44 Nutrition HESI concept Metabolism-Nutrition
Clients with eating disorders often exhibit similar symptoms. What should the nurse expect an adolescent with anorexia nervosa to exhibit? 1 Affective instability 2 Repetitive motor mechanisms 3 Depersonalization and derealization 4 Disheveled and unkempt physical appearance
1 Individuals with anorexia often display irritability, hostility, and a depressed mood. Repetitive motor mechanisms are associated with autism. Depersonalization and derealization are associated with individuals with schizophrenia. Clients with eating disorders are usually meticulous about dress and physical appearance; a disheveled appearance is associated with dementia or depression.
A nurse is teaching a client who had a myocardial infarction about the prescribed 1500-calorie, 2-gram sodium, weight-reducing diet. Which low-sodium, low-calorie nutrients should the nurse recommend that the client include in the diet? Select all that apply. 1 Lean steak 2 Celery sticks 3 Baked chicken 4 Tuna fish salad 5 Mashed potatoes
3 and 5 Baked chicken is low in calories and sodium. Mashed potatoes are low in sodium and calories. Beef is high in calories. Celery sticks are high in sodium. Canned tuna fish is high in sodium.
A nurse teaches the parents of a school-aged child with celiac disease about the foods that should be eliminated from the diet. Which foods do the parents name that indicate to the nurse that the teaching has been understood? Select all that apply. 1 Milk 2 Cheese 3 Oatmeal 4 Rice cakes 5 Corn on the cob 6 Whole-wheat bread
3 and 6 Oat grain, in addition to wheat, rye, and barley grains, contains gluten, which should be eliminated from the diet in children with celiac disease. Foods made with wheat grain, a major source of gluten, must be eliminated from the diet of a child with celiac disease. Gluten contains the gliadin fraction that causes celiac syndrome. There is no gluten in milk or other dairy products. There is no gluten in rice grain; it is a substitute for the grains that must be eliminated from a diet that should be gluten free. Corn can be eaten safely because it does not contain gluten.
A mother brings her 16-month-old daughter to the well-child clinic for a checkup. She is upset and reports, "My child refuses to eat at mealtimes. It's a battle between us." What is the best response by the nurse? 1 "How often do you offer her food?" 2 "What's her daily eating schedule?" 3 "Does the doctor know that she refuses food?" 4 "It may be helpful to keep a daily diary of the food she eats."
4 Although toddlers develop physiological anorexia in response to a decreased growth rate and need for autonomy, they usually ingest enough food to meet their caloric needs. The mother's concern may be eased when she realizes how much food her child actually eats, not just at mealtimes. The mother's response will not help determine how much food the child eats throughout the day. The child's daily eating schedule may become relevant after the amount of daily intake is determined. Health teaching is the nurse's responsibility.
The nurse prepares a list of recommended foods for a client with hypertension that is to begin a 2-gram sodium diet. The list should include which foods? Select all that apply. 1 Beef steaks 2 Aged cheeses 3 Luncheon meats 4 Cooked broccoli 5 Dehydrated soups
1 and 4 Beef is low in sodium. Broccoli does not have significant sodium levels. Aged cheeses are high in sodium as well as saturated fat. Luncheon meat is processed and has high sodium levels to help with its preservation. Dehydrated soups are high in sodium unless they specifically state on the package that they are low in sodium.
A nurse is caring for an infant with phenylketonuria. What diet should the nurse anticipate will be prescribed by the health care provider? 1 Fat-free 2 Protein-enriched 3 Phenylalanine-free 4 Low-phenylalanine
4 Because phenylalanine is an essential amino acid it must be provided in quantities sufficient for the promotion of growth but low enough to maintain a safe blood level. Phenylalanine is derived from protein, not fat. An enriched-protein diet contains increased amount of proteins, including phenylalanine, which should be ingested in limited amounts. Because phenylalanine is an essential amino acid, it cannot be totally removed from the diet.
After teaching a client about a low fat diet, it is most important for the nurse to document: 1 Client's receptiveness to the education. 2 Family members/significant others were educated as well as the client. 3 Client's weight loss goals. 4 Client's ability to plan a low fat meal.
4 Documenting that client's ability to plan a low fat meal demonstrates the client's ability to apply the education to their lifestyle. Clients can be receptive to education but not understand it. It helps to include family members or significant others in the education. However, it is most effective if the clients themselves take ownership of their health care plan. Not all clients on a low fat diet need to lose weight.
A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. What is an appropriate nursing response? 1 "The staff will provide total care because the infection causes severe fatigue." 2 "Mood elevators will be prescribed to improve depression and irritability." 3 "Iron will be prescribed for the anemia and the stools will be dark." 4 "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."
4 One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron supplements are not tolerated well by clients in kidney failure and reduce the client's own stimulus to produce red blood cells; folate usually is prescribed.
A nurse is providing education about excellent food sources of vitamin A for a client who is deficient in this vitamin. Which foods should the nurse include in the teaching? Select all that apply. 1 Carrots 2 Oranges 3 Tomatoes 4 Skim milk 5 Leafy greens
1 and 5 Yellow/orange vegetables contain large quantities of the pigments alpha-, beta-, and gamma-carotene; beta-carotene is the major chemical precursor of vitamin A in human nutrition. Cantaloupe, sweet potatoes, and apricots also are high in vitamin A. Dark green leafy vegetables contain large quantities of the pigments alpha-, beta-, and gamma-carotene; beta-carotene is the major chemical precursor of vitamin A in human nutrition. Broccoli, cabbage, spinach, and collards also are high in vitamin A. Oranges are considered a good source of both vitamin C and potassium. Tomatoes are a good source of vitamin C. Levels of vitamin A are higher in whole milk than in skim milk.
A nurse is caring for a child with a diagnosis of cystic fibrosis. Which schedule of chest physiotherapy (CPT) is best? 1 Three times a day, before meals 2 Three times a day, halfway between meals 3 Two times a day, on awakening and at bedtime 4 Two times a day, after breakfast and after dinner
2 CPT is performed several hours after meals to avoid regurgitation and several hours before meals so unpleasant odors and tastes do not affect the appetite. CPT should be done more frequently than two times a day. CPT performed after a meal may result in vomiting.
The nurse is creating a discharge teaching plan for a client that had a subtotal gastrectomy. The nurse should include what instructions about minimizing dumping syndrome? Select all that apply. 1 Drink fluids with meals 2 Eat small frequent meals 3 Lie down for one hour after eating 4 Chew food five times before swallowing 5 Select foods that are low in fiber
2 and 3 Small, frequent meals keep the volume within the stomach to a minimum at any one time, limiting dumping syndrome. Lying down delays emptying of the stomach contents, which will limit dumping syndrome. Fluids should be taken between meals to decrease the volume within the stomach at one time. Dumping syndrome occurs after eating because of the rapid movement of food into the jejunum without the usual digestive mixing in the stomach and processing in the duodenum. Chewing a set number of times before swallowing is not pertinent to solving this problem. High fiber, complex carbohydrates, moderate fats, and high protein in small frequent meals are recommended to prevent dumping syndrome
A client is diagnosed with gastroenteritis. What does the nurse determine is the basic intention underlying the unique dietary management for this client? 1 Provide optimal amounts of all important nutrients. 2 Increase the amount of bulk and roughage in the diet. 3 Eliminate chemical, mechanical, and thermal irritation. 4 Promote psychologic support by offering a wide variety of foods.
3 Irritation of the mucosa may cause increased bleeding or perforation and therefore should be avoided. All clients' diets should be nutritionally balanced; this is not specific to this client's problem. Bulk and roughage may irritate the mucosa and should be decreased. Psychologic support is not the primary goal; efforts should be made to include foods that are psychologically beneficial but eliminate foods that are irritating to the mucosa.
The multidisciplinary team decides to use a behavior modification approach for a young woman with anorexia nervosa. Which planned nursing intervention is an appropriate approach to use with this client? 1 Having the client role-play interactions with her parents 2 Providing the client with a high-calorie, high-protein diet 3 Restricting the client to her room until she has gained 2 lb 4 Forcing the client to talk about her favorite foods for 1 hour a day
3 Restricting the client to her room until she gains 2 lb reinforces behaviors that will assist in the achievement of specific goals. Having the client role-play interactions with her parents is not part of a behavior modification program. Providing the client with a high-calorie, high-protein diet is not part of a behavior modification program. Anorexic clients talk freely about food; the problem is ingestion, not discussion.
A nurse is teaching a client with hypertension about a sodium-restricted diet. What information should the nurse emphasize? 1 Using salt-free natural seasonings can taste the same as salt. 2 Desiring the taste for salt is inherent but can be overcome with practice. 3 Liking the taste of table salt is learned but it is not a biological necessity. 4 Substituting table salt with potassium chloride can be done freely.
3 The taste for salt is learned from habitual use and can be unlearned or reduced with health improvement motivation and creative salt-free food preparation. Substitutes do not taste the same as salt. The taste for salt is learned. Using salt substitutes containing potassium chloride may be unsafe; excessive use can produce abnormally high serum potassium levels.
A chelating agent is prescribed for a child with lead poisoning. Because chelating agents may cause hypocalcemia, the nurse encourages the child to eat foods that are high in calcium. Which meals are good sources of calcium? Select all that apply. 1 Beef broth, glazed ham, green beans, and cookies 2 Chicken noodle soup, liver and onions, and fruit salad 3 Vegetable soup, roast beef, baked potato, and apple juice 4 Cream of mushroom soup, macaroni and cheese, broccoli, and milk 5 Pea soup, roast chicken breast, mashed potatoes, creamed spinach, and orange juice
4 and 5 This meal is high in calcium. The creamed soup, cheese on the macaroni, broccoli, and milk are high in calcium. This meal is high in calcium; the white-meat chicken, creamed spinach, and orange juice are high in calcium; mashed potatoes are made with milk, which is high in calcium. Beef broth, glazed ham, green beans, and cookies are not high in calcium. Chicken noodle soup, liver and onions, and fruit salad are not high in calcium. Vegetable soup, roast beef, a baked potato, and apple juice are not high in calcium.