Chapter 36- Nutrition
The nurse prepares to administer an intermittent feeding to a client who has a nasogastric feeding tube. Arrange the following steps in the correct order 1. Verify correct tube placement. 2. Position client with head of bed elevated 30 to 45° degrees 3. Aspirate all gastric contents. 4. Flush tube with 30 mL water. 5. Verify that residual volume is less than 400 mL. 6.Administer feeding A) 1,2,3,4,5,6 B) 2,1,3,5,4,6 C) 2,3,1,4,6,5 D) 1,3,2,4,5,6 E) 1,4,2,3,5,6
Ans: B Feedback: The correct order for administering an intermittent feed to a client who has a nasogastric feeding tube is (1) Position client with head of bed elevated 30 to 45° degrees; (2) Verify correct tube placement; (3) Aspirate all gastric contents; (4) Verify that residual volume is less than 400 mL; (5) Flush tube with 30 mL water; and (6) Administer feeding.
13. A nurse has documented that a client has anorexia. What does this term mean? A) Eating more than daily requirements B) Lack of appetite C) Vitamin C deficiency D) Fluid deficit
Ans: B Feedback: Anorexia is lack of appetite. It may be related to multiple factors, including diseases, psychosocial causes, impaired ability to chew and taste, or inadequate income.
To promote health of the fetus, the nurse should instruct the woman in the first trimester of pregnancy to do which of the 24. following? A) Eliminate high-fiber foods B) Eat foods high in folic acid C) Consume saturated fats D) Consume milk products in the last trimester
Ans: B Feedback: Folic acid deficiency in pregnant women can lead to neural tube deficits in the fetus. Women during pregnancy may experience constipation. Increased fiber intake is recommended. Saturated fats are to be eaten only in moderation. Milk products are important during the entire pregnancy.
A nurse is caring for a client with complaints of chest pain. Which of the following test results would indicate whether 31. the client is at risk for cardiac disease? A) Test results of levels of unsaturated fats B) Test results for dyslipidemia C) Test results of levels of balanced proteins D) Test results of levels of calories in each food intake
Ans: B Feedback: Health care providers test for dyslipidemia to assess clients' risks for cardiovascular disease. Measuring levels of protein, calories, or unsaturated fats will not help to assess if a client is at risk for cardiac and vascular disease.
A hospitalized client has been NPO with only intravenous fluid intake for a prolonged period. What assessments might 10. indicate protein-calorie malnutrition? A) Fever, joint pain, dehydration B) Poor wound healing, apathy, edema C) Sleep disturbances, anger, increased output D) Weight gain, visual deficits, erythema of skin
Ans: B Feedback: The stress of illness, surgery, or prolonged periods of time on simple intravenous therapy without oral intake places hospitalized clients at risk for developing protein-calorie malnutrition. This can result in weakness, poor wound healing, mental apathy, and edema.
A nurse researching a diet for a client with diabetes includes foods that supply energy to the body. Which of the 25. following are classes of nutrients that supply this energy? Select all that apply. A) Vitamins B) Proteins C) Fats D) Minerals E) Carbohydrates
Ans: B, C, E Feedback: Of the six classes of nutrients, three supply energy (carbohydrates, proteins, lipids [fats]) and three are needed to regulate body processes (vitamins, minerals, water).
A nurse calculates the BMI of a client during a general survey as 26. Under which of the following categories would this 30. client fall? A) Underweight B) Normal C) Overweight D) Obesity Class I
Ans: C Feedback: BMI values are: Underweight <18.5; normal 18.5 to 24.9; overweight 25.0 to 29.9; obesity class I 30.0 to 34.9; obesity class II 35.0 to 39.9; and extreme obesity 40.0+.
A nurse is caring for a client with excessive abdominal fat. Which of the following is a risk associated with excessive abdominal fat about which the nurse should inform the client? A) Emaciation B) Cachexia C) Cardiovascular disease D) Anorexia
Ans: C Feedback: Excess abdominal fat may lead to cardiovascular disease, hypertension, and diabetes. Anorexia is the loss of appetite. Emaciation is characterized by excessive leanness. Cachexia is the general wasting away of body tissue.
8. Which client will have an increased metabolic rate and require nutritional interventions? A) A healthy young adult who works in an office B) A retired person living in a temperate climate C) A person with a serious infection and fever D) An older, sedentary adult with painful joints
Ans: C Feedback: Factors that increase metabolic rate include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of some hormones. Aging, prolonged fasting, and sleep decrease metabolic rate.
A nutritionist helps to plan a diet for a client with diabetes. Which of the following foods is a carbohydrate that should 29. be included to help improve glucose tolerance? A) Milk B) Eggs C) Oatmeal D) Nuts
Ans: C Feedback: Oatmeal is a water-soluble carbohydrate that helps improve glucose tolerance in diabetics. Milk, eggs, and nuts are proteins.
A nurse is helping a client design a weight-loss diet. To lose one pound of fat (3,500 calories) per week, how many 9. calories should be decreased each day? A) 100 B) 250 C) 500 D) 1,000
Ans: C Feedback: One pound of body fat equals about 3,500 calories. To gain or lose one pound in a week, daily calorie intake should be reduced by 500 calories per day (3,500 calories divided by 7 equals 500 calories per day).
A client visits a health care facility with complaints of loss of appetite following a prolonged illness. How should the 21. nurse document the client's condition? A) Emaciation B) Cachexia C) Anorexia D) Nausea
Ans: C Feedback: The nurse should document the loss of appetite following prolonged illness as anorexia. Emaciation is excessive leanness. Cachexia is the general wasting away of body tissue. Nausea usually precedes vomiting and is associated with gastrointestinal sensations.
16. What independent nursing intervention can be implemented to stimulate appetite? A) Administer prescribed medications. B) Recommend dietary supplements. C) Encourage or provide oral care. D) Assess manifestations of malnutrition.
Ans: C Feedback: There are many methods of stimulating appetite in a client to prevent malnutrition. One independent nursing intervention that is useful is to encourage or provide oral care.
18. A client has been prescribed a clear liquid diet. What food or fluids will be served? A) Milk, frozen dessert, egg substitutes B) High-calorie, high-protein supplements C) Hot cereals, ice cream, chocolate milk D) Jell-O, carbonated beverages, apple juice
Ans: D Feedback: Clear liquid diets contain only foods that are clear liquids at room or body temperature. Included are gelatin, fat-free broth, bouillon, ice pops, clear juices, carbonated beverages, regular and decaffeinated coffee, and tea. A full liquid diet includes all fluids and foods that become liquid at room temperature. This would include ice cream, chocolate milk, and liquid dietary supplements.
A client is discussing weight loss with a nurse. The patient says, "I will not eat for two weeks, then I will lose at least 10 7. pounds." What should the nurse tell the client? A) "What a good idea. Go ahead. That will jump start your weight loss!" B) "Many people find that to be an ideal way to lose weight quickly and easily." C) "That will increase your metabolic rate and help you lose weight." D) "That will decrease your metabolic rate and make weight loss more difficult."
Ans: D Feedback: Most nutritionists agree that fasting or following a very low-calorie diet defeats a weight-loss plan because the body interprets this eating pattern as starvation, and compensates by slowing down the basal metabolic rate, making it even more difficult to lose weight.
A nurse is discussing infant care with a woman who just had a baby girl. What type of nutrition would the nurse 14. recommend for the infant? A) Solid foods after the first month B) No solid foods until age 1 year C) Bottle feeding with cow's milk D) Breast-feeding or formula with iron
Ans: D Feedback: Nutritional needs per unit of weight are greater in infants than at any other time in the life cycle. Breast-feeding or a commercial formula with iron is recommended as the major source of nutrition for the first 6 to 12 months of life. Cow's milk is not recommended for infants under 1 year. Solid foods are usually not introduced until 6 months.
19. What is the route of administration for TPN? A) Oral B) Subcutaneous C) Intramuscular D) Intravenous
Ans: D Feedback: TPN meets the client's nutritional needs by way of nutrient-filled solutions administered intravenously through a central line, usually the subclavian or internal jugular veins.
17. A nurse is feeding a client. Which of the following statements would help a person maintain dignity while being fed? A) "I am going to feed you your cereal first, and then your eggs." B) "I wish I had more time so I could feed you all of your meal." C) "I know you don't like me to feed you, but you need to eat." D) "What part of your dinner would you like to eat first?"
Ans: D Feedback: The loss of independence that comes with the inability to self-feed can be a severe blow to a person's self-esteem. Asking the person his or her preference regarding the order of items eaten can help maintain dignity while being fed.
11. How often would a nurse recommend a client eat or drink a source of vitamin C? A) Once a week B) Once a month C) Three times a week D) Every day
Ans: D Feedback: Vitamin C, a water-soluble vitamin, is usually not stored in the body. Deficiency symptoms are apt to develop quickly when intake is inadequate; a daily intake is recommended.
While reviewing an adult client's chart, a nurse notes average daily intake of fluids as 2,000 mL/day. What will the 12. nurse do based on this information? A) Change the plan of care to include forcing fluids. B) Ask the client to drink more water during the day. C) Post a sign limiting fluids to 1,000 mL every 24 hours. D) Continue with care; this is a normal fluid intake.
Ans: D Feedback: Water intake averages 2,000 to 2,500 mL/day for adults. The nurse would continue with care, because the client has a normal fluid intake.
15. What information do anthropometric measurements provide in adults? A) Indirect measure of protein and fat stores B) Direct measure of degree of obesity C) Indication of degree of growth rate D) Reflection of social interaction with others
Ans: A Feedback: Anthropometric measurements are used to determine body dimensions. In children, they are used to assess growth rate; in adults, they give indirect measurements of body protein and fat stores.
32. For which of the following clients should the nurse anticipate the need for a pureed diet? A) A man whose stroke has resulted in difficulty swallowing B) A woman who has required gallbladder surgery C) A man with dementia who is unable to follow instructions D) An obese woman after bariatric surgery
Ans: A Feedback: Pureed diets are indicated for clients who have significant problems chewing and/or swallowing. Surgery and confusion are not indications for this change in the texture and consistency of food.
In planning to meet the nutritional needs of a critically ill client in the intensive care unit, which factor will increase the 2. client's basal metabolic rate? A) Infection B) Advanced age C) Prolonged fasting D) Long periods of sleep
Ans: A Feedback: Factors that increase a person's basal metabolic rate (BMR) include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones (epinephrine and thyroid hormones). Aging, prolonged fasting, and sleep all decrease BMR.
A nurse is caring for a client with a history of cardiac and vascular disease. Which of the following fats should the nurse 20. allow in the client's diet for his condition? A) Unsaturated fats B) Trans fats C) Saturated fats D) Hydrogenated fats
Ans: A Feedback: Unsaturated fat is a healthier form of fat than saturated fat, because it contains less hydrogen, and therefore can be included in the client's diet. Saturated fats are lipids that contain as much hydrogen as their molecular structure can hold, and are generally solid. Most saturated fats are found in animal sources, such as the marbled fat in meat. Saturated fats are responsible for cardiac and vascular diseases. Trans fats are unsaturated fats that have been hydrogenated, a process in which hydrogen is added to the fat. Consumption of trans fats, saturated fats, and hydrogenated fats increases the risk of coronary heart disease.
A nurse is caring for a young adult female client who has a folic acid defiency. When teaching the client about this 23. condition, the nurse would include a discussion about the client's increased risk for which of the following? A) Neural tube deficits in the fetus B) Inadequate absorption of calcium and phosphorus C) Hemolysis of red blood cells D) Impaired neuromuscular functioning
Ans: A Feedback: Folic acid deficiency in pregnant women can lead to neural tube deficits like spina bifida in the fetus. Because fetal neural development begins so early in pregnancy, women in their childbearing years must have adequate folic acid intake. Deficiency in vitamin D intake leads to inadequate absorption of calcium and phosphorus, and a deficiency of mineralization in bones and teeth. Increased hemolysis of red blood cells, poor reflexes, impaired neuromuscular functioning, and anemias are signs of vitamin E deficiency, not folic acid deficiency.
27. Which of the following are signs and symptoms of poor nutritional status? A) Flaky facial skin, facial edema, pale skin color B) Tongue is a deep red in color with surface papillae present. C) Firm, pink nailbeds D) Firm hair that is resistant to plucking
Ans: A Feedback: Healthy skin is uniform in color and not swollen.
28. Which of the following laboratory results indicates the presence of malnutrition? A) Serum albumin 2.8 g/dL B) Hemoglobin (Hgb) 11.3 g/dL C) Creatinine 1.9 mg/dL D) Hematocrit (Hct) 56%
Ans: A Feedback: Increased Hct indicates dehydration.
The nurse is testing the blood glucose levels of a client with a history of diabetes. The nurse has performed hand hygiene, checked the order, informed the client and turned on the monitor. After removing a test strip from the vial, the 6. nurse should do which of the following? A) Confirm that the strip and the meter share the same code. B) Massage the client's finger toward the selected puncture site. C) Cleanse the client's finger with alcohol. D) Pierce the client's skin with the lancet.
Ans: A Feedback: It is important to confirm that the code on the strip and the meter match. This should precede massaging and cleansing the client's finger or piercing his/her skin.
Which of the following nutritional guidelines should a nurse provide to a client who is entering the second trimester of 5. her pregnancy? A) "You'll need to eat more calories and to make sure you eat a balanced diet high in nutrients." B) "Try to eat your normal number of calories, but aim to eat a diet that's higher in fruits and vegetables." C) "The more food energy you consume, the greater the chances that you will have a healthy pregnancy." D) "Maintain your regular calorie intake, but take some supplements and emphasize organic foods."
Ans: A Feedback: Nutrient needs during pregnancy increase to support growth and maintain maternal homeostasis, particularly during the second and third trimesters. During the last two trimesters, women of normal weight need approximately 300 extra calories per day. Key nutrient needs include protein, calories, iron, folic acid, calcium, and iodine. It would be inaccurate to encourage the client to maximize calorie intake.
A nurse performing a nutritional assessment determines that the BMI of a 5'11" (1.8 meters) male client who weighs 81 33. kilograms is which of the following? A) 25.1 B) 18.5 C) 20.3 D) 28.6
Ans: A Feedback: The formula for calculating BMI is (body weight in kilograms) divided by (body height in meters squared). (weight in kg) (height in meters) * (height in meters)
The nurse caring for a client for several days has assessed that he has been eating poorly during his hospitalization. 4. Which nursing measure should the nurse implement to assist the client in improving his nutritional intake? A) Encourage his daughter to prepare food at home and bring it to the client. B) Serve large meals and encourage the client to eat as much as possible. C) Provide distractions while the client is fed so that he will eat more. D) Provide bland meals.
Ans: A Feedback: The nurse should solicit food preferences and encourage favorite foods from home, when possible. Be sure the foods look attractive and the eating area is free of odors, clutter, and distractions during mealtime. Provide small, frequent meals to avoid overwhelming the client with large amounts of food.
Most nutritionists recommend increasing fiber in the diet. In addition to other benefits, how does fiber affect 34. cholesterol? A) Increases fecal excretion of cholesterol B) Decreases fecal excretion of cholesterol C) Facilitates intake and use of trans fat D) Raises blood cholesterol levels
Ans: A Feedback: To help lower serum cholesterol levels, researchers recommend limiting cholesterol intake, eating less total fat, eating more unsaturated fat, and increasing fiber intake. Fiber increases fecal excretion of cholesterol.
A client is interested in losing 15 pounds, and she informs the nurse she is counting her calorie intake each day. The client has a goal of losing one pound a week until she reaches her goal. The client asks the nurse how many calories she should decrease daily to lose a pound a week. What is the nurse's best response? A) 500 calories/day B) 200 calories/day C) 300 calories/day D) 400 calories/day
Ans: A Feedback: To lose 1 pound (0.45 kg) in a week, daily calorie intake should be decreased by 500 calories a day. One pound of body fat equals about 3,500 calories; 3,500 calories divided by 7 days
A dietitian is providing an in-service for the nurses on a medical-surgical unit. During the in-service, she informs the group that there are six classes of nutrients, and three supply the body with energy. What are the three sources of 1. energy? A) Carbohydrates, protein, and lipids B) Vitamins, minerals, and water C) Carbohydrates, protein, and water D) Lipids, vitamins, and minerals
Ans: A Feedback: Of the six classes of nutrients, three supply energy (carbohydrates, protein, and lipids), and three are needed to regulate body processes (vitamins, minerals, and water).
26. Which of the following factors increase BMR? Select all that apply. A) Growth B) Infections C) Fever D) Emotional tension E) Aging
Ans: A, B, C, D Feedback: Factors that increase BMR include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones, especially epinephrine and thyroid hormones. Aging, prolonged fasting, and sleep all decrease BMR.