foods from home." The nurse responds, based on the understanding about which principle? 1. The client's health care provider (HCP) needs to give permission for the foods. 2. The mother can bring the daughter any foods that she desires. 3. This is permissible as long as the foods are nutritious and high in iron. 4. Foods from home are generally discouraged on the postpartum unit.

2. The mother can bring the daughter any foods that she desires. On most postpartum units, clients on regular diets are allowed to eat whatever kinds of food they desire. Generally, foods from home are not discouraged. The nurse does not need to obtain the HCP's permission. Although it is preferred, the foods do not necessarily have to be high in iron. In some cultures, there is a belief in the "hot-cold" theory of disease; certain foods (hot) are preferred during the postpartum period, and other foods (cold) are avoided. Therefore, the nurse should allow the mother to bring her daughter "special foods from home." Doing so demonstrates cultural sensitivity and aids in developing a trusting relationship.

The nurse observes that the client's total parenteral nutrition (TPN) solution is infusing too slowly. The nurse calculates that the client has received 300 mL less than was prescribed for the day. The nurse should: 1. maintain the flow rate at the current rate and document any discrepancy in the chart. 2. assess the infusion system, note the client's condition, and notify the health care provider. 3. discontinue the solution and administer dextrose in 5% water until the infusion problem is resolved. 4. increase the flow rate to infuse an additional 300 mL over the next hour.

2. assess the infusion system, note the client's condition, and notify the health care provider. The nurse's most appropriate action is to assess the infusion system to determine the cause of the inaccurate flow rate and to note the client's response to the decreased infusion, especially signs of hypoglycemia. The health care provider should be notified of the infusion discrepancy. The flow should never be increased without a prescription, nor should large volumes of TPN ever be infused over a short period of time. Too rapid administration of TPN can cause hyperglycemia, electrolyte imbalances, and dangerous fluid shifts. Maintaining the flow rate without notifying the health care provider delays a definitive intervention and does not meet the client's needs. There is no clinical reason to remove the TPN, and TPN should never be discontinued abruptly. If there is a need to temporarily discontinue the TPN, such as when a client is going to surgery or the next bag is unavailable, a 10% dextrose solution should be infused. This prevents a rebound hypoglycemia.

After teaching the client about bottle-feeding, which client statement indicates the need for additional teaching? 1. "Bottle-fed babies up to 6 months of age may gain as much as 1 ounce (30 g)/day." 2. "Iron-fortified formulas are usually recommended for newborns." 3. "Whole milk is an acceptable alternative to formula once the baby is 4 months old." 4. "Bottle-fed babies will usually regain their birth weight by 10 to 14 days of age."

3. "Whole milk is an acceptable alternative to formula once the baby is 4 months old." Neither unmodified cow's milk nor whole milk is an acceptable alternative for newborn nutrition. The American Academy of Pediatrics and Canadian Pediatric Society recommend that infants be given breast milk or formula until 1 year of age. However, the American Academy of Pediatrics Committee on Nutrition has decreed that cow's milk could be substituted in the second 6 months of life, but only if the amount of milk calories does not exceed 65% of total calories and iron is replaced through solid foods. The protein content in cow's milk is too high, is poorly digested, and may cause gastrointestinal tract bleeding. Bottle-fed infants may gain as much as 1 oz (30 g)/day up to age 6 months. Iron-fortified formulas are recommended. Bottle-fed neonates may regain their birth weight by 10 to 14 days of age.

A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is: 1. assessing vital signs every 30 minutes. 2. elevating the head of the bed 60 degrees. 3. monitoring the blood glucose level closely. 4. providing a daily bath.

3. monitoring the blood glucose level closely. Most TPN solutions contain a high glucose content, placing the client at risk for hyperglycemia. Therefore, the most important nursing action is to monitor the child's blood glucose level closely. A child receiving TPN isn't likely to require vital sign assessment every 30 minutes or elevation of the head of the bed. A daily bath isn't a priority.

A client with diabetes who takes insulin has a blood glucose level of 40 mg/dL (2.22 mmol/L). What should the nurse offer the client to begin to raise the blood glucose level? Select all that apply. 1 one tablespoon (15 mL) of peanut butter 2. one-quarter cup (60 mL) of tuna 3. one-half cup (120 mL) of orange juice 4. one cup (240 mL) of milk 5. one-half cup (120 mL) of regular soda 6. one slice of bread

3. one-half cup (120 mL) of orange juice 4. one cup (240 mL) of milk 5. one-half cup (120 mL) of regular soda 6. one slice of bread To treat a low blood glucose level, the nurse should provide the client with approximately 15 g of carbohydrate and monitor the blood glucose level within 15 minutes. The orange juice, milk, bread, or soda would provide approximately 15 g of carbohydrate. Meat or fish, such as tuna, do not contain carbohydrate. Processed peanut butter may contain small amounts of carbohydrate, but it is also high in fat and protein. Peanut butter is not a good option to raise a blood glucose level in a timely manner.

A nurse is teaching the parents of a child with cystic fibrosis about proper nutrition. Which instruction should the nurse include? 1. Encourage foods high in vitamin B. 2. Restrict fluids to 1,500 ml per day. 3. Limit salt intake to 2 g per day. 4. Encourage a high-calorie, high-protein diet.

4. Encourage a high-calorie, high-protein diet. The child should be encouraged to eat a high-calorie, high-protein diet. In cystic fibrosis, the pancreatic enzymes (lipase, trypsin, and amylase) become so thick that they plug the ducts. In the absence of these enzymes, the duodenum can't digest fat, protein, and some sugars; therefore, the child can become malnourished. A child with cystic fibrosis needs to drink plenty of fluid and take salt supplements, especially on warm days or when exercising, to help maintain hydration and adequate sodium levels. Water-soluble forms of the fat-soluble vitamins (A, D, E, and K) are essential.

One month following a subtotal gastrectomy for cancer, the nurse is evaluating the nursing care goal related to nutrition. What indicates that the client has attained the goal? The client has: 1. resumed normal dietary intake of three meals a day. 2. regained weight loss. 3. controlled nausea and vomiting through regular use of antiemetics. 4. achieved adequate nutritional status through oral or parenteral feedings.

4. achieved adequate nutritional status through oral or parenteral feedings. An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of three meals a day. Nausea and vomiting would not be considered an expected outcome of gastric surgery, and regular use of antiemetics would not be anticipated.

The nurse is teaching the mother of a preschool-aged child with celiac disease about a gluten-free diet. The nurse determines that the mother understands the diet if she tells the nurse she will prepare: 1. oatmeal and skim milk 2. wheat toast and grape jelly 3. eggs and orange juice 4. rye toast and peanut butter

3. eggs and orange juic Children with celiac disease cannot digest the protein in common grains such as wheat, rye, and oats. Eggs and orange juice would be appropriate foods.

Parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic enzymes. Which response by the nurse is most appropriate? 1. "Pancreatic enzymes promote absorption of nutrients and fat." 2. "Pancreatic enzymes prevent intestinal mucus accumulation." 3. "Pancreatic enzymes promote adequate rest." 4. "Pancreatic enzymes help prevent meconium ileus."

1. "Pancreatic enzymes promote absorption of nutrients and fat." Pancreatic enzymes are given to a child with cystic fibrosis to aid fat and protein digestion. They don't promote rest or prevent mucus accumulation or meconium ileus.

The nurse is teaching an adolescent with celiac disease about dietary changes that will help maintain a healthy lifestyle. Which of the following foods can the nurse safely recommend as part of the adolescent's diet? Select all that apply. 1. Apples 2. Corn 3. Pizza 4. Bagels 5. Potatoes

1. Apples 2. Corn 5. Potatoes Celiac disease is an intolerance to the gluten factor of protein found in grains. Specific grains to be removed from the diet include wheat, rye, oats, and barley. Clients with a diagnosis of celiac disease can tolerate corn, fruits, and vegetables.

A client tells the nurse during a postpartum parenting class that she has switched her 6-month infant from formula to cow's milk to save money on the cost of formula. Which one of the following statements made by the nurse would be the best? 1. "Cow's milk has higher amounts of iron, which could interfere with blood volume." 2. "Cow's milk can be safely given to an infant older than one year of age." 3. "Powdered formula can be blended with cow's milk to supplement." 4. "Cow's milk has as lower amounts of protein. The infant will need additional amounts of milk to meet the infant's needs."

2. "Cow's milk can be safely given to an infant older than one year of age." The quality and quantity of nutrients in cow's milk differs greatly from those of human milk, and cow's milk does not contain many of the various growth and immunological factors found in human milk. With regard to nutrient content, cow's milk contains great amounts of protein and minerals and smaller amounts of essential fatty acids than human milk. Cow's milk has low iron content, and the iron is poorly absorbed. To lower the risk of iron-deficiency anemia, cow's milk is not recommended before 12 months of age.

A nurse is conducting a nutrition class for a group of teenagers. Which of the following food choices would a nurse encourage this group to consume to increase their dietary fiber content? 1. Baked French fries with ketchup 2. Sandwiches on whole wheat bread 3. Chicken legs with gravy 4. Grape-flavored juice

2. Sandwiches on whole wheat bread The nurse would know that, of the choices provided, the sandwiches on whole wheat bread are the best source of fiber. The other options do not reflect good sources of fiber.

A client is admitted with multiple pressure ulcers. When developing the client's diet plan, the nurse should include: 1. fresh orange slices. 2. ice cream. 3. ground beef patties. 4. steamed broccoli.

3. ground beef patties. Meat is an excellent source of complete protein, which this client needs to repair the tissue breakdown caused by pressure ulcers. Oranges and broccoli supply vitamin C but not protein. Ice cream supplies only some incomplete protein, making it less helpful in tissue repai

Because of religious beliefs, a client, who is an Orthodox Jew, refuses to eat hospital food. Hospital policy discourages food from outside the hospital. The nurse should next: 1. explain alternatives to food such as intravenous fluids that can provide nutrition during hospitalization. 2. teach the client that it is important to eat the food served. 3. encourage the client's family to bring food for the client because of the special circumstances. 4. discuss the situation and possible courses of action with the dietitian and the client.

4. discuss the situation and possible courses of action with the dietitian and the client. The best course of action when a client is not able to eat food that is contrary to religious beliefs is to discuss the situation with the client and the dietitian. Health team members may need to confer about this client's needs. Telling the client that it is important to eat what is served is unlikely to help; the client has already refused the food, and this approach does not address the client's concerns. Encouraging the family to bring suitable food to the hospital may be acceptable. However, the family should not bear sole responsibility for meeting the client's nutritional needs. Health care team members need to seek ways the hospital can address the client's concerns. Suggesting that foods may be replaced with intravenous fluids may be perceived as a threat and is not a realistic solution.

A nurse is providing nutritional teaching for a client with a family history of colon cancer. Which food choice by the client demonstrates an understanding of the correct diet to follow? 1. Egg salad on rye bread 2. Spaghetti and meat sauce 3. Hot dogs and sauerkraut 4. Vegetarian chili

4. Vegetarian chil A high-fiber, low-fat food, such as vegetarian chili, increases gastric motility and decreases the chance of constipation, helping to reduce the risk of colon cancer. The other choices are not representative of a high-fiber, low-fat diet.

TPN is ordered for a client with Crohn's disease. The TPN solution is having an intended outcome when: 1. the client's nutritional needs are met. 2. the client is in a negative nitrogen balance. 3. the client is hydrated. 4. the client does not have metabolic acidosis.

1. the client's nutritional needs are met. The goal of TPN is to meet the client's nutritional needs. TPN is not used to treat metabolic acidosis; ketoacidosis can actually develop as a result of administering TPN. TPN is a hypertonic solution containing carbohydrates, amino acids, electrolytes, trace elements, and vitamins. It is not used to meet the hydration needs of clients. TPN is administered to provide a positive nitrogen balance.

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? 1. Low-fat 2. Full-liquid 3. High-protein 4. 1,800-calorie ADA

3. High-protein Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

A client's nutritional status has been severely compromised through prolonged episodes of nausea and vomiting. Which nutritional therapy will be the most effective in correcting nutritional deficits before surgery? 1. high-protein between-meal nourishment four times a day 2. total parenteral nutrition (TPN) for several days 3. IV infusion of normal saline solution at 125 mL/hour 4. continuous enteral feedings at 200 mL/hour

2. total parenteral nutrition (TPN) for several days TPN bypasses the enteral route and provides total nutrition: protein, carbohydrates, fats, vitamins, minerals, and trace elements. The client is not able to tolerate oral feedings. Enteral feedings would enter the stomach and could increase feelings of fullness, nausea, and vomiting that the client may have had. IV isotonic saline, which contains only water, sodium, and chloride, provides incomplete nutrition.

The nurse is planning care for a client who has been experiencing a manic episode for 6 days and is unable to sit still long enough to eat meals. Which choice will best meet the client's nutritional needs at this time? 1. Offer a bowl of vegetable soup. 2. Offer a green salad topped with chicken pieces. 3. Offer a peanut butter sandwich. 4. Offer to have the family bring in favorite foods.

3. Offer a peanut butter sandwich. Giving the client finger foods that have protein, carbohydrates, and calories supplies energy and allows the client to eat while on the move. A salad or soup is very difficult for the client to eat while moving and may not supply the nutrients needed. Favorite foods from home may or may not be appropriate to eat while walking.

A bottle-fed infant, age 3 months, is brought to the pediatrician's office for a well-child visit. During the previous visit, the nurse taught the mother about infant nutritional needs. Which statement by the mother during the current visit indicates effective teaching? 1. "I started putting cereal in the bottle with formula because the baby kept spitting it out." 2. "I'm giving the baby skim milk because he was getting so chubby." 3. "I started the baby on cereals and fruits because he wasn't sleeping through the night." 4. "I'm giving the baby iron-fortified formula and a fluoride supplement because our water isn't fluoridated."

4. "I'm giving the baby iron-fortified formula and a fluoride supplement because our water isn't fluoridated." Iron-fortified formula supplies all the nutrients an infant needs during the first 6 months; however, fluoride supplementation is necessary if the local water supply isn't fluoridated. Before age 6 months, solid foods such as cereals aren't recommended because the GI tract tolerates them poorly. Also, a strong extrusion reflex causes the infant to push food out of the mouth. Mixing solid foods in a bottle with liquids deprives the infant of experiencing new tastes and textures and may interfere with development of proper chewing. Skim milk doesn't provide sufficient fat for an infant's growth.

The nurse administers fat emulsion solution during TPN as prescribed based on the understanding that this type of solution: 1. promotes effective metabolism of glucose. 2. provides extra carbohydrates. 3. maintains a normal body weight. 4. provides essential fatty acids.

4. provides essential fatty acids. The administration of fat emulsion solution provides additional calories and essential fatty acids to meet the body's energy needs. Fatty acids are lipids, not carbohydrates. Fatty acids do not aid in the metabolism of glucose. Although they are necessary for meeting the complete nutritional needs of the client, fatty acids do not necessarily help a client maintain normal body weight.

What recommendation should the nurse give a family about appropriate beverages for children? 1. Sugary drinks, including juice, should be avoided. 2. Give children whole milk until 5 years of age. 3. It is better to give your child bottled water rather than tap water. 4. Offering sports drinks is the ideal way to provide hydration during physical activity.

1. Sugary drinks, including juice, should be avoided Sugary drinks contain empty calories and considered to be a major factor in the childhood obesity epidemic. Juice should be limited to no more than 120 to 180 mL per day. Water from community sources is more likely to contain fluoride that promotes dental health than bottled water. Sports drinks are considered sugary drinks. Unless a child has had excessive fluid loss, water is all that is needed to stay hydrated during physical activity

The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which menu selection would best meet the client's needs? 1. baked chicken, an apple, and a slice of white bread 2. ham sandwich on rye bread and an orange 3. mixed green salad with blue cheese dressing, crackers, and cold cuts 4. hot dogs, baked beans, and celery and carrot sticks

1. baked chicken, an apple, and a slice of white bread Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in both fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically asymptomatic.

A nurse should encourage a client with a wound to consume foods high in vitamin C because this vitamin: 1. enhances protein synthesis. 2. restores the inflammatory response. 3. enhances oxygen transport to tissues. 4. reduces edema.

1. enhances protein synthesis. The client should be encouraged to consume foods high in vitamin C because vitamin C is essential for protein synthesis, an important part of wound healing. Hemostasis is responsible for the inflammatory response and reducing edema. Hemoglobin is responsible for oxygen transport.

A client is receiving total parenteral nutrition (TPN) solution. The nurse should assess a client's ability to metabolize the TPN solution adequately by monitoring the client for which sign? 1. tachycardia 2. hyperglycemia 3. hypertension 4. elevated blood urea nitrogen concentration

2. hyperglycemia During TPN administration, the client should be monitored regularly for hyperglycemia. The client may require small amounts of insulin to improve glucose metabolism. The client should also be observed for signs and symptoms of hypoglycemia, which may occur if the body overproduces insulin in response to a high glucose intake or if too much insulin is administered to help improve glucose metabolism. Tachycardia or hypertension is not indicative of the client's ability to metabolize the solution. An elevated blood urea nitrogen concentration is indicative of renal status and fluid balance.

In evaluating a client's response to nutrition therapy, which laboratory test would be of highest priority to examine? 1. CBC differential 2. Albumin level 3. Lymphocyte count 4. Serum potassium level

2. Albumin level Protein and vitamin C help build and repair injured tissue. Albumin is a major plasma protein; therefore, a client's albumin level helps gauge his nutritional status. Potassium levels indicate fluid and electrolyte status. Lymphocyte count and differential count help assess for infection.

A client with schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority? 1. Reassure the client that he is safe. 2. Assist the client with feeding. 3. Encourage the client to socialize with his peers. 4. Assist the client with showering.

2. Assist the client with feeding. According to Maslow's hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging.

A client has an order for a clear liquid diet. The nurse is assisting the client to complete a menu. Which of the following would be appropriate for the client to order? 1. Pudding 2. Broth 3. Tea 4. Apple juice 5. Cream soup

2. Broth 3. Tea 4. Apple juice A clear liquid diet includes foods that are clear (that you can see through) and are liquid at room temperature. Apple juice, broth, and tea are clear. Pudding and cream soup would not meet the criteria of clear liquids.

The client with a major burn injury receives total parenteral nutrition (TPN). The expected outcome is to: 1. correct water and electrolyte imbalances. 2. ensure adequate caloric and protein intake. 3. provide supplemental vitamins and minerals. 4. allow the gastrointestinal tract to rest.

2. ensure adequate caloric and protein intake. Nutritional support with sufficient calories and protein is extremely important for a client with severe burns because of the loss of plasma protein through injured capillaries and an increased metabolic rate. Gastric dilation and paralytic ileus commonly occur in clients with severe burns, making oral fluids and foods contraindicated. Water and electrolyte imbalances can be corrected by administration of IV fluids with electrolyte additives, although TPN typically includes all necessary electrolytes. Resting the gastrointestinal tract may help prevent paralytic ileus, and TPN provides vitamins and minerals; however, the primary reason for starting TPN is to provide the protein necessary for tissue healing.

Which intervention should the nurse include in the plan of care to ensure adequate nutrition for a very active, talkative, and easily distractible client who is unable to sit through meals? 1. Direct the client to the room to eat. 2. Offer the client nutritious finger foods. 3. Ask the client about food preferences. 4. Ask the client's family to bring the client's favorite foods from home.

2. Offer the client nutritious finger foods. For the client who is unable to sit through meals to maintain adequate nutrition, the nurse should offer the client nutritious finger foods and fluids that he can consume while "on the run." Foods high in protein and carbohydrates, such as half of a peanut butter sandwich, will help to maintain nutritional needs. Adequate fluid intake is necessary, especially if the client has been started on lithium therapy. Directing the client to his room to eat is not helpful because the client will not stay in his room long enough to eat. Asking the client's family to bring his favorite foods or asking the client about his food preferences is not helpful in ensuring adequate nutrition for the hyperactive client who is unable to sit and eat.

An obese 36-year-old multigravid client at 12 weeks' gestation has a history of chronic hypertension. She was treated with methyldopa before becoming pregnant. When counseling the client about diet during pregnancy, the nurse realizes that the client needs additional instruction when she makes which statement? 1. "I should eat more frequent meals if I get heartburn." 2. "I need to consume more fluids and fiber each day." 3. "I need to reduce my caloric intake to 1,200 calories a day." 4. "A regular diet is recommended during pregnancy."

3. "I need to reduce my caloric intake to 1,200 calories a day." Pregnancy is not the time for clients to begin a diet. Clients with chronic hypertension need to consume adequate calories to support fetal growth and development. They also need an adequate protein intake. Meat and beans are good sources of protein. Most pregnant women report that eating more frequent, smaller meals decreases heartburn resulting from the reflux of acidic secretions into the lower esophagus. Pregnant women need adequate hydration (fluids) and fiber to prevent constipation.

A client is asking about dietary modifications to counteract the long-term effects of prednisone. What is the most appropriate information for the nurse to give the client? 1. "Increase your intake of complex carbohydrates." 2. "Increase your intake of polyunsaturated fats." 3. "Increase your intake of calcium and vitamin D." 4. "Increase your intake of dietary sodium."

3. "Increase your intake of calcium and vitamin D." Problems associated with long-term corticosteroid therapy include sodium retention, osteoporosis, and hyperglycemia. An increase in calcium and vitamin D is needed to help prevent bone deterioration. Dietary modifications need to reduce sodium, maintain high protein levels for tissue repair, and reduce carbohydrates, as there is a tendency toward hyperglycemia. Increased intake of complex carbohydrates is not indicated because of hyperglycemia. There should be decreased fat intake because there is a tendency for central fat deposition.

A student with type 1 diabetes tells the nurse she is feeling light-headed. The student's blood sugar is 60 mg/dL (3.3 mmol/L). Using the 15-15 rule, the nurse should give: 1. 15 g of carbohydrate and 15 g of protein. 2. 15 oz of juice and retest in 15 minutes 3. 15 g of carbohydrate and retest the blood sugar in 15 minutes. 4. 15 mL of juice and give another 15 mL in 15 minutes.

3. 15 g of carbohydrate and retest the blood sugar in 15 minutes. The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes 15 g of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate equals 60 calories and is roughly equal to ½ cup (120 mL) of juice or soda, six to eight lifesavers, or a tablespoon of honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat the sequence. Fifteen milliliters of juice would only provide 8 calories. This would not be sufficient carbohydrates to treat the hypoglycemia. Protein does not treat insulin-related hypoglycemia; however, a protein-starch snack may be offered after the blood glucose improves. Fifteen ounces of juice would be approximately 440 mL—almost four times the recommended 4 oz (120 mL) of juice.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? 1. Restrict potassium. 2. Reduce fat to 10%. 3. Restrict sodium. 4. Increase calories.

3. Restrict sodium. A primary dietary intervention is to restrict sodium, thereby reducing fluid retention. Increased protein catabolism results in loss of muscle mass and necessitates supplemental protein intake. The client may be asked to restrict total calories to reduce weight. The client should be encouraged to eat potassium-rich foods because serum levels are typically depleted. Although reducing fat intake as part of an overall plan to restrict calories is appropriate, fat intake of less than 20% of total calories is not recommended.

The nurse is caring for an infant diagnosed with nonorganic failure to thrive. Which action should be included in the plan of care for the infant? 1. Requiring the parents to attend a community support group prior to discharge 2. Reporting the parents to social services for suspected abuse 3. Weighing the unclothed infant at the same time every day 4. Suggesting to the infant's mother to continue to try to feed the infant even when the infant is crying

3. Weighing the unclothed infant at the same time every day Daily weights are an appropriate intervention for an infant with failure to thrive. It would be inappropriate for the nurse to encourage the mother to continue to try to feed the infant when crying because the infant may develop further aversion to eating. It is also inappropriate to assume that abuse has taken place; there is no information in the stem to suggest this. The parents would benefit from a community support group; however, the nurse cannot require the parents to attend a community support group prior to discharge.

Which meal would be most appropriate for a 15-year-old with glomerulonephritis with severe hypertension? 1. egg noodles, hamburger, canned peas, milk 2. baked ham, baked potato, pear, canned carrots, milk 3. baked chicken, rice, beans, orange juice 4. hot dog on a bun, corn chips, pickle, cookie, milk

3. baked chicken, rice, beans, orange juice The best selection of food would include no added salt or salty food. Because sodium cannot be excreted due to the oliguria and to avoid increasing the hypertension, a low-salt diet is recommended. Most canned foods have sodium added as a preservative. Ham, hot dogs, canned peas, canned carrots, corn chips, pickles, and milk are high in sodium.

A client has been taking prescribed aspirin in large doses and reports having stomach irritation, sometimes with vomiting. Which food or beverage noted from the client's diet history should the nurse suggest the client avoid? 1. scrambled eggs 2. sweetened tea 3. glass of wine 4. dry toast

3. glass of wine Gastrointestinal irritation is a common side effect of aspirin, especially when taken in large doses. Such signs and symptoms as anorexia, nausea, vomiting, diarrhea, and constipation are also common. The combination of aspirin and alcohol is especially likely to cause gastrointestinal irritation, sometimes to the point of doing direct damage to gastric mucosa. Dry toast, eggs, and sweetened tea are not gastrointestinal irritants

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? 1. low-protein, high-potassium 2. high-carbohydrate, high-protein 3. low-protein, low-sodium, low-potassium 4. high-calcium, high-potassium, high-protein

3. low-protein, low-sodium, low-potassium Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

A client with alcohol dependency is prescribed a B-complex vitamin. The client states, "Why do I need a vitamin? My appetite is just fine." Which of the following responses by the nurse is most appropriate? 1. "The amount of vitamins in the alcohol you drink is very low." 2. "Your doctor wants you to take it for at least 4 months." 3. "You've been drinking alcohol and eating very little." 4. "The vitamin is a nutritional supplement important to your health."

4. "The vitamin is a nutritional supplement important to your health." Stating that the vitamin is a nutritional supplement important to the client's health is the best response. The client is nutritionally depleted, and the B-complex vitamins produce a calming effect on the irritated central nervous system and prevent anemia, peripheral neuropathy, and Wernicke's encephalopathy. Although the statements about drinking alcohol and eating very little and that there is a low amount of vitamins in the alcohol consumed may be true, they fail to address the client's concerns directly and fail to provide the necessary information, as does telling the client that the doctor wants the client to take the vitamin for 4 months.

A nurse is administering total parenteral nutrition (TPN) to a client hospitalized with severe anorexia nervosa. Which laboratory finding would alert the nurse to a potential problem? 1. Elevated phosphate level 2. Elevated glucose levels 3. Decreased CD4 cell counts 4. Decreased magnesium level

4. Decreased magnesium level A decreased magnesium level indicates continued malnutrition problems; the prescribing physician or an advanced practice nurse would have to adjust the chemical composition of the TPN. Elevated glucose levels are expected in a client receiving TPN because of the high concentration of glucose being administered. A client with anorexia nervosa is at risk for a decreased, not elevated, phosphate level. A decreased CD4 cell count is a laboratory value associated with a diagnosis of human immunodeficiency virus or acquired immunodeficiency syndrome, not with a diagnosis of anorexia nervosa.

Which adverse effects occur when there is too rapid an infusion of TPN solution? 1. hypokalemia 2. hypoglycemia 3. negative nitrogen balance 4. circulatory overload

4. circulatory overload Too rapid infusion of a TPN solution can lead to circulatory overload. The client should be assessed carefully for indications of excessive fluid volume. A negative nitrogen balance occurs in nutritionally depleted individuals, not when TPN fluids are administered in excess. When TPN is administered too rapidly, the client is at risk for receiving an excess of dextrose and electrolytes. Therefore, the client is at risk for hyperglycemia and hyperkalemia.

What type of diet should the nurse teach the parents to give an older infant with cystic fibrosis (CF)? 1. low-protein diet 2. high-fat diet 3. low-carbohydrate diet 4. high-calorie diet

4. high-calorie diet CF affects the exocrine glands. Mucus is thick and tenacious, sticking to the walls of the pancreatic and bile ducts and eventually causing obstruction. Because of the difficulty with digestion and absorption, a high-calorie, high-protein, high-carbohydrate, moderate-fat diet is indicated.

A client is recovering from a gastric resection for peptic ulcer disease. Which outcome indicates that the goal of adequate nutritional intake is being achieved 3 weeks following surgery? The client: 1. drinks 2,000 mL/day of water. 2. experiences occasional episodes of nausea and vomiting. 3. experiences a rapid weight gain within 1 week. 4. increases food intake and tolerance gradually.

4. increases food intake and tolerance gradually. Weight gain will be slow and gradual because less food can be eaten at one time due to the decreased stomach size. More food and fluid will be tolerated as edema at the suture line decreases and healing progresses. The remaining stomach may stretch over time to accommodate more food. Nausea and vomiting can interfere with nutritional intake. Water provides hydration, but not calories and nutrients. Rapid weight gain may be due to fluid retention and would not reflect adequate nutrition.