Ch 35: Nutritional Support Products, Vitamins, and Mineral Supplements

c) 2,000 to 3,000 mL of fluid per day Pg. 697 The body's need for water is influenced by many variables, including activity, climate, and health. A general guideline is to consume 1.0 mL of fluid per calorie consumed, with a minimum of 1500 mL/day. Therefore the patient's recommended intake of water is at least 2,000 mL per day.

1. The nurse is admitting a healthy 35-year-old woman to the outpatient surgery department for the removal of a plantar wart. The patient consumes approximately 2,000 cal/day. What is the patient's recommended intake of water? a) 3,000 to 4,000 mL of fluid per day b) 1,000 mL of fluid per day c) 2,000 to 3,000 mL of fluid per day d) 1,500 mL of fluid per day

d) Vegetable oils Pg. 697 Sources of vitamin E include vegetables oils, margarine, salad dressing, other foods made with vegetable oil, nuts, seeds, wheat germ, dark green vegetables, whole grains, and fortified cereals. The other foods do not increase your intake of vitamin E.

10. If you were told to eat more vitamin E, what would you want to eat more of? a) Skim milk b) Lean meat c) Egg whites d) Vegetable oils

d) Orange juice Pg. 718 Taking an iron preparations with orange juice assists in the absorption of iron.

11. The nurse is caring for a client who is receiving an iron supplement for treatment of anemia. What food/liquid will the nurse offer the client to take with the iron that will increase the iron's absorption? a) Milk b) Toast c) Water d) Orange juice

d) "Nutrients are best obtained from foods" Pg. 726 Nutrients are best obtained from foods; when they cannot be obtained from foods, they can be provided by oral, enteral (via GI tubes), or parenteral (IV) feedings to meet a client's nutritional needs.

12. A male client tells the nurse that he obtains all of his nutrients from vitamins. What is the correct explanation the nurse would give this client? a) "You cannot obtain enough vitamin B6 from vitamins" b) "You should consult your health care provider for the correct strength of the vitamins" c) "The effectiveness of the vitamins depends on the brand" d) "Nutrients are best obtained from foods"

d) Potassium Pg. 704 Diets rich in fruits and vegetables are likely to be high in potassium and low in sodium. Generally, sodium and potassium content are inversely related: processed foods are low in potassium and high in sodium; fresh wholesome foods are high in potassium and lower in sodium. Fruits and vegetables do not contain high amounts of sodium, iron, or iodine

13. Many people throughout the world are practicing vegetarians. Their diet is rich in fruits and vegetables so it is also likely to be rich in: a) Iodine b) Sodium c) Iron d) Potassium

c) "Lie down for about 30 minutes, and then be careful when you sit and stand up" Pg. 711 Niacin may cause vasodilation, so it is important for the client to lie down for approximately 30 minutes after niacin has been administered to prevent falling or fainting. The client should use care when arising. It can cause facial flushing, and the client can take 325 mg of aspirin to help with this.

14. The nurse has just administered oral niacin to a client. What is the most important instruction the nurse can give to this client at this time? a) "If your face becomes flushed, it is important not to take any type of medication" b) "You can expect to feel very cold for the next ten minutes. This will subside in about 10 minutes" c) "Lie down for about 30 minutes, and then be careful when you sit and stand up" d) "This medication has better absorption if you go for a brisk 10-minute walk"

c) Taking large doses of vitamin A is potentially harmful Pg. 710 Supplements taken to augment an intake that is already adequate are unnecessary; using supplements and fortified foods may be potentially dangerous—as is the case with vitamin A. Americans do consume adequate amounts of vitamins, and beta-carotene supplements are not routinely recommended.

15. Which of the following statements about vitamins is true? a) Because of the potential health benefits, beta-carotene supplements are routinely recommended b) Most Americans do not consume adequate amounts of vitamin C c) Taking large doses of vitamin A is potentially harmful d) Most Americans do not consume adequate amounts of thiamine, riboflavin, and niacin

a) Older adults may need a reduced dose because of decreased renal function Pg. 721 Older adults may need a reduced dose because of decreased renal function. Liver function is not an issue because magnesium is excreted in the urine.

16. A senior-level nurse is teaching a course on lifespan considerations when administering magnesium infusions. Which of the following information would the nurse include while teaching the subject? a) Older adults may need a reduced dose because of decreased renal function b) Older adults may need a reduced dose because of increased liver function c) Older adults may need a reduced dose because of decreased liver function d) Older adults may need an increased dose because of increased renal function

b) Bile salts Pg. 697 Fat-soluble vitamins are absorbed from the intestine with dietary fat, and absorption requires the presence of bile salts and pancreatic lipase.

17. Understanding the absorption of fat-soluble vitamins, what substance is necessary to facilitate absorption from the intestine with dietary fat? a) Mucus b) Bile salts c) Dextrose d) Hepatic enzymes

d) Polystyrene sulfonate Pg. 722 With less severe hyperkalemia, sodium polystyrene sulfonate, a cation exchange resin, administered orally, removes potassium from the body in the stool. Glucose and insulin and calcium gluconate are used to treat severe hyperkalemia. Normal saline can assist with increased fluid intake but is not prescribed as treatment for hyperkalemia.

18. A nurse is caring for client with a serum potassium level of 5.8 mEq/L. Which treatment does the nurse anticipate the prescriber to order? a) Calcium gluconate b) Normal saline c) Glucose and insulin d) Polystyrene sulfonate

c) Warfarin Pg. 710 Vitamin K is used to reverse the effects of warfarin. It does not, however, affect the pharmacokinetics of heparin. Vitamin K is not an antidote to vitamin A or iron overdose.

19. The health care provider has ordered immediate (STAT) administration of vitamin K for a client who accidently overdosed on a medication. The nurse knows that the client overdosed on what drug? a) Vitamin A b) Ferrous sulfate c) Warfarin d) Heparin

d) Folic acid Pg. 702 Sexually active women of childbearing potential need an adequate intake of folic acid to prevent severe birth defects in infants. To help prevent birth defects from folic acid deficiency, the U.S. Food and Drug Administration requires that folic acid be added to breads and cereal-grain products.

2. The nursing instructor is discussing dietary needs as they relate to age. According to the instructor, adequate intake of what vitamin is especially important in sexually active women of childbearing age to prevent severe birth defects? a) Vitamin D b) Vitamin K c) Vitamin B12 d) Folic acid

b) Because older adults may need a reduced dosage as a result of decreased renal function Pg. 721 Older adults may need a reduced dosage of magnesium because of decreased renal function. The nurse should closely monitor serum magnesium levels when magnesium is administered to older adults.

20. An elderly client has been ordered magnesium 483 mg daily orally. The student nurse is about to administer that dose when the nursing instructor questions it. The student states that the regular dose is 54 to 483 mg/day. Why did the instructor question this dose? a) To be cautious because magnesium interacts poorly with several other drugs b) Because older adults may need a reduced dosage as a result of decreased renal function c) To ensure that the student knows medication values well d) The student should be dividing the single dose in several administrations to improve processing of the medication

b) Potassium Pg. 704 Potassium is the major electrolyte in the intracellular body fluid that is excreted or retained during diuretic therapy. Potassium cannot be stored and needs to be replaced by daily consumption. Potassium is responsible for cardiac muscle contraction; if too high or too low the electrolyte can cause cardiac arrhythmia. Plasma, 0.9% NACL, and TPN are IV solutions that are administered to a client.

21. A 69-year-old client, who has been prescribed a daily diuretic, is admitted to critical care with a cardiac arrhythmia. Which electrolyte should be monitored due to its' effect on heart rate and excretion or retention during diuretic therapy? a) Plasma b) Potassium c) 0.9% NaCl d) TPN

d) Phlebitis and/or thrombosis Pg. 720 The IV site is monitored for phlebitis and/or thrombosis. Pain in the proximal and distal body parts are not considered at the IV site. Monitoring potassium and chloride would require a blood test.

22. The nurse knows to monitor the IV site for which of the following complications during parenteral management of body fluids? a) Pain in the most distal body part b) Pain in the most proximal body part c) Potassium and chloride d) Phlebitis and/or thrombosis

c) 2500 mg Pg. 703 Total calcium intake—from both supplements and foods—should not exceed the UL of 2500 mg per day.

23. An adult client has asked the nurse about the potential need for calcium supplements. What should the nurse identify as the daily upper intake level for this mineral? a) 1500 mg b) 2000 mg c) 2500 mg d) 1000 mg

a) Ensure that potassium infuses in no less than 4 hours Pg. 717 When administering potassium to the client, the nurse should ensure that the entire IV solution infuses in no less than 4 hours. Concentrated potassium solutions are for IV mixtures only and should never be used undiluted. Direct IV injection of potassium could result in sudden death. When potassium is given IV, it is always diluted in 500 to 1000 mL of an IV solution. The nurse should use a large vein for administration of potassium, so the veins in the back of the hand should be avoided. If potassium is to be taken orally, then it should always be administered after meals with a full glass of water to decrease the incidence of GI disturbances and nausea.

24. A nurse is caring for a client who is to receive IV potassium. Which action would be appropriate? a) Ensure that potassium infuses in no less than 4 hours b) Administer the potassium before meals c) Inject potassium directly into the client's vein d) Use the veins in the back of the hand

d) 130 mEq/L Pg. 704 Hyponatremia, a serum sodium level of less than 135 mEq/L, usually results from excessive water retention.

25. An elderly client postoperative hip replacement is experiencing signs of hyponatremia. The nurse checks the client's electrolyte levels. Which of the following serum sodium levels confirms this diagnosis? a) 145 mEq/L b) 135 mEq/L c) 150 mEq/L d) 130 mEq/L

c) It can be safely prescribed for clients experiencing liver failure d) Enteral nutrition contains with a mixture of fluid and nutrients e) It requires the insertion of a feeding tube into the mouth, nose, or directly in the stomach Pg. 723 Enteral nutrition is used when the GI tract is fully functional. Tubes can be inserted in the nose, mouth and directly in the stomach. Enteral nutrition provides fluid and nutrients and can be prescribed for clients with liver failure. Liquid preparation of medications should be used instead of crushing tables and mixing with the tube feeding formula.

26. What information should be included in the teaching of a client prescribed enteral nutrition? Select all that apply. a) Tablets should be crushed and mixed with the tube feeding formula before being introduced into the feeding tube b) This nutrition is used when the gastrointestinal (GI) tract is nonfunctional c) It can be safely prescribed for clients experiencing liver failure d) Enteral nutrition contains with a mixture of fluid and nutrients e) It requires the insertion of a feeding tube into the mouth, nose, or directly in the stomach

c) Bioavailability varies within the context of the total diet Pg. 703 Factors that complicate the study of trace minerals include the fact that bioavailability varies within the context of the total diet.

27. Trace minerals in the body, though small in quantity, play large roles in its functioning. Trace minerals have been hard to study because of what factor? a) Reliable and valid indicators of trace element status are readily available b) The comparability of trace mineral content of foods is high c) Bioavailability varies within the context of the total diet d) Food composition data are not necessary for all trace minerals

b) Vitamin B12 Pg. 711 Vitamin B12 occurs in meat, fish, poultry, shellfish, milk, dairy products, eggs, and some fortified foods. It does not occur in plant sources. A strict vegan who consumes no animal products is at risk for a B12 deficiency. The best sources of vitamin B6 include meat, fish, poultry, organ meats, enriched cereals and meatless soy products, nuts, lentils, and some vegetables and fruit. Vitamin K sources are green leafy vegetables. Vitamin C sources are citrus fruits.

28. A nurse is caring for a client who is a strict vegan. Which vitamin deficiency is the client at risk for developing? a) Vitamin C b) Vitamin B12 c) Vitamin B6 d) Vitamin K

a) Serum electrolyte levels Pg. 707 Electrolyte and acid-base imbalances often occur in critically ill clients and are usually treated, as in other clients, with very close monitoring of serum electrolyte levels and avoidance of excessive amounts of replacement products.

29. The nurse is caring for a critically ill client in the unit who has an IV dedicated to fluid and electrolyte replacement. To prevent imbalances and adverse reactions, what should the nurse closely monitor? a) Serum electrolyte levels b) Serum albumin levels c) BUN and creatine levels d) Hemoglobin and hematocrit levels

d) Slow the infusion to keep the vein open and notify the primary care provider and apply a cardiac monitor Pg. 720 Slowing the infusion to keep the vein open and notifying the primary care provider is indicated due to a change in condition. Check the pulse rate at regular intervals, telemetry or continual monitoring may be initiated if an irregularity in the heart rate is observed. For example, when potassium is administered to a patient with cardiac disease, a cardiac monitor is needed to monitor the heart rate and rhythm continuously during therapy. Continuing to monitor the pulse rate, blood pressure, and respiratory rate every 30 minutes as well as monitoring intake and output is indicated after the provider h as been notified of the change in condition.

3. A client is receiving an IV potassium infusion. During the infusion, the client develops an irregular pulse. The nurse would take which action(s)? a) Measure intake and output at the start of the irregular pulse, then notify the primary care provider b) Continue to monitor the blood pressure every 30 to 60 minutes until the infusion is complete, then notify the primary care provider c) Continue to monitor the pulse rate every 15 to 30 minutes until the infusion is complete, then notify the primary care provider d) Slow the infusion to keep the vein open and notify the primary care provider and apply a cardiac monitor

a) "The body stores fat-soluble vitamin excess to use later" Pg. 697 Fat-soluble vitamins, vitamins A, D, E, and K, are stored in the body when taken in excess. They are absorbed from the intestine with dietary fat and are available in food and as supplements. Water-soluble vitamins, B complex vitamins and vitamin C, are not stored in the body and are rapidly eliminated. Food and not supplements is recommended as the best source of fat-soluble vitamins. Some foods rich in fat-soluble vitamins are broccoli, carrots, egg yolks, and fortified milk.

30. A client asks the nurse about fat-soluble vitamins. Which statement should the nurse include when discussing fat-soluble vitamins with a client? a) "The body stores fat-soluble vitamin excess to use later" b) "Organic fat-soluble supplements are the best" c) "B1, B3, and B6 are part of the fat-soluble vitamins" d) "Fat-soluble vitamins are only available by supplements"

d) Keep intake of vitamin K foods constant Pg. 711 Vitamin K is used to reverse the effects of a warfarin overdose. It is important to teach the client to keep intake of vitamin K foods constant as this can reverse the medication. The client should be instructed not to double the dose. There is no need to call the provider for additional information. Laboratory appointments for warfarin are scheduled more frequently than annually.

31. A nurse is caring for a client prescribed warfarin for chronic atrial fibrillation. Which information should be included in this client's medication teaching plan? a) Schedule annual laboratory appointments b) Call the provider for additional information c) If you miss a dose, take a double dose d) Keep intake of vitamin K foods constant

d) Intravenous Pg. 721 The intravenous route is the preferred route for electrolyte administration when the body is unable to absorb electrolytes given orally. It is also the preferred route when the body will not absorb electrolytes quickly enough to prevent life-threatening complications. The intramuscular, subcutaneous, and intradermal routes do not help in absorption of electrolytes as fast as the intravenous route. Thus, these routes are not preferred.

4. A client who is taking chemotherapeutic drugs for treatment of a malignant cancer has repeated bouts of vomiting. Electrolytes are administered to maintain the serum electrolyte balance. However, the client cannot absorb electrolytes taken orally. Which is the preferred route of electrolyte administration in such a case? a) Intramuscular b) Subcutaneous c) Intradermal d) Intravenous

d) "How is your energy level compared with a few days ago?" Pg. 718 The nurse should assess for increased energy, vigor, and feeling of well-being. Pruritus, visual changes, and restless legs do not accompany iron deficiency and would not be addressed in follow-up assessments.

5. A client diagnosed with iron deficiency has been taking oral ferrous sulfate for the past several days. When the nurse is assessing for therapeutic effects, what question is most warranted? a) "Do you feel like you're able to see a bit more clearly now?" b) "Is your skin feeling itchy when you're at rest?" c) "Are you having any leg spasms or restless legs at night?" d) "How is your energy level compared with a few days ago?"

c) Immediately following administration Pg. 721 Intravenous magnesium sulfate produces immediate action that lasts about thirty minutes. Intramuscular injections act in one hour and last three to four hours.

6. A health care provider orders intravenous magnesium sulfate to control convulsions in a pregnant client. When will the preparation take effect? a) 2-3 hours following administration b) 1-2 hours following administration c) Immediately following administration d) 3-6 hours following administration

b) When they are taken in megadoses Pg. 698 In megadoses, vitamins function like drugs, not nutrients.

7. When do vitamins act as drugs in the body? a) When they are taken in combination with other vitamins b) When they are taken in megadoses c) When they are taken in minidoses d) When they are prescribed by a health care provider

a) 129 Pg. 704 Normal values for sodium are 135-145meq/L. The value of 129 would indicate hyponatremia while the 150 value would be indicative of hypernatremia.

8. After receiving the results of blood work for a client with dehydration, the nurse knows which sodium level is indicative of hyponatremia? a) 129 b) 145 c) 150 d) 136

b) "UL is lowest level of intake for healthy people" Pg. 699-702 RDA is the amount estimated to meet the needs of children and adults from studies of healthy adults. UL is the maximum intake considered unlikely to pose a health risk in almost all healthy people in a specified group. UL is established from the total intake from food, fortified food, and supplements.

9. A nurse is teaching a client about recommended dietary allowance (RDA) and tolerable upper intake levels (UL) for certain vitamins and minerals. Which statement by the client during the teaching session identifies the need for additional instruction? a) "RDA is the amount estimated to meet the needs of children and adults" b) "UL is lowest level of intake for healthy people" c) "UL is from total intake of food, fortified food, and supplements" d) "RDA was established by studies of healthy adults"