quizzes nutrition
A student has a calorie requirement of 1,600 kcals/ day. Which amount of added sugar is the limit for their recommended intake each day? 40 grams 50 grams 60 grams 30 grams 80 grams 20 grams 70 grams
40 grams
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
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? A. Blood albumin is an excellent way to assess a patient's current protein nutrition status B. Plasma proteins can decrease with infection C. Plasma proteins can decrease with liver disease D. Blood albumin is more reflective of overall health than nutrition status
A
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? A. Dietary interventions have not been shown to significantly alter the fat distribution found in this condition B. Increased consumption of whole grains will speed up cholesterol metabolism C. Limiting intake of saturated fats will promote weight loss and decrease symptoms D. Cosmetic surgery is not covered by insurance, but will permanently remove the accumulated fat, especially around the dorsocervical area and trunk
A
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? A. The younger child only needs a portion of about two to three tablespoons of each food to be considered a serving B. Allow the 2.5 year-old to choose alternative food from the refrigerator if they do not like dinner C. A 2.5 year-old child only needs 1,400 kcalories a day since they are not in a growth spurt D. Encourage the 2.5 year-old to consume more vegetables by promising a fun game after dinner for anyone who eats all their vegetables
A
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.
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.
The UL for sodium consumption is 2.3 gm per day to maintain a normal sodium intake and high sodium can increase blood pressure. I will give you a pamphlet on low sodium food alternatives such as unsalted nuts and you should check labels to make sure the sodium is 140 mg or less per serving.
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 nine six eight four five
seven
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
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
Adequate protein in the diet is essential for muscle-building. Name one other function of protein in the body.
pH balance calories blood components healing immune function hormones enzymes fluid balance growth and development energy
anabolism and catabolism: Adolescent growth spurt
anabolism
anabolism and catabolism: pregnancy
anabolism
All of the following are good sources of protein except one choice. Which food is not a good source of protein? peanut butter tofu skim milk lentils brown rice
brown rice
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?
0
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)
1. Do you like fruits and vegetables? Those would be great foods to eat to consume more fiber. Apples, pears, and bananas are great options. 2. Foods that are closer to their original form have more fiber than processed foods. For example, fruits that have the skin still on them such as apples have more fiber than without the skin. Whole grains also have more fiber than processed grains, so switching from white bread to whole wheat bread would be a great idea to consume more fiber.
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).
1. is there a risk of decreased intake of the nutrient? 2. is there a risk of decreased absorption or increased losses of the nutrient by the body? 3. is there a risk of increased needs of the nutrient that are not being met?
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 135 grams 120 grams 90 grams 75 grams 150 grams 105 grams
120 grams
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? A. If you are going to smoke, have your last cigarette no closer than one hour before the assessment B. Arrive at the assessment at least 30 minutes ahead of time so you can rest before the test starts C. Avoid intake of a meal in the four hours prior to the test D. Avoid taking any dietary supplement with bitter orange for at least four hours before the test
A
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? A. "Excessive vitamin E causes altered blood clotting" B. "Excessive thiamin causes increased uptake of glucose and hyperglycemia" C. " Excessive vitamin B-12 causes altered cognition that could affect anesthesia" D. " Excessive iron (Fe) causes constipation"
A
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? A. Vitamin deficiencies do not manifest symptoms quickly in cells that turn over slowly in the body, such as bone. B. Bowed legs are more likely to become apparent following a teenage growth spurt and low iron status C. A vegan diet can lead to vitamin B-12 deficiency, which quickly causes bone changes by affecting erythropoietin production in bone marrow D. Bowed legs are a symptom of vitamin D deficiency and so it is likely that this recent vegan diet caused rickets
A
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? A. Calcium needs in the pregnant teen are not increased compared with those of a 25 year old pregnant female B. Pregnancy weight gain guidelines for a teen are higher than those of a 25 year old pregnant female of the same weight as the teen C. Weight gain guidelines for teens follow the BMI categories used for adults D. Linear growth of the pregnant young teen may be negatively affected by poor diet
A
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? A. What would you like me to know about your dietary practices? B. You need to watch out for sodium. I see in your chart that you were born in China. Do you use low-sodium or regular soy sauce? C. Please tell me what your people believe about the effect of diet on high blood pressure. D. Please tell me about special foods you typically eat to celebrate Easter.
A
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? A. Promotes laxation B. Prevents toxins from accumulating in the liver C. Assists gallbladder in excreting bile D. Aids in the absorption of minerals
A
Health recommendations about alcohol intake use the terminology of a "standard drink". Why are recommendations given in terms of a "standard drink"? A. The total grams of alcohol is the same for each standard drink B. The standard drink portion varies depending on calorie content of the beverage C. The total percentage of alcohol is the same for each standard drink D. The standard drink portion is the usual volume consumed for the beverage
A
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? A. Recumbent length can be measured B. Ask the patient how tall they are C. Use an infantometer to measure length D. Double the measured leg length
A
Many different nutrition screening tools exist. Which statement about these tools is accurate? A. Each nutrition screening tool is developed for use with a set population B. Nutrition screening tools are for use only in the in-patient setting C. Nutrition screening tools provide a quick way to do a full nutrition assessment D. Each nutrition screening tool includes documentation of the patient's weight
A
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? A. Encourage the parent to follow a healthy eating pattern even though they are at a healthy weight B. Track calorie intake and energy expenditure in the child to make sure they expend more calories than they consume C. Minimize intake of carbohydrates in the form of breads and pastas as those foods are fattening D. Allow the child one food "treat" per day after they have consumed all of their dinner
A
Sweat rate calculation helps in making a plan to maintain fluid balance in the athlete. Which answer describes how sweat rate is calculated? A. Athlete is weighed in dry clothing after voiding both before and after exercise B. Exercise clothing is weighed before and after a workout to determine sweat volume C. On the day of exercise, volume of fluid intake for 24 hours and urine output for 24 hours are compared D. The volume of fluid intake during exercise and urine output following exercise are compared
A
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? A. Poor iron status in the mother can contribute to risk of delivering a low birth weight baby B. Consuming enough iron during pregnancy prevents the need for an iron supplement in breastfed babies until age 9 months C. Iron deficiency in the mother puts the baby at risk of food allergies because of the non-food items the mother eats as a result of the pica that develops D. Poor iron status in the fetus leads to reduced bone development because of altered erythropoietin
A
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? A. Poor iron status in the mother can contribute to risk of delivering a low birth weight baby B. Consuming enough iron during pregnancy prevents the need for an iron supplement in breastfed babies until age 9 months C. Iron deficiency in the mother puts the baby at risk of food allergies because of the non-food items the mother eats as a result of the pica that develops D. Poor iron status in the fetus leads to reduced muscle development in utero
A
Why might an older female patient experience a higher blood alcohol level than a younger male who consumed the same amount of alcohol? A. Females produce less alcohol dehydrogenase B. Aging causes elevated liver function tests (LFTs) C. Males have larger livers D. Aging causes an increase in alcohol dehydrogenase production
A
Which explanation below correctly describes why symptoms of poor protein nutrition include ascites and pedal edema? A. Poor protein status alters oncotic pressure B. Lack of protein intake often is accompanied by a lack of calorie intake C. Lack of protein intake leads to cachexia D. Poor protein status leads to skin breakdown
A.
"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? A. Parenteral nutrition causes an increased risk of aspiration B. The intestinal barrier becomes permeable when the gut is not used and bacteria can travel from the GI tract to the peritoneal cavity C. The gastrointestinal tract needs to be used in order to provide essential fatty acids D. Parenteral nutrition provides too much fluid and electrolytes directly into the blood stream
B
,.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? A. The American Academy of Pediatrics recommends that teens limit intake of caffeine to 250 mg/ day B. Mixing energy drinks with alcohol is associated with an increased risk of binge drinking C. Energy drinks are a healthier alternative to soda because they are lower in sugar content D. Energy drinks are suitable for teens who experience anxiety because the caffeine helps with alertness and focus
B
A 30-year-old female presents to an obstetric clinic for her first prenatal visit and shares with the nurse that because she had 'issues with high blood sugar' during her last pregnancy. Because of this problem, she decided to go on a very low carbohydrate diet to 'get her blood sugar in line and lose some weight ' starting two months before trying to conceive this baby. The patient is still following the diet four months later and asks for advice about the diet. Given the patient's report, what is the most appropriate information the nurse should share in response to the woman's request for advice? A. The diet the patient is following is a beneficial way to lose weight before pregnancy and to control blood sugar during pregnancy B. The need for carbohydrate during pregnancy increases compared with pre-pregnancy because the fetal brain needs glucose C. Having high blood sugar during pregnancy happens sometimes but is unlikely to occur with each pregnancy D. The need for carbohydrate during pregnancy increases compared with pre-pregnancy to provide a source of triglycerides for the fetal brain
B
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? A. Elevating the head-of-the-bed while sleeping B. Having a beer after dinner each night while watching television. C. Consuming beverages that are too hot or cold D. Drinking chamomile tea to help induce sleep
B
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? A. Consume favorite foods to boost appetite B. Avoid foods with a strong odor C. Try salty and sugary foods to reach the taste threshold for these flavors D. Sip a small glass of milk every 2 hours to provide protein and prevent dehydration
B
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? A. "You need to find some alternatives to feed the child or their growth will be affected" B. "I can tell you are worried. Let's brainstorm some ideas today and also consider a referral to our dietitian" C. "It is safe to include soybean oil in the diet when someone is allergic to soy because the oil contains no protein" D. "You can find sources of calcium from other foods like kale or almonds"
B
A gluten-free diet is the only treatment for celiac disease. Which of the following foods is allowed on a gluten-free diet? A. Malted milk ball candy B. Winter squash baked with quinoa C. Wheat germ sprinkled on top of fruit D.Vegetable barley soup
B
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? A. Consume increased carbohydrate from sweetened beverages and sugary desserts to provide more energy per bite B. Eat small, frequent meals to minimize effort and energy expended during eating C. Eat a large dinner to maximize intake and reduce CO2 production during sleep D. Consume adequate antioxidant vitamins, such as vitamins A and C, to offset development of free radicals that rob the body of oxygen
B
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? A. Limiting hang time of a formula that has been poured into a feeding set to no more than 8 hours B. Flushing the feeding tube with water before and after administration of medications C. Keeping the head of the bed up 30-45 degrees D. Using a longer enteral feeding tube, such as a naso-duodenal tube, to bypass the stomach
B
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? A. Increasing intake of sweetened iced or hot tea B. Decreasing intake of lactose-containing foods C. Eating nutrient-dense foods at the start of the meal before symptoms occur D. Avoiding intake of sports drinks because of the sugar
B
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? A. Spoon-thick - consistency of pudding B. Thin liquids - consistency of water C. Nectar-thick - consistency of tomato juice or a smoothie D. Honey-thick - consistency of honey
B
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? A. Malnutrition is linked with increased risk of infection B. Malnutrition is linked with an altered BMI-for age C. Malnutrition is linked with altered pharmacokinetics D. Malnutrition is linked with increased length of stay in the hospital
B
Mixing energy drinks and alcohol is a health risk. Which answer explains the reason this practice of mixing the two together is not recommended? A. Energy drinks contain a high amount of sugar B. Caffeine gives the drinker a false sense of unimpaired motor skill ability C. Blood alcohol concentration (BAC) takes longer to rise when alcohol and caffeine are combined compared with alcohol consumed by itself D. Caffeine is considered a dietary supplement by the Food and Drug Administration
B
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? A. Babies should be offered only rice cereal as the initial grain in their diet B. Babies can be offered a rotation of cereals made from different grains as their initial solid food C. Cow's milk or a milk alternative can be offered to a baby at age 6 months to provide a good source of calcium D. The practice of mixing some baby cereal in a bottle with infant formula is an ideal way to slowly introduce more solid food into the diet
B
Some patients require varying levels of feeding assistance during meals. Which of the following practices should be avoided when providing feeding assistance? A. When hand feeding a cognitively impaired patient, verbal cues to swallow may be needed B. When hand feeding a cognitively impaired individuals, sit at eye level and mix together the pureed peas and mashed potatoes to facilitate intake C. When assisting a post-operative patient with fractured ribs and an arm in a sling, open all containers and cut up food D. When assisting a visually impaired patient, set up their tray using clockface directions ( I put your milk at 2 o'clock on your tray).
B
The Recommended Dietary Allowance (RDA) for protein is the daily amount of protein recommended for which person? A. College age student trying to build more muscle B. Middle-aged adult who walks a mile each day C. Post-operative patient with a surgical wound to heal D. Vegan adult who developed a pressure ulcer after prolonged bedrest for a back injury
B
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? A. Equations are complicated and require many measurements that are difficult to do B. Equations have a high margin of error because they were developed for a set population but are used on the general population C. Equations do not take into account whether someone has elevated blood urea nitrogen (BUN) D. Equations are only valid for use in the older adult
B
The nurse and a patient are discussing dietary supplement labeling and health concerns after a patient shares that they purchased a new dietary supplement and have started taking it. Following education by the nurse, which statement by the patient indicates a good understanding of dietary supplement health and safety information A. The term time-tested on a dietary supplement label means the manufacture has research on file with the Food and Drug Administration (FDA) regarding their product" B. "Dietary supplements are not tested for safety before being sold" C. "The term satisfaction guaranteed on a dietary supplement label means that the product is effective" D. "Dietary supplements are pre-approved by the Food & Drug Administration (FDA) before they can be put on the market"
B
What is the American Academy of Pediatrics recommendation regarding offering children fruit juice? A. Fruit juice intake should be limited to 100% orange juice in toddlers. B. Fruit juice intake should be limited to no more than 6 oz/ day in children age 1-6 years of age C. Fruit juice intake should be limited to 4 oz/ day in children younger than age one year D. Fruit juice should be avoided by pediatric patients and water offered instead
B
Which of the following is true about mineral status in the body? A. Any dose of a mineral is safe to take in supplement form because the kidney excretes excess and prevents toxicity B. Excess intake of some minerals can lead to a deficiency of other minerals because some minerals compete with each other for absorption C. Mineral deficiencies can easily be measured with a blood test D. Minerals with a +2 charge (divalent cations) can cause chelation of corticosteroids when consumed together
B
Which of the following statements is true regarding the use of dietary supplements during cancer treatment? A. Antioxidants, like vitamin C, may improve tolerance to radiation treatment B. Antioxidants, like vitamin C, may interfere with the effects of radiation treatment C. It is uncommon that cancer patients take dietary supplements during active cancer treatment D. It is recommended that cancer patients take a high potency multivitamin during cancer treatment to compensate for poor dietary intake
B
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? A. Switching to a vegetarian diet is the safest thing to do for the next two weeks in order to avoid milk products B. Milk can be a hidden ingredient in food so every food label must be checked, even flavorings C. Small amounts of milk can be tolerated but must be in cooked form, such as in a cake or hot cereal D. Milk must be avoided completely, but often yogurt is tolerated
B
A patient asks the nurse for some guidance on healthy eating. Which suggestion could the nurse offer that is based on current dietary recommendations? A. "Avoid high carbohydrate grains because they cause weight gain" B. "Fill half your dinner plate with fruits and vegetables" C. "Decrease intake of cow's milk because it contains harmful hormones" D. "Increase your intake of red meat to get enough iron"
B.
A patient asks the nurse how to figure out if the rice they bought is a whole grain. What should the nurse say to explain how to find this information? A. Read the Nutrition Fact Panel to see if a whole grain is listed under fiber B. Review the ingredient list for forms of the grain that are close to the original version of the grain, like brown rice C. Rice is not a whole grain; only whole wheat is a whole grain D. Look for the whole grain emblem on the front of the package
B.
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. A. a diet high in oxalates found in many green leafy vegetables B. substitution of fortified almond milk in place of cow's milk in the diet C. chronic use of acid reduction medications for a gastric ulcer D. fat malabsorption
B.
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? A. Consume three meals per day and no snacks B. Sip liquids with the meal C. Lie down after eating D. Avoid sugar-free drinks
C
A gluten-free diet is the only treatment for celiac disease. Your patient who has celiac disease asks you if salad dressing is okay to have on a gluten-free diet. Choose the correct response that accurately answers the patient's question. A. No, all dressings have gluten in them B. Yes, salad dressings are okay because oils contain no gluten C. I don't know. We need to check the ingredient label D. Yes, as long as there is no soy protein isolate
C
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? A. Administering an enteric coated drug orally to maintain its enteric coating property B. No example is problematic C.All examples are problematic D. Flushing the feeding tube with water following the administration of a fluoroquinolone antibiotic and then restarting the feeding E. Administering phenytoin (Dilantin) via a jejunostomy tube (J-Tube) F. Crushing an extended-release form of a drug and mixing it with water to administer via the feeding tube
C
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. A. Products made with white flour (not whole grain) are a poor source of folic acid B. Pregnant females should avoid taking a multivitamin that contains 100% of the folic acid daily requirement C. Gluten-free products often lack fortification with folic acid D. Neural tube defects occur late in the pregnancy and are linked with low intake of folic acid
C
If someone consumes adequate protein intake, but lacks intake of adequate calories, what metabolic consequence could occur as a result? a. Protein from the diet will be used to maintain muscle while fat stores will be liberated to be used as an energy source b. Protein from the diet will be reserved for antibody synthesis while fat stores will be liberated to be used for an energy source c. Protein from the diet will be sacrificed to be used as an energy source d. Protein from the diet will be used to maintain muscle and the body will adjust its metabolic rate to require fewer calories
C
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? A. Take a calcium supplement and avoid intake of dairy B. Try eating a small amount of ice cream instead of milk C. Try consuming a small amount of yogurt instead of milk D. Purchase any brand of almond milk to get needed calcium
C
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? A. Eczema-like rash on trunk of body B. Bowed legs C. Moon face D. Altered blood pH towards acid range
C
Many nutrients are required for a wound to heal properly. Which of the following is true regarding nutrition and wound healing? A. Vitamin C should be avoided to limit bleeding at the wound site B. High vitamin E intake is required to keep scar tissue from forming C. Iron is required to deliver oxygen to the wound site D. Increased fluid should be avoided to diminish swelling at the wound site
C
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? A. Cognitive decline in older adults causes decreased consumption of fluids B. Older adults limit fluid intake to the daytime to reduce the need for night time urination C. Older adults have lower total body water because of reduced muscle mass D. Taste perception changes with age and results in decreased fluid intake because fluids taste bland
C
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? A. Foods with low sugar content, such as English muffin instead of a muffin, because bacteria feed on sugar as fuel and we want to starve the bacteria. B. Foods with low fat content, such as plain rice or potato, because fat causes early satiety C. Foods with high protein content, such as pudding or custard, because protein is being lost through the wound and is needed for healing D. Foods with high fat content, such as fried food, because bacteria need oxygen and fat produces less oxygen through metabolism compared with other sources of calories
C
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? A. Taking probiotics permanently alters the intestinal bacteria to a more healthful mix of microbes B. Because most probiotics are regulated as dietary supplements, they are required by the Food & Drug Administration (FDA) to have premarket testing done to assure their safety for use by adults. C. The majority of research findings on probiotics are in agreement that probiotics are effective in treating diarrhea associated with antibiotic use D. The majority of research findings on probiotics are in agreement that probiotics are effective in treating Crohn's disease
C
Which volume represents the total daily recommended intake of fluid for the average female adult? A. Almost four liters/ day B. About eight cups/ day C. Almost three liters/ day D. Almost two liters/ day
C
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? A. choose only hard alcohol, such as vodka or tequila, to avoid the sugars in beer and mixed drinks B. consume alcohol as an equivalent of two carbohydrate choices in the diet C. consume alcohol only with food and when blood glucose is controlled D. do not consume alcohol
C
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
Carbohydrates give energy to the body in the form of glucose and our body uses glucose for energy. Glucose is important due to the fact that they fuel our organs and body systems such as including the brain, heart, and CNS. An example is fiber which is a carbohydrate that promotes laxation and keeps blood cholesterol levels in check. - 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. Explain what happens when the diet lacks carbohydrate and mention protein sparing effect
A nurse working in a college health center is discussing muscle-building with a student who is taking amino acid pills in addition to a high protein diet. Which statement by the nurse is the best advice for this student? A. "Make sure your amino acids pills contain a good amount of leucine so you can store up the extra for later use in muscle building" B. "Make sure your diet contains only essential amino acids because nonessential amino acids are just excreted as nitrogen in the urine" C. "Amino acid pills are only needed if you are not consuming enough calories" D. "You will build muscle only if you also consume enough calories"
D
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? A. Hepatitis leads to increased need for intake of B vitamins so this patient should prioritize those nutrients over any concern about protein. B. Hepatitis leads to cirrhosis before the liver disease progresses to encephalopathy so there is no need to consume a low protein diet unless cirrhosis occurs C. Reduced protein intake helps reduce ammonia byproducts of protein metabolism from reaching the brain and causing encephalopathy and therefore this approach is advised. D. 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
D
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? A. Complicated drug-food interactions for some drugs can lead to nonadherence to medication schedules B. Elevated blood lipid levels from protease inhibitors requires a modified fat diet C. St. John's Wort utilizes the same metabolic enzyme system as some protease inhibitors and its use could lead to treatment failure D.All classes of antiretroviral medications need be taken on an empty stomach and this recommendation causes many clients to skip meals
D
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. A. Dietary supplements containing glutamine have been shown to trigger muscle protein synthesis B. Older adults should be offered bland, smooth textured foods such as pudding or ice cream for protein sources C. The RDA for protein intake in the older adult is 1.7gm/ kg body weight D. Spreading protein servings over the day in ~20 gram increments can trigger muscle protein synthesis
D
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? A. Accidently swallowing water from the pool while swimming is safe since the water is chlorinated B. Utilize the salad bar for getting adequate antioxidants from local vegetables C. Only choose hot, cooked foods when sampling food from street vendors D. Local fruits are safe as long as you wash and peel them yourself
D
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? A. A Curling's ulcer leads to diminished gut peristalsis B. Increased water losses from the burn injury drive up fuel needs because the end-product of metabolism is carbon dioxide and water C. Burn injuries cause severe pain, which makes it difficult to maintain an appetite D. Inflammation, heat loss, and tissue destruction cause hypermetabolism
D
What is the recommendation by the Dietary Guidelines for Americans and the World Health Organization (WHO) regarding intake of added sugars in the diet? A. Limit intake to less than 25% of total carbohydrate per day B. Aim to consume no added sugar in the diet C. Limit intake to less than 10% of total carbohydrate intake per day D. Limit intake to less than 10% of total calories per day E. Limit intake to less than 25% of total calories per day
D
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 initial office visit? A. Take a calcium supplement and avoid intake of any source of dairy B. Switch out dairy to milk alternatives like almond milk, soy cheese, and nondairy ice cream C. Try a small amount of ice cream instead of milk D. Try a small amount of yogurt instead of milk
D
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? A. Check the label for the term 'multigrain' B. Choose 'wheat bread' over 'white bread' at the sandwich shop C. Check the package front for the 'whole grain' emblem D. Check the ingredient listing for grains with the word 'whole' or a grain closest to its original form
D
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? A. Iced tea with a teaspoon of sugar B. Cranberry flavored seltzer water C. Grape popsicle D. Lime-flavored gelatin (Jello) E. Black tea with a teaspoon of skim milk
E
true or false: Claims made on the front of a package such as "rich in vitamins" or "made with less sodium" indicate that the food is an overall healthy option
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.
True or false A low blood calcium level is an early warning sign of a calcium deficiency
False Low blood calcium is seldom indicative of nutrition status and instead is indicative of a medical concern that is affecting blood calcium homeostasis/regulation in the body
True or false: 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.
False No warnings are required even when side effects are known about a dietary supplement.
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.
If I was the nurse in this situation I would tell the patient that many supplements can be hepatotoxic meaning can enlarge the liver and I would advise the patient with this disease to abstain from using certain supplements such as Artemesia or cascara and many more. These supplements have been associated with liver injury and failure. I would also provide my patient with a list of supplements that should not be taken and remind my patient to ask their providers before taking any supplement.
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.
Most drugs bind to plasma proteins. If there is a protein deficiency resulting in fewer plasma proteins needed for drug binding transport then the drugs would not bind and therefore remain freely in circulation. Non bonded drugs are active. Therefore these active drugs could then potentially lead to drug toxicity.
The 24-hour recall is often used as part of a nutrition assessment. List one criticism of this tool.
One criticism of this tool is that a patient may not recall everything they have consumed in a 24-hour time span. An example of this would be a patient not giving an accurate portion size.
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.
One dietary intervention the nurse should suggest to a patient who has been diagnosed with gastroparesis is to have small, frequent meals 4 to 6 times a day with low fiber and low-fat foods. I would explain to the patient that high fiber is avoided due to the risk of gastric bezoar formation which are undigested food masses that can occur when food remains in the intestine for too long.
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.
One example of a risk factor for iatrogenic malnutrition is a clear liquid diet. A clear liquid diet is inadequate to meet nutritional needs and should not be used for longer than a few days. If a patient is on a clear liquid diet for a longer period of time they would need oral nutrition supplements containing energy and protein. A patient would also require a nutrition consult so other nutrition supplements can be included and figured out in their diet.
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.
One idea I could offer to a concerned caregiver would be to offer their child choices such as giving them two vegetables and saying which one would want. This allows the child to have more control while eating other foods.
List one suggestion that the nurse can offer to help improve nutrition intake using oral liquid nutrition supplements (such as Ensure or Boost).
One suggestion a nurse can offer to improve nutrition intake using liquid oral liquid nutrition supplements is to serve the liquid supplement cool or cold. Supplements can have a strong taste a room temperature and the taste of oral liquid nutrition supplements does not always taste good to patients. Therefore patients will have a decreased intake and will not have enough protein/calories/vitamins (adequate nutrition).
Define the term 'sarcopenia'.
Sarcopenia is known as muscle loss in aging adults which is not preventable by the recommended intake of protein of 82.3 +- 0.8 g/day. Increased dietary intake of protein (1.0-1.2 g/kg of body weight) is recommended as well as exercise and strength training to increase muscle mass and improve a person's quality of life. It is important to have the right amount of energy to conserve protein and not have it be sacrificed as an energy source.
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.
The nurse should say 6 months. The timing makes sense because the baby will need to match developmental milestones. They need to be able to properly sit up and chew so they do not aspirate. Giving solid foods before 4-6 months is not a good plan because the pancreatic enzymes are not ready.
As part of your nursing assessment you calculate that your lightly active patient who weighs 220 lbs and is overweight is consuming an average of 120-140 gms of protein per day. Compare the patient's intake with the recommended protein intake for this person. In just a few sentences, what advice would you give to the patient based on your assessment and calculation?
The patients recommended protein intake would be 80 gms based on their weight, however, this person is in a surplus of 40-60 grams of protein. Based on the assessment and calculations I would tell my patient that they need to consume less protein. Too much protein can result in higher calorie intake which will be stored and turn into fat, it can also change the blood pH and become more acidic and take calcium from the bone to act as a buffer leading to bone health issues as well. This patient would need to be more active and less sedentary if consuming as many proteins.
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.
The school nurse can be a role model regarding weight stigma. The nurse should tell them about media literacy and how it is photoshopped and tell them not to try to meet the standards of social media regarding weight and body image.
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?
The weight gain recommendations are based on a woman's BMI. A woman that is underweight would have a lower BMI and higher recommended weight gain. Someone overweight would have a lower recommended weight gain.
Your post-operative patient is eating poorly, picking at pudding and jello and otherwise just drinking the Ensure nutrition drink delivered with their three 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)
This patient is probably getting enough protein through the ensure drinks however they are not consuming enough calories. It is also important to have a balance and variety in nutrition and having the same ensure nutrition drink restricts you to one source of nutrition. It is important to receive all nutrients which you cannot get from the same drink for every meal. Nutrition is important in wound healing because proteins are important for the structural function of the skin and function important because it helps with the transport of blood and cells which is needed for the inflammation and wound healing process.
True or false Even with adequate intake by the mother, the vitamin D content of breastmilk is insufficient to meet the needs of the infant.
True
True or false: Glucose is the simple sugar that circulates in our blood stream. In the hospital, glucose is given in the intravenous form called dextrose
True
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? a. 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 b. Food and supplement labels can make health claims about a disease and this label is an example of that type of claim c. The claim is a nutrient claim, which is allowed because of the high vitamin C in orange juice d. This claim is a superfood claim, which is allowed because of the high amount of antioxidants and vitamins in the juice
a
Choose which scenario is an appropriate application of the Recommended Dietary Allowance recommendation. This example is for vitamin B-12 A. the new vegan who no longer consumes animal foods B. the older adult who is taking a medication that binds the vitamin, limiting its absorption C. the teenager who is deficient in the vitamin due to following a trendy raw food diet D. the young adult who had gastric surgery that resulted in altered absorption of the vitamin
a
Which statement about protein digestion and absorption is accurate? a. Protein is digested in the large intestine along with fluid and electrolytes b. Protein is absorbed in the small intestine after being broken down to peptides and amino acids c. Protein is absorbed in the stomach after being broken down by pepsin d. Protein is absorbed in the pancreas after pancreatic enzymes break it down
b
The Recommended Dietary Allowance (RDA) are nutrient guidelines that are specific to gender and age population groups. Which of the following scenarios is an appropriate application of the RDA? a. To recommend iron intake for a pregnant female who has a closely spaced second pregnancy and never recovered from her low iron status from her first pregnancy b. To recommend an iron intake amount to the college student who consumes no red meat, poultry or legumes c. To recommend an iron intake amount to a high school distance runner who is anemic d. To determine the proper supplement dose of iron for a middle age male with a gastric ulcer who is taking medication that causes reduced iron absorption
b.
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? A. The pregnant female needs increased carbohydrate intake to synthesize needed triglycerides for fetal brain development B. The pregnant female needs increased carbohydrate intake to provide sufficient lactose content for breast milk production C. The pregnant female needs increased carbohydrate intake to provide needed glucose for the fetus D. The pregnant female needs increased carbohydrate intake to meet her suggested weight gain targets for a healthy pregnancy
c
anabolism and catabolism: experiencing a burn injury
catabolism
anabolism and catabolism: experiencing a trauma
catabolism
anabolism and catabolism: undergoing surgery
catabolism
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.
could be any of the following: syrup honey sucrose anything ending in ose brown sugar high fructose corn syrup
True or false: 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.
false
true or false: An essential amino acid is an amino acid that the body can synthesize using metabolic byproducts found in the body's amino acid pool
false
True or false 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
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
true or false Dieting during adolescence is linked with improved body image and lowered risk of overweight in adulthood.
false Dieting in adolescence and childhood is linked with poor body image and long-term issues with managing weight into adulthood.
True or false Intake of fish should be avoided during pregnancy because of the negative risk of high intake of mercury on fetal brain development.
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.
true or false 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).
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
True or False: 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 The 130 gm carbohydrate is the minimum needed - not total needed per day - and is just for brain function. Our bodies need more than 130gm/ day for muscle and other functions, depending on someone's activity level. If insufficient carbohydrate is consumed, the body can breakdown protein to make needed glucose - but then the protein is no longer available to be a building block.
true or false The body is capable of adjusting mineral absorption rate when someone has a mineral deficiency and this adjustment corrects the deficiency
false The 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.
true or false 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
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.
True or false The requirement for daily iron intake remains unchanged for males from age five years through adulthood.
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.
True or false Wearing heavy clothing to increase sweating during exercise is a helpful way to burn more calories and lose fat.
false Wearing heavy clothing during exercise can contribute to increased sweat losses - but these losses are only water and not fat loss.
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.
options Calcium iron
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
options Tetracycline Tetracyclines Thyroxine Levothyroxine Fluoroquinolones
Someone's basal metabolic rate (BMR) is influenced by many factors. What factor influences BMR more than any other factor?
options muscle LBM leanness muscle mass body size body weight lean body mass
Some minerals can cause altered heart rhythm if blood levels of the mineral are low. Name two.
options potassium K calcium Potassium Calcium Magnesium Mg Ca magnesium
Nutrition misinformation is common on social media, in advertising, and more. List one 'red flag' for nutrition quackery or misinformation that you could teach a patient to look for and alert them to possible misinformation when they are reading an advertisement for a dietary supplement
options time tested meaningless medical terms multiple claims quick and easy fixes personal testimonials all natural satisfaction guaranteed meaningless medical jargon psuedomedical jargon one product does it all
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. (just list one nutrient - do not write a sentence or list more than one nutrient, please)
options vitamin B12 iron calcium
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?
thiamin
True or false 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
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
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.
wet diapers