138: Nutrition EAQs
A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response should alert the nurse that the client is experiencing dumping syndrome? 1 Constipation 2 Clay-colored stools 3 Sensations of hunger 4 Reactive hypoglycemia
4 Rapid gastric emptying that occurs after a gastric resection causes rapid elevation of blood glucose followed by increased insulin secretion, resulting in reactive hypoglycemia and dumping syndrome. Diarrhea, not constipation, occurs. Steatorrhea, not clay-colored stools, may occur. Anorexia, not sensations of hunger, occurs.
A client expresses a desire to breast-feed her preterm neonate, who is in the neonatal intensive care unit (NICU). The client states that she will pump her breasts until her baby is ready to breast-feed. The infant has been sucking on a pacifier for 1 week in accordance with protocol. How should the nurse respond to the mother's request? 1 By telling the client that this is unnecessary because the infant is being fed by gavage 2 By discouraging the client because of the time and effort it will take to pump her breasts 3 By instructing the client that breast milk is inadequate because it does not contain the necessary nutrients 4 By supporting the client's decision and explaining that the infant may lie close to her breast for nippling as desired
4 The infant may be fed with breast milk by means of gavage, and the pumping will stimulate milk production that should be adequate when the infant is ready to breast-feed. Until that time, the infant may try to breast-feed after pumping or lie close to the mother's breast for nippling as long as the infant can tolerate it. If the infant is being fed by means of gavage, the mother's breasts may be pumped and the breast milk used for gavage feedings. Time cost and effort are insufficient reasons for the nurse to discourage breast-feeding. Breast milk provides adequate nutrition, protects the infant from necrotizing enterocolitis, and provides antibodies.
A client with arthritis reports receiving several dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce? 1 Wheat germ and yeast 2 Yogurt and blackstrap molasses 3 Multiple vitamin supplements in large doses 4 Adequate foods in a variety of different food groups
4 There is no special diet for arthritis. A balanced diet, consisting of foods from all groups of the MyPlate dietary guidelines, is essential in maintaining nutrition. Limiting the diet to particular foods does not provide all the essential nutrients. If nutritional intake is adequate, large doses of multivitamins are unnecessary and are dangerous. Topics
The parents of a preschooler tell the nurse that they try to inculcate good eating habits by asking the child to be at the table until the "plate is clean." What condition is the child at risk for? 1 Anorexia 2 Depression 3 Aggression 4 Poor eating habits
4 Asking the child to be at the table until the "plate is clean" results in overeating and develops poor eating habits later in life. Anorexia is seen if the child does not consume the required amount of food. Depression may be seen in a child if there are any psychological issues. Aggression occurs from sociocultural and familial influences on the child.
The nurse is providing instructions to a client on how to reduce the dietary intake of sodium. Which information should the nurse include in the instructions? 1 Avoid carbonated beverages 2 Use steak sauce for flavoring foods 3 Increase the intake of dairy products 4 Restrict the use of artificial sweeteners
1 Carbonated beverages generally are high in sodium and should be avoided. Steak sauce is high in sodium and should be avoided. Many dairy products contain sodium and should be avoided. Artificial sweeteners do not contain sodium and do not have to be restricted.
What should the nurse teach the parents about introducing a 6-month-old infant to solid foods? 1 The infant should be offered one new solid food at a time. 2 The infant may be offered fruit juices or fruit-flavored drinks. 3 The infant should be offered solid foods after the first birthday. 4 The infant should receive iron supplements in addition to solid foods
1 The infant should be offered one new solid food at a time so that an allergic reaction to the new food is easily identified. The infant should not be offered fruit juices or fruit-flavored drinks because these liquids do not provide appropriate calories. The infant should be introduced to solid food after the age of six months. After the first birthday, most infants can change from breast milk or formula to whole milk. Solid foods such as cereals, fruits, vegetables, and meats provide iron and additional sources of vitamins. The infant does not need to be given iron supplements in addition to solid foods.
The nurse teaches a client about the increased need for vitamin A to meet the demands imposed by rapid fetal tissue growth during pregnancy. Which foods should the nurse encourage the client to ingest to meet this increased need? Select all that apply. 1 Carrots 2 Citrus fruits 3 Fat-free milk 4 Cantaloupes 5 Extra egg whites
1,4 Carrots provide the precursor pigment carotene, which the body converts to vitamin A. Cantaloupes also contain large amounts of carotene, which the body converts to vitamin A. Citrus fruits contain only a very small amount of vitamin A precursor. Fat-free milk contains only about half the needed vitamin A precursor. Egg whites contain no vitamin A precursor.
A multigravida of Asian descent weighs 104 lb (47.2 kg), having gained 14 pounds (6.4 kg) during the pregnancy. On her second postpartum day, the client is withdrawn and eating very little from the meals provided. Which intervention is most important for the nurse to implement? 1 Report these findings to the healthcare provider. 2 Encourage the family to bring in special foods preferred in their culture. 3 Order a high-protein milkshake to supplement between meals. 4 Call the dietitian to work with client to plan high calorie meals for the client to eat
2 In family-centered childbearing, care should be adapted to the client's cultural needs and preferences whenever possible. Discussing the problem with the healthcare provider is the nurse's responsibility but will not address the client's preferences. Ordering a high-protein milkshake as a between-meal snack may offer the client an option but is unlikely to meet the cultural preferences. Having the dietitian assist with planning meals does not address the underlying problem.
A nurse evaluates a client's understanding regarding oral contraceptives and concludes teaching is successful when the client states, "While I'm taking birth control pills I should increase my intake of foods containing" what nutrient? 1 Calcium 2 Folic acid 3 Vitamin A 4 Vitamin D
2 Oral contraceptives are thought to cause deficiencies of folic acid, vitamin C, vitamin B6 and vitamin B12. It is important for the nurse to instruct the client to consume a diet rich in these essential nutrients. It is unnecessary to increase calcium intake when taking oral contraceptives. There is no clinical evidence to link oral contraceptives to a deficiency of vitamin A or vitamin D.
During a physical examination, the nurse finds that a 3-year-old child has markedly fewer teeth than expected for that age. Which foods should be included in the child's diet to promote tooth formation? Select all that apply. 1 Boiled egg 2 Skim milk 3 Tomatoes 4 Kale 5 Apples
2,4 The presence of fewer teeth than expected in a 3-year-old child indicates a calcium deficiency. Milk and kale are known to be rich sources of biologically available calcium. A boiled egg is rich in protein and will help to build muscle mass but will not provide calcium unless the toddler eats the egg shell. Tomatoes and apples are not good sources of calcium although they are good sources of vitamins and minerals to improve immunity.
The healthcare provider prescribes a low-fat, 2-gram sodium diet for a client with hypertension. The nurse should explain that the purpose of restricting sodium is to do what? 1 Chemically stimulate the loop of Henle 2 Diminish the thirst response of the client 3 Prevent reabsorption of water in the distal tubules 4 Cause fluid to move toward the interstitial compartment
3 Sodium absorbs water in the kidneys' renal tubules. When dietary intake of sodium is decreased, water is not reabsorbed and edema is reduced. A decrease in sodium will prevent the reabsorption of water. Furosemide stimulates the loop of Henle to inhibit the reabsorption of sodium and chloride at the proximal and distal tubules. Adequate hydration is the major factor that diminishes the thirst response. A low-sodium diet will help move fluid from the interstitial compartment to the intravascular compartment.
A 4-year-old child is found to have Hirschsprung disease (aganglionic megacolon), and the healthcare provider prescribes a special diet. The nurse is assigned to provide dietary instructions for the parents. What diet will the nurse be teaching the parents? 1 High-fat 2 High-fiber 3 Low-calorie 4 Low-residue
4 A low-residue diet is important to prevent the development of bulk, which will further irritate the colon. There are no recommended changes in the amount of fat in the diet. A high-fiber diet is contraindicated because it may cause an obstruction. To maintain or improve the child's nutritional status, calories should not be restricted.
The nurse instructs a client with a new colostomy to avoid foods and drinks that produce a large amount of gas, specifically to avoid the intake of what? 1 Milk 2 Cheese 3 Coffee 4 Cabbage
4 Cabbage is a gas-producing food that can cause a client with a colostomy problems with odor control and ballooning of the ostomy bag, which may break the device seal and allow leakage. Milk, cheese, and coffee should not cause excessive gas problems in moderation. The client with a new colostomy should slowly introduce new foods into the diet to test toleration.
A client is diagnosed as having malabsorption syndrome secondary to celiac sprue. The client asks the nurse if there is anything that can help improve symptoms. What should the nurse encourage the client to incorporate into the diet for symptom improvement? 1 Folic acid 2 Vitamin B12 3 Corticosteroids 4 Gluten-free diet
4 Gluten, a cereal protein, appears to be responsible for morphologic changes of the intestinal mucosa with nontropical sprue (adult celiac disease). Folic acid, along with antimicrobial agents, is used to treat tropical, not celiac, sprue; it causes dramatic improvement in tropical sprue. Vitamin B12 may be administered if macrocytic anemia or achlorhydria develops; however, it does not correct the major pathology. Corticosteroids may be used for refractory celiac disease.
Which statement by the nurse is true about the diet plan for toddlers? 1 Finger foods should be avoided. 2 Toddlers need 4 to 6 cups of milk per day. 3 Low-fat or skim milk should be given until the child is 2 years old. 4 Milk should be supplemented with solid food items like vegetables and fruits
4 Mothers of toddlers should supplement their children's milk intake with solid food items; this will ensure a balanced diet for adequate growth. Serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for independence and control. The intake of milk should be limited to 2 to 3 cups per day in toddlers.The consumption of more than a quart of milk per day will decrease the child's appetite for essential solid foods and result in inadequate iron intake. Children below 2 years of age should not be given low-fat or skim milk because the fat is important for growth.