TEST BANK for Lutz's Nutrition and Diet Therapy 7th Edition by Erin E. Mazur, Nancy A. Litch

Lutz’s Nutrition and Diet Therapy 7th Edition Mazur Litch Test Bank Chapter 1. Nutrition in Human Health MULTIPLE CHOICE 1. Promoting a health care service that improves diabetes management for the elderly in a community would assist in which of the following? a. supporting the National Health Goals-Healthy People 2020 b. reducing world hunger in the United States and Asia c. improving Medicare reimbursement claims d. providing access to child care services for children ANS: A Healthy People 2020 has a wide influence and is the focus of the nations main objective to promote health and prevent disease.

DIF: Cognitive Level: Application REF: 3-Feb TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. A patient requires a nutrition assessment. The most appropriate professional to perform the assessment is a a. physician. b. nurse. c. public health nutritionist. d. registered dietitian.

ANS: D The registered dietitian is the nutrition expert registered with the Commission of Dietetic Registration (CDR), the certifying agency of Academy of Nutrition and Dietetics. Registered dietitians are the only professionals who have met strict educational and professional prerequisites and passed a national registration examination, which would properly prepare them to conduct a nutrition assessment.

DIF: Cognitive Level: Application REF: 1 TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. The sum of all body processes inside living cells that sustain life and health is a. science. b. digestion. c. metabolism. d. nutrition.

ANS: C Metabolism is the sum of all chemical changes that take place in the body. Metabolism provides energy, builds tissue, and regulates metabolic processes in the body.

DIF: Cognitive Level: Knowledge REF: 4-Mar TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nutrients that provide the body with its primary source of fuel for energy are a. vitamins. b. minerals. c. fiber. d. carbohydrates.

ANS: D Carbohydrates (e.g., starches and sugars) are the bodys primary fuel to carry out necessary processes; fat is the secondary source of energy.

DIF: Cognitive Level: Knowledge REF: 4 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Which of the following is the most accurate statement regarding the functions of protein? a. Proteins can be a primary fuel source even if there is adequate carbohydrate intake. b. Proteins are a necessary nutrient to provide energy for the body in times of stress. c. Proteins can be used as coenzyme factors during cell metabolism. d. Proteins are essential to tissue building and repair within the body.

ANS: D The primary function of proteins is to provide amino acids, which are the building units necessary to build and repair tissues within the body. This is a constant process that ensures adequate growth and maintenance of tissues for a strong body.

DIF: Cognitive Level: Comprehension REF: 4 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. A 65-year-old man requires 2000 kcal/day without any specific fat or carbohydrate requirements. The approximate number of kilocalories per day from fat his diet should provide is kcal/day. a. 400 to 700 b. 100 to 300 c. 500 to 800 d. 900 to 1200 ANS: A Fat should provide no more than 20% to 35% of the total kilocalories per day, so for a 2000-kcal diet 400 to 700 kcal should be provided.

DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 7. The bodys main storage form of carbohydrate is a. glycogen. b. glycerol. c. glucagon. d. glucose.

ANS: A Glycogen is a polysaccharide that is the main storage form of carbohydrate in the human body. It is mainly stored in the liver and to a lesser extent in muscle tissue.

DIF: Cognitive Level: Knowledge REF: 4 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The number of kilocalories provided by one slice of bread that contains 30 g carbohydrate, 3 g protein, and 1 g fat is kcal. a. 34 b. 136 c. 141 d. 306

ANS: C Calculate as follows: Carbohydrate provides 4 kcal/g, protein provides 4 kcal/g, and fat provides 9 kcal/g. Therefore: 30 g carbohydrate 4 kcal/g = 120 kcal 3 g protein 4 kcal/g = 12 kcal 1 g fat 9 kcal/g = 9 kcal = 141 total kcal (120 kcal + 12 kcal + 9 kcal) DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The number of kilocalories from fat in a sandwich that contains 22 g fat is kcal. a. 88 b. 132 c. 154 d. 198 ANS: C Fat provides 9 kcal/g. Thus, 22 g fat 9 kcal/g = 198 kcal.

DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The number of kilocalories from protein in a sandwich that contains 15 g protein is kcal. a. 45 b. 60 c. 75 d. 135 ANS: B Protein provides 4 kcal/g. Thus, 15 g protein 4 kcal/g = 60 kcal.

DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The basic building units of protein are called acids. a. fatty b. amino c. nucleic d. carboxyl ANS: B The basic building units of protein are amino acids, which are necessary for building, repairing, and maintaining body tissues.

DIF: Cognitive Level: Knowledge REF: 4 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The main nutrients involved in metabolic regulation and control are a. water and vitamins. b. vitamins and minerals. c. vitamins and fatty acids.

d. minerals and carbohydrates.

ANS: B Vitamins and minerals are the key nutrients in regulating and controlling the many chemical processes in the body. Vitamins and minerals function as coenzyme factors, which are components of cell enzymes that govern cell chemical reactions in cell metabolism.

DIF: Cognitive Level: Knowledge REF: 5 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The dietary regimen that would provide optimal nutrition for a person who is recovering from an extended illness is a diet a. low in protein, fat, and carbohydrates; high in minerals and vitamins; and very low in fiber. b. providing adequate amounts of carbohydrates, protein, fat, minerals, and vitamins along with adequate water and fiber. c. high in protein, fiber, and fluid; low in carbohydrates; and adequate in vitamins and minerals. d. with essential amounts of vitamins and minerals; high in protein; and low in fat, carbohydrates, and fiber.

ANS: B Optimal nutrition incorporates a varied diet supplying adequate amounts of all nutrients, including carbohydrates, protein, fat, vitamins, minerals, fiber, and fluid.

DIF: Cognitive Level: Application REF: 5 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. A young woman is 5 months pregnant. She currently lives in a condition of poverty and often runs out of money to buy food. She is most at risk for a. liver damage. b. osteopenia. c. undernutrition. d. overnutrition.

ANS: C A person with undernutrition, or an intake less than the desired amounts of nutrients a person needs to sustain and maintain health, carries a greater risk for physical illness than a person receiving adequate nutrition. In this case, a young pregnant woman living in poverty who cannot obtain the necessary nutrition for her and her baby is in a state of undernutrition, placing both at nutritional risk.

DIF: Cognitive Level: Application REF: 5 TOP: Nursing Process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. Which factors place a person at the greatest risk for malnutrition? a. poor appetite, insufficient nutrient intake, poor hygiene, and depleted nutrition reserves b. poor hygiene, insufficient exercise, and excess carbohydrate intake c. depleted carbohydrate intake, poor hygiene, and excess calorie intake d. poor appetite, insufficient nutrient intake, depleted nutrition reserves, and a form of metabolic stress ANS: D Malnutrition appears when nutritional reserves are depleted and nutrient and energy intake is not sufficient to meet day-to-day needs or added metabolic stress.

DIF: Cognitive Level: Knowledge REF: 5 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. Mr. Katz, who is 48 years old, is admitted to the hospital with a fracture to his left hip. He weighs 248 lb (54 lb above his desired weight). He is considered to be in a state of overnutrition.

The statement most true regarding his state of overnutrition is a. desired nutrients are consumed in excess amounts without the risk of malnutrition. b. because excess body fat is evident and excess calories are consumed, there is no risk of nutrient deficiency leading to malnutrition. c. even though excess body fat and excess nutrient intake are evident, there still may be a risk for some type of nutrient deficiency leading to malnutrition. d. excess body weight may or may not be present along with excess consumption of carbohydrates and fat, which results in inadequate vitamin and mineral intake.

ANS: C Overnutrition results from excess nutrient and energy intake over time, resulting in excess weight and a state of obesity. Malnutrition can result from excess body weight and the lack of vitaminand mineral-rich food consumption (e.g., consumption of fatty and carbohydrate-rich foods only).

DIF: Cognitive Level: Application REF: 5 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Which is least likely to be a primary cause of malnutrition? a. conditions of poverty b. prolonged hospitalization c. homelessness d. exercise ANS: D Malnutrition appears when nutritional reserves are depleted and nutrient and energy intake is not sufficient to meet day-to-day needs or the additional requirements necessary during periods of stress.

DIF: Cognitive Level: Application REF: 6-May TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. Overnutrition is characterized by a. overeating at a meal. b. excess nutrient and energy intake over time. c. eating a diet with too much variety. d. using dietary supplements.

ANS: B Overnutrition results from excess nutrient and energy intake over time or occurs when excessive amounts of nutrient supplements are consumed, resulting in tissue-damaging effects.

DIF: Cognitive Level: Comprehension REF: 6 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. The Dietary Reference Intakes (DRIs) address the nutrient needs of a. all adults. b. most healthy population groups. c. minority ethnic groups. d. pregnant women, infants, and children.

ANS: B

The DRIs refer to a system of reference values that can be used for assessing and planning diets for healthy population groups and other purposes.

DIF: Cognitive Level: Knowledge REF: 7-Jun TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. The Dietary Reference Intakes (DRIs) are developed by the a. U.S. Public Health Service. b. Food and Drug Administration (FDA). c. National Academy of Sciences, Food and Nutrition Board. d. National Institutes of Health (NIH).

ANS: C DRIs are developed by the National Academy of Sciences, Food and Nutrition Board.

DIF: Cognitive Level: Knowledge REF: 7-Jun TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. When not enough scientific evidence is available to establish a Recommended Dietary Allowance (RDA), the value used to guide intake is called the a. Dietary Reference Intake (DRI). b. tolerable upper intake level (UL). c. estimated average requirement (EAR). d. adequate intake (AI).

ANS: D AI is used as a guide when not enough scientific data are available to establish the RDA figure.

DIF: Cognitive Level: Knowledge REF: 7 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 22. You are asked to help plan meals for a local monthly community dinner meeting for the elderly. The tool that would be most helpful for planning healthy meals is the a. Dietary Reference Intakes. b. Dietary Guidelines for Americans. c. MyPlate food guidance system. d. basic four food groups.

ANS: C MyPlate, provided by the U.S. Department of Agriculture, provides a valuable tool for meal planning, providing serving sizes for each food group and the ability to create a balanced meal from each group listed.

DIF: Cognitive Level: Knowledge REF: 8-Jul TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 23. You are asked to explain the Dietary Guidelines for Americans to an adult community evening class at the local college. The most appropriate areas to cover in teaching this topic include a. appropriate amounts of sodium, saturated fat, cholesterol, transfatty acids, whole grains, and alcohol. b. adequate calories and protein for weight maintenance, smoking cessation, herbal supplements, and food fads. c. importance of low-carbohydrate diets, smoking cessation, herbal supplements, appropriate food groups, and sodium and potassium. d. food security, weight maintenance, glucose monitoring, and blood pressure monitoring

technique.

ANS: A The Dietary Guidelines outline key recommendations to balance calories and maintain weight along with foods and food components to reduce including sodium, saturated fatty acids, cholesterol, transfatty acids, added fats and sugars, refined grains, along with recommendations for limiting alcohol.

DIF: Cognitive Level: Application REF: 10 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A patient asks you what he should eat to maintain an optimal diet. An appropriate response would be to a. eat a variety of foods and eat in moderation. b. avoid all fast food and processed foods. c. eat only natural, organic foods. d. use vitamin and mineral supplements to ensure adequate nutrients.

ANS: A An optimal diet contains a variety of foods and in appropriate quantities to maintain proper weight and health. All foods can fit into a healthy diet in moderation.

DIF: Cognitive Level: Application REF: 5 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. The goal of the MyPlate food guide is to promote a. variety, proportion moderation, gradual improvements, and physical activity. b. physical activity, portion control, daily blood pressure monitoring, and gradual improvements in health. c. portion control, daily physical activity, daily glucose monitoring, moderation, and variety. d. variety, moderation, weighing food portions, daily blood pressure monitoring, and glucose monitoring.

ANS: A The goal of MyPyramid is to promote variety, proportion moderation, gradual improvements, and physical activity.

DIF: Cognitive Level: Knowledge REF: 7 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 26. A patient is to receive 2400 kcal/day while recovering from a motor vehicle accident. He is to receive 50% of calories from carbohydrates, 25% of calories from fat, and 25% of calories from protein. Which of the following represents the appropriate calories for each substrate? a. 1500 kcal from carbohydrates, 500 kcal from fat, and 400 kcal from protein b. 1400 kcal from carbohydrates, 600 kcal from fat, and 400 kcal from protein c. 1200 kcal from carbohydrates, 600 kcal from fat, and 600 kcal from protein d. 1600 kcal from carbohydrates, 400 kcal from fat, and 400 kcal from protein ANS: C 2400 kcal 0.50 = 1200 kcal from carbohydrates; 2400 kcal 0.25 = 600 kcal from fat; and 2400 kcal 0.25 = 600 kcal from protein.

DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance: Physiological Integrity, Physiological Adaptation

27. A patient is placed on a 2300-kcal diet. The health care provider is asked to calculate the grams of carbohydrates he is receiving from the diet. The number of grams of carbohydrates is a. 50 g. b. 35 g. c. 250 g. d. impossible to calculate from this data.

ANS: D The percentage of carbohydrate in the diet typically ranges from 45% to 65% of total calories depending on individual needs, tastes, habits, living situations, and energy demands. However, the health care provider would need to know the specific foods the patient is eating to calculate carbohydrate intake.

DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance: Physiological Integrity, Physiological Adaptation 28. A 52-year-old single woman comes to the health professional for advice on maintaining optimal nutritional health. Her food intake records indicate that she likes to eat at fast food restaurants at least twice a week, and relies on processed foods for the majority of her dietary intake. She maintains an active lifestyle and works part time at the local bank. The next step to assist this woman would be to a. assess meal plan options along with the ability to prepare nutritious foods. b. obtain laboratory values to further assess her nutrition status and recommend supplementing her diet with vitamins and minerals. c. find ways to decrease eating at fast food restaurants and incorporate physical exercise into her daily routine. d. recommend that she use the MyPlate food guide to change her eating style and attend cooking classes at the local community center.

ANS: A The American food environment has been constantly changing over the past several years, with more people eating out and consuming more processed foods. Educating people to follow the MyPlate food guide and the Dietary Guidelines for Americans is important to maintain a healthy lifestyle.

DIF: Cognitive Level: Analysis REF: 8-Jul TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance: Physiological Integrity, Physiological Adaptation 29. The person most at risk for malnutrition would be a(n) a. active young adult who eats 3 to 5 servings of fruits and vegetables along with lean meats and fish and complex carbohydrates and exercises 3 times a week. b. young child who refuses to eat peas, green beans, and broccoli but loves fruits and other vegetables. c. middle-aged man undergoing chemotherapy for leukemia and who is having difficulty eating solid food. d. young weight lifter who has recently undergone surgery for a compound fracture of his left femur.

ANS: C

Malnutrition appears when nutrition reserves are depleted or nutrient and energy intake is not sufficient to meet the day-to-day needs along with the added metabolic stress. In this case, cancer and chemotherapy place an increased metabolic stress on the body and the patient is unable to consume enough food to meet his nutrient requirements, placing him at risk for malnutrition.

DIF: Cognitive Level: Application REF: 6-May TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. C.G. is a 45-year-old man who has a history of diabetes, and the dietary history reveals that he enjoys a good breakfast with whole grain cereal and fruit. For lunch he usually eats soup or an entre consisting of a salad and meat along with 2% milk and a sugared soda. He usually has an afternoon snack of chips and sugared soda and dinner is eaten at a restaurant most days of the week where he chooses steaks, hamburgers, and fries or onion rings along with a salad and a beer or other high- calorie beverage. One of the most important recommendations for C.G. would be a. not to eat at restaurants on a regular basis unless he chooses salads only along with water. b. to continue with whole grains, lean proteins, and vegetables and replace sugary sodas with sugar-free beverages. c. to drink skim milk and eliminate soups, replacing them with fatty fish five meals a week. d. to enjoy his diet as is but encourage adequate amounts of exercise throughout the week.

ANS: B The Choose MyPlate approach encourages making food choices for a healthy lifestyle including balancing calories; enjoying food but in a portion-controlled approach; encouraging whole grains, fruits, vegetables, and low fat dairy; decreasing high fat and sugary foods; and monitoring sodium. In this case where diabetes is a concern as well, a meal plan emphasizing portion control, whole grains, vegetables, and drinks without sugar would be appropriate.

Chapter 2. Carbohydrates MULTIPLE CHOICE 1. Carbohydrates are nutrients that are composed of the elements carbon, hydrogen, and a. oxygen. b. nitrogen. c. water. d. glucose.

ANS: A The chemical nature of carbohydrates is carbon, hydrogen, and oxygen.

DIF: Cognitive Level: Knowledge REF: 14 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. Carbohydrates play a major role in nutrition because they a. provide a long-term energy store. b. are digested in the stomach. c. help regulate body functions. d. provide the bodys major source of energy.

ANS: D Rationale: Carbohydrates are the major source of energy for the body, comprising approximately 50% of total caloric intake.

DIF: Cognitive Level: Application REF: 13 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Carbohydrates are stored as glycogen in the a. central nervous system and muscles. b. heart and liver. c. small intestine. d. liver and muscles.

ANS: D Rationale: Carbohydrates are stored as glycogen in the liver and muscles.

DIF: Cognitive Level: Knowledge REF: 17 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. An example of a food that contains a fructose sugar is a. milk. b. honey. c. molasses. d. corn.

ANS: B Fructose is a monosaccharide and is the sweetest of the simple sugars. It is primarily found in fruits and honey.

DIF: Cognitive Level: Knowledge REF: 14 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Examples of the simple carbohydrates include a. glucose and galactose. b. sucrose and starch. c. lactose and lignin. d. fructose and glycogen.

ANS: A Monosaccharides are the simple sugar units used to build more-complex carbohydrates. The monosaccharides are glucose, galactose, and fructose.

DIF: Cognitive Level: Application REF: 15-16 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The sugar to which all other sugars are converted and the one that circulates in the blood to provide major fuel for the bodys cells is a. sucrose. b. fructose. c. glucose. d. maltose.

ANS: C Glucose is a monosaccharide considered the basic single sugar in the bodys metabolism. Glucose is the form of sugar circulating in the blood and is the primary fuel for the cells.

DIF: Cognitive Level: Knowledge REF: 14 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Carbohydrates are called quick energy foods because a. they do not take long to prepare and are readily available.

b. the human body can rapidly break them down to yield energy. c. they are abundant in fast foods and can be readily absorbed. d. they can yield more energy than other nutrients.

ANS: B Carbohydrates are considered quick energy foods because they can readily be metabolized in the body to yield glucose, the main fuel source for the body.

DIF: Cognitive Level: Comprehension REF: 14 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The carbohydrate form in which glucose is stored in the body is a. starch. b. polysaccharide. c. glycogen. d. fructose.

ANS: C Glucose is stored in the body as glycogen.

DIF: Cognitive Level: Knowledge REF: 17 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Of the following, the best food choices for dietary fiber include a. fruit and fruit juice. b. rice and crackers. c. iceberg lettuce and tomato juice. d. lentils and corn.

ANS: D Dietary fiber is found in unrefined and whole plant foods. Of the choices listed, lentils and corn provide the highest amount of dietary fiber.

DIF: Cognitive Level: Application REF: 17 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. Types of dietary fiber include a. lactose, galactose, and maltose. b. polysaccharides and polyols. c. starch, ptyalin and glucose d. cellulose, lignin, and noncellulose.

ANS: D Dietary fiber is found in plant foods. Plants contain several types of dietary fiber, including cellulose, lignin, and noncellulose polysaccharides.

DIF: Cognitive Level: Knowledge REF: 17-19 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The recommended daily intake of dietary fiber for an adult woman is g/day. a. 15 b. 21 c. 25 d. 30 ANS: C The recommended intake of fiber for men and women aged 50 years and younger is 38 g/day and 25 g/day, respectively.

DIF: Cognitive Level: Knowledge REF: 19 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The health professional is determining the caloric intake for a patient. Her caloric intake from fiber would be a. 3.4 kcal/g. b. 0 kcal/g. c. 4 kcal/g. d. 9 kcal/g.

ANS: B Human beings lack the necessary enzymes to digest dietary fiber and so, unlike other carbohydrates, dietary fiber does not provide energy.

DIF: Cognitive Level: Application REF: 17 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. Wavelike contractions of the muscle fibers of the stomach and intestinal walls are called a. segmentation. b. peristalsis. c. metabolism. d. digestion.

ANS: B The mechanical digestive process in the stomach entailing wavelike contractions of the muscle fibers of the stomach wall that mix food particles with gastric secretions is called peristalsis.

DIF: Cognitive Level: Knowledge REF: 24-25 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. A basket of fruit contains ripe grapes, apples, and oranges as well as pears and peaches that are not quite ripe. The fruits with the highest amount of simple sugar are the a. pears and apples. b. peaches and oranges. c. grapes and apples. d. peaches and pears.

ANS: C Fructose is a simple sugar; ripe fruit contains more fructose than less-ripe fruit.

DIF: Cognitive Level: Application REF: 14 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. An apple contains a type of soluble dietary fiber called a. lignin. b. starch. c. cellulose. d. pectin.

ANS: D Pectin is a water-soluble fiber found in many fruits. Cellulose and lignin are insoluble fibers.

Starch is another polysaccharide found in grains, legumes, and other vegetables and in small amounts in fruit. Starch does not necessarily contain dietary fiber.

DIF: Cognitive Level: Application REF: 17-18 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. Of the following, the food with the lowest carbohydrate content (as a percentage of weight) would be a. orange juice. b. raisins. c. whole milk. d. dried beans.

ANS: C Milk contains the least carbohydrate content (as a percentage of weight); it contains lactose, but the amount is diluted by all the liquid in the milk. Carbohydrates are more concentrated in dried fruits, juices, and starchy vegetables.

DIF: Cognitive Level: Analysis REF: 15-16 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Digestion of the starch component of a peanut butter sandwich begins in the a. mouth. b. stomach. c. small intestine. d. liver.

ANS: A The digestion of carbohydrate-rich foods such as starches and sugars begins in the mouth, where the enzyme ptyalin begins to break the starch down into smaller particles.

DIF: Cognitive Level: Knowledge REF: 24 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. A negative effect of sugar alcohols is that they a. contain more kilocalories than sugar. b. can cause intoxication. c. promote bacterial disease in the colon. d. may cause diarrhea.

ANS: D Excessive amounts of sugar alcohols in food products can cause diarrhea because of the slow digestion of the product.

DIF: Cognitive Level: Comprehension REF: 20 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. Once monosaccharides are absorbed into the intestinal bloodstream, they are transported to the a. cells. b. liver. c. heart. d. brain.

ANS: B The monosaccharides glucose, galactose, and fructose are absorbed directly into the portal blood circulation.

DIF: Cognitive Level: Knowledge REF: 26-27 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. A client has a goal of increasing fiber intake to 30 grams per day. Current intake reveals the

following information: Breakfast intake- 3/4 cup sugary corn popped cereal, 1 cup skim milk, 1 slice white toast, and 1/2 cup orange juice. Lunch- 2 ounces sliced turkey, 1 slice wheat bread, 1 tablespoon mayonnaise, 2 chocolate chip cookies, and 1 cup water. Dinner- 4 ounces beef, 1/2 cup green beans, 3/4 cup instant mashed potatoes with butter, 1 biscuit, and 1 cup skim milk. As the nutrition expert counseling this patient, one appropriate recommendation might be: a. Encourage whole grain breads and cereals in place of white breads and cereals. b. Double the amount of proteins such as turkey and beef and eliminate sugar intake. c. Add 2 tablespoons of omega-3 fatty acid enriched margarine to breads and potatoes. d. No changes are required since adequate fiber intake is present.

ANS: A Rationale: The recommended daily fiber intake is 38 grams per day for men. This intake requires consistent use of whole grains, legumes, vegetables and fruits, along with seeds and nuts. Meats and fats such as butter and margarine do not contain fiber.

DIF: Cognitive Level: Analysis REF: 19|27-28 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 21. An example of a food low in carbohydrates is a. low-fat yogurt. b. steak. c. beans. d. potatoes.

ANS: B Meats such as beef, poultry, and fish do not contain carbohydrates. Yogurt contains some carbohydrates from the milk and is often sweetened. Starchy vegetables such as beans and potatoes are high in carbohydrates.

DIF: Cognitive Level: Application REF: 22-24 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 22. The major site or organ in the body for metabolic processing of carbohydrates is the a. intestine. b. heart. c. brain. d. liver.

ANS: D The liver is the major site for metabolic processing of carbohydrates.

DIF: Cognitive Level: Knowledge REF: 22|26-27 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. The digestion of milk yields the monosaccharides a. fructose and glucose. b. galactose and glucose. c. galactose and sucrose. d. glucose and maltose.

ANS: B The digestion of milk yields the monosaccharides galactose and glucose from the disaccharide

lactose.

DIF: Cognitive Level: Knowledge REF: 15-16 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. A food that contains maltose would be a. milk. b. fruit. c. molasses. d. table sugar.

ANS: C Maltose is found in molasses.

DIF: Cognitive Level: Application REF: 15-16 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. A molecule of glycogen is composed of hundreds of units of a. galactose. b. glucose. c. glucose, fructose, and galactose. d. disaccharide.

ANS: B Glycogen is composed of glucose units.

DIF: Cognitive Level: Knowledge REF: 17 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. Sufficient dietary carbohydrates prevent excess formation of a. ketones. b. ammonia. c. amino acids. d. water.

ANS: A Ketones result from the rapid breakdown of fat. The breakdown of fat occurs when carbohydrate intake is inadequate. Sufficient carbohydrate intake prevents ketosis from occurring.

DIF: Cognitive Level: Knowledge REF: 22 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. The preferred source of energy for the heart muscle is a. glucose. b. glycogen. c. fatty acids. d. amino acids.

ANS: C Glycogen is the emergency fuel for the heart, whereas fatty acids are the preferred fuel.

DIF: Cognitive Level: Knowledge REF: 24 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. The number of kilocalories from carbohydrates in a baked potato that contains 40 g carbohydrate is kcal. a. 40 b. 80

c. 160 d. 360 ANS: C Carbohydrate contains 4 kcal/g, so 40 g 4 kcal/g = 160 kcal.

DIF: Cognitive Level: Application REF: 21 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. A food that is a good source of fiber is a. oatmeal. b. prune juice. c. salmon. d. cornstarch.

ANS: A Plant foods contain the best sources of fiber. Oatmeal is a whole grain cereal and is therefore high in fiber.

DIF: Cognitive Level: Application REF: 18-19|21 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. Which of the following carbohydrates provides the fastest source of energy? a. ground beef b. cranberry juice c. whole grain cereal d. milk ANS: B Cranberry juice contains fructose, a single carbohydrate or monosaccharide, which requires no digestion and so is more quickly absorbed than more complex carbohydrates found in whole grains.

Chapter 3. Fats MULTIPLE CHOICE 1. The functions of fat in the body include a. enzyme production, insulation of long bones, and bone structure. b. formation of bone structure and energy for daily activities. c. flavoring low fat foods, supplying fatty acids, and lubrication for vital organs. d. insulation of vital organs, temperature regulation, and cell membrane structure.

ANS: D In the body, fat around vital organs and under the skin provides insulation and helps regulate body temperature; fat is also a component of cell membrane structure.

DIF: Cognitive Level: Knowledge REF: 36 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The number of kilocalories from fat in a meal that contains 35 g fat is a. 35. b. 140. c. 315. d. 350.

ANS: C

Fat contains 9 kcal/g, so 35 g 9 kcal/g = 315 kcal.

DIF: Cognitive Level: Application REF: 36 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The recommended total calories provided by fat in an 1800 calorie diet would be a. 180-270 calories. b. 360-630 calories. c. 540-630 calories. d. 540-720 calories.

ANS: B It is recommended that no more than 20% to 35% of total calories come from fat. In an 1800 calorie diet: 1800 x .20 = 360 calories. 1800 x .35 = 630 calories.

DIF: Cognitive Level: Application REF: 42-43 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. An element not found in triglycerides is a. carbon. b. hydrogen. c. nitrogen. d. oxygen.

ANS: C Carbon, hydrogen, and oxygen make up fat, whereas nitrogen is found as part of the protein molecule.

DIF: Cognitive Level: Knowledge REF: 31 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Triglycerides are composed of a. glycerol and amino acids. b. transfatty acids. c. hydrogenated fatty acids. d. glycerol and fatty acids.

ANS: D A triglyceride is composed of three fatty acids attached to a glycerol base.

DIF: Cognitive Level: Knowledge REF: 31 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The chemical feature that distinguishes a saturated fatty acid from an unsaturated fatty acid is the a. amount of water it contains. b. amount of cholesterol it contains. c. source. d. amount of hydrogen it contains.

ANS: D Fatty acids are saturated or unsaturated depending on whether they are filled with hydrogen. A fatty acid that is not completely filled with all the hydrogen it can hold is unsaturated; the structure of a saturated fatty acid is completely filled with all the hydrogen bonds it can hold.

DIF: Cognitive Level: Knowledge REF: 31-32 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. An example of a food that contains a high level of saturated fatty acids is a. beef steak. b. olive oil. c. green tomatoes. d. whole-grain bread.

ANS: A Saturated fats are commonly found in animal products. Unsaturated and monounsaturated fats are mostly derived from plant sources. However, tropical oils such as coconut and palm oils as well as hydrogenated oils are saturated.

DIF: Cognitive Level: Application REF: 32 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. Of the following fats, the one that is least saturated is a. safflower oil. b. corn. c. cottonseed. d. soybean.

ANS: A Unsaturated fats listed in order of degree of unsaturation are safflower, corn, cottonseed, and soybean.

DIF: Cognitive Level: Application REF: 33 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Most fatty acids in plant foods are a. monounsaturated. b. polyunsaturated. c. unsaturated. d. saturated.

ANS: C Plant foods are mostly composed of unsaturated fats. However, tropical oils such as palm, palm kernel, and coconut as well as hydrogenated oils are composed of saturated fats.

DIF: Cognitive Level: Comprehension REF: 33 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. A patient is concerned with her weight. Her energy intake is calculated to be 1600 calories.

Intake records reveal that her fat intake for the past month has been 120 calories or less per day.

The appropriate intervention would be to a. assess for essential fatty acid deficiency. b. continue to monitor for changes. c. continue current meal plan. d. draw lab work immediately.

ANS: A An essential fatty acid is one that is essential for the body; its absence will create a specific deficiency. The body cannot manufacture essential fatty acids and must obtain them from the diet.

DIF: Cognitive Level: Analysis REF: 34

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. The body needs linoleic acid for a. digestion of food. b. protein metabolism. c. fluid balance. d. blood clotting.

ANS: D The body needs linoleic acid for functions related to tissue strength, cholesterol metabolism, muscle tone, blood clotting, and heart action.

DIF: Cognitive Level: Knowledge REF: 34-35 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The best food choice to provide linolenic acid is a. strawberries. b. canola oil. c. raisin toast. d. lard.

ANS: B Linolenic acid is primarily found in soybean, canola, and flaxseed oil.

DIF: Cognitive Level: Application REF: 34 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. An example of a food that contains hidden fats is a. salad dressing. b. skim milk. c. rice. d. skinless chicken.

ANS: D Even when all the visible fat has been removed from meat, approximately 6% of the total fat that surrounds the muscle fibers remains.

DIF: Cognitive Level: Application REF: 37 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The process of adding hydrogen to fatty acids is called a. hydrolysis. b. hydrogenation. c. emulsification. d. hydration.

ANS: B Hydrogenation is the process of introducing hydrogen into the fat molecule; this makes the fat more saturated.

DIF: Cognitive Level: Knowledge REF: 33 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. A change brought about as the result of hydrogenation is a. liquid fats become solids.

b. fats become less saturated. c. monoglycerides become diglycerides. d. vitamins are destroyed.

ANS: A Hydrogenation is the process of introducing hydrogen into the fat molecule; liquid fats such as vegetable oil are made into solids such as margarine and shortening in this manner.

DIF: Cognitive Level: Application REF: 33 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. An example of a food that does not contain cholesterol is a. liver. b. sausage. c. cheese. d. coconut.

ANS: D Cholesterol is a substance that naturally occurs in all animal foods but not in plant foods.

DIF: Cognitive Level: Application REF: 36 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Cholesterol is synthesized by the body mainly in the a. intestine. b. liver. c. adipose tissue. d. skin.

ANS: B Endogenous cholesterol is synthesized in many body tissues, particularly the liver. Small amounts are synthesized in the adrenal cortex, skin, intestines, testes, and ovaries.

DIF: Cognitive Level: Knowledge REF: 34 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. After a dietary assessment is completed, it reveals that a client consumes 50% of daily calories from fat. This amount of fat places the client at risk for a. obesity, arthritis, and elevated blood pressure. b. obesity, elevated blood fats, and diabetes. c. elevated blood pressure, diabetes, and allergies. d. diabetes, dementia, and stroke.

ANS: B According to the Dietary Reference Intakes, no more than 20% to 35% of total calories should come from fat. Excess fat intakes places a person at risk for health problems, including obesity, elevated blood fats, and diabetes.

DIF: Cognitive Level: Application REF: 42 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 19. Factors that increase the risk of heart disease include a. family history of cancer. b. increased stress and obesity. c. anemia and low thyroid levels. d. gallbladder disease.

ANS: B Heart disease is a leading cause of death in developed countries. Various risk factors are associated with heart disease, including excess dietary fat, especially saturated fat and cholesterol, along with obesity, diabetes, elevated blood fats, and elevated blood pressure.

Additional lifestyle factors include smoking, stress, and lack of exercise.

DIF: Cognitive Level: Knowledge REF: 43 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 20. The substances that serve as the major vehicles for fat transport in the bloodstream are a. micelles. b. glycolipids. c. chylomicrons. d. bile salts.

ANS: C After absorption, monoglycerides and fatty acids are reformed into triglycerides, which are then packaged into lipoproteins called chylomicrons. Chylomicrons are made of triglycerides, cholesterol, phospholipids, and proteins, and allow fatty substances to enter the circulation.

DIF: Cognitive Level: Knowledge REF: 41 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. After eating a dinner of fried chicken, gravy, and mashed potatoes, chemical digestion of the fat component primarily takes place in the a. mouth. b. stomach. c. small intestine. d. large intestine.

ANS: C The largest part of chemical digestion occurs in the small intestine with bile salts from the gallbladder (which serve as an emulsifier) and several enzymes, including gastric lipase (tributyrinase) and pancreatic lipase, which break down triglycerides to diglycerides and monoglycerides.

DIF: Cognitive Level: Application REF: 39-41 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. The hormone responsible for stimulating the gallbladder to contract and release bile into the small intestine is a. gastric lipase. b. cholecystokinin. c. enteric lipase. d. enterokinin.

ANS: B Cholecystokinin release is stimulated when fat enters the duodenum. Cholecystokinin then causes the gallbladder to contract.

DIF: Cognitive Level: Knowledge REF: 39 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. End products of fat digestion do not include a. fatty acids. b. glycerol.

c. diglycerides. d. monosaccharides.

ANS: D The end products of fat digestion include fatty acids, glycerol, and diglycerides.

Monosaccharides are a type of carbohydrate.

DIF: Cognitive Level: Knowledge REF: 40-41 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. An important function of bile is to a. digest triglycerides. b. activate the intestinal lipases. c. break fat into smaller particles. d. split fatty acids into two-carbon molecules.

ANS: C Bile functions as an emulsifier rather than an enzyme. Bile assists in the preparation of fat for chemical digestion by its specific enzymes. This preparation accomplishes two tasks: it (1) breaks down fat into small particles; and (2) lowers the surface tension of the dispersed and suspended fat particles.

DIF: Cognitive Level: Knowledge REF: 39-40 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. A type of fat that may be associated with a high risk of atherosclerosis if consumed on a regular basis is a. olive oil. b. safflower oil. c. margarine. d. lard.

ANS: D Lard is a highly saturated fat. Excess intake of cholesterol and saturated fat is associated with atherosclerosis.

DIF: Cognitive Level: Application REF: 42-43 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. Fat substitutes are used in food products to a. reduce the cost of popular foods. b. reduce the transfatty acid content of the food. c. prolong the shelf life of the food. d. improve the flavor and physical texture of low-fat foods.

ANS: D Fat substitutes, such as Simplesse and Olestra, provide improved flavor and physical texture to low-fat foods and can help reduce total dietary fat.

DIF: Cognitive Level: Knowledge REF: 36 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. The greatest number of kilocalories is provided by a. 40 g carbohydrates. b. 30 g fat. c. 60 g carbohydrates. d. 50 g protein.

ANS: B 30 g of fat provides the most kilocalories. Fat provides 9 kcal/g; both carbohydrates and proteins provide 4 kcal/g.

Calculations: 30 g fat x 9 kcal/g = 270 kcal 40 g carbohydrate x 4 kcal/g = 160 kcal 60 g carbohydrate x 4 kcal/g = 240 kcal 50 g protein x 4 kcal/g = 200 kcal DIF: Cognitive Level: Application REF: 36 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. A food relatively high in saturated fat is a. corn oil. b. peanut oil. c. avocado oil. d. margarine.

ANS: D Margarine is higher in saturated fat than corn oil, peanut oil, and avocado oil. Margarine is made from oil by hydrogenation. This makes the oil more solid and more saturated.

DIF: Cognitive Level: Application REF: 33-34 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. In a diet that contains 50 g fat and a total of 1500 kcal, the proportion of total kilocalories from fat is a. 3%. b. 13%. c. 30%. d. 33%.

ANS: C Fat contains 9 kcal/g; 50 g 9 kcal/g = 450 kcal. 450 kcal/1500 total kcal = 0.30, or 30%.

DIF: Cognitive Level: Application REF: 36|42 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. A good source of monounsaturated fat is a. fish. b. margarine. c. avocado. d. tofu.

ANS: C Monounsaturated fats include olives and olive oil, peanuts and peanut oil, canola oil, almonds, pecans, and avocados.

Chapter 4. Protein MULTIPLE CHOICE 1. Proteins are built from simpler organic compounds called a. indispensable amino acids. b. amino acids. c. fatty acids. d. monosaccharides.

ANS: B All proteins are made of building block units called amino acids. Proteins are made from both dispensable and indispensable amino acids.

DIF: Cognitive Level: Knowledge REF: 47 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The element that is contained in proteins but not in carbohydrates or lipids is a. carbon. b. hydrogen. c. nitrogen. d. oxygen.

ANS: C Nitrogen is present in proteins but not in carbohydrates or lipids. Amino acids, the building blocks of protein, are named for their chemical structure; amino refers to compounds containing nitrogen.

DIF: Cognitive Level: Knowledge REF: 47 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Two types of protein in the body are protein and protein. a. complete, incomplete b. animal, vegetable c. dispensable, indispensable d. tissue, plasma ANS: D Two types of protein in the body are tissue and plasma protein. Amino acids are classified as indispensable, dispensable, or conditionally indispensable in the diet according to whether the body can make them.

DIF: Cognitive Level: Comprehension REF: 49 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The number of amino acids that are indispensable for human beings is a. 6. b. 9. c. 11. d. 14.

ANS: B Nine amino acids are classified as indispensable amino acids because the body cannot manufacture them in sufficient quantity or at all.

DIF: Cognitive Level: Knowledge REF: 48|51 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. In the diet, the greatest proportion of indispensable amino acids is provided by a. black beans. b. peanuts. c. safflower oil. d. turkey.

ANS: D Indispensable amino acids are provided mostly by high-protein animal products.

DIF: Cognitive Level: Application REF: 51 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. A protein that contains all indispensable amino acids in the correct proportion and ratio is called a. simple. b. incomplete. c. complete. d. indispensable.

ANS: C A complete protein contains all nine indispensable amino acids in the correct proportion and ratio needed by the body.

DIF: Cognitive Level: Knowledge REF: 51 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The number of kilocalories from protein in a sandwich that contains 24 g protein is kcal. a. 6 b. 96 c. 120 d. 216 ANS: B Each gram of protein has 4 kcal, so 24 g 4 kcal = 96 kcal.

DIF: Cognitive Level: Application REF: 51 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. An animal protein that has relatively little value as a dietary protein source when eaten alone is a. egg. b. gelatin. c. milk. d. fish.

ANS: B Gelatin is a protein food of animal origin, but it lacks three essential amino acids and has only small amounts of leucine.

DIF: Cognitive Level: Knowledge REF: 51 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Proteins from plant sources that are classified as incomplete include a. wheat, peanuts, and corn. b. milk, nuts, and cheese. c. oats, gelatin, and soybeans. d. corn, chicken, and milk.

ANS: A Grains, peanuts, and corn are examples of plant proteins that are considered incomplete proteins because the food is deficient in one or more of the nine indispensable amino acids. Examples include grains, nuts, seeds, and legumes.

DIF: Cognitive Level: Application REF: 51 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. An example of a protein-free body substance is

a. collagen. b. hemoglobin. c. insulin. d. glycogen.

ANS: D Glycogen is the storage form of carbohydrates and does not contain protein.

DIF: Cognitive Level: Application REF: 14|50-51 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The primary function of protein in the diet is to supply a. energy for growth and development. b. insulation for vital organs. c. material for growth and maintenance. d. all 20 amino acids for heart maintenance.

ANS: C The primary function of protein is to supply material in the body for growth, maintenance, and repair.

DIF: Cognitive Level: Knowledge REF: 50 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. Protein plays an important role in the body a. as the first source of energy fuel. b. in the conversion of glucose to glycogen for storage. c. as a coenzyme needed for energy utilization. d. in defense against disease and infection.

ANS: D Protein assists in the bodys defense against disease and infection by helping build special white blood cells called lymphocytes.

DIF: Cognitive Level: Knowledge REF: 51 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. After a piece of grilled chicken is digested by the mouth and stomach, it eventually reaches the small intestine, where it is digested by the following enzymes secreted by the pancreas: a. chymotrypsin, trypsin, and carboxypeptidase b. chymotrypsin, pepsin, and trypsin c. sucrase, pepsin, and carboxypeptidase d. lactase, chymotrypsin, and carboxypeptidase ANS: A Chymotrypsin, trypsin, and carboxypeptidase are three enzymes produced by the pancreas to continue breaking down proteins into simpler peptides and amino acids.

DIF: Cognitive Level: Knowledge REF: 56-57 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. Proteins are absorbed as a. fatty acids. b. disaccharides. c. amino acids. d. polypeptides.

ANS: C

Proteins are broken down to individual amino acids to be absorbed; polypeptides require further enzymatic breakdown before they can be absorbed.

DIF: Cognitive Level: Knowledge REF: 56 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. Pepsinogen secreted by the gastric cells is converted into pepsin by a. food in the stomach. b. hydrochloric acid. c. gastric lipase. d. pancreatic lipase.

ANS: B Hydrochloric acid secreted by the stomach converts pepsinogen, an inactive enzyme, into pepsin.

Pepsin is the active form of the enzyme, which begins protein digestion.

DIF: Cognitive Level: Knowledge REF: 54-55 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. Protein catabolism is increased in conditions such as a. pregnancy. b. childhood. c. puberty. d. illness.

ANS: D Protein catabolism, or the breakdown of protein, is increased during illness or disease and increases the bodys need for protein and kilocalories to rebuild tissue and meet the demands of an increased metabolic rate.

DIF: Cognitive Level: Knowledge REF: 49-50 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. The phase of metabolism that makes growth and repair possible is a. digestion. b. catabolism. c. anabolism. d. homeostasis.

ANS: C Anabolism is the metabolic process that makes growth and repair possible in the body. It is especially necessary after an illness or disease process. Anabolism also is found during periods of rapid fetal growth during pregnancy, the first year of life, lactation during breast-feeding, and adolescent growth and development into adulthood.

DIF: Cognitive Level: Knowledge REF: 49-50 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. A gastric enzyme that coagulates the protein in milk and is produced by infants but not by adults is a. hydrochloric acid. b. pepsinogen. c. trypsin. d. rennin.

ANS: D Rennin is the gastric enzyme found in the gastric juice of human infants and some young animals

such as calves. Rennin is important to the infant in the digestion of milk.

DIF: Cognitive Level: Knowledge REF: 55 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. A protein-digesting enzyme found in the stomach rather than in pancreatic secretions is a. trypsin. b. pepsin. c. chymotrypsin. d. carboxypeptidase.

ANS: B Pepsin is the main gastric enzyme that digests proteins.

DIF: Cognitive Level: Knowledge REF: 54-55 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. The enzyme trypsin is activated by the enzyme a. zymogen. b. bile. c. gastrin. d. enterokinase.

ANS: D Trypsin is activated by the enzyme enterokinase. Enterokinase is secreted from the intestinal cells when food enters the duodenum.

DIF: Cognitive Level: Knowledge REF: 55 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. The enzymes aminopeptidase and dipeptidase are secreted by the a. mouth. b. stomach. c. small intestine. d. pancreas.

ANS: C Aminopeptidase and dipeptidase are enzymes secreted by glands in the wall of the small intestine.

DIF: Cognitive Level: Knowledge REF: 56 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. Complementary proteins a. provide higher quality protein when eaten together. b. enhance each others metabolic actions. c. are more easily absorbed. d. taste good together.

ANS: A Combining complementary proteins helps to supply adequate amounts of all nine indispensable amino acids for the diet. Because plant proteins are incomplete, a mixture can provide adequate amounts of amino acids. A normal eating pattern throughout the day along with the bodys reserve supply of protein ensures a complementary balance of high-quality protein. Those who follow a vegetarian eating pattern must combine proteins to meet needs.

DIF: Cognitive Level: Knowledge REF: 51-52 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. In the mouth, protein foods are a. broken down to amino acids. b. broken up mechanically by chewing. c. broken down to peptides. d. coagulated by rennin.

ANS: B Protein digestion begins in the mouth, where food is mechanically processed by chewing.

DIF: Cognitive Level: Knowledge REF: 54 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Of the following, the food with the highest quality protein is a. an omelet with cheese, whole wheat toast, and orange juice. b. stir fry with chicken, green beans, and carrots. c. stuffed turkey breast, peas, and baked potato. d. a bean burrito, corn on the cob, and tomato salad.

ANS: A Eggs are the highest-quality protein food and carry a chemical score of 100. Other foods are compared to it according to their amino acid ratios.

DIF: Cognitive Level: Application REF: 56-58 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. Which of the following conditions might result in the greatest catabolism? a. growth b. multiple trauma with extensive organ damage c. rehabilitation after routine gallbladder surgery d. healing a broken bone in the arm ANS: B Protein catabolism, or the breakdown of protein, is increased during illness or disease and increases the bodys need for protein and kilocalories to rebuild tissue and meet the demands of an increased metabolic rate. In this case, multiple trauma with extensive organ damage requires a greater catabolic rate compared with the other choices and would create the greatest increase in metabolic rate and need for tissue repair.

DIF: Cognitive Level: Application REF: 58 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. If the excretion of nitrogen exceeds the nitrogen intake, the condition is called a. total nitrogen balance. b. positive nitrogen balance. c. negative nitrogen balance. d. anabolism.

ANS: C If the body takes in less nitrogen than it excretes, a negative balance occurs. This means that the body has an inadequate protein intake and is losing nitrogen by breaking down more tissue than it is building up.

DIF: Cognitive Level: Comprehension REF: 49-50 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. The grams of high-quality protein required daily for an individual who weighs 170 lb and is close to ideal body weight would be g. a. 45.2 b. 55.3 c. 61.8 d. 94.0 ANS: C The Recommended Daily Allowance for both men and women is set at 0.8 g of high-quality protein per kilogram of desirable body weight per day. In this case, 170 lb/2.2 lb/kg = 77.3 kg.

77.3 kg 0.8 g/kg = 61.8 g/day of protein.

DIF: Cognitive Level: Application REF: 59 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Wellness 28. In planning a vegetarian meal, an appropriate combination of complementary proteins would be a. cornmeal tamales and beans. b. lentils and beans. c. bean sprouts and cabbage. d. whole wheat and rice.

ANS: A In planning complementary food combinations, different families of foods (e.g., grains, legumes, nuts, and dairy) are mixed. Grains usually are low in threonine and high in methionine, whereas legumes are high in threonine and low in methionine. Therefore, grains and legumes help balance each other in the amount of indispensable amino acids required by the body. Acceptable combinations include (1) grains and peas, beans, or lentils; (2) legumes and seeds; and (3) grains and dairy. In the choices given, cornmeal tamales and beans combine foods limited in different amino acids.

DIF: Cognitive Level: Application REF: 51-52 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Wellness 29. A client weighs 130 lbs. She is close to desirable body weight and consumes a total of 40 grams of protein/day. The most appropriate nutritional counseling would be to a. increase protein intake. b. maintain current protein intake. c. decrease protein intake. d. increase use of complementary proteins.

ANS: A The RDA for protein for both men and women is set at 0.8 grams of high-quality protein per kilogram of desirable body weight per day.

Based on 0.8 g protein/kg body weight/day: 130 lbs 2.2 lbs/kg = 59 kg body weight 59 kg x 0.8 g protein/kg = 47 grams protein/day Thus, this clients protein intake is lower than her estimated needs. It would be appropriate to recommend an increase in protein intake.

Chapter 5. Energy Balance

MULTIPLE CHOICE 1. A nutrient that does not provide energy for the body is a. carbohydrate. b. protein. c. vitamin. d. fat.

ANS: C The energy nutrients are carbohydrate, fat, and protein.

DIF: Cognitive Level: Knowledge REF: 81 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. Energy is lost from the body as a. heat. b. urine. c. sweat. d. fat.

ANS: A Energy is lost from the body as heat when the internal energy cycle changes stored energy into body fuels, which the body uses for various functions. As the cycle continues water is excreted, carbon dioxide is exhaled, and heat is radiated, returning the end products to the external environment.

DIF: Cognitive Level: Knowledge REF: 82 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The unit of measurement used to refer to the amount of energy in food is the a. watt. b. kilogram. c. milligram. d. kilocalorie.

ANS: D The kilocalorie is the unit of measure used to measure the amount of energy in food and is the amount of heat necessary to raise 1 kg of water 1 C. DIF: Cognitive Level: Knowledge REF: 81-82 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The total number of kilocalories in a snack that contains 10 g carbohydrate, 2 g protein, and 5 g fat is kcal. a. 17 b. 68 c. 93 d. 153 ANS: C 10 g carbohydrate 4 kcal/g = 40 kcal.

2 g protein 4 kcal/g = 8 kcal.

5 g fat 9 kcal/g = 45 kcal.

Total calories = 40 kcal + 8 kcal + 45 kcal = 93 kcal.

DIF: Cognitive Level: Application REF: 82 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. Which of the following represents an external energy cycle? a. the moon b. growing plants c. crystals d. metabolism ANS: B The external energy cycle includes plants, which transform energy from the sun into stored chemical energy.

DIF: Cognitive Level: Application REF: 82 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. After foods are eaten, they are converted into which of the following body fuels? a. amino acids and fatty acids b. fatty acids and glucose c. glucose and triglycerides d. glycogen and glucose ANS: B After foods are eaten, they are converted into fatty acids and glucose, both of which are used as fuel for the body.

DIF: Cognitive Level: Application REF: 82 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Metabolic rate would increase with a body temperature of a. 97.4 F. b. 98.4 F. c. 98.6 F. d. 101.2 F. ANS: D Fever increases basal metabolic rate by approximately 7% for each 1 F rise in temperature.

Normal body temperature is 98.4 F or 98.6 F; 101.2 F would be high enough to cause a significant increase in metabolic rate.

DIF: Cognitive Level: Application REF: 86 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The amount of energy the body needs to maintain life while at digestive, physical, and emotional rest is called the a. basal metabolic rate. b. indirect calorimetry. c. respiratory quotient. d. nitrogen balance.

ANS: A Basal metabolic rate is measured when an individual is at complete digestive, physical, and emotional rest.

DIF: Cognitive Level: Knowledge REF: 83 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Metabolically active tissues in the body include a. the heart, muscles, and intestine. b. the brain, nerves, and hair.

c. the liver, kidney, and fingernails and toenails. d. all body tissues.

ANS: A The majority of energy is used by small but highly active tissues, including the liver, brain, heart, kidney, and gastrointestinal tract. These organs account for less than 5% of the total body weight but 60% to 75% of basal metabolic needs.

DIF: Cognitive Level: Knowledge REF: 83 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. Indirect calorimetry is used to measure which of the following? a. basal or resting energy expenditure b. weight c. physical activity d. body mass index ANS: A Indirect calorimetry measures the amount of energy a person uses while at rest. A portable metabolic cart allows the person to breathe into an attached mouthpiece or ventilated hood system while lying in bed and the normal exchange of oxygen and carbon dioxide is measured.

The metabolic rate can be determined from the rate of oxygen utilization.

DIF: Cognitive Level: Knowledge REF: 83-84 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The term for the effect of food intake on metabolic rate is a. thermic effect of food. b. resting metabolic rate. c. total energy requirement. d. indirect calorimetry.

ANS: A Once food is eaten, it stimulates metabolism and requires extra energy for digestion, absorption, and transport of the nutrients to the cells. This stimulation is referred to as the thermic effect of food.

DIF: Cognitive Level: Knowledge REF: 88 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The sum of basal metabolism, energy expended in physical activity, and thermic effect of food is known as a. metabolic rate. b. energy intake. c. basal energy needs. d. total energy requirement.

ANS: D Together, basal metabolism, physical activities, and the thermic effect of food make up the total energy requirement.

DIF: Cognitive Level: Knowledge REF: 88 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. When energy intake exceeds energy expenditure, the result can be a. anorexia. b. malnutrition.

c. weight gain. d. hyperactivity.

ANS: C When energy intake exceeds energy expenditure, weight gain may result. Excess intake without expenditure results in excess storage of energy as body fat.

DIF: Cognitive Level: Knowledge REF: 88 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. An activity that results in increased energy expenditure is a. cleaning house. b. balancing a checkbook. c. experiencing emotional stress. d. playing video games.

ANS: A Different kilocalorie expenditures occur with different types of activities. In this case, cleaning house requires muscular work and so uses more energy than the other activities. Mental exertion has no effect on energy needs.

DIF: Cognitive Level: Application REF: 88-90 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The thermic effect of food refers to the fact that a. all nutrients contain calories. b. certain foods are more stimulating than others to the gastrointestinal tract. c. the presence of food in the stomach starts the process of digestion. d. the process of digestion, absorption, and metabolism of food requires energy.

ANS: D Once food is eaten, it stimulates metabolism and requires extra energy for digestion, absorption, and transport of the nutrients to the cells. This stimulation is referred to as the thermic effect of food.

DIF: Cognitive Level: Knowledge REF: 88 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. The bodys sources of stored energy include a. glucose. b. adipose tissue. c. undigested food. d. bone.

ANS: B Adipose tissue stores energy until required by the body.

DIF: Cognitive Level: Knowledge REF: 83 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Basal metabolic rate is controlled by the hormone a. cortisol. b. growth hormone. c. thyroxine. d. insulin.

ANS: C The hormone thyroxine controls the metabolic rate in the body. The thyroid function test can

assess metabolism by measuring the activity of the gland and the blood levels of its hormone, thyroxine.

DIF: Cognitive Level: Knowledge REF: 84 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. The first source of stored energy to be used during a period of fasting is a. amino acids. b. glycogen. c. adipose tissue. d. glucose.

ANS: B A 12- to 48-hour reserve of glycogen exists in the liver and muscle and is quickly depleted if not replenished by daily food intake. Adipose tissue is used for energy after glycogen stores are used, followed by the breakdown of muscle mass in extreme cases of fasting or starvation.

DIF: Cognitive Level: Knowledge REF: 83 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. Which of the following foods has the greatest caloric density? a. banana b. bread c. nuts d. milk ANS: C Nuts have the greatest caloric density of choices given because they have the highest concentration of energy for the same quantity of food. Nuts are composed of a higher percentage of fat (the highest-energy nutrient) compared with bread, milk, or a banana, which are low in fat.

DIF: Cognitive Level: Application REF: 82 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. Nutrient density means the a. total weight of the nutrients in a food. b. digestibility of the nutrients in a food. c. concentration of energy in a given amount of food. d. concentration of nutrients in a given amount of food.

ANS: D Nutrient density is the concentration of nutrients in a given amount of food.

DIF: Cognitive Level: Knowledge REF: 82 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. The liver and muscles store enough glycogen to last hours. a. 4 to 6 b. 6 to 24 c. 12 to 48 d. 24 to 72 ANS: C A 12- to 48-hour reserve of glycogen exists in the liver and muscles and is quickly depleted if not replenished by daily food intake.

DIF: Cognitive Level: Knowledge REF: 83 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. In cases of extreme starvation, the energy substrate most likely to be used as a last resort would be a. glycogen. b. muscle mass. c. adipose tissue. d. amino acids.

ANS: B Energy stored as protein exists in limited amounts in muscle mass and is only used once glycogen and fat stores have been exhausted.

DIF: Cognitive Level: Knowledge REF: 83 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Fever increases basal metabolic rate approximately for each rise. a. 1%, 1 F b. 1%, 1 C c. 1%, 7 F d. 7%, 1 F ANS: D Fever increases basal metabolic rate approximately 7% for each 1 F rise in temperature.

DIF: Cognitive Level: Knowledge REF: 86 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Energy expenditure is increased by a. physical exercise. b. mental work. c. stress. d. fatigue.

ANS: A Physical exercise increases energy expenditure because it involves muscular work.

DIF: Cognitive Level: Knowledge REF: 86-87 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. Energy needs per pound of body weight a. increase with age. b. increase throughout childhood. c. decrease with age. d. are greater in women than in men.

ANS: C Energy needs per pound of body weight generally decrease during the aging process, with a gradual decline in basal metabolic rate and physical activity that decreases the total energy requirement.

DIF: Cognitive Level: Comprehension REF: 90 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. A 65-year-old mans energy intake should focus on meals a. high in calories with nutrient-dense foods. b. low in calories and high in fiber and meat. c. with a lower caloric density and increased nutrient density.

d. high calorie level for middle age with lowered nutrient density.

ANS: C As the aging process continues, there is a gradual decline in basal metabolic rate and physical activity, resulting in a decrease in the total energy requirement. Food choices should reflect a decline in caloric density and a greater emphasis on nutrient density.

DIF: Cognitive Level: Application REF: 90 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 27. Resting energy expenditure is a. the same as basal energy expenditure. b. slightly higher than basal energy expenditure. c. slightly lower than basal energy expenditure. d. more accurate for predicting energy needs than is basal energy expenditure.

ANS: B Resting energy expenditure is slightly higher than basal energy expenditure. Basal metabolism is measured when an individual is at complete digestive, physical, and emotional rest. It differs from resting energy expenditure, which is slightly higher because of the sum of all internal working activities of the body, some of which may not be at complete rest.

DIF: Cognitive Level: Comprehension REF: 83 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. Mr. Jones normally has a basal metabolic rate of 1500 kcal. He develops a fever of 100.6 F. His rate would now be approximately kcal. a. 1550 b. 1600 c. 1710 d. 1830 ANS: C Fever increases basal metabolic rate approximately 7% for each 1 F rise in temperature. In this case, Mr. Jones has a temperature above normal of 2 F (normal = 98.6 F). The resultant increase in calories is 1500 kcal (0.07 2) = 210 additional kcal. 210 kcal + 1500 kcal = 1710 kcal (approximate new rate).

DIF: Cognitive Level: Analysis REF: 86 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 29. The person requiring the highest energy needs per unit of body weight is a a. 15-year-old boy. b. 45-year-old man. c. 75-year-old grandmother. d. 7-year-old girl.

ANS: A During periods of growth, the growth hormone stimulates cell metabolism and raises basal metabolic rate. Growth is highest during infancy and adolescence.

DIF: Cognitive Level: Application REF: 90 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential

30. The estimated daily basal metabolic rate for a man who weighs 150 lb is kcal. a. 1500 b. 1575 c. 1636 d. 1686 ANS: C To calculate the basal metabolic rate (BMR), use the general formula: Men = 1.0 kcal/kg/hour; 1 kg = 2.2 lb.

Convert weight (lb) to kg: 150 lb/2.2 lb/kg = 68 kg.

Multiply by formula: BMR (kcal) = 1.0 kcal/kg/hour 68 kg 24 hours in a day = 1636 kcal.

Chapter 6. Vitamins MULTIPLE CHOICE 1. For a compound to be classified as a vitamin, it must a. be synthesized by the body. b. be required in large quantities. c. perform a vital function. d. be water soluble.

ANS: C For a compound to be defined as a vitamin, it must be a vital, organic, dietary substance that is not a carbohydrate, fat, protein, or mineral and is necessary in only very small amounts to perform a specific metabolic function or prevent an associated deficiency. It also cannot be manufactured by the body in sufficient amounts to sustain life and must be supplemented by the body.

DIF: Cognitive Level: Comprehension REF: 95 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. A vitamin that behaves more like a hormone than a vitamin is vitamin a. A. b. D. c. E. d. K. ANS: B Vitamin D is a prohormone made in the skin by sunlight.

DIF: Cognitive Level: Knowledge REF: 99 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The provitamin form of vitamin A that is found in plant pigments is a. beta-carotene. b. chlorophyll. c. beta-xanthophyll. d. calciferol.

ANS: A Beta-carotene is the provitamin form of vitamin A found in plant pigments. The body converts it to vitamin A, making it a primary source of the vitamin.

DIF: Cognitive Level: Knowledge REF: 97 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. Spinach, carrots, and sweet potatoes are good sources of a. beta-carotene. b. vitamin A. c. vitamin D. d. vitamin E. ANS: A Carotene is a group name of three red and yellow pigments (alpha-, beta-, and gamma-carotene) found in dark green and yellow vegetables and some fruits. The body converts beta-carotene to vitamin A. DIF: Cognitive Level: Application REF: 98-99 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Liver is a rich source of a. vitamin A (retinol). b. vitamin C. c. vitamin D. d. vitamin E. ANS: A Liver is a rich source of preformed, natural vitamin A. Other sources include fish liver oils, egg yolk, butter, and cream.

DIF: Cognitive Level: Application REF: 98 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. An important function of vitamin A is to a. be incorporated into the bile. b. help with blood clotting. c. act as an antioxidant. d. help form rhodopsin in the eye.

ANS: D Vitamin A helps form the visual pigment rhodopsin in the eye. Retinol, the name given to vitamin A, is an essential part of rhodopsin, commonly known as visual purple. This lightsensitive substance enables the eye to adjust to the different amounts of available light.

DIF: Cognitive Level: Knowledge REF: 97 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. A deficiency of vitamin A may result in a. osteoporosis. b. bile obstruction. c. breakdown of cell membranes. d. night blindness.

ANS: D Night blindness results from a deficiency of vitamin A. Vitamin A helps form the visual pigment rhodopsin in the eye. Retinol, the name given to vitamin A, is an essential part of rhodopsin, commonly known as visual purple. This light-sensitive substance enables the eye to adjust to the different amounts of available light.

DIF: Cognitive Level: Knowledge REF: 97 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. Fish liver oils are a good source of a. vitamin D. b. vitamin E. c. protein. d. iron.

ANS: A Fish liver oils are a natural source of vitamin D. Some other foods are fortified with vitamin D. Because milk is a common food and already contains calcium and phosphorus, it is the most practical to fortify with this vitamin.

DIF: Cognitive Level: Application REF: 101 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The active hormonal form of vitamin D is a. cholecalciferol. b. calciferol. c. calcitriol. d. calcitonin.

ANS: C The active form of vitamin D is calcitriol. Vitamin D is made in the body with the help of the suns ultraviolet rays. The compound made in the skin by sunlight is a prohormone. This irradiated compound, cholecalciferol (calciferol), is in its inactive form. It is then activated by two successive enzymes, first in the liver and then in the kidney, to become the active form, calcitriol.

DIF: Cognitive Level: Knowledge REF: 99 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. Two foods that are commonly fortified with vitamin D are a. cereals and macaroni products. b. milk and margarine. c. flour and salt. d. vegetable oils and shortenings.

ANS: B Because milk is a common food and already contains calcium and phosphorus, it is the most practical to fortify with vitamin D. Butter substitutes, such as margarines, are also fortified.

DIF: Cognitive Level: Application REF: 101 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. Synthesis of the active hormonal form of vitamin D is the result of the combined action of the a. skin, liver, and kidney. b. pancreas, thyroid, and liver. c. skin, skeleton, and liver. d. kidney, skeleton, and liver.

ANS: A Vitamin D production begins in the skin with the help of the suns ultraviolet rays. The compound made in the skin by sunlight is a prohormone. This irradiated compound, cholecalciferol (calciferol), is in its inactive form. It is then activated by two successive enzymes, first in the liver and then in the kidney, to become the active form, calcitriol.

DIF: Cognitive Level: Knowledge REF: 99-100 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The last organ involved in the production of the physiologically active form of vitamin D is the a. liver. b. kidney. c. intestine. d. skin.

ANS: B Cholecalciferol (inactive form found in skin) is activated by two successive enzymes, first in the liver and then in the kidney, to become the active form, calcitriol.

DIF: Cognitive Level: Knowledge REF: 99-100 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The primary function of vitamin D is to regulate the absorption and metabolism of the minerals a. sodium and potassium. b. iron and phosphorus. c. calcium and phosphorus. d. sodium and calcium.

ANS: C The primary function of vitamin D is the absorption of calcium and phosphorus. The hormone form calcitriol acts with two other hormones: parathyroid hormone and the thyroid hormone calcitonin. In balance with these two hormones, vitamin D hormone stimulates the absorption of calcium and phosphorus in the small intestine.

DIF: Cognitive Level: Knowledge REF: 100 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. A vitamin D deficiency in growing children that results in the malformation of skeletal tissue, especially the long bones, is referred to as a. rickets. b. scurvy. c. pellagra. d. beriberi.

ANS: A Rickets is a disease associated with vitamin D deficiency. It is characterized by malformation of skeletal tissue in growing children in which long bones are soft and often bend under the weight of the child.

DIF: Cognitive Level: Knowledge REF: 101 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. Recommended intakes for vitamin D are difficult to establish because a. exposure to sunlight varies. b. it is present in so many foods. c. the body stores such large amounts. d. the amount in food varies with the season.

ANS: A Recommended intakes for vitamin D are difficult to establish because of its unique hormone-like

nature, difference in exposure to sun (affected by time spent outside and climate), and limited food sources.

DIF: Cognitive Level: Application REF: 100 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. A toxic level of vitamin D is most likely to result in a. liver damage. b. hyperpigmentation. c. blindness. d. calcification of soft tissues.

ANS: D A toxic level of vitamin D can result in calcification of soft tissues such as kidneys and lungs as well as fragile bones.

DIF: Cognitive Level: Knowledge REF: 101 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Sunflower oil is a rich source of a. vitamin A. b. vitamin B. c. vitamin D. d. vitamin E. ANS: D The richest sources of vitamin E are vegetable oils. Other food sources include nuts, fortified cereals, and avocado.

DIF: Cognitive Level: Application REF: 103 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. The requirement for vitamin E varies by the amount of an individuals a. sun exposure. b. dietary selenium. c. animal fat intake. d. polyunsaturated fatty acid intake.

ANS: D The requirement for vitamin E varies with the amount of polyunsaturated fatty acids in the diet.

DIF: Cognitive Level: Knowledge REF: 102 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. Vitamin E protects membranes because it acts as a(n) a. barrier. b. peroxide. c. antioxidant. d. clotting factor.

ANS: C Vitamin E protects membranes by acting as natures most potent fat-soluble antioxidant. The polyunsaturated fatty acids in lipid membranes are easy for oxygen to break down, and vitamin E can interrupt this oxidation and protect the fatty acids of the cell membrane from damage.

DIF: Cognitive Level: Knowledge REF: 102 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. The fat-soluble vitamin responsible for the synthesis of blood-clotting factors by the liver is

vitamin a. A. b. D. c. E. d. K. ANS: D The basic function of vitamin K is in the blood-clotting process. The most known vitamin Kdependent blood factor is prothrombin.

DIF: Cognitive Level: Knowledge REF: 103 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. A good food source of vitamin K is a. spinach. b. sunflower oil. c. pork. d. oranges.

ANS: A Vitamin K is found in green leafy vegetables, which provide 50 to 800 mcg of phylloquinone per 100 g of food. Smaller amounts are found in milk and other dairy, meats, fortified cereals, fruits, and vegetables.

DIF: Cognitive Level: Application REF: 105 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. In the past, vitamin A content was listed in International Units (IU); it is now listed in a. milligrams. b. micrograms. c. beta-carotene equivalents. d. retinol equivalents.

ANS: D Vitamin A is listed in retinol equivalents. One IU of vitamin A equals 0.3 mcg retinol or 0.6 mcg beta-carotene.

DIF: Cognitive Level: Knowledge REF: 97-98 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. The hormones that participate in calcium metabolism are a. estrogen and oxytocin. b. cortisone and epinephrine. c. aldosterone and thyroxine. d. parathyroid and calcitriol.

ANS: D The hormone form calcitriol acts with two other hormones: parathyroid hormone and the thyroid hormone calcitonin to stimulate the absorption of calcium in the small intestine.

DIF: Cognitive Level: Knowledge REF: 100 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. There is a metabolic partnership between vitamin E and a. zinc. b. chromium. c. selenium.

d. iron.

ANS: C Selenium is a trace mineral that works with vitamin E as an antioxidant. A selenium-containing enzyme, glutathione peroxidase, is the second line of defense in preventing oxidative damage to cell membranes. Selenium spares vitamin E by reducing its requirement, the same as vitamin E does for selenium.

DIF: Cognitive Level: Knowledge REF: 102 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. An athlete who increases his or her intake of pasta will also increase his or her need for a. folic acid. b. thiamin. c. pyridoxine. d. vitamin C. ANS: B The starch in the pasta would be digested and absorbed as glucose. Thiamin acts a coenzyme factor related to the production of energy from glucose and the storage of energy as fat, making energy available to support normal growth.

DIF: Cognitive Level: Application REF: 108 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. An alcoholic is most likely to be deficient in a. biotin. b. folic acid. c. thiamin. d. pyridoxine.

ANS: C Alcohol inhibits the absorption of thiamin. Alcohol-induced thiamin deficiency causes Wernickes encephalopathy.

DIF: Cognitive Level: Knowledge REF: 108 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. The three body systems that can be affected by a thiamin deficiency are the systems. a. nervous, respiratory, and urinary b. nervous, cardiovascular, and gastrointestinal c. gastrointestinal, respiratory, and endocrine d. lymphatic, cardiovascular, and endocrine ANS: B The nervous, cardiovascular, and gastrointestinal tract can all be affected by thiamin deficiency.

The central nervous system depends on glucose for energy; if thiamin is not present in adequate amounts, sufficient energy cannot be made for the nerves to perform their functions. The heart muscle depends on thiamin as well. Without adequate thiamin, the heart muscle weakens and heart failure results. Thiamin also is necessary for the gastrointestinal tract to function properly.

The cells of smooth muscle and secretory glands must have energy to perform their work, and thiamin is a necessary agent for producing that energy.

DIF: Cognitive Level: Knowledge REF: 108 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. The vitamin that is destroyed by light is

a. vitamin C. b. niacin. c. riboflavin. d. biotin.

ANS: C Riboflavin is easily destroyed by light. Milk, a major source of riboflavin, is sold and stored in plastic or cardboard containers to protect it from light exposure.

DIF: Cognitive Level: Knowledge REF: 110 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. The most important source of riboflavin is a. milk. b. lean meats. c. enriched grains. d. green leafy vegetables.

ANS: A Milk is the major source of riboflavin.

DIF: Cognitive Level: Knowledge REF: 110 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. The function of all B-complex vitamins is to a. regulate fluid balance. b. function as body structures. c. function as coenzymes. d. provide calories for energy.

ANS: C The B-complex vitamins function as coenzymes that are necessary agents to break down compounds, but are not consumed in the process.

DIF: Cognitive Level: Knowledge REF: 119-124 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. The disease associated with niacin deficiency is a. anemia. b. cheilosis. c. pellagra. d. beriberi.

ANS: C Pellagra is a disease caused by the lack of niacin. It is characterized by skin lesions along with gastrointestinal, mucosal, neurologic, and mental symptoms. The four Ds associated with pellagra are dermatitis, diarrhea, dementia, and death.

DIF: Cognitive Level: Knowledge REF: 110 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 32. The amino acid that can be converted to niacin in the body is a. leucine. b. phenylalanine. c. tryptophan. d. valine.

ANS: C

Some of the niacin the body requires can be made from the essential amino acid tryptophan. The total requirement in the body for niacin is stated in terms of niacin equivalents to account for both sources.

DIF: Cognitive Level: Knowledge REF: 110 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Wellness 33. A good food source of niacin is a. a banana. b. a tomato. c. beef. d. oatmeal.

ANS: C Meat is a major source of niacin. The greatest intake of niacin in the United States comes from mixed dishes high in meat, poultry, or fish.

DIF: Cognitive Level: Application REF: 111 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 34. The vitamin most closely associated with protein metabolism is a. thiamin. b. pyridoxine. c. folic acid. d. choline.

ANS: B Vitamin B6 (pyridoxine) has an essential role in protein metabolism and functions in many cell reactions involving amino acids.

DIF: Cognitive Level: Knowledge REF: 112 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 35. Which of the following diets can help ensure adequate and balanced vitamin intake? a. a high-calorie diet composed of mainly fruits and vegetables b. a high-protein diet concentrating on red meat and fish c. a varied diet composed of all food groups eaten in controlled portions d. a varied diet with a higher emphasis on grains and fish ANS: C Eating a well-balanced, varied diet can help ensure adequate and balanced intake by supplying needed nutrients from all the food groups in proper portion sizes.

DIF: Cognitive Level: Application REF: 124 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Wellness 36. The person most at risk for vitamin D deficiency is a a. 12-year-old girl who plays soccer at the local playground twice a week. b. 28-year-old mother who breastfeeds her 5-month-old infant and takes a daily stroll in the neighborhood. c. 62-year-old woman who lives in a cold climate and rarely goes outdoors. d. 42-year-old man who plays golf once a week.

ANS: C

Vitamin D is synthesized in the skin with exposure to sunlight. People who do not go outdoors may be at higher risk for developing a vitamin D deficiency.

DIF: Cognitive Level: Application REF: 101 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 37. The best food source of folic acid is a. grapefruit. b. chicken. c. cheese. d. broccoli.

ANS: D Rich sources of folate are found in liver, green leafy vegetables, yeast, and legumes. Broccoli would be a high source of folate among the choices.

DIF: Cognitive Level: Application REF: 114 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 38. A folic acid deficiency induces a form of anemia called anemia. a. microcytic b. megaloblastic c. pernicious d. aplastic ANS: B Megaloblastic anemia can be caused by a lack of folate.

DIF: Cognitive Level: Knowledge REF: 113 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 39. The B vitamin predominantly found in foods of animal origin is a. pantothenic acid. b. niacin. c. thiamin. d. cobalamin.

ANS: D Because cobalamin occurs as a protein complex in foods, its sources are mostly of animal origin.

DIF: Cognitive Level: Knowledge REF: 116 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 40. Vitamin C deficiency is associated with a. scurvy. b. beriberi. c. pernicious anemia. d. megaloblastic anemia.

ANS: A Extreme vitamin C deficiency is associated with scurvy.

DIF: Cognitive Level: Knowledge REF: 107 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 41. A 62-year-old woman who smokes one pack of cigarettes a day and whose food intake records reveal a minimal intake of vitamin C foods may be at risk for a. easy bruising and pinpoint hemorrhages.

b. cracked and bleeding lips. c. fevers and infections. d. neurologic disorders.

ANS: A Signs of vitamin C deficiency are tissue bleeding, including easy bruising and pinpoint skin hemorrhages. Smokers deplete their supply of vitamin C more rapidly than nonsmokers.

Cigarette smoke is a source of environmental free radicals, and vitamin C is needed to break down toxic compounds in cigarette smoke.

DIF: Cognitive Level: Analysis REF: 107 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 42. An example of a meal high in vitamin C is a. bacon, lettuce, and tomato sandwich and strawberries. b. hamburger, french fries, and salad. c. pasta salad, whole-grain roll, and apple. d. nachos with refried beans and salsa.

ANS: A The best sources of vitamin C are citrus fruits, tomatoes, cabbage and other leafy green vegetables, berries, melons, peppers, broccoli, potatoes, and yellow vegetables.

DIF: Cognitive Level: Application REF: 107 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 43. Phytochemicals act as a. vitamins and minerals. b. cofactors and enzymes. c. antioxidants and hormones. d. antibiotics and antifungals.

ANS: C Phytochemicals act as antioxidants and hormones. The beneficial effects of phytochemicals are believed to result from synergistic actions of multiple nutrients as opposed to acting as an isolated compound.

DIF: Cognitive Level: Knowledge REF: 120 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 44. Foods rich in phytochemicals include a. mushrooms and algae. b. fruits and vegetables. c. yogurt and goats milk. d. soy milk and tofu.

ANS: B Fruits and vegetables are rich sources of phytochemicals. The term phytochemical comes from the Greek word phyton, meaning plant.

DIF: Cognitive Level: Application REF: 120 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 45. A young woman who is interested in becoming pregnant should be counseled on healthy eating choices, especially regarding folate-containing foods, which may help prevent a. neural tube defects.

b. osteomalacia. c. pernicious anemia. d. aplastic anemia.

ANS: A Adequate folate intake before and during pregnancy greatly reduces the risk of neural tube defects in infants.

Chapter 7. Minerals MULTIPLE CHOICE 1. The mineral present in the body in the greatest amount is a. sodium. b. calcium. c. iron. d. chloride.

ANS: B Calcium is present in the greatest amount in the body and functions in bone and teeth formation, blood clotting, muscle and nerve action, and metabolic reactions.

DIF: Cognitive Level: Knowledge REF: 128 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The factors most responsible for regulating calcium absorption from food are a. activity and diet. b. dietary intake and vitamin D hormone. c. metabolic rate and cardiovascular function. d. vitamin D hormone, calcitonin, and parathyroid hormone.

ANS: D The absorption of dietary calcium depends on the interaction of three hormonesvitamin D, parathyroid hormone, and calcitoninthat directly control absorption along with indirect metabolic stimuli from the estrogen hormones.

DIF: Cognitive Level: Knowledge REF: 130 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Binding agents such as oxalic acid and phytic acid inhibit absorption of a. potassium. b. sodium. c. sulfur. d. calcium.

ANS: D Oxalic acid is a compound found in some plants such as spinach, rhubarb, Swiss chard, beet greens, and certain other vegetables and nuts that form insoluble salts with calcium, called oxalates.

DIF: Cognitive Level: Knowledge REF: 132-133 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The person most at risk for developing osteoporosis is a a. 25-year-old woman who plays tennis 3 times a week. b. 35-year-old woman who has sustained multiple trauma and is bedridden. c. 55-year-old woman who exercises 3 times a week and consumes adequate milk and dairy products at least 3 times a day.

d. 14-year-old girl who runs track and drink 4 glasses of milk daily.

ANS: B Osteoporosis is not a primary calcium deficiency disease, but it does result from a combination of factors that create chronic calcium deficiency. These factors include inadequate intake, poor intestinal absorption connected with hormones controlling calcium absorption and metabolism, and lack of exercise that stimulates muscle insertion action on bones and determines the strength, shape, and mass of bone. The 35-year-old woman who is bedridden is at a higher risk for osteoporosis than the others who are active.

DIF: Cognitive Level: Application REF: 131 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 5. An example of a food that is a good source of calcium is a. kidney beans. b. whole-grain bread. c. yogurt. d. spinach.

ANS: C Good sources of calcium include milk and milk products, including cheese, yogurt, and ice cream.

DIF: Cognitive Level: Application REF: 132-133 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 6. An example of a breakfast high in calcium is a. scrambled eggs and toast. b. pancakes and syrup. c. sausage biscuit. d. cereal and milk.

ANS: D Cereal and milk provide good sources of calcium because calcium-rich foods include milk and milk products.

DIF: Cognitive Level: Application REF: 132-133 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The functions of energy metabolism and acid-base balance are regulated by a. sodium. b. iron. c. potassium. d. phosphorus.

ANS: D The functions of phosphorus include bone and teeth formation, energy metabolism, and acidbase balance.

DIF: Cognitive Level: Application REF: 132-133 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. Two foods that are most important in bone formation are a. margarine and apples. b. milk and yogurt.

c. bread and red meat. d. cereal and yogurt.

ANS: B Milk and yogurt are good sources of calcium and phosphorus which both play a role in boneforming tissue.

DIF: Cognitive Level: Application REF: 132-133|135 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. An important function of sodium is a. energy metabolism. b. water balance. c. tooth formation. d. nerve conduction.

ANS: B Sodium functions in water balance, acid-base balance, muscle action, and nutrient absorption.

DIF: Cognitive Level: Knowledge REF: 135-136 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. Most of the bodys sodium is found in a. plasma. b. water outside cells. c. water inside cells. d. cerebrospinal fluid.

ANS: B Sodium is the major guardian of the bodys water outside the cell (extracellular), which helps prevent dehydration.

DIF: Cognitive Level: Knowledge REF: 135-136 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. Processed foods supply a large percent of what mineral? a. manganese b. magnesium c. sodium d. iron ANS: C Food manufacturers add significant amounts of salt and other sodium compounds to processed foods.

DIF: Cognitive Level: Application REF: 136-137 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The major mineral in water inside cells is a. sodium. b. chloride. c. potassium. d. magnesium.

ANS: C Potassium is the major electrolyte controlling the water inside the cell (intracellular fluid).

DIF: Cognitive Level: Knowledge REF: 137 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. Of the foods below, the one providing the best source of potassium is a. spinach. b. lemonade. c. processed cheese crackers. d. french fries.

ANS: A The richest dietary sources of potassium are unprocessed foods, including oranges and bananas; vegetables such as broccoli and leafy green vegetables; fresh meats; whole grains; and milk products.

DIF: Cognitive Level: Application REF: 137-138 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The two minerals that occur in the water outside cells and regulate water balance are a. calcium and potassium. b. sodium and chloride. c. phosphorus and magnesium. d. iron and zinc.

ANS: B Sodium and chloride are the two minerals found in the water outside cells; both help control body-water balance.

DIF: Cognitive Level: Knowledge REF: 135|138 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. Chloride is incorporated into a. pancreatic secretions. b. intestinal secretions. c. gastric secretions. d. skeletal tissue.

ANS: C Chloride is a key element in the hydrochloric acid secreted in gastric juices.

DIF: Cognitive Level: Knowledge REF: 138 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. An important function of sulfur in the body is a. building connective tissue. b. tooth formation. c. fat formation. d. acid-base balance.

ANS: A Sulfur is necessary for collagen synthesis and is important in building connective tissue. Sulfur is also involved in the structure of hair, skin, and nails; general metabolic functions; and vitamin structure.

DIF: Cognitive Level: Knowledge REF: 140 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. A food that enhances nonheme iron absorption is a. orange juice. b. white toast. c. olive oil.

d. sausage.

ANS: A Vitamin C and moderate amounts of lean meat help enhance the absorption and availability of nonheme iron. Orange juice is a good source of vitamin C. DIF: Cognitive Level: Application REF: 144 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. Which of the following foods would be most important to assist with thyroxine synthesis? a. iodized table salt b. fresh green lettuce c. apple d. yogurt ANS: A Iodized table salt contains iodine, which helps synthesize thyroxine. Thyroxine-stimulating hormone stimulates the thyroid gland to take up more iodine for thyroxine synthesis when the blood level of thyroxine falls below normal.

DIF: Cognitive Level: Application REF: 146 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. The main dietary source of iodine is a. seafood. b. legumes. c. iodized table salt. d. fortified foods.

ANS: C Iodized table salt is the major reliable source of iodine. The amount of iodine in natural food varies depending on the content of the soil. Seafood is another good source of iodine, but is less reliable because most people do not eat seafood daily.

DIF: Cognitive Level: Application REF: 146 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. Copper has a metabolic association with a. silicon. b. chromium. c. iron. d. molybdenum.

ANS: C Copper is frequently called the iron twin because copper and iron are metabolized in much the same way and both are components of cell enzymes.

DIF: Cognitive Level: Knowledge REF: 149 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. Chromium is a component of the factor that facilitates the action of insulin. This factor is called a. factor III. b. antipernicious factor. c. glucogenic factor. d. glucose tolerance factor.

ANS: D

Chromium functions as an essential component of the organic complex glucose tolerance factor, which stimulates the action of insulin.

DIF: Cognitive Level: Knowledge REF: 150-151 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. A significant food source of selenium is a. shrimp. b. processed snacks. c. canned fruit. d. a fresh apple.

ANS: A Significant sources of selenium include seafood, kidney, liver; meats and whole grains provide some selenium.

DIF: Cognitive Level: Application REF: 148 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. The main function of fluoride is to a. provide structural support. b. prevent anemia. c. prevent dental caries. d. slow aging.

ANS: C The main function of fluoride is to prevent dental caries. Fluoride strengthens the ability of the tooth structure to withstand the erosive effect of bacterial acids.

DIF: Cognitive Level: Knowledge REF: 149 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Trace minerals are called trace because they are a. not as important as the other minerals. b. found in small quantities in food sources. c. found in small quantities in the body. d. difficult to detect in the body.

ANS: C Trace elements occur in very small amounts in the body. Trace elements are defined as those having a required intake of less than 100 mg/day.

DIF: Cognitive Level: Knowledge REF: 129 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. Minerals are a. organic compounds. b. elements. c. made by plants. d. liquid at room temperature.

ANS: B Minerals are chemical elements.

DIF: Cognitive Level: Knowledge REF: 128 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. An example of a lunch high in potassium is a a. hamburger on a bun with sliced tomatoes.

b. grilled cheese sandwich and pretzels. c. pasta salad and hard roll. d. bagel with cream cheese and dill pickle.

ANS: A Rich food sources of potassium include unprocessed foods, including fruits such as oranges and bananas; vegetables such as broccoli and leafy greens; fresh meats; whole grains; and milk products.

DIF: Cognitive Level: Application REF: 137-138 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Wellness 27. Potassium deficiency may be caused by a. allergies. b. food poisoning. c. psychological stress. d. myocardial infarction.

ANS: B Potassium deficiency is more likely to develop with prolonged vomiting or diarrhea, use of diuretic drugs, severe malnutrition, or surgery.

DIF: Cognitive Level: Application REF: 137 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 28. Amino acids that contain sulfur are a. phenylalanine and calcium. b. threonine and tyrosine. c. methionine and cystine. d. leucine and tryptophan.

ANS: C The amino acids methionine and cystine contain sulfur.

DIF: Cognitive Level: Knowledge REF: 140 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. The trace element the body needs to produce antibodies, convert carotene to vitamin A, and form hemoglobin is a. copper. b. iron. c. magnesium. d. zinc.

ANS: B Iron is necessary for hemoglobin synthesis, proper glucose metabolism in the cell, antibody production, drug detoxification in the liver, collagen and purine synthesis, and conversion of carotene to vitamin A. DIF: Cognitive Level: Application REF: 140 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. A significant source of phosphorus would be provided by a. lean broiled beef. b. an apple.

c. chocolate. d. lemonade.

ANS: A The best sources of phosphorus are high-protein foods, including milk and milk products, meat, fish, and eggs.

Chapter 8. Water MULTIPLE CHOICE 1. The hormone that conserves body water is a. vitamin D hormone. b. antidiuretic hormone. c. aldosterone. d. parathyroid hormone.

ANS: B Antidiuretic hormone works on the kidneys nephrons to induce reabsorption and conservation of water.

DIF: Cognitive Level: Knowledge REF: 168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The two minerals that occur in the extracellular fluid and regulate water balance are a. calcium and potassium. b. sodium and chloride. c. phosphorus and magnesium. d. potassium and magnesium.

ANS: B Sodium and chloride are the two minerals that occur in the extracellular fluid and regulate water balance.

DIF: Cognitive Level: Knowledge REF: 163-164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. A person is most likely to have a high body water content if he/she is a. overweight. b. underweight. c. a bodybuilder. d. sedentary.

ANS: C An athlete would have a high body water content related to the amount of muscle mass. Muscle mass contains a relatively large amount of water.

DIF: Cognitive Level: Application REF: 161 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 4. The term extracellular fluid includes a. plasma and tissue secretions. b. plasma and fluid inside cells. c. fluid surrounding cells and in beverages. d. fluid surrounding cells and fluid inside cells.

ANS: A Extracellular fluid is the total body water outside the cells.

DIF: Cognitive Level: Knowledge REF: 161 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. A basic mechanism for maintaining body hydration is a. thirst. b. electrolyte balance. c. acid-base balance. d. activity level.

ANS: A Thirst is the basic mechanism for maintaining hydration.

DIF: Cognitive Level: Knowledge REF: 161 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The hormone responsible for promoting conservation of sodium in the kidney is a. aldosterone. b. antidiuretic hormone. c. angiotensin. d. renin.

ANS: A Aldosterone is produced by the adrenal glands, which trigger the kidneys nephrons to reabsorb sodium.

DIF: Cognitive Level: Knowledge REF: 168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Mr. Jones consumes approximately 1500 mL/day from fluid contained in liquids and foods and from metabolism of foods. What percent of his fluid requirement does he meet if he requires 2400 mL/day? a. 41% b. 51% c. 62% d. 84% ANS: C The intake from liquids, liquids in foods, and metabolism is approximately 1500 mL/day so 1500 mL divided by 2400 mL = 62%.

DIF: Cognitive Level: Analysis REF: 163 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 8. Water formed from metabolism comes from a. what is contained in foods. b. moving from compartment to compartment. c. what is absorbed from gastrointestinal secretions. d. oxidation of nutrients in the cells.

ANS: D Metabolic water, or water of oxidation, is the product of cell oxidation when nutrients are burned in the body for energy.

DIF: Cognitive Level: Comprehension REF: 163 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The approximate volume of digestive secretions produced by the stomach each day is mL.

a. 1000 b. 1500 c. 2000 d. 2500 ANS: D The approximate total volume of digestive secretions produced by an average-sized adult is 8200 mL per 24 hours. Of this amount, 2500 mL is from gastric secretions.

DIF: Cognitive Level: Knowledge REF: 167 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The kidneys must excrete water in the urine because a. the body needs to get rid of the ingested water. b. water provides the vehicle for excretion of waste products. c. they physiologically cannot retain all the water. d. hormones ensure that a maximal amount of water is retained by the body.

ANS: B The largest amount of water exits through the kidneys. A certain amount of water must be excreted as urine to carry the various waste products of metabolism. This is called obligatory water loss because it is compulsory for survival and must occur daily for health.

DIF: Cognitive Level: Knowledge REF: 163 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. Plasma proteins and electrolytes are examples of solutes a. filtered from the plasma by the kidneys. b. found in body fluids that influence movement of water. c. released into the plasma by the liver. d. recycled by the mucosa during digestion.

ANS: B Plasma proteins, mainly in the form of albumin and globulin, are organic compounds of large molecular size responsible for controlling water movement in the body and guarding blood volume by influencing the shift of water in and out of capillaries in balance with the surrounding water. Electrolytes are particles that are free to move throughout a solution to maintain chemical balance.

DIF: Cognitive Level: Application REF: 157|163-164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. An example of a substance that can pass through a capillary membrane is a. glucose. b. hemoglobin. c. plasma proteins. d. antibodies.

ANS: A Glucose passes through a capillary membrane. The walls of the capillaries are thin and porous; therefore water molecules and small particles can move freely across them.

DIF: Cognitive Level: Application REF: 164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. An acid has a pH a. greater than 7.0.

b. lower than 7.0. c. greater than 5.0. d. lower than 5.0.

ANS: B A pH less than 7.0 is considered acidic, whereas anything above 7.0 is considered basic. A pH of 7.0 is neutral.

DIF: Cognitive Level: Knowledge REF: 169 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. An example of a cation is a. sodium. b. phosphate. c. carbonate. d. sulfate.

ANS: A Cations are ions carrying positive charges, such as sodium, potassium, calcium, and magnesium.

DIF: Cognitive Level: Knowledge REF: 164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The organic molecule responsible for creating colloidal osmotic pressure is a. glucose. b. an electrolyte. c. protein. d. sodium.

ANS: C Protein is an organic molecule responsible for creating colloidal osmotic pressure.

DIF: Cognitive Level: Application REF: 164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. An example of an electrolyte is a. glucose. b. iron. c. potassium. d. carbon dioxide.

ANS: C Electrolytes are small, inorganic substances that can dissociate or break apart in a solution and carry an electrical charge. Examples include potassium, sodium, chloride, calcium, magnesium, carbonate, phosphate, and sulfate.

DIF: Cognitive Level: Comprehension REF: 163-164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Ways in which water and solutes move across membranes include a. diffusion and filtration. b. capillary action and circulation. c. peristalsis and contraction. d. conduction and pulsation.

ANS: A Forces that move water and solutes across membranes include osmosis, diffusion, filtration, active transport, and pinocytosis.

DIF: Cognitive Level: Knowledge REF: 165-166 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. Functions of water in the body include a. providing an energy source. b. temperature control. c. nerve impulse transmission. d. transport of vitamins A, D, E, and K. ANS: B The body water supply acts as a solvent, serves as a means of transport, provides form and structure, regulates temperature control, and provides lubrication for the body.

DIF: Cognitive Level: Knowledge REF: 158 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Wellness 19. The term used to denote concentration of electrolytes in a given volume is a. valence. b. colloidal osmotic pressure. c. pH. d. milliequivalent.

ANS: D Milliequivalents are used to express the number of electrolytes per unit of fluid in a solution.

DIF: Cognitive Level: Knowledge REF: 164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. Cations primarily responsible for controlling body water distribution are a. sodium and chloride. b. calcium and phosphorus. c. sodium and potassium. d. sodium and bicarbonate.

ANS: C Sodium and potassium are cations that function to control the distribution of water in the body.

Sodium is the major extracellular electrolyte and potassium is the major intracellular electrolyte.

DIF: Cognitive Level: Knowledge REF: 164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. A patient who is experiencing severe diarrhea and vomiting would have a. increased body water requirements. b. decreased body water requirements. c. no change in body water requirements. d. an immediate need for intravenous fluid.

ANS: A Diarrhea and vomiting increase the loss of fluid from the body and hence increase body water requirements to replace losses and maintain a state of homeostasis.

DIF: Cognitive Level: Application REF: 159 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 22. The kidneys launder the blood by a. osmosis.

b. filtration. c. active transport. d. diffusion.

ANS: B The kidneys filter the blood to maintain the appropriate levels of all constituents of blood and remove waste products.

DIF: Cognitive Level: Knowledge REF: 167 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Oral rehydration therapy is preferred over intravenous therapy for fluid replacement caused by diarrhea because it a. is quicker. b. tastes better. c. is more readily available. d. provides electrolytes as well as fluid.

ANS: C Oral hydration is preferred over intravenous therapy if it is able to be consumed by the patient because it is just as effective as intravenous therapy, is more readily available, and is less expensive.

DIF: Cognitive Level: Knowledge REF: 168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies, Basic Care and Comfort 24. The predominant regulator(s) of circulating blood volume is(are) a. electrolytes. b. plasma proteins. c. water intake. d. hormones.

ANS: B Plasma protein molecules are retained in blood vessels, controlling water movement in the body and guarding blood volume by influencing the shift of water in and out of capillaries in balance with the surrounding water.

DIF: Cognitive Level: Knowledge REF: 164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. Water retention would be the result of the hormone a. ADH. b. estrogen. c. progesterone. d. insulin.

ANS: A Antidiuretic hormone promotes water conservation; it works on the kidneys nephrons to induce reabsorption of water. In any stressful situation with threatened or real loss of body water, this hormone is released to conserve vital body water.

DIF: Cognitive Level: Comprehension REF: 168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 26. Thirst tends to be an unreliable index of fluid needs in a. infants.

b. pregnant women. c. breast-feeding women. d. older adults.

ANS: D Thirst is an unreliable index of fluid needs in the elderly because the thirst mechanism usually diminishes with age and dehydration can easily occur.

DIF: Cognitive Level: Knowledge REF: 159|161 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 27. Plasma proteins maintain colloidal osmotic pressure because a. they are large molecules. b. proteins are not found in the cells. c. proteins are positively charged. d. they contain water as part of their structure.

ANS: A Plasma proteins maintain colloidal osmotic pressure because they are large molecules, mainly in the form of albumin and globulin. Plasma protein molecules are retained in the blood vessels, controlling water movement in the body and guarding blood volume by influencing the shift of water in and out of capillaries in balance with the surrounding water.

DIF: Cognitive Level: Knowledge REF: 164 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. Treatment for diarrhea in children is to a. withhold oral intake and immediately begin intravenous fluids until diarrhea stops. b. sponge with an electrolyte solution of sodium, potassium, and sugar. c. give an age-appropriate diet along with oral fluids that contain sodium, potassium, sugar, and sodium bicarbonate. d. administer the BRAT (bananas, rice, applesauce, and tea) diet.

ANS: C Administering an age-appropriate diet along with fluids that contain sodium, potassium, glucose, and sodium bicarbonate is beneficial in treating diarrhea and replacing lost fluid and electrolytes to bring the body to a state of homeostasis.

DIF: Cognitive Level: Application REF: 168 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Basic Care and Comfort 29. The electrolyte present in the most abundance in gastric digestive fluids is a. chloride. b. potassium. c. sodium. d. bicarbonate.

ANS: A The approximate concentration of certain electrolytes in gastric secretions of the digestive fluids is mostly composed of chloride followed by sodium and potassium.

DIF: Cognitive Level: Knowledge REF: 167 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. For osmosis to occur there must be

a. a semipermeable membrane. b. cations and anions. c. membrane channels. d. hormonal control.

ANS: A Osmosis is the process by which water moves from an area of low concentration to an area of high concentration; this can only happen if the two areas are separated by a semipermeable membrane.

Chapter 9. Digestion, Absorption, Metabolism, and Excretion MULTIPLE CHOICE 1. The process of digestion involves and actions. a. thermal, chemical b. chemical, electrical c. mechanical, chemical d. mechanical, thermal ANS: C For nutrients to be delivered to the cells, food goes through a series of mechanical and chemical changes.

DIF: Cognitive Level: Knowledge REF: 65 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The rhythmic contractions of the stomach and intestine that propel food along are called a. segmentation. b. peristalsis. c. cardiospasm. d. pendular movements.

ANS: B Peristalsis is the alternating muscular contractions and relaxations that force the contents forward through the gastrointestinal tract. The smooth muscles of the gastrointestinal wall provide these two movements to ensure continuous passage of the food mass and valve control along its journey.

DIF: Cognitive Level: Knowledge REF: 66 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. An example of a gastric secretion is a. intestinal lipase. b. pancreatic amylase. c. bile. d. hydrochloric acid.

ANS: D Gastric secretions include enzymes, hydrochloric acid and buffer ions, mucus, water and electrolytes.

DIF: Cognitive Level: Application REF: 67 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. A pizza slice is being consumed by a hungry teen. The first actions of biting, chewing, and breaking up the slice into smaller particles is called a. peristalsis.

b. segmentation. c. pendular movements. d. mastication.

ANS: D Mastication begins mechanical digestion in the mouth. Mastication is the biting and chewing that begins to break food into smaller particles.

DIF: Cognitive Level: Knowledge REF: 66 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. A food that begins chemical digestion in the mouth is a. chicken. b. yogurt. c. candy. d. bread.

ANS: D In the mouth, salivary glands secrete salivary amylase, which is the general name for any starchsplitting enzyme. Thus a food with starch content, such as bread, could begin its chemical digestion in the mouth.

DIF: Cognitive Level: Application REF: 69-70 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. After ingested food is mixed and churned with gastric secretions, the semifluid mass is called a. chyle. b. chyme. c. renin. d. bolus.

ANS: B By the time the food mass reaches the lower portion of the stomach, it is a semiliquid, acid-food mix called chyme.

DIF: Cognitive Level: Knowledge REF: 67 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. One type of movement in the small intestine is a. mastication. b. segmentation. c. kinetic propulsion. d. expulsion.

ANS: B The intestinal muscles produce several types of movement that aid digestion, including peristalsis, pendular movements, segmentation, longitudinal rotation, and surface villi motions.

DIF: Cognitive Level: Knowledge REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. Compared with the pH in the stomach, the pH in the small intestine is a. lower. b. higher. c. the same. d. neutral.

ANS: B

The pH of the stomach is acidic (lower) and the pH of the small intestine is alkaline (higher).

DIF: Cognitive Level: Application REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The enzyme that would be most important for digesting a skinless chicken breast would be a. sucrase. b. lipase. c. peptidase. d. bile.

ANS: C A skinless chicken breast contains more protein than any other nutrient. The protein is partially digested to peptides by peptidase.

DIF: Cognitive Level: Application REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. A food that is high in a macronutrient broken down by trypsin is a. bread. b. fruit. c. margarine. d. chicken.

ANS: D Trypsin breaks down protein to dipeptides. In this case, chicken is the high-protein food.

DIF: Cognitive Level: Application REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The lining of the stomach and intestine is protected from strong acid by a. pepsinogen. b. bile. c. mucus. d. the presence of food.

ANS: C Because the stomach contains hydrochloric acid, mucus is available to protect its lining from the erosive effects of the acid. Large quantities of mucus are secreted by the intestinal glands to protect the mucosal lining from irritation and erosion caused by the high acidic gastric contents entering the duodenum.

DIF: Cognitive Level: Knowledge REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The hormone that stimulates the pancreas to release its secretions is a. gastrin. b. enterogastrone. c. cholecystokinin. d. secretin.

ANS: D The hormone secretin, which is produced by the mucosal glands in the first part of the intestine, controls the secretion of enzymes and other substances from the pancreas.

DIF: Cognitive Level: Knowledge REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. A meal consisting of country fried steak, carrots, and a baked potato with butter and sour

cream would stimulate the hormone cholecystokinin because of the a. presence of food in the duodenum. b. presence of fat in the duodenum. c. entry of the acidic chyme into the duodenum. d. entry of bile into the duodenum.

ANS: B The stimulus for the release of cholecystokinin is the presence of fat in the duodenum. Once stimulated, cholecystokinin stimulates the gallbladder to release bile to emulsify fat.

DIF: Cognitive Level: Application REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. After eating fried chicken the end products from the digestion of fat include a. glycerol and fatty acids. b. glucose and fatty acids. c. amino acids and dipeptides. d. cholesterol and glycerol.

ANS: A The end products of digestion of fats are glycerol and fatty acids. Intestinal lipase splits fat into glycerides and fatty acids.

DIF: Cognitive Level: Knowledge REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. A means of absorption that occurs in the small intestine is a. exchange. b. pinocytosis. c. filtration. d. electrochemical transport.

ANS: B Simple diffusion, facilitated diffusion, active diffusion, and pinocytosis are the processes by which nutrients cross the inner intestinal wall and into the body circulation. Pinocytosis is the penetration of larger materials by attaching to the thicker cell membrane and being engulfed by the cell.

DIF: Cognitive Level: Knowledge REF: 71|73 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. After absorption, the end products of carbohydrate and protein digestion enter the a. lacteal. b. bile duct. c. blood system. d. bowel.

ANS: C Once carbohydrates and protein are digested and absorbed, they cross the inner intestinal wall and enter the bloodstream.

DIF: Cognitive Level: Knowledge REF: 73 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. The primary nutritional function of the large intestine is a. absorption of fats. b. absorption of water.

c. excretion of waste products. d. completion of the digestive process.

ANS: B The primary function of the large intestine is to absorb water from the chyme. The water is absorbed in the first half of the colon.

DIF: Cognitive Level: Knowledge REF: 73 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. Bacteria found in the colon are significant because they a. synthesize some vitamins. b. are a source of contamination. c. finish digesting whatever remains in the colon. d. are necessary for mineral absorption.

ANS: A Vitamin K is synthesized from bacteria in the large intestine.

DIF: Cognitive Level: Application REF: 76 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. Gas formation in the colon is the result of a. ingestion of certain foods. b. ingestion of too much water. c. inadequate ingestion of fiber. d. bacterial action on undigested items.

ANS: D Bacterial action on indigestible food items in the large intestine can contribute to the formation of gas.

DIF: Cognitive Level: Knowledge REF: 73-74 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. After digestion, fatty materials are absorbed into the a. bloodstream. b. outer skin. c. colon. d. lacteals.

ANS: D Because fatty materials are not water soluble, these molecules pass into the lymph vessels in the villi (the lacteals), then into the larger lymph vessels of the body, and eventually into the bloodstream.

DIF: Cognitive Level: Knowledge REF: 71 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. Dietary fiber is beneficial because it a. is high in nutrients. b. is readily digested. c. adds bulk to feces. d. absorbs excess nutrients.

ANS: C Food fiber is not digested because human beings lack the specific enzymes required, but adds bulk to the diet.

DIF: Cognitive Level: Application REF: 73 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. The sum total of all the chemical changes that an organism performs to maintain its life and produce energy is the result of a. metabolism. b. digestion. c. absorption. d. respiration.

ANS: A Metabolism is the sum total of all chemical changes that take place in the body by which it maintains itself and produces energy for all its functions.

DIF: Cognitive Level: Knowledge REF: 73 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Bile contains a. hormones. b. enzymes. c. plasma. d. emulsifiers.

ANS: D Bile is an emulsifying agent that aids in fat digestion and absorption.

DIF: Cognitive Level: Knowledge REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Two organs that work with the small intestine in digestion are the a. liver and kidneys. b. stomach and large intestine. c. pancreas and liver. d. large intestine and colon.

ANS: C The pancreas aids in digestion by secreting enzymes to aid in protein, carbohydrate, and fat digestion. The presence of fat in the small intestine triggers the release of bile from the gallbladder; bile is made in the liver and the gallbladder is located in the liver.

DIF: Cognitive Level: Comprehension REF: 68 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. Conversion of amino acids to glucose is called a. metabolism. b. glycogenosis. c. gluconeogenesis. d. catabolism.

ANS: C Gluconeogenesis is the conversion of amino acids to glucose.

DIF: Cognitive Level: Knowledge REF: 71|75 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. The surface of the intestinal wall has mucosal folds, villi, and microvilli to a. aid in peristalsis. b. increase the surface area for absorption.

c. decrease the surface area for absorption. d. increase the number of enzyme-secreting cells.

ANS: B Mucosal folds, villi, and microvilli combine to make the inner surface some 600 times greater than the area of the outer surface of the intestine. This increases the surface area available for absorption.

DIF: Cognitive Level: Knowledge REF: 71 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. Ways to minimize formation of stomach gas include a. avoiding caffeine. b. chewing with your mouth open. c. drinking liquids through a straw. d. not gulping.

ANS: D Stomach gas can be minimized by avoiding carbonated beverages, chewing with the mouth closed, not gulping food, not drinking from a can or through a straw, and not eating while nervous.

DIF: Cognitive Level: Application REF: 74 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. A beverage that may cause intestinal gas in adults is a. milk. b. coffee. c. apple juice. d. cola.

ANS: A Many adults lack the enzyme lactase to digest milk. For adults who do not produce this enzyme, undigested lactose from milk is fermented by bacteria in the colon, causing intestinal gas.

DIF: Cognitive Level: Application REF: 74 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. Ms. J. complains of gas and bloating along with abdominal pain, especially after drinking milk or eating ice cream or cheese. She may have a. lactose intolerance. b. phenylalanine intolerance. c. calcium deficiency. d. vitamin D deficiency.

ANS: A Lactose intolerance is characterized by a wide range of gastrointestinal problems such as gas, bloating, and abdominal pain after eating milk and other dairy products. Patients with lactose intolerance do not produce lactase. Undigested lactose from dairy products is fermented by bacteria in the colon, causing gas and other symptoms.

DIF: Cognitive Level: Analysis REF: 74 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. Which of the following foods would require peptidases to assist in its chemical digestion? a. chicken.

b. banana. c. orange juice. d. margarine.

ANS: A Proteins require amino peptidase to assist in removing end amino acids from polypeptides.

Chicken is a food high in protein.

Chapter 10. Life Cycle Nutrition: Pregnancy and Lactation MULTIPLE CHOICE 1. Nutritional needs during pregnancy are affected by a. the mothers age. b. the sex of the infant. c. the mothers food cravings. d. whether the mother works.

ANS: A Nutritional needs during pregnancy are affected by the mothers age along with height and prepregnancy weight.

DIF: Cognitive Level: Application REF: 174-175 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 2. A pregnant womans energy needs must be met in order to a. spare vitamins. b. spare adipose stores. c. prevent fetal deformity. d. spare protein.

ANS: D Adequate energy is necessary to spare protein. If inadequate kilocalories from energy are provided, then protein will be used for energy. Protein increase is approximately 50% more than the average adult requirement.

DIF: Cognitive Level: Knowledge REF: 174-175 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 3. Daily kilocalorie needs during the second trimester exceed normal requirements by approximately kcal. a. 100 b. 200 c. 340 d. 500 ANS: C The national standard recommends an increase of 340 kcal/day during the second trimester and approximately 450 kcal/day during the third trimester of pregnancy.

DIF: Cognitive Level: Knowledge REF: 174 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 4. The amount of extra protein required by pregnant women compared with nonpregnant women is approximately g/day.

a. 10 b. 15 c. 25 d. 30 ANS: C Protein intake should increase 25 g/day during pregnancy on top of nonpregnancy needs. This increase is approximately 50% more than the average adult requirements.

DIF: Cognitive Level: Knowledge REF: 175 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 5. Increased protein is necessary in pregnancy for a. preventing gestational diabetes. b. sparing carbohydrates for energy needs. c. growing maternal tissues. d. preventing pregnancy-induced hypertension.

ANS: C Increased protein is necessary in pregnancy for sparing carbohydrates for energy, rapid growth of the fetus, development of the placenta, growth of maternal tissues, increased maternal blood volume, and amniotic fluid.

DIF: Cognitive Level: Knowledge REF: 174-175 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 6. A good source of calcium during pregnancy is a. orange juice drink. b. lean ground beef. c. milk. d. baked beans.

ANS: C Calcium is essential for fetal development of bones and teeth as well as for the mothers own body needs. Milk or milk substitute products and generous amounts of green vegetables and enriched or whole grains are good sources of calcium.

DIF: Cognitive Level: Application REF: 175 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 7. A good source of iron during pregnancy would be a. watermelon b. orange juice c. macaroni and cheese d. lean ground beef ANS: D Iron is distributed primarily in meat, eggs, vegetables, and fortified cereals.

DIF: Cognitive Level: Knowledge REF: 175-176 TOP: Nursing Process: Application MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

Maintenance 8. Iron needs increase during pregnancy because of a. maternal constipation. b. increased maternal blood volume. c. increased maternal metabolic rate. d. poor iron absorption during pregnancy.

ANS: B Iron needs are increased during pregnancy for increased hemoglobin synthesis required for the greater maternal blood volume as well as for the babys necessary prenatal storage of iron.

DIF: Cognitive Level: Knowledge REF: 175-176 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 9. Adequate folate in the periconceptional period helps prevent a. cretinism. b. mental retardation. c. neural tube defects. d. gestational diabetes.

ANS: C Folate builds mature red blood cells throughout pregnancy and is particularly needed during the early periconceptional period to ensure healthy embryonic tissue development and prevent malformation of the neural tube.

DIF: Cognitive Level: Knowledge REF: 177 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 10. The B-complex vitamins are required in greater amounts during pregnancy because a. fetal demands for the vitamins are high. b. more hemoglobin is synthesized. c. the vitamins are excreted in greater quantities. d. metabolic activities increase.

ANS: D The B vitamins are needed in increased amounts because of their vital role as coenzyme factors in energy production and protein metabolism.

DIF: Cognitive Level: Knowledge REF: 176 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. Daily intake of vitamin C should be increased during pregnancy because it a. is an important factor in tissue growth. b. plays an important role in protein synthesis. c. is necessary for the energy-producing pathways. d. is important in development of bones in the fetus.

ANS: A Vitamins A and C are needed in higher amounts during pregnancy because they are both important factors of tissue growth.

DIF: Cognitive Level: Knowledge REF: 176-177 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

Maintenance 12. Drinking 3 to 4 cups of milk a day during pregnancy is recommended because it is a good source of a. folate. b. iron. c. vitamin D. d. vitamin C. ANS: C Milk is a good source of vitamin D along with calcium, phosphorus, and magnesium for fetal development of bones and teeth as well as for the mothers own bodily needs.

DIF: Cognitive Level: Application REF: 175 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 13. Appropriate snack choices for a pregnant woman with morning sickness may include a. a meal of hot soup and Gatorade. b. lemonade with added sugar and peppermint sticks. c. a glass of hot decaffeinated tea. d. whole-wheat toast with a small amount of light butter and a small piece of fruit.

ANS: D Small, frequent meals and snacks that are fairly dry and consisting mostly of easily digested energy foods (e.g., carbohydrates), mostly cold foods, with liquids between meals, are recommended for women with morning sickness.

DIF: Cognitive Level: Application REF: 179-180 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 14. A condition of severe, prolonged, and persistent vomiting during pregnancy is called a. hyperemesis gravidarum. b. placenta previa. c. gestational diabetes. d. preeclampsia.

ANS: A Hyperemesis gravidarum is morning sickness in early pregnancy that progresses from a mild state to a severe and prolonged state requiring medical treatment.

DIF: Cognitive Level: Knowledge REF: 179 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 15. A food choice to help alleviate constipation during pregnancy is a. figs. b. chocolate. c. white bread. d. saltines.

ANS: D Helpful remedies for constipation include high-fiber foods such as whole grains, vegetables,

dried fruits, and other fruits and juices.

DIF: Cognitive Level: Application REF: 180 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 16. An acceptable ending pregnancy weight for a normal-weight woman whose prepregnancy weight is 125 lb is lb. a. 130 to 135 b. 135 to 145 c. 145 to 150 d. 150 to 160 ANS: D Weight gain for a normal-weight woman with a body mass index of 19.8 to 26 is 25 to 35 lb.

Thus, 125 lb + 25 to 35 lb = 150 lb to 160 lb.

DIF: Cognitive Level: Application REF: 177-178 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 17. Total weight gain during the first trimester should be approximately lbs. a. 1 to 2 b. 2 to 4 c. 6 to 10 d. 10 to 15 ANS: B Recommended weight gain in the first trimester of pregnancy is approximately 2 to 4 lbs.

DIF: Cognitive Level: Knowledge REF: 177-178 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 18. A pregnancy is considered high risk if the mother a. is 16 years old. b. is vegetarian. c. works full time. d. exercises 4 or 5 times per week.

ANS: A Nutritional risk factors at the onset of pregnancy include age 18 years or younger or 35 years or older; frequent pregnancies; poor obstetric history or poor fetal performance; poverty; bizarre or trendy food habits; abuse of nicotine, alcohol, or drugs; chronic disease with therapeutic diet; and weight less than 85% or more than 120% of normal.

DIF: Cognitive Level: Application REF: 180 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. A pregnant adolescent is at risk because she a. does not know how to care for herself. b. has not established good eating habits. c. is still in a growth stage of development.

d. will not know about the pregnancy until after the fetal organs have formed.

ANS: C A pregnant adolescent is at risk because adolescence itself is a stage of growth. The physiologic demands of the pregnancy can compromise the teenagers needs for her own unfinished growth and development.

DIF: Cognitive Level: Knowledge REF: 180-181 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. A very overweight pregnant woman older than 30 years of age is at high risk for a. anemia. b. gestational diabetes. c. edema. d. phenylketonuria.

ANS: B Risk factors for women who are more than 120% of standard weight or who have a body mass index of more than 26 include gestational diabetes. During pregnancy, there is an increased metabolic workload along with an increased volume of blood and its load of metabolites, including glucose. Some of this extra glucose spills over into the urine.

DIF: Cognitive Level: Knowledge REF: 180 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. During pregnancy, women should be encouraged not to a. exercise. b. have sexual intercourse. c. drink alcoholic beverages. d. drink decaffeinated coffee.

ANS: C Social habits of alcohol, cigarette, and drug use can cause fetal damage and are contraindicated during pregnancy. Extensive, habitual use of alcohol leads to the well-documented fetal alcohol syndrome.

DIF: Cognitive Level: Knowledge REF: 182-183 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 22. The most common cause of anemia during pregnancy is a. folic acid deficiency. b. lack of intrinsic factor. c. iron deficiency. d. vitamin C deficiency.

ANS: C Iron-deficiency anemia is most common during pregnancy.

DIF: Cognitive Level: Knowledge REF: 175-176 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Of the following, the best source of folate would be a. fruit juices.

b. green leafy vegetables. c. whole grains. d. citrus fruits.

ANS: B Folate is found in food sources such as green leafy vegetables, legumes, yeast, chicken, beef, and liver.

DIF: Cognitive Level: Application REF: 177 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 24. The finding of glycosuria during a routine laboratory test may suggest that the woman has a. anemia. b. gestational diabetes. c. phenylketonuria. d. hypertension.

ANS: B Gestational diabetes presents with glycosuria or sugar spilling over into the urine. Other predisposing factors include age 30 years and older; those who are overweight and have a history of previously unexplained stillbirths; delivery of large babies weighing 9 lbs or more; habitual abortions; births of babies with multiple congenital defects; and family history of diabetes or ethnicity associated with a high incidence of diabetes.

DIF: Cognitive Level: Knowledge REF: 185 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. High blood pressure and the accumulation of protein in the urine may be signs of a. preeclampsia. b. hyperemesis. c. alcoholism. d. gestational diabetes.

ANS: A High blood pressure can be fatal to the mother and fetus. If symptoms progress with the accumulation of proteinuria, the condition is referred to as preeclampsia.

DIF: Cognitive Level: Application REF: 185 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 26. Three important factors that support adequate lactation are a. diet, exercise, and vitamin supplements. b. intake of dairy products, fluids, and rest. c. diet, fluids, and rest and relaxation. d. intake of bland foods and adequate fluids.

ANS: C Successful lactation requires an adequate diet, including energy and nutrients for both the process and product, adequate fluid for adequate milk production, and rest and relaxation to enhance the production and letdown reflexes of breast-feeding.

DIF: Cognitive Level: Knowledge REF: 186-189 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 27. Nutrition counselors should encourage pregnant teenagers to a. avoid fast food. b. eat foods from all the basic food groups. c. drink fat-free (skim) rather than whole milk. d. eat foods high in dietary fiber.

ANS: B Pregnant teens should consume foods from all five basic foods groups to support fetal development as well as their own growth and development needs.

DIF: Cognitive Level: Application REF: 181-182 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 28. Advantages of breast-feeding for the mother include a. less fluid retention. b. rapid weight loss. c. fewer maternal infections. d. convenience and economy.

ANS: D The advantages of breast-feeding include benefits to both mother and baby, such as the ability of human milk to meet the unique needs of the infant and convenience and economy.

DIF: Cognitive Level: Knowledge REF: 190-191 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 29. During pregnancy, intake of caffeine for a 132-lb woman should be a. avoided. b. limited to 100 mg of coffee per day. c. limited to 300 mg of coffee per day. d. unlimited in quantity.

ANS: C During pregnancy, caffeine intake should be limited. The overall conclusion is that moderate amounts of caffeine (5 to 6 mg/kg/day) throughout the day do not have negative effects on reproduction or fetal health. Thus, 60 kg (132 lb) 5 = 300 mg of caffeine/day.

DIF: Cognitive Level: Application REF: 183-184 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 30. The best food choice that provides a source of folate is a. spinach. b. lemonade. c. corn chips. d. sausage patty.

ANS: A

Food sources of folate include enriched flour and grains, green leafy vegetables, legumes, soybeans, wheat germ, orange juice, asparagus, and broccoli.

Chapter 11. Life Cycle Nutrition: Infancy, Childhood, and Adolescence MULTIPLE CHOICE 1. At birth, the reflexes an infant has are a. rooting, biting, and swallowing. b. sucking, munching, and swallowing. c. rooting, sucking, and swallowing. d. grasping, sucking, and gagging.

ANS: C At birth the rooting, sucking, and swallowing reflexes are present along with the tonic neck reflex.

DIF: Cognitive Level: Knowledge REF: 203|207 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 2. Foods for infants should be prepared without added a. sugar and salt. b. salt and herbs. c. wheat and sugar. d. milk and wheat.

ANS: A Foods for infants are prepared without added sugar and salt. Foods should not be overseasoned to let tastes develop gradually.

DIF: Cognitive Level: Knowledge REF: 206 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 3. The phase that shows the most erratic growth is a. infancy. b. childhood. c. adolescence. d. adulthood.

ANS: B During childhood, physical growth and appetite occur in spurts. The generally slow and irregular growth rate continues in the early school years, and body changes occur gradually.

DIF: Cognitive Level: Application REF: 207|209 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 4. During a checkup at the clinic, a childs growth is evaluated by using a. fitness testing. b. clinical observation. c. food records. d. growth charts.

ANS: D Growth charts are an assessment tool for measuring normal growth patterns in infants, children,

and adolescents. These charts are based on large numbers of well-nourished children representing the national population.

DIF: Cognitive Level: Knowledge REF: 196 TOP: Nursing Process: Assessment|Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 5. A good source of energy for children is a. chicken. b. cereal with added sugar. c. whole wheat toast. d. a vitamin supplement.

ANS: C The main energy source for children is carbohydrates, preferably complex carbohydrates.

Carbohydrates spare protein so that it is available for building tissue during childhood rather than being broken down for energy needs. Whole wheat toast is a good source of complex carbohydrates. Cereal also provides carbohydrates, but sugar-sweetened cereal provides less complex carbohydrates.

DIF: Cognitive Level: Application REF: 198 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 6. In the growing years, most calories are needed for a. tissue growth. b. physical activities. c. specific dynamic effect. d. basal metabolic needs.

ANS: D Basal metabolism accounts for 50% of total daily caloric intake during childhood.

DIF: Cognitive Level: Knowledge REF: 196 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 7. An example of a food that provides building material for tissue growth is a. bread. b. cheese. c. broccoli. d. an orange.

ANS: B Protein is the fundamental tissue-building substance of the body. Cheese is a food high in protein.

DIF: Cognitive Level: Application REF: 198 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 8. An 8-month-old infant who receives approximately 0.4 L of fluid per day is meeting a. 200% of fluid needs per day. b. 100% of fluid needs per day.

c. 75% of fluid needs per day. d. 50% of fluid needs per day.

ANS: C Approximate daily fluid needs during growth years for infants 7 to 12 months is 0.8 L/day.

DIF: Cognitive Level: Application REF: 198 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 9. Compared with adults, infants and young children have more body fluid a. outside the cells. b. inside the cells. c. in the bloodstream. d. in intestinal secretions.

ANS: A A larger proportion of an infants and childs total body water is outside the cells and more easily available for loss, potentially resulting in dehydration.

DIF: Cognitive Level: Knowledge REF: 198 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 10. A good source of calcium for the growing child is a. milk. b. juice drink. c. dinner roll. d. hot dog.

ANS: A Milk is a good source of calcium. Calcium is an important nutrient for the growing child to assist with bone and tooth development.

DIF: Cognitive Level: Application REF: 201 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. An adequate source of iron for a breast-fed infant at 8 months of age is a. cows milk. b. goats milk. c. enriched rice cereal. d. applesauce.

ANS: C The iron content of breast milk is highly absorbable and fully meets the needs of an infant for the first 6 months of life. At that point, the infants nutritional needs for iron exceed what is provided exclusively by breast milk, and the addition of pureed meats and enriched cereals after approximately 6 months of age helps supply additional iron.

DIF: Cognitive Level: Application REF: 201 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. Hypervitaminosis of vitamins A or D is most likely to occur because of

a. excessive milk intake. b. overexposure to the sun. c. overuse of vitamin supplements. d. inadequate intake of vegetables and fruits.

ANS: C The overuse of vitamin supplements can lead to hypervitaminosis of vitamins A or D. Excess intake may occur over prolonged periods as a result of ignorance, carelessness, or misunderstanding.

DIF: Cognitive Level: Knowledge REF: 201 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 13. The feeding process is an important part of the following developmental factors: a. bonding relationship with parent b. self-identity for the infant c. autonomy for the infant and parent d. infant self-actualization ANS: A The feeding process is an important part of the bonding relationship between parent and child.

The feeding process influences positive growth.

DIF: Cognitive Level: Knowledge REF: 203 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 14. A low birth weight infant weighs less than a. 1500 grams. b. 2500 grams. c. 3000 grams. d. 3500 grams.

ANS: B A low birth weight infant weighs less than 2500 grams while a very low birth weight infant weighs less than 1500 grams.

DIF: Cognitive Level: Knowledge REF: 201 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 15. The most suitable first solid food for an infant 7 months of age would be a. yogurt. b. pureed bananas. c. pureed squash. d. infant rice cereal.

ANS: D Ironfortified infant cereal made from rice, barley, or oats (these are offered one at a time) are usually the most suitable first solid food for infants.

DIF: Cognitive Level: Application REF: 205 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

16. The ideal first food for newborns is a. infant formula. b. cows milk. c. breast milk. d. rice cereal.

ANS: C The ideal first food for newborns is breast milk because its nutrients are uniquely adapted to meet the growth needs of the infant in forms that are easily digested, absorbed, and used.

DIF: Cognitive Level: Knowledge REF: 203 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 17. The first milk secreted by a new mother is called a. lactation. b. colostomy. c. colostrum. d. prolactin.

ANS: C Colostrum is a thin, yellow fluid first secreted by the mammary gland a few days after childbirth, preceding the mature breast milk.

DIF: Cognitive Level: Knowledge REF: 203 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 18. The approximate recommended age for adding solid food to an infants diet is months. a. 4 b. 6 c. 8 d. 12 ANS: B The recommended practice is to introduce solid foods at approximately 6 months of age.

Younger infants are not ready to swallow and digest solid foods and they do not yet need other nutrients besides those provided by breast milk or infant formula.

DIF: Cognitive Level: Knowledge REF: 205 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 19. Babies should not be put to sleep with a bottle of formula because a. infants should not hold their own bottles. b. this could lead to early tooth decay. c. infants should not suck while asleep. d. susceptibility to diarrhea is increased.

ANS: B In addition to other concerns, babies should not be put to sleep with a bottle of formula because it can lead to early tooth decay as bacteria ferment nutrients in the formula to produce acid, which damages tooth enamel.

DIF: Cognitive Level: Knowledge REF: 204 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

Maintenance 20. A type of feeding not recommended for infants during the early months is a. breast milk. b. amino acid-based formula. c. soy-based formula. d. cows milk.

ANS: D Cows milk is not recommended for infants during the first year of life because its concentration may cause gastrointestinal bleeding and it provides too heavy a load of solutes for the infants renal system.

DIF: Cognitive Level: Application REF: 205 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 21. Young children should be offered a. large portions so they can decide how much to eat. b. small portions so they can ask for more if hungry. c. larger portions of food as they grow older. d. the same amount of food each day.

ANS: B In feeding young children, a variety of foods should be offered and served in small portions.

Children can ask for seconds if they are still hungry.

DIF: Cognitive Level: Application REF: 208-209 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 22. Failure to thrive may be caused by a. early sitting and crawling. b. sleeping with a bottle. c. overuse of vitamin supplements. d. overdilution of formula.

ANS: D Diluting formula provides fluid without adequate nutrients.

DIF: Cognitive Level: Knowledge REF: 209|211 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Food intake may decrease after the first year of life and caloric need is not as great because a. the child is using baby fat stores. b. muscle development is occurring. c. the child is still relatively inactive. d. the growth rate slows down.

ANS: D During the first year of life growth is rapid, especially during the first 6 months. After the first year the growth rate tends to slow down, and food intake decreases.

DIF: Cognitive Level: Knowledge REF: 206 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 24. During the school-age years, the rate of growth

a. increases rapidly. b. is slow and irregular. c. increases slowly. d. is similar to that during the preschool years.

ANS: B The rate of growth during the school-age years is slow and irregular, with body changes occurring gradually.

DIF: Cognitive Level: Knowledge REF: 209 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 25. The final major growth spurt of childhood occurs a. at the end of the school-age period. b. with the onset of puberty. c. at the end of adolescence. d. during young adulthood.

ANS: B The final growth spurt of childhood occurs with the onset of puberty. This rapid growth is evident in increasing body size and development of sex characteristics in response to hormonal influences.

DIF: Cognitive Level: Knowledge REF: 213 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 26. Eating disorders are common in adolescent girls because a. their appetites are low. b. adolescents are busy and may miss meals. c. society and peers value thinness. d. they tend to be overzealous in following low-fat eating patterns.

ANS: C Eating disorders are common is young girls and in boys because of social, family, and personal pressures concerning figure control, which are strong influences on them to fit in and be accepted.

DIF: Cognitive Level: Application REF: 214 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. The ideal first food for infants is a. human milk. b. cows milk. c. soy-based formula. d. amino acid-based formula.

ANS: A Human milk is the ideal first food for infants and is recommended by physicians and dietitians.

Cows milk is not recommended and should never be fed to an infant during the first year of life.

Unmodified cows milk can cause gastrointestinal bleeding and provides too heavy a load of solutes for the infants renal system. Appropriate infant formula can be used if the mother chooses not to breast-feed or if some condition prevents breast-feeding.

DIF: Cognitive Level: Knowledge REF: 203 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 28. Older infants can finger-feed themselves with a refined pincer grasp at a. 6 to 8 months. b. 7 to 9 months. c. 10 to 12 months. d. 12 to 18 months.

ANS: C At 10 to 12 months, infants can finger feed themselves with a refined pincer grasp.

DIF: Cognitive Level: Knowledge REF: 205-207 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 29. Parents who use natural foods should be advised to a. add honey to water if the infant is constipated. b. avoid giving honey to a child younger than 1 year. c. add honey to infant foods as a good source of energy. d. use only unprocessed honey.

ANS: B Honey should not be given to an infant younger than 1 year because botulism spores have been reported in honey and the immune capacity of the young infant cannot resist this infection.

DIF: Cognitive Level: Knowledge REF: 206 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. Effective strategies for weight management in children include a. regular physical activity. b. counting calorie intake. c. eliminating snacks. d. eliminating fried foods.

ANS: A Regular physical activity is a key strategy in maintaining a healthy weight in children along with varied and healthy food choices.

Chapter 12. Life Cycle Nutrition: The Mature Adult MULTIPLE CHOICE 1. John is a 34-year-old who is active in his community coaching football. He was also recently promoted to a director level position at this job. John is in adulthood. a. young b. young and middle c. middle d. older ANS: A Young adulthood is between the ages of 20 and 44 years. Physical maturity and independence are apparent with the ability to form new relationships, adopt new roles, and make many more choices regarding lifestyle.

DIF: Cognitive Level: Application REF: 220 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 2. A 42-year-old who makes independent decisions regarding who to marry and what type of family is desired is considered to be making what type of choices? a. independent b. dependent c. wealthy d. introspective ANS: A Young adults between the ages of 20 and 44 years are independent in making choices regarding relationships, careers, jobs, marriage, and family.

DIF: Cognitive Level: Application REF: 220 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 3. Making a choice to lose weight and manage ones cholesterol level is most characteristic of which of the following age groups? a. young adult b. middle adult c. school-age child d. adolescence ANS: B Wellness, health promotion, and reduction of disease risks are becoming the focus of health care for the middle adult years.

DIF: Cognitive Level: Application REF: 220 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 4. Diabetes is an example of a chronic disease most often appearing during a. childhood. b. early adulthood. c. middle adulthood. d. older adulthood.

ANS: C Early evidence of chronic disease appears in some middle-aged adults.

DIF: Cognitive Level: Application REF: 220 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Biologic processes associated with aging may cause a. an increased metabolic rate. b. increased anxiety. c. an increased ratio of adipose-to-muscle tissue. d. increased kidney function.

ANS: C Physical findings associated with aging include an increased ratio of adipose-to- muscle tissue.

As the aging process occurs, skeletal muscle mass is reduced, causing a loss of approximately 40% by age 70 years. Skeletal muscle loss is not mandatory; it can be lessened with exercise.

DIF: Cognitive Level: Application REF: 221 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 6. Prescription and over-the-counter drugs can affect nutritional status because they a. may contain toxins. b. often result in addiction. c. usually contain nutrients. d. may affect appetite or absorption of nutrients.

ANS: D Medication use can affect overall nutritional status because many drugs affect appetite or the absorption of nutrients.

DIF: Cognitive Level: Application REF: 228-230 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Energy requirements decrease as adults age because a. older adults have less stress than younger adults. b. younger adults are still growing; older adults are not. c. the height of adults decreases with age. d. the number of functioning body cells decreases with age.

ANS: D Energy requirements decrease with the aging process because of the decrease in the number of functioning body cells and reduced physical activity.

DIF: Cognitive Level: Knowledge REF: 222 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 8. Each decade, basal energy needs decrease a. 0.5% to 1%. b. 1% to 2%. c. 2% to 4%. d. 5% to 8%.

ANS: B Basal metabolic rate declines an average of 1% to 2% per decade of life.

DIF: Cognitive Level: Knowledge REF: 222 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 9. If an older adult is losing weight, his or her caloric intake is a. less than energy needs. b. approximately the same as energy needs. c. greater than energy needs. d. poorly distributed throughout the day.

ANS: A Weight loss is associated with a caloric intake that is less than what is required for energy needs at the time.

DIF: Cognitive Level: Application REF: 226-227 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. A 65-year-old patients ideal body weight is 115 lbs and on the yearly physical for the past 2 years reveals a recorded weight of 121 lbs. The assessment for this patient would be which of the following? a. slightly underweight b. close to ideal body weight c. slightly overweight d. maintained constant weight ANS: B The assessment is close to ideal body weight. Ongoing review of body mass index indicates that weight ranges in the older adult associated with longer life are not necessarily the desirable weights given, but weights 10% to 25% greater. Thus thin older adults, rather than those of moderate weight, have a reduced life expectancy.

DIF: Cognitive Level: Application REF: 226-227 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. The number of calories per day supplied as carbohydrate for older adults who require 2000 kcal per day would be a. 450 to 650. b. 750 to 1250. c. 900 to 1300. d. 1100 to 1450.

ANS: C For the older adult, 45% to 65% of total energy intake should be supplied as carbohydrate, with the majority being mostly complex carbohydrates.

2000 kcal divided by 45% to 65 % = 900 to 1300 calories per day.

DIF: Cognitive Level: Application REF: 222 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. The older adults diet should include adequate carbohydrates to a. provide a substrate for vitamins and minerals. b. support normal brain function. c. provide building material for muscle mass. d. maintain blood glucose level.

ANS: B The National Academy of Sciences has determined that an absolute minimum of 130 g/day of carbohydrates is necessary to maintain normal brain function for children and adults.

DIF: Cognitive Level: Knowledge REF: 222 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 13. It may be advisable for an older adult to take a vitamin or mineral supplement a. daily. b. weekly.

c. if he or she has been ill. d. if he or she is under stress.

ANS: C Supplements often are recommended for persons in debilitated states or who have malabsorption.

DIF: Cognitive Level: Application REF: 223 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 14. Contributing factors for osteoporosis include a. inadequate calcium and vitamin D intake. b. increased estrogen after menopause. c. excess weight. d. excess iron intake.

ANS: A Contributing factors for osteoporosis include inadequate intakes of calcium and vitamin D, physical inactivity, smoking and alcohol use, thin build, certain medical conditions and medications.

DIF: Cognitive Level: Knowledge REF: 223 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 15. Physiologic problems of older adults include a. diarrhea. b. increased salivary secretions. c. decreased thirst and taste sensations. d. increased muscle tone.

ANS: C As a person ages, a decrease in the thirst mechanism occurs that can lead to inadequate fluid intake and resultant dehydration. The older adult also experiences a decrease in taste, smell, and vision, which affects food intake.

DIF: Cognitive Level: Knowledge REF: 222|226 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. An older adult is most likely to have inadequate nutrient intake if he or she lives a. in a retirement community. b. with a spouse. c. alone. d. with family.

ANS: C Inadequate nutrient intake is more apparent in elderly people who live alone compared with those who have a companion to eat with and enjoy the food.

DIF: Cognitive Level: Knowledge REF: 224 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 17. The Older Americans Act provides home-delivered meals for those who a. cannot afford food. b. prefer not to leave home.

c. are ill or disabled. d. are malnourished.

ANS: C The Older Americans Act provides services to the elderly that include congregate and homedelivered meals with related education and food-service components.

DIF: Cognitive Level: Application REF: 229-230 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 18. The Older Americans Act provides a. congregate and home-delivered meals. b. meals served at shelters and community centers. c. meals served at care facilities and hospices. d. meals for homeless older adults.

ANS: A The Older Americans Act provides congregate and home-delivered meals with related nutrition education and food-service components.

DIF: Cognitive Level: Knowledge REF: 229-230 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 19. Congregate meals are most often served at a a. church. b. senior center. c. nursing home. d. hospital.

ANS: B Congregate meals are served in senior centers and other public or private community facilities.

DIF: Cognitive Level: Knowledge REF: 229 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 20. The congregate meal for seniors is a. breakfast. b. the noon meal. c. the evening meal. d. decided by the center.

ANS: B Congregate meals provide the noon meal.

DIF: Cognitive Level: Knowledge REF: 229 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 21. Factors that commonly contribute to malnutrition in older adults include a. type 2 diabetes and heart disease. b. loss of teeth or poorly fitting dentures. c. a weight 10% above desirable standards. d. increased energy and nutrient needs.

ANS: B

Many factors contribute to malnutrition in the elderly, including inadequate food and nutrient intake as a result of ill-fitting or loss of dentures.

DIF: Cognitive Level: Knowledge REF: 224|226 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. The protein needs of an older adult are influenced by the adequacy of intake. a. fiber b. caloric c. vitamin d. mineral ANS: B Adequate calorie intake is essential in the older adult to prevent calories from protein intake being used for energy needs.

DIF: Cognitive Level: Knowledge REF: 222-223 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 23. Dehydration is more common in older adults than in younger adults because a. the kidneys excrete too much water. b. the thirst mechanism diminishes. c. intracellular versus extracellular water balance is disturbed. d. more water needs to be ingested to maintain hydration.

ANS: B As a person ages the thirst mechanism diminishes, which may result in inadequate fluid intake and dehydration.

DIF: Cognitive Level: Comprehension REF: 226 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Factors that influence the nutrition needs of young adults include a. growth. b. climate. c. personality type. d. physical activity.

ANS: D The nutrition needs of young adults are influenced by physical activity as well as any other conditions, such as pregnancy.

DIF: Cognitive Level: Knowledge REF: 220-221 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 25. Feeding older adults with sensitivity includes a. giving sufficient time to chew and swallow. b. serving only pureed foods. c. avoiding liquids with meals. d. serving bland foods.

ANS: A Feeding older adults with sensitivity helps them achieve adequate intake. Giving sufficient time

to chew and swallow is important while feeding adults with sensitivity.

DIF: Cognitive Level: Knowledge REF: 226 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 26. The Mini Nutritional Assessment (MNA) identifies a. emotional stability. b. nutritional risk. c. vitamin deficiency. d. social isolation.

ANS: B The MNA is designed to identify nutritional risk. It is a reliable tool that is sensitive and can detect the risk of malnutrition.

DIF: Cognitive Level: Knowledge REF: 224-226 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 27. A major factor in weight control is a. physical activity. b. mineral supplementation. c. steroid use. d. vitamin supplementation.

ANS: A Physical activity is a major factor in weight management and it can help prevent debilitating conditions of aging.

DIF: Cognitive Level: Knowledge REF: 226 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 28. Examples of foods high in nutrients that help prevent osteoporosis are a. cottage cheese and oranges. b. yogurt and canned salmon. c. oatmeal and green leafy vegetables. d. broccoli and liver.

ANS: B Foods high in calcium can help prevent osteoporosis. Foods such as yogurt and canned salmon are significant sources of calcium.

DIF: Cognitive Level: Application REF: 223 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 29. Older adults need more vitamin D than younger adults because they a. are less efficient at making their own. b. are in a state of positive calcium balance. c. excrete large amounts in their urine. d. do not eat enough fat to absorb the vitamin efficiently.

ANS: A As a person ages, the body becomes less efficient in making vitamin D and more may have to be provided in the diet through foods that have been fortified, including milk and milk products, breads, and margarines.

DIF: Cognitive Level: Knowledge REF: 223 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 30. For residents in long-term care facilities the type of diet model recommended is a. most restrictive. b. least restrictive. c. no sugar. d. low protein.

ANS: B The least restrictive diet model is recommended since it is the most beneficial in the older population and stage of life.

Chapter 13. Food Management MULTIPLE CHOICE 1. One of the most common deficiencies in the world is deficiency. a. zinc b. biotin c. iron d. ascorbic acid ANS: C Iron-deficiency, protein-energy malnutrition, vitamin A deficiency, and iodine deficiency are the most common deficiencies in the world today.

DIF: Cognitive Level: Application REF: 257 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 2. Farmers use pesticides to a. increase the shelf life of foods. b. control plant diseases. c. prevent food-borne disease. d. increase crop yields.

ANS: B Pesticides are used to control plant diseases. Farmers use certain chemicals to control a wide variety of destructive insects that reduce crop yield.

DIF: Cognitive Level: Application REF: 242 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 3. Farming methods that use natural means of pest control without the use of synthetic pesticides are called a. fossil fuel. b. genetically modified. c. organic. d. irradiated.

ANS: C Organic farming methods use natural means of pest control and meet the standards set by the U.S. Department of Agriculture National Organic Program. Organic foods are grown without the use of synthetic pesticides or fertilizers, sewage sludge, or ionizing radiation.

DIF: Cognitive Level: Knowledge REF: 242 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 4. Lead absorption is increased in children with a. malnutrition. b. iron deficiency. c. high sugar intakes. d. unsafe drinking water.

ANS: B Iron deficiency increases lead absorption fourfold or fivefold, thus increasing the risk of lead toxicity.

DIF: Cognitive Level: Knowledge REF: 256 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 5. Children exposed to high levels of lead are at risk for a. mental deficits. b. heart problems. c. respiratory problems. d. kidney problems.

ANS: A Children exposed to high levels of lead sustain permanent neurologic damage that can manifest itself in the form of mental deficits.

DIF: Cognitive Level: Application REF: 256 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 6. Mercury poisoning is most often caused by eating which of the following? a. raw seafood b. improperly canned foods c. fish from contaminated water d. crops grown with pesticides ANS: C Mercury poisoning is most often caused by eating fish from contaminated water. Methyl mercury is a toxin contaminating large bodies of water and the fish within that water.

DIF: Cognitive Level: Application REF: 256 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 7. The main government agency responsible for food safety is the a. Centers for Disease Control. b. U.S. Food and Drug Administration (FDA).

c. U.S. Public Health Service (PHS). d. Federal Trade Commission (FTC).

ANS: B The U.S. Food and Drug Administration is responsible for ensuring, among other things, that Americas food supply is safe, pure, and wholesome.

DIF: Cognitive Level: Knowledge REF: 237-238 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 8. A health claim approved by the FDA is a. apples and the prevention of hypertension. b. low sodium and the prevention of hypertension. c. zinc and the prevention of wounds. d. spinach and the prevention of diabetes.

ANS: B Low sodium and the prevention of hypertension is a health claim approved by the FDA. The FDA guidelines indicate that any health claim on a label must be supported by substantial scientific evidence.

DIF: Cognitive Level: Knowledge REF: 241 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 9. Leftovers placed in the refrigerator should be stored at or below F. a. 32 b. 40 c. 42 d. 45 ANS: B Home refrigerator temperatures should be maintained at 40 F or lower.

DIF: Cognitive Level: Application REF: 247 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 10. Food additives the nutritional value of foods. a. decrease b. sometimes increase c. have no effect on d. are legal only if they increase ANS: B Food additives can sometimes increase the nutritional value of foods, along with helping produce uniform qualities, standardizing many functional factors, preserving foods by preventing oxidation, and controlling acidity or alkalinity.

DIF: Cognitive Level: Comprehension REF: 245 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. Hazard Analysis and Critical Control Point (HACCP) food safety systems a. include testing to ensure that food will not cause food-borne illness. b. allow food safety inspectors to critique food production without visiting the site.

c. can be used only in restaurants and food-service facilities. d. help prevent food-borne illness by controlling specific aspects of food production.

ANS: D HACCP is a food safety system that focuses on preventing food-borne illness by identifying critical points and eliminating hazards.

DIF: Cognitive Level: Knowledge REF: 248|250 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. Bacterial food poisoning is caused by a. ingestion of toxic bacteria. b. toxins produced by bacteria in the intestines. c. toxins produced by bacteria in the bloodstream. d. ingestion of toxins produced by bacteria in the food before it is eaten.

ANS: D Bacterial food poisoning is caused by the ingestion of bacterial toxins that have been produced in the food by the growth of specific kinds of bacteria before the food is eaten.

DIF: Cognitive Level: Knowledge REF: 251 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 13. The Food and Drug Administration enforces federal regulations pertaining to a. the use of pesticides. b. food prices. c. nutrition labeling. d. food subsidies.

ANS: C Nutrition labeling regulations are enforced by the Food and Drug Administration.

DIF: Cognitive Level: Knowledge REF: 238 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 14. The bacterial toxin that may contaminate improperly canned green beans is produced by a. Staphylococcus aureus. b. Salmonella typhi. c. Listeria monocytogenes. d. Clostridium botulinum.

ANS: D Clostridium botulinum is an anaerobic (or nearly so) bacterial toxin. The relatively air-free can and canning temperatures provide good conditions for toxin production.

DIF: Cognitive Level: Knowledge REF: 252-253 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 15. Under the Commodity Supplemental Food Program, surpluses of perishable foods are a. bought by the government to distribute to the needy. b. sold below market value in most places. c. sent to Third World countries.

d. processed to make nonperishable food items.

ANS: A Under the Commodity Supplemental Food Program, the U.S. Department of Agriculture purchases surplus food items that are good sources of nutrients often lacking in the diets of target populations and then distributes the food to state agencies and tribal organizations.

DIF: Cognitive Level: Knowledge REF: 259 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 16. To prevent food-borne parasitic infections, an important consideration for meat is to a. buy from a reliable source. b. freeze before it is cooked. c. cook thoroughly before eating. d. store raw meat in air-tight packaging.

ANS: C Thorough cooking kills parasites in meats.

DIF: Cognitive Level: Application REF: 256 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 17. Under the Supplemental Nutrition Assistance Program (SNAP), food stamps are supposed to supplement a households food needs for a. 1 week. b. 2 weeks. c. 1 month. d. 2 months.

ANS: C Under the SNAP, the person or household is issued a debit card, or food stamps, which are supposed to supplement the households food needs for 1 month.

DIF: Cognitive Level: Knowledge REF: 259 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 18. The National School Lunch Program provides meals for a. low income children. b. all students. c. children at nutritional risk. d. children younger than 12 years.

ANS: B The National School Lunch Program provides meals for all students.

DIF: Cognitive Level: Knowledge REF: 260 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 19. The WIC program provides nutritious foods to a. low-income pregnant women whos infants birth weight is less than 4 lbs. b. all children between the ages of 2 and 5 who are in a preschool program. c. all pregnant women and their children younger than 5 years who live in rental housing. d. low-income women who are pregnant or breast-feeding and their children who are younger

than 5 years.

ANS: D The Women, Infants, and Children (WIC) food program provides nutrition supplementation, education, counseling, and referrals for health care and social services to women who are pregnant or who have recently given birth and to their infants and children younger than 5 years.

DIF: Cognitive Level: Knowledge REF: 259-260 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 20. Nutrition programs established by the government for the elderly include a. Share a Meal. b. Drive-Through Meals. c. Congregate Meals Program. d. Nutrition Supplements Program.

ANS: C Congregate meals are provided by the Nutrition Services Incentive Program.

DIF: Cognitive Level: Knowledge REF: 260 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 21. To increase shelf life, which of the following may be treated by irradiation? a. apples b. yogurt c. hotdogs d. milk ANS: A Fresh produce such as apples may be irradiated to increase shelf life. Irradiation can kill bacteria and parasites on food after harvest.

DIF: Cognitive Level: Application REF: 245 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 22. Standard information on the Nutrition Facts panel on a food label includes a. serving size. b. cooking instructions. c. whether the product is kosher. d. total calories per container.

ANS: A Food labels contain a Nutrition Facts panel that lists the amount of nutrients in a standard serving of food along with kilocalories from fat, percentage of daily values, number of kilocalories per gram of fat, carbohydrates, and protein.

DIF: Cognitive Level: Application REF: 239-241 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 23. If a food has a label description of low cholesterol, it must also be low in a. sodium. b. calories. c. saturated fat.

d. total fat.

ANS: C Foods described as low cholesterol must also be low in saturated fat.

DIF: Cognitive Level: Application REF: 241 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 24. A microorganism that can live and grow without oxygen is called a. aerobic. b. anaerobic. c. antioxidant. d. antibiotic.

ANS: B Anaerobic means that a microorganism can live and grow in an oxygen-free environment.

DIF: Cognitive Level: Knowledge REF: 252 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 25. Someone who has flu-like symptoms (severe diarrhea, fever, and headache) 3 days after attending a catered event probably has a. influenza. b. a food-borne infection. c. bacterial food poisoning. d. heavy metal poisoning.

ANS: B A food-borne infection presents with flu-like symptoms and is caused by the ingestion of food that is heavily contaminated with bacteria.

DIF: Cognitive Level: Application REF: 250 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. Most food-related hazards to consumers are caused by a. food-borne illness. b. overuse of additives. c. contamination of foods with pesticides. d. eating fish from contaminated water.

ANS: A Most food-related hazards to consumers are caused by food-borne illness, which causes a high incidence of illness and death.

DIF: Cognitive Level: Application REF: 245|247 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 27. A food item that is a particularly effective carrier of Staphylococcal food poisoning is a. potato salad. b. an apple. c. sweet potato. d. a soda cracker.

ANS: A Staphylococcal food poisoning often is caused by food handlers with infected cuts. Therefore

foods that require handling during preparation, such as chopping potatoes, are more likely to be contaminated. Foods that are particularly effective carriers for staphylococci and their toxins include custard or cream-filled bakery goods, processed meats, ham, tongue, cheese, ice cream, potato salad, sauces, chicken and ham salads, and combination dishes.

DIF: Cognitive Level: Application REF: 251-252 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 28. A food item that contains lecithin is a. baking soda. b. ice cream. c. baked potato. d. whole wheat bread.

ANS: B Lecithin is a food additive that acts as an emulsifier in dairy products.

DIF: Cognitive Level: Application REF: 246 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 29. A health claim allowed by the Food and Drug Administration would be a. low sodium and the prevention of hypertension. b. a low-carbohydrate diet and the prevention of obesity. c. supplemental vitamin A and the prevention of osteoporosis. d. high protein intake and an increased risk of cancer.

ANS: A The Food and Drug Administration guidelines indicate that any health claim on a label must be supported by substantial scientific evidence. Low sodium and the prevention of hypertension is supported by established evidence.

DIF: Cognitive Level: Knowledge REF: 240-241 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 30. An example of a food covered by a Women, Infants, and Children (WIC) voucher would be a. lemonade. b. fortified cereal. c. popsicles. d. chocolate chip cookies.

ANS: B Foods covered with issued vouchers include milk, eggs, cheese, juice, fortified cereals, fruits, vegetables, and infant formulas.

Chapter 14. Nutrient Delivery MULTIPLE CHOICE 1. The person most responsible for nutrition care in a clinical setting is the a. physician. b. nurse. c. clinical dietitian.

d. patient.

ANS: C The clinical dietitian is the person responsible for nutrition care in the clinical setting. The nurse, physician, and patient all work with the dietitian to make a successful plan of care.

DIF: Cognitive Level: Knowledge REF: 333 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 2. The member of the health care team who is in closest continual contact with patients and their families is the a. physician. b. clinical dietitian. c. licensed nurse. d. physical therapist.

ANS: C The nurse provides 24-hour care to the patient and is in closest contact with the patient and family.

DIF: Cognitive Level: Knowledge REF: 332-333 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 3. Methods used for nutrition assessment of patients include a. computed tomographic scans. b. laboratory tests. c. physical therapy. d. fitness testing.

ANS: B Methods used for nutrition assessment of patients include laboratory tests, anthropometrics, observations, and diet history.

DIF: Cognitive Level: Knowledge REF: 334 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The anthropometric measure that gives an estimate of subcutaneous fat is a. weight. b. height. c. midupper arm circumference. d. skinfold thickness.

ANS: D Subcutaneous fat is best measured by skinfold thickness recorded with calipers.

DIF: Cognitive Level: Knowledge REF: 335-336 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. A plasma protein used to assess nutritional status is a. serum albumin. b. alkaline phosphatase. c. total iron binding capacity. d. blood urea nitrogen

ANS: A Serum albumin and prealbumin are plasma proteins used to assist in the evaluation of nutritional status.

DIF: Cognitive Level: Knowledge REF: 339 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. A laboratory test that indicates immune function is the a. serum albumin. b. serum transferrin. c. hematocrit. d. lymphocyte count.

ANS: D One measure of immune status can be measured is the lymphocyte count.

DIF: Cognitive Level: Knowledge REF: 339 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The laboratory test used to determine nitrogen balance is a. serum albumin. b. hemoglobin. c. urinary urea nitrogen. d. serum transferrin.

ANS: C Urinary urea nitrogen is a 24-hour urine test that measures the products of protein metabolism.

This can be compared to protein intake to estimate nitrogen balance.

DIF: Cognitive Level: Knowledge REF: 339 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. An alternative measure for height for a nonambulatory patient is a. total arm span. b. skin calipers. c. waist circumference. d. creatinine height index.

ANS: A Total arm span measurement can be used as an alternative to estimate height for those who cannot stand.

DIF: Cognitive Level: Knowledge REF: 338 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. A clinical sign of poor nutritional status is a. pale eye conjunctiva. b. firm muscle tone. c. good attention span. d. appropriate body weight.

ANS: A Pale eye conjunctiva may be a sign of iron deficiency.

DIF: Cognitive Level: Knowledge REF: 341 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. A dietary analysis that requires the patient to keep accurate records of what he or she eats and drinks is a a. diet history. b. food intake recall. c. food record. d. calorie count.

ANS: C A food record is a list of foods consumed over a certain number of days kept by the patient. A calorie count records foods and beverages eaten by the patient. Diet histories and food intake recalls require patients to think back and remember what they have eaten over the last few days.

DIF: Cognitive Level: Knowledge REF: 334-335 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. A method of determining a persons basic eating habits is a a. 24-hour food record. b. urinalysis. c. diet history. d. calorie count.

ANS: C The diet history provides knowledge of the patients basic eating habits.

DIF: Cognitive Level: Knowledge REF: 336 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. Nutrition care must be centered care. a. team b. family c. disease d. person ANS: D Nutrition care must be based on individual needs and must be person centered.

DIF: Cognitive Level: Knowledge REF: 331 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. An oral diet can be modified by a. energy value, temperature, or cooking method. b. nutrient content, temperature, or spice content. c. energy value, energy density, or texture. d. nutrient content, energy value, or texture.

ANS: D Oral diet modification can consist of changes in nutrient content, energy value, or texture.

DIF: Cognitive Level: Knowledge REF: 342 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. An example of an oral diet that has been modified is

a. low-residue diet. b. regular diet. c. high protein tube feeding. d. parenteral nutrition.

ANS: A Nutrition components of the oral diet can be modified in three ways: texture such as low-residue or liquid; energy value, increased or decreased; and nutrients such as fat, protein, carbohydrate, vitamins or minerals.

DIF: Cognitive Level: Knowledge REF: 342 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. Enteral feeding is administered through a. the gastrointestinal tract. b. the bowel. c. an intravenous drip. d. a syringe.

ANS: A Enteral feeding is a formula-based feeding delivered into various parts of the gastrointestinal tract.

DIF: Cognitive Level: Knowledge REF: 342 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. Many types of herbal remedies have the following property that can cause adverse interactions with other drugs: a. growth b. medicinal c. cancer d. mehcanical ANS: B Many types of herbs have medicinal properties that should be evaluated on an individual basis to determine appropriateness with patients current dietary habits and prescribed medications to avoid adverse reactions.

DIF: Cognitive Level: Knowledge REF: 344-345|349 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. The nurse must have a good understanding of nutrition principles because he or she a. decides whether the food tray is appropriate for the patient. b. knows the patients likes and dislikes. c. must feed some patients. d. interprets and supports the nutrition care plan.

ANS: D The nurse requires an adequate understanding of nutrition principles because he or she interprets and supports the plan of nutrition care for the patient. The nurse works more closely with the patient than any other practitioner.

DIF: Cognitive Level: Application REF: 333 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

Maintenance 18. The identification and labeling of an actual occurrence, risk of, or potential for developing a nutrition problem is referred to as the nutrition a. diagnosis. b. assessment. c. plan. d. intervention.

ANS: A The nutrition diagnosis involves the identification and labeling of an actual occurrence, risk of, or potential for developing a nutrition problem.

DIF: Cognitive Level: Knowledge REF: 341 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 19. A complete nutrition assessment should include gathering information about a. use of over-the-counter supplements. b. number of relatives living. c. all medications taken 5 years ago. d. clothing and shoe size.

ANS: A A complete nutrition assessment involves a complete diet history, including information about over-the-counter supplements (vitamins and herbs), along with food intake, fluids, and drugs.

DIF: Cognitive Level: Application REF: 334-335 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 20. One food that would be excluded from a liquid diet is a. apple juice. b. gelatin. c. cottage cheese. d. broth.

ANS: C Cottage cheese, a milk-based product, would be excluded from a clear liquid diet.

DIF: Cognitive Level: Application REF: 342 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. Hypogeusia may suggest a. a nutrient imbalance. b. a lack of physical exercise. c. excessive oral hygiene. d. a life-threatening emergency.

ANS: A Hypogeusia may suggest a nutrient imbalance.

DIF: Cognitive Level: Knowledge REF: 340 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

22. A statement such as evidence of iron-deficiency anemia is part of the a. nutrition diagnosis statement. b. clinical flow sheet. c. diet order. d. medical order.

ANS: A A term such as evidence of iron-deficiency anemia could be part of the nutrition diagnosis statement, which helps identify nutrition problems, including nutrient deficiencies.

DIF: Cognitive Level: Knowledge REF: 341 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 23. Hospitalized patients should be weighed a. naked. b. every day. c. at the same time each day. d. before they go to the bathroom.

ANS: C Hospitalized patients should be weighed at consistent times each day to obtain consistent measurements and observe trends.

DIF: Cognitive Level: Knowledge REF: 337 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 24. A tool that would be useful to assess changes in subcutaneous fat over a 12-month period would be a. a tape measure. b. a scale. c. calipers. d. a clamp.

ANS: C Skin calipers are a useful tool to measure skinfold thickness. Calipers measure the relative amount of subcutaneous fat at various body sites.

DIF: Cognitive Level: Application REF: 338-339 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. An example of a diet with modified texture is a diet. a. liquid b. low-energy c. high-protein d. vegetarian ANS: A A liquid diet is an example of a diet with a modified texture.

DIF: Cognitive Level: Knowledge REF: 342 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. Limited oral intake related to fatigue and nausea as evidenced by average daily intake of

calories less than 500 kcal and 8-lb weight loss during past 2 months is an example of what phase of the nutrition care process? a. diagnosis b. intervention c. assessment d. monitoring ANS: A The nutrition diagnosis phase of the care process involves the identification and labeling of an actual occurrence, risk of, or potential for developing a nutrition problem. In this case, limited oral intake is the problem, related to fatigue and nausea is the etiology, and as evidenced by average daily intake of calories less than 500 kcal and 8-lb weight loss during past 2 months are the signs.

DIF: Cognitive Level: Application REF: 341 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. The nutrition care process step of recommending additional glucose testing would be considered which part of the care process? a. assessment b. planning c. monitoring and evaluation d. nutrition diagnosis ANS: C Recommending a glucose test would be considered under the nutrition monitoring and evaluation phase to assist in measuring progress toward the patients goals.

DIF: Cognitive Level: Knowledge REF: 343 TOP: Nursing Process: Planning|Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. A food that contains furanocoumarin which can interact with certain medications is a. red apple slices. b. grapefruit juice. c. mashed potatoes. d. chicken noodle soup.

ANS: B Grapefruit juice contains furanocoumarin and can interact with certain medications.

DIF: Cognitive Level: Knowledge REF: 344 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. The process of identifying and labeling of an actual occurrence of, risk of, or potential for developing a nutrition problem that dietetics professionals are responsible for treating independently is referred to as a. a problem. b. nutrition diagnosis. c. etiology. d. an intervention.

ANS: B The nutrition diagnosis is the identification and labeling of an actual occurrence of, risk of, or

potential for developing a nutrition problem that dietetics professionals are responsible for treating independently.

Chapter 15. Interactions: Food and Nutrients Versus Medications and Supplements 18. A patient with diabetes is recovering at home after foot surgery. He takes antidepressant and antihypertensive medications, as well as an oral hypoglycemia agent. When the nurse visits at noon to change his dressing, his or her greatest concern would be a .

the open bottle of vodka on the table next to his recliner.

b .

the fact that he has not yet eaten lunch.

c .

his reliance mainly on canned and prepackaged food in the house.

d .

his complaints that his family does not come and help him.

ANS: A For a patient taking several medications, especially including one for depression, the open bottle of vodka may signify alcohol dependency and may cause serious interactions with his medications. It is not uncommon for patients to each lunch after noon. Convenience food is higher in sodium than fresh food, but it is less of a concern than potentially high alcohol intake.

His complaints about his lack of help may or not be a concern, depending on other help that is available to him.

Chapter 16. Weight Management MULTIPLE CHOICE 1. When energy intake exceeds energy expenditure, the result may be a. anorexia. b. malnutrition. c. obesity. d. hyperactivity.

ANS: C More energy intake as food than energy output as physical activity and basal metabolic needs results in obesity.

DIF: Cognitive Level: Application REF: 286 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. If the ideal weight for height for a person is 110 lbs and his/her current weight is 140 lbs then he/she can be classified as a. slightly overweight. b. underweight. c. obese. d. extreme obese.

ANS: C Obesity generally means body weight exceeds ideal body weight for height by 20%. In this case 140 lbs is 27% above ideal weight. (140 110/110%)

DIF: Cognitive Level: Application REF: 280 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The most important factor in determining fatness or leanness is a. weight. b. height. c. body composition. d. diet.

ANS: C Body composition, instead of absolute weight in pounds, provides a better evaluation of overall health relative to weight.

DIF: Cognitive Level: Knowledge REF: 281 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 4. An example of an extreme weight-loss measure is a. a sound food plan. b. aerobic exercise. c. behavior modification. d. fasting.

ANS: D Extreme practices to lose weight include fasting, fad diets, macronutrient restrictions, and clothing and body wraps.

DIF: Cognitive Level: Application REF: 289 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The most precise method for determining body composition is a. skinfold calipers. b. body weight. c. underwater weighing. d. fitness testing.

ANS: C Underwater, or hydrostatic, weighing is the most precise method for determining body composition.

DIF: Cognitive Level: Knowledge REF: 282 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 6. It is difficult to define ideal weight because a. body weight increases with age. b. men tend to weigh more than women. c. body weight is largely determined by genetics. d. a wide range of weights can be associated with good health.

ANS: D Defining ideal body weight is difficult because of the wide range of weights associated with good health.

DIF: Cognitive Level: Application REF: 284|286 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 7. The total body fat content that is associated with the lowest risk of chronic disease for women is a. 7.0% 15.8%. b. 14.5% 22.0%. c. 12.0% 25.8%. d. 32.2% 36.9%.

ANS: D For women, the ideal range of total body fat associated with the lowest risk of chronic disease is 32.2% 36.9%.

DIF: Cognitive Level: Knowledge REF: 283 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 8. A teenage girl who has a distorted body image and refuses to maintain a minimal acceptable body weight should be evaluated for a. anorexia nervosa. b. bulimia nervosa. c. fasting. d. compulsive dieting.

ANS: A The American Psychiatric Association has established criteria for the diagnosis of anorexia nervosa, including a disturbed view of body size or shape, refusal to maintain or gain the minimal body weight for age and height, intense fear of weight gain or becoming fat, and absence of at least three menstrual cycles for females.

DIF: Cognitive Level: Application REF: 305 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 9. Health problems related to obesity include a. hypertension and lung disease. b. hypertension and diabetes. c. diabetes and arthritis. d. arthritis and asthma.

ANS: B American adults who are overweight or obese increase their risk of conditions such as hypertension; type 2 diabetes; heart disease; sleep apnea; gastroesophageal reflux; degenerative joint disease; and prostate, breast, and colon cancers.

DIF: Cognitive Level: Application REF: 286 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 10. For men, the range of body fat percentage associated with the lowest risk of chronic disease is a. 7.0% 15.8%.

. 14.5% 22.0%. c. 21.0% 25.8%. d. 32.2% 36.9%.

ANS: C A body fat content within the range of 21% to 25.8% of total body weight is associated with the lowest risk of chronic disease for men between the ages of 20 and 79 years.

DIF: Cognitive Level: Knowledge REF: 283 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. The acceptable amount of total body weight provided by fat for a 120-lb woman is approximately lbs. a. 8.4 15.0 b. 18.6 22.1 c. 25.6 30.5 d. 38.6 44.2 ANS: D Total body fat content for women is between 32.2% to 36.9% of total body weight120 lbs x 32.2% = 38.64 lbs and 120 lbs x 36.9% = 44.28 lbs.

DIF: Cognitive Level: Application REF: 283 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. Mary is a 32-year-old woman who admits to repeated episodes of eating large quantities of food at one sitting, including two boxes of cookies, a family-size bag of chips, six candy bars, and even more at times. She then vomits to rid her body of the food. This would be an example of a. anorexia nervosa. b. bulimia nervosa. c. fasting. d. compulsive overeating.

ANS: B Bulimia nervosa is an eating disorder involving repeated episodes of binge eating followed by a compensatory mechanism to rid the body of excess calories.

DIF: Cognitive Level: Application REF: 305 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. A 2-lb increase in fat is the kilocalorie equivalent of kcal. a. 1000 b. 3000 c. 3500 d. 7000 ANS: D One pound of fat is the kilocalorie equivalent of 3500 kcal, so 2 lbs would be equivalent to 7000 kcal.

DIF: Cognitive Level: Application REF: 286 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. A major contributing factor to the increase in obesity in the United States is a. excessive alcohol intake. b. excessive sugar intake. c. lack of exercise. d. lack of concern about weight control.

ANS: C Lack of exercise is a major contributing factor to the increase in obesity in the United States.

DIF: Cognitive Level: Knowledge REF: 286 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 15. An effective method for weight reduction includes a. fasting. b. limiting food groups. c. the drug phenylpropylamine. d. behavior modification.

ANS: D Behavior modification is an effective method of weight reduction designed to help change patterns that contribute to excessive weight, such as excess food intake as well as lack of exercise.

DIF: Cognitive Level: Application REF: 294 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 16. Surgical techniques used for weight reduction are a. not very helpful and expensive. b. the only alternative for extreme obesity. c. associated with significant risks. d. not effective.

ANS: C Significant risks are associated with surgical techniques for weight reduction along with other problems and side effects. Inherent risk of surgery and post-surgery malnutrition are critical issues that should be thoroughly addressed with the patient.

DIF: Cognitive Level: Knowledge REF: 292 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 17. In all probability, the most significant factor in the development of obesity is a. genetics and family food patterns. b. psychological influences. c. social influences. d. physiologic influences.

ANS: A Genetics and family food patterns play a significant factor in the development of obesity. Family

food patterns can provide an environment that allows the genetic trait to present itself.

DIF: Cognitive Level: Knowledge REF: 286-287 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 18. If a child has obese parents, the likelihood of the child also being obese is a. no different from that of any other child. b. very great. c. very low. d. dependent on other environmental factors.

ANS: B Genetic factors have a major influence on obesity. However, a genetic influence is not the determining factor. The daily life, environment, and habits the person chooses influence the expression of this gene trait.

DIF: Cognitive Level: Application REF: 287 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 19. Expression of genetic factors a. determines an individuals body weight. b. influences an individuals chance of becoming overweight. c. cannot be overcome by diet and exercise habits. d. is solely responsible for similarities in body weight within families.

ANS: B The expression of genetic factors influences an individuals chance of becoming overweight.

However, a genetic influence is not the determining factor. The daily life, environment, and habits chosen influence the expression of this gene trait.

DIF: Cognitive Level: Knowledge REF: 287 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 20. The most important key to a successful weight-loss program is a. personal motivation. b. exercise. c. dietary restriction. d. a good nutrition counselor.

ANS: A For a successful weight-loss program, personal motivation is a key factor to obtain desired results.

DIF: Cognitive Level: Knowledge REF: 293 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 21. Food behaviors of value in a weight-reduction program include a. eating quickly. b. choosing small portions. c. eating while doing other activities. d. skipping meals.

ANS: B

Choosing small portions is a food behavior of great value in a weight-reduction program.

DIF: Cognitive Level: Application REF: 293-294 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance, Psychological Integrity 22. To lose 2 lbs over a 2-week period, caloric intake would need to be reduced by kcal/ day. a. 150 b. 300 c. 350 d. 500 ANS: D Rationale: Loss of 2 lbs is equivalent to 7000 kcals. Over 14 days, this would mean a decrease of 500 kcal/day.

DIF: Cognitive Level: Application REF: 296 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 23. Clinically severe or significant obesity is defined as a BMI of a. 40 or greater or a BMI of 35-39 with at least one obesity-related disorder. b. 35 or greater or a BMI of 35-39 with at least three obesity-related disorders. c. 35 or greater with at least two obesity-related disorders. d. 30 with hypertension and type 2 diabetes.

ANS: A Clinically severe or significant obesity is defined as a BMI of 40 or greater or a BMI of 35 to 39 with at least one obesity related disorder including hypertension, type 2 diabetes, stroke, heart disease, gallbladder disease, sleep apnea, osteoarthritis, and certain cancers.

DIF: Cognitive Level: Knowledge REF: 286 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 24. In young, very fit adult men, the percentage of body weight that is fat is between a. 3.0% and 5.5%. b. 5.0% and 12.0%. c. 7.0% and 15.8%. d. 20.4% and 35.5%.

ANS: C The percentage of body weight that is fat in healthy adult men aged 34 years or younger is between 7.5% and 15.8%. The percentage of fat in women is 20% to 35%.

DIF: Cognitive Level: Knowledge REF: 283 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 25. A hormone that seems to control eating behavior and fat storage is a. insulin. b. thyroxine. c. leptin. d. growth hormone.

ANS: C Leptin is a hormone that seems to control eating behavior and fat storage. The obesity gene encodes for a hormone-like protein believed to play a role in determining a persons set point for fat storage.

DIF: Cognitive Level: Knowledge REF: 287 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 26. Dangers associated with the use of very-low-calorie diets include a. dehydration. b. decreased metabolic rate. c. sleep disorders. d. hyperactivity.

ANS: B Very-low-calorie diets can possibly cause semistarvation, which causes acidosis, low blood pressure, electrolyte loss, tissue protein loss, and decreased basal metabolic rate.

DIF: Cognitive Level: Application REF: 288 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 27. Body wraps result in a loss of a. muscle tissue. b. cellulite. c. body fat. d. water.

ANS: D Body wraps result in the loss of body water. Special sauna suits or body wrapping claim to help weight loss in certain spots of the body or clear up so-called cellulite tissue (the term cellulite is not a scientific term). The resulting small weight loss is caused by temporary water loss.

DIF: Cognitive Level: Knowledge REF: 292 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. The rate of weight loss by overweight adults should not exceed lbs/week. a. 1 to 2 b. 2 to 4 c. 3 to 5 d. 4 to 6 ANS: A The safe rate of weight loss for overweight adults should not exceed 1 to 2 lbs/week.

DIF: Cognitive Level: Knowledge REF: 294 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 29. Problems associated with bulimia nervosa include a. dry skin. b. breathing difficulties. c. abnormal hair growth. d. erosion of dental enamel.

ANS: D Erosion of dental enamel is a result of stomach acid coating the teeth while vomiting. Additional oral problems include oral mucosal irritation, decreased salivary secretions, and dry mouth.

DIF: Cognitive Level: Knowledge REF: 305 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Psychological Integrity 30. A sound food plan for weight loss contains a. very little fat content. b. very little carbohydrate. c. higher protein than carbohydrate. d. a balance of macronutrients.

ANS: D A sound food plan for weight loss contains a balance of macronutrients along with realistic goals, adequacy of nutrition and kilocalories, and cultural appeal.

DIF: Cognitive Level: Knowledge REF: 296 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 31. The hormone that tends to have the opposite effect to leptin is a. ghrelin. b. secretin. c. insulin. d. peptidase.

ANS: A The counterpart to leptin is the enteric peptide ghrelin. Ghrelin is an appetite stimulant secreted from the stomach to activate the appetite-regulating network.

Chapter 17. Diet in Diabetes Mellitus and Hypoglycemia MULTIPLE CHOICE 1. The primary organ involved in the disease process of type 1 diabetes mellitus is the a. adrenal gland. b. pancreas. c. kidney. d. liver.

ANS: B The hormone insulin must be present for glucose to be used by the cells in the body. Insulin is produced by the cells of the pancreas. Thus the pancreas is the organ involved in the disease process of type 1 diabetes mellitus.

DIF: Cognitive Level: Knowledge REF: 400 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The main factors that influence development of type 2 diabetes mellitus are a. weight and heredity. b. liver disease. c. enzyme deficiencies. d. childhood illnesses.

ANS: A Weight and heredity seem to play a role in the development of type 2 diabetes mellitus.

DIF: Cognitive Level: Knowledge REF: 401-402 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Type 2 diabetes is most common in a. infants. b. children. c. adolescents. d. older adults.

ANS: D Type 2 diabetes is most common in adults 40 years or older, although it may be seen at younger ages.

DIF: Cognitive Level: Knowledge REF: 403 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. A food that represents one carbohydrate exchange would be a. 1 slice whole wheat bread b. 1 cup vanilla ice cream c. 5 ounces white tuna d. 1 tsp margarine ANS: A 1 slice whole wheat bread would be 1 carbohydrate exchange. Starches consisting of breads, cereals, and grains are part of the carbohydrate list.

DIF: Cognitive Level: Application REF: 417 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. In reviewing the plan of care for a patient with type 2 diabetes who is overweight and likes to eat sweets, an initial goal might be to a. start 10 units of regular insulin 30 minutes before each meal. b. replace snack of 5 filled chocolate cookies with 3 graham crackers. c. check blood sugar after eating cookies and initiate sliding scale insulin. d. remove all carbohydrate foods and encourage only high protein foods.

ANS: B Replacing chocolate cookies with graham crackers would be an initial step in improving weight loss and implementation of a healthy lifestyle of proper nutrition and exercise.

DIF: Cognitive Level: Application REF: 412-413|415 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. A 62-year-old patient with a history of blood sugars slightly above normal and recurrent skin infections may need to be further assessed for a. type 2 diabetes. b. gestational diabetes. c. chronic kidney disease. d. hepatitis.

ANS: A With a history of abnormal blood sugars and recurrent skin infections, assessment for type 2 diabetes should be completed.

DIF: Cognitive Level: Application REF: 404-405

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Uncontrolled diabetes is related to the abnormal metabolism of a. carbohydrates and proteins. b. proteins and fats. c. carbohydrates, proteins, and fats. d. carbohydrates only.

ANS: C Uncontrolled diabetes causes alterations in glucose metabolism as well as abnormal metabolism of proteins and fats.

DIF: Cognitive Level: Knowledge REF: 405 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. A blood sugar of 85 mg/dL would be considered a. below normal. b. borderline. c. normal. d. above normal.

ANS: C The normal range of blood glucose is 70 to 110 mg/dL. DIF: Cognitive Level: Application REF: 405 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The largest portion of islet cells in the pancreas are the cells that synthesize a. glucagon. b. insulin. c. somatostatin. d. growth hormone.

ANS: B The largest portion of islet cells are the cells that synthesize insulin, a hormone.

DIF: Cognitive Level: Knowledge REF: 400 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The hormone that is synthesized by the pancreatic islet cells is a. glycogen. b. ketone. c. somatostatin. d. insulin.

ANS: C Somatostatin is produced in the cells of the pancreatic islets.

DIF: Cognitive Level: Knowledge REF: 407 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The hormone considered to act in a manner opposite to insulin is a. glucagon. b. somatostatin. c. growth hormone.

d. adrenaline.

ANS: A Glucagon is a hormone that acts in a manner opposite to insulin to balance the overall blood glucose level. It can rapidly break down stored glycogen and, to a lesser extent, fat.

DIF: Cognitive Level: Knowledge REF: 407 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. Which of the following functions is not associated with the hormone insulin? a. moves glucose into the cell b. inhibits fat breakdown c. converts glucose into glycogen d. mobilizes liver glycogen to yield glucose ANS: D Insulin does not mobilize liver glycogen to yield glucose. Insulin circulates glucose into cells by way of specialized insulin receptors, helps change glucose to glycogen and store it in muscles and liver, stimulates the change of glucose to fat for storage as body fat, inhibits the breakdown of tissue fat and protein, promotes uptake of amino acids by skeletal muscle, and influences the burning of glucose for constant energy as needed.

DIF: Cognitive Level: Knowledge REF: 405|407 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The accumulation of glucose in the blood is called a. glycosuria. b. polydipsia. c. hyperglycemia. d. hypoglycemia.

ANS: C The accumulation of glucose in the blood is called hyperglycemia and the presence of low glucose in the blood is called hypoglycemia.

DIF: Cognitive Level: Knowledge REF: 402 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. Ketones are a by-product of the metabolism of a. carbohydrates. b. proteins. c. fats. d. alcohol.

ANS: C Ketones form as a by-product of fat metabolism when the supply of glucose is insufficient.

DIF: Cognitive Level: Knowledge REF: 407 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. An individual attends a community sponsored health screening event and a slightly elevated blood sugar is detected. An appropriate intervention would be to a. inform the individual that he/she has diabetes and should go to the emergency room immediately. b. recommend the individual begin a high protein, low carbohydrate diet and begin exercising. c. recommend the individual follow up with his/her health care practitioner for further evaluation.

d. tell the individual not to worry and there is no need for any additional follow-up.

ANS: C A recommendation to follow up with their health care practitioner would be most appropriate.

The community screening helps to identify those who may benefit from additional medical follow-up and screening for risk of diabetes in the community.

DIF: Cognitive Level: Application REF: 409 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 16. The three common long-term complications of diabetes affect the cells of the a. pancreas, liver, and spleen. b. kidney, eye, and nerve tissue. c. kidney, liver, and spleen. d. heart, liver, and brain.

ANS: B Long-term complications of diabetes affect the kidney (nephropathy), eye (retinopathy), and nerve tissue (neuropathy).

DIF: Cognitive Level: Knowledge REF: 408-409 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. For a patient receiving a 2000 kcal diet, the recommended range of calories that should come from carbohydrate is a. 500 750 kcal. b. 750 900 kcal. c. 900 1300 kcal. d. 1350 165 kcal.

ANS: C The amount of calories provided by carbohydrate on a 2000 kcal diet would range from 900 1300 kcal. 45% 65% of calories should come from carbohydrate. 2000 kcal x 45% = 900 kcal and 2000 kcal x 65% = 1300 kcal.

DIF: Cognitive Level: Application REF: 412 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. A good source of fiber rich food is a. steel cut oats. b. grilled chicken breast. c. cinnamon apple sauce. d. an English muffin.

ANS: A Steel cut oats is a good source of fiber.

DIF: Cognitive Level: Application REF: 412-413 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 19. For a patient with diabetes, a good nonnutritive choice to sweeten tea would be a. cane sugar. b. aspartame. c. honey.

d. fructose.

ANS: B Commonly used nonnutritive sweeteners include aspartame, which has no nutritional value.

Sorbitol, honey, and fructose are all nutritive sweeteners because they do provide energy.

DIF: Cognitive Level: Application REF: 412-413 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 20. The nonnutritive sweetener that is composed of two amino acids is a. saccharine. b. aspartame. c. cyclamate. d. acesulfame-K. ANS: B Aspartame is made from two amino acids: phenylalanine and aspartic acid.

DIF: Cognitive Level: Knowledge REF: 412 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. The amount of dietary energy intake from fat recommended for a person with diabetes receiving an 1800 kcal diet should range a. 100 150 kcal. b. 220 575 kcal. c. 250 630 kcal. d. 360 630 kcal.

ANS: D The percentage of energy from fat for a person with diabetes should be between 20% and 35%.

On an 1800 kcal diet: 1800 kcal x 20% = 360 kcal and 1800 kcal x 35% = 630 kcal.

DIF: Cognitive Level: Application REF: 412 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. A menu selection high in saturated fat is a. grilled turkey burgers with onion and peppers. b. baked ziti with sausage and cream sauce. c. baked salmon and herbed potatoes. d. baked macaroni and tomato sauce.

ANS: B Baked ziti with sausage and cream sauce would contain saturated fats from the sausage and the cream based sauce.

DIF: Cognitive Level: Application REF: 413-414 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. The form of insulin that has its peak action within 7 to 14 hours is a. rapid-acting form. b. intermediate-acting form. c. long-acting form. d. oral hypoglycemic agent.

ANS: B Intermediate-acting (NPH) insulin has a peak action ranging from 7 to 14 hours.

DIF: Cognitive Level: Knowledge REF: 420 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Women with a history of gestational diabetes mellitus are at risk for developing a. chronic kidney disease. b. type 2 diabetes. c. type 1 diabetes. d. morbid obesity.

ANS: B The risk for developing type 2 diabetes is significantly higher in women with a history of gestational diabetes.

DIF: Cognitive Level: Knowledge REF: 403-404 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. For individuals with type 2 diabetes, exercise a. decreases insulin efficiency. b. stimulates the release of insulin. c. decreases risk of cardiovascular disease. d. raises blood glucose levels.

ANS: C Exercise increases the number of insulin receptors on muscle cells. Long-term studies have shown that with type 2 diabetes, exercise helps control blood glucose and reduces the risk of cardiovascular disease, hyperlipidemia, hypertension, and obesity.

DIF: Cognitive Level: Knowledge REF: 414 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 26. Type 2 diabetes usually appears after the age of years. a. 30 b. 40 c. 50 d. 60 ANS: B Type 2 diabetes usually appears after the age of 40 years but is now also being diagnosed in children.

DIF: Cognitive Level: Knowledge REF: 402 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. Mr. Jones is 20 lb above his desirable weight and has type 2 diabetes. A recommendation to Mr. Jones would be to a. increase kilocalorie intake. b. include between-meal snacks. c. take extra food during exercise. d. decrease kilocalorie intake.

ANS: D Decreasing kilocalorie intake will help Mr. Jones lose weight and control his type 2 diabetes.

DIF: Cognitive Level: Application REF: 411 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

28. The number of kcals from protein for an adult with diabetes receiving a 2200 kcal diet should be between a. 100 330 kcal. b. 220 770 kcal. c. 250 800 kcal d. 350 1200 kcal.

ANS: B The protein content for an adult with diabetes is 10% to 35% of total energy intake. On a 2200 kcal diet: 2200 x 10% = 220 kcal and 2200 x 35% = 770 kcal.

DIF: Cognitive Level: Application REF: 412 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. A food that is not in the meat group of the Choose Your Foods: Exchange Lists for Diabetes is a. turkey. b. shrimp. c. egg. d. milk.

ANS: D Turkey, shrimp, and egg are all part of the meat and meat substitute group. Milk is in a separate group.

DIF: Cognitive Level: Knowledge REF: 417 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. If the diet prescription for type 1 diabetes allows 2200 kcal, and if the common distribution of kilocalories is followed, then the number of grams of carbohydrates in the diet plan should be g. a. 50 b. 100 c. 200 d. 275 ANS: D Approximately 50% of total kilocalories should be supplied from carbohydrates. In this case, 2200 kcal (50%) = 1100 kcal 4 g/kcal = 275 kcal.

Chapter 18. Diet in Cardiovascular Disease MULTIPLE CHOICE 1. The underlying pathologic process in coronary heart disease appears to be a. atrophy of the heart muscle. b. weakened coronary vessels. c. fibrous plaques in coronary vessels. d. inadequate nutrition to the heart muscle.

ANS: C The underlying pathologic process in coronary heart disease is atherosclerosis. This process is characterized by the formation of fatty fibrous plaques that may begin in childhood and develop into fatty streaks, largely composed of cholesterol, on the inside lining of major blood vessels.

DIF: Cognitive Level: Knowledge REF: 379 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The underlying pathologic process in coronary heart disease is known as a. angina. b. atherosclerosis. c. hypertension. d. myocardial infarction.

ANS: B The underlying pathologic process in coronary heart disease is known as atherosclerosis, characterized by the formation of fatty fibrous plaques that may begin in childhood and develop into fatty streaks, largely composed of cholesterol, on the inside lining of major blood vessels.

DIF: Cognitive Level: Knowledge REF: 379 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. An infarct in a major artery supplying the brain results in a. a myocardial infarction. b. a coma. c. a cerebrovascular accident. d. hypertension.

ANS: C An infarct in a major artery supplying the brain is called a cerebrovascular accident. Cells die when they are deprived of their normal blood supply, and the local area of dead tissue is called an infarct.

DIF: Cognitive Level: Knowledge REF: 379 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. A localized area of dying or dead tissue is called a(n) a. atheroma. b. infarct. c. thrombus. d. lesion.

ANS: B Cells die when deprived of their normal blood supply. The local area of dying or dead tissue is called an infarct.

DIF: Cognitive Level: Knowledge REF: 379 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. A risk factor for coronary heart disease that cannot be controlled is a. obesity. b. family history. c. lack of exercise. d. smoking.

ANS: B Risk factors associated with heart disease are sex, age, family history, elevated serum cholesterol, and dietary fat as well as compounding diseases such as diabetes, hypertension, and metabolic syndrome. Family history, age, and sex cannot be controlled.

DIF: Cognitive Level: Knowledge REF: 382-383 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential

6. Protection against coronary heart disease is associated with a high-density lipoprotein (HDL) value of at least mg/dL. a. 30 b. 40 c. 60 d. 80 ANS: C The optimal level for HDL is 60 mg/dL or greater.

DIF: Cognitive Level: Knowledge REF: 382-383 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 7. A food choice that may be limited in a meal plan controlling fat and cholesterol is a. pork sausage. b. baked beans. c. broiled fish. d. glazed carrots.

ANS: A Dietary cholesterol and saturated fat are found in large amounts in foods of animal origin such as meat, dairy, and butter.

DIF: Cognitive Level: Application REF: 384 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 8. The function of lipoproteins is to carry a. proteins to the liver for metabolism. b. proteins to the cells for metabolism. c. fat and cholesterol to the cells for energy and metabolism. d. cholesterol to adipose tissue for storage.

ANS: C Because fat is not soluble in water, it is carried in the bloodstream in small wrapped packages of protein called lipoproteins. The function of lipoproteins is to carry fat and cholesterol to the cells for energy and metabolism.

DIF: Cognitive Level: Knowledge REF: 381 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Of the following, an appropriate seasoning choice to use for a sodium-restricted diet would be a. celery salt. b. lemon juice. c. soy sauce. d. BBQ sauce.

ANS: B Lemon juice is very low in sodium. Celery salt, soy sauce, and BBQ sauce all contain sodium as a component.

DIF: Cognitive Level: Application REF: 389 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. Appropriate snacks for a patient with hypertension would include a. corn chips and salsa. b. pretzel rings and cheese dip. c. orange juice with whole wheat toast. d. french fries with apple slices.

ANS: C Orange juice with whole wheat toast contains the least sodium. Nutrition therapy for hypertension includes sodium control to control fluid accumulation. High potassium foods such as orange juice may also be helpful.

DIF: Cognitive Level: Application REF: 389-393 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. Dietary guidelines from the American Heart Association for foods to limit or consume in moderation include a. avoid all foods that contain cholesterol and animal fats. b. cut back on foods that contain partially hydrogenated vegetable oils. c. aim to eat less than 100 mg of cholesterol each day. d. do not consume foods with dairy fat.

ANS: B Foods to limit or consume in moderation include cutting back on those that contain partially hydrogenated vegetable oils to reduce trans fats in the diet, cutting back on foods that are high in dietary cholesterol, and aiming to eat less than 300 mg of cholesterol each day.

DIF: Cognitive Level: Knowledge REF: 384 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. Dietary modifications during the first 24 to 48 hours after myocardial infarction include a. increasing fiber intake. b. avoiding cholesterol. c. reducing energy intake. d. reducing fluid intake.

ANS: C All care after a myocardial infarction is aimed at ensuring cardiac rest so that the damaged heart can be restored to normal functioning. Energy restriction reduces metabolism and therefore reduces the workload for the heart.

DIF: Cognitive Level: Application REF: 387 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. Heart failure results in a. difficulty breathing. b. anemia. c. dehydration. d. myocardial infarction.

ANS: A In heart failure the progressively weakened heart muscle is unable to maintain an adequate

cardiac output to sustain normal blood circulation. The resulting fluid imbalances cause edema, which makes breathing difficult and places more stress on the laboring heart.

DIF: Cognitive Level: Knowledge REF: 388 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The Therapeutic Lifestyle Changes (TLC) diet recommends limiting daily cholesterol intake to no more than mg daily. a. 200 b. 300 c. 400 d. 600 ANS: A The TLC diet includes not exceeding a total of 200 mg dietary cholesterol daily.

DIF: Cognitive Level: Knowledge REF: 385 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 15. The greatest proportion of dietary fatty acids should be a. saturated. b. polyunsaturated. c. monounsaturated. d. fish oil.

ANS: C The greatest proportion of dietary fatty acids should be monounsaturated fat and should not exceed 20% of the total fat intake of 25% to 35% of total calories.

DIF: Cognitive Level: Knowledge REF: 385 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. A food that should be limited by patients with heart failure is a. shredded wheat cereal b. salted potato chips c. tofu d. angel food cake ANS: B Because of sodiums role in tissue fluid balance, high-sodium foods such as salted potato chips are restricted in the treatment of cardiac edema.

DIF: Cognitive Level: Application REF: 388-389 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. The cause of essential hypertension is a. coronary heart disease. b. stress. c. hormone imbalance. d. unknown.

ANS: D The cause of essential hypertension is unknown, although injury to the inner lining of the blood vessel wall appears to be an underlying link.

DIF: Cognitive Level: Knowledge REF: 389 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. A patients blood pressure reading is 150/92 mm Hg. This would be considered a. hypotension. b. stage 1 hypertension. c. normotension. d. stage 2 hypertension.

ANS: B A blood pressure reading greater than 140/90 mm Hg indicates the presence of stage 1 hypertension.

DIF: Cognitive Level: Application REF: 390 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. The diagnosis of stages 1 and 2 hypertension is based on the blood pressure. a. systolic b. diastolic c. systolic and diastolic d. resting ANS: C Current hypertension screening and treatment programs identify persons with hypertension according to the severity of the systolic and diastolic blood pressures.

DIF: Cognitive Level: Knowledge REF: 390-391 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. The main source of dietary sodium in food is a. processed foods. b. found naturally in foods. c. found in cooking compounds. d. found as a mineral in drinking water.

ANS: A The main source of dietary sodium comes from processed foods, fast food, and some types of restaurant foods.

DIF: Cognitive Level: Knowledge REF: 389 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. Nutrition therapy for those with heart failure restricts sodium to a. 1.0 gram per day. b. 1.5 grams per day. c. 2.0 grams per day. d. 2.5 grams per day ANS: C A 2 g/day sodium restriction is recommended for those with heart failure.

DIF: Cognitive Level: Knowledge REF: 389 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 22. An example of a food that is recommended with the DASH eating plan is a. lemonade. b. a fresh orange.

c. a bread roll. d. bottled water.

ANS: B A diet rich in fruits (such as oranges), vegetables, and low-fat dairy products with a reduced content of saturated and total fat is recommended with the DASH eating plan.

DIF: Cognitive Level: Application REF: 392-393 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 23. Hypertension is common in some ethnic groups, including a. Europeans. b. Asians. c. African Americans. d. Native Americans.

ANS: C There is a high incidence of hypertension in African Americans, with the highest incidence among older African American women.

DIF: Cognitive Level: Knowledge REF: 389 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. The best way to control coronary heart disease is a. by early diagnosis. b. to meet regularly with a dietitian. c. to eliminate fat from the diet. d. to develop a heart-healthy lifestyle during childhood.

ANS: D Developing a heart-healthy lifestyle during childhood may be the best way to control heart disease.

DIF: Cognitive Level: Application REF: 383-385 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 25. Examples of foods high in soluble dietary fiber are a. whole-wheat bread and crackers. b. pureed fruits and vegetables. c. potatoes and yams. d. oat bran and legumes.

ANS: D Foods high in soluble fiber include oat bran and legumes.

DIF: Cognitive Level: Application REF: 385 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 26. The Dietary Approaches to Stop Hypertension (DASH) diet encourages intake of a. foods high in monounsaturated fats. b. foods high in soluble fiber. c. fruits, vegetables, and low-fat dairy products. d. breads, cereals, rice, and pasta.

ANS: C The DASH diet recommends eating four to six servings of fruits, four to six servings of vegetables, and two to three servings of low-fat dairy foods per day.

DIF: Cognitive Level: Knowledge REF: 392-393 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential, Health Promotion and Maintenance 27. Appropriate food choices for a breakfast while following the DASH diet may include a. fried egg, biscuit and gravy. b. hash brown casserole and sausage. c. whole grain toast with a banana. d. chipped beef and a croissant with butter.

ANS: C Whole grain toast with a banana provides whole grains and fruit. The DASH diet recommends eating four to six servings of fruits, four to six servings of vegetables, and two to three servings of low-fat dairy foods per day in addition to lean meats and high-fiber grains.

DIF: Cognitive Level: Application REF: 392-393 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 28. An example of a low-sodium food is a. canned salmon. b. a peanut butter sandwich. c. a biscuit. d. shredded wheat cereal.

ANS: D Low-sodium foods include shredded wheat cereal. Processed foods such as canned, frozen, and baked products contain higher amounts of sodium.

DIF: Cognitive Level: Application REF: 389 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. An example of a food that is a good source of calcium is a. olive oil. b. skim milk. c. oatmeal. d. lemonade.

ANS: B Milk is a good source of calcium.

DIF: Cognitive Level: Application REF: 392 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 30. A food that can be used freely on a sodium-restricted diet is a. canned salmon. b. a peanut butter sandwich. c. a biscuit. d. a fresh apple.

ANS: D Fruits contain negligible amounts of sodium in their natural state. Processed foods, including canned, frozen, and other packaged items, contain various amounts of sodium.

Chapter 19. Diet in Renal Disease MULTIPLE CHOICE 1. The microscopic functional units of the kidney are called a. nephrons. b. glomeruli. c. tubules. d. loops of Henle.

ANS: A The nephron is the function unit of the kidney. It performs functions such as filtration, reabsorption, secretion, and excretion.

DIF: Cognitive Level: Knowledge REF: 425 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The structure responsible for filtering the blood is the a. loop of Henle. b. proximal tubule. c. distal tubule. d. glomerulus.

ANS: D The glomerulus filters the blood. Only the larger blood proteins and cells remain behind in the circulating blood as it leaves the glomerulus.

DIF: Cognitive Level: Knowledge REF: 425-426 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Disease conditions that can interfere with normal nephron function include a. obstruction and infection. b. chronic caffeine intake. c. chronic alcohol abuse. d. anemia.

ANS: A Obstruction and infection can interfere with normal nephron function.

DIF: Cognitive Level: Knowledge REF: 428 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. Glomerulonephritis or nephritic syndrome is one of the causes of a. stage 5 CKD or ESRD. b. stage 1 CKD. c. kidney stones. d. heart failure.

ANS: A Glomerulonephritis is one of the three most common causes of stage 5 CKD. DIF: Cognitive Level: Knowledge REF: 429 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Clinical symptoms associated with chronic kidney disease do not include a. anemia. b. diabetes mellitus. c. hypertension.

d. bone pain.

ANS: B Complications of chronic kidney disease do not include diabetes mellitus.

DIF: Cognitive Level: Knowledge REF: 428 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The presence of protein in the urine is called a. hematuria. b. oliguria. c. proteinuria. d. anuria.

ANS: C Proteinuria results from an abnormal excess of serum proteins in the urine.

DIF: Cognitive Level: Knowledge REF: 429-430 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Classic symptoms of acute glomerulonephritis include a. azotemia. b. proteinuria. c. ascites. d. anemia.

ANS: B Classic symptoms of acute glomerulonephritis include hematuria and proteinuria, although edema and hypertension also may occur.

DIF: Cognitive Level: Knowledge REF: 429-430 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. Azotemia refers to elevated blood levels of a. glucose. b. cholesterol. c. amines. d. urea.

ANS: D Elevated blood levels of urea nitrogen and other nitrogenous products are reflected in the characteristic laboratory finding of azotemia.

DIF: Cognitive Level: Knowledge REF: 433 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Nephrotic syndrome, or nephrosis, is a disease that a. is caused by chronic hypertension. b. allows large amounts of protein to escape into the tubule. c. causes the buildup of toxic wastes in the blood. d. results in the formation of kidney stones.

ANS: B Nephrotic syndrome, or nephrosis, results from nephron tissue damage to both the glomerulus and tubule. The primary damage is to the major filtering membrane of the glomerulus, which allows large amounts of protein to pass into the tubule.

DIF: Cognitive Level: Knowledge REF: 430 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The massive edema of nephrotic syndrome is caused by a. blockage in the nephron tubules. b. excessive fluid intake. c. large protein losses in the urine. d. a diet too high in sodium.

ANS: C In nephrotic syndrome, large amounts of protein pass into the tubule. The large protein loss leads to massive edema and ascites as well as proteinuria.

DIF: Cognitive Level: Application REF: 430 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. Medical nutrition therapy for nephrotic syndrome includes a. high protein intake. b. moderate protein intake. c. high potassium intake. d. fluid restriction.

ANS: B Medical nutrition therapy for nephrotic syndrome includes moderate protein intake, at 0.8 g/kg/ day to meet nutritional and growth needs and without excess.

DIF: Cognitive Level: Application REF: 430 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. The hormone that causes the kidneys to reabsorb water and decrease urine production is a. renin. b. vitamin D. c. erythropoietin. d. antidiuretic hormone.

ANS: D Antidiuretic hormone (ADH) works on the distal nephron tubule to conserve water by reabsorption.

DIF: Cognitive Level: Application REF: 427 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The sudden shutdown of kidney function as the result of traumatic injury is called a. nephrosis. b. glomerulonephritis. c. acute kidney failure. d. chronic kidney failure.

ANS: C Acute kidney failure results when renal function in healthy kidneys shuts down suddenly after some metabolic insult or traumatic injury, causing a life-threatening situation. This is a medical emergency.

DIF: Cognitive Level: Knowledge REF: 431 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. A major clinical symptom of acute kidney failure is a. hematuria.

b. proteinuria. c. oliguria. d. massive edema.

ANS: C A major symptom of acute kidney failure is oliguria, which is caused when the cellular debris from the tissue damage blocks the renal tubules.

DIF: Cognitive Level: Knowledge REF: 431 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. A progressive increase in serum urea levels occurs in a. acute renal failure. b. glomerulonephritis. c. chronic kidney failure. d. nephrotic syndrome.

ANS: C A progressive increase in serum urea levels occurs in chronic kidney failure. Increasing loss of nephron function results in elevated amounts of nitrogenous metabolites, such as urea.

DIF: Cognitive Level: Knowledge REF: 433 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. Ms. Jones comes to the emergency department with a severe drug reaction to penicillin. She may be at risk for a. diabetes or heart disease. b. high sodium intake. c. protein-energy malnutrition. d. acute kidney failure.

ANS: D Acute kidney failure can result from drug reactions in allergic or sensitive persons, such as a reaction to antibiotics (such as penicillin) or antimicrobial agents.

DIF: Cognitive Level: Application REF: 431 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Mr. Brady has chronic kidney disease. He is 55 years of age, weighs 165 lbs, and has a GFR of 22mL/min. His estimated energy needs per day are approximately a. 2200 kcal/d. b. 2350 kcal/d. c. 2625 kcal/d. d. 2850 kcal/d.

ANS: C Carbohydrate and fat must provide enough energy to spare protein, and for those individuals who are younger than 60 years of age with CKD and GFRs less than 25 mL/min, 35 kcal/kg/day are required to meet this need. In this case, 165 lbs = 75 kg. 75 kg x 35 kcal/kg/d = 2625 kcal.

DIF: Cognitive Level: Application REF: 434 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 18. The bone disease called osteodystrophy is associated with

a. glomerulonephritis. b. acute renal failure. c. chronic renal failure. d. nephrotic syndrome.

ANS: C The disturbed metabolism of calcium and phosphate from lack of vitamin D, a process that occurs in the kidneys, leads to bone pain from osteodystrophy in patients with chronic renal failure.

DIF: Cognitive Level: Knowledge REF: 432-433 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 19. The classic symptoms of chronic kidney failure result from a. a diet high in sodium. b. a diet chronically low in fluid intake. c. severe trauma to the body. d. progressive loss of nephrons.

ANS: D Chronic kidney failure, or chronic renal insufficiency, is caused by the progressive breakdown of renal tissues, which impairs all renal function. Few functioning nephrons remain, and they gradually deteriorate.

DIF: Cognitive Level: Application REF: 432 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. The bone disease osteodystrophy develops because of the kidneys inability to a. excrete calcium. b. activate vitamin D. c. absorb vitamin D. d. excrete urea.

ANS: B The disturbed metabolism of calcium and phosphate from lack of vitamin D activation, a process that occurs in the kidneys, leads to bone pain from osteodystrophy.

DIF: Cognitive Level: Knowledge REF: 433 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. Symptoms of chronic kidney failure include a. nitrogen retention. b. euphoria. c. jaundice. d. inability to sleep.

ANS: A Symptoms of chronic kidney disease include fluid imbalances, electrolyte imbalances, nitrogen retention, anemia, hypertension, and azotemia.

DIF: Cognitive Level: Knowledge REF: 433 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. Carbohydrates and fats are important in the diets of patients with kidney disease because they a. prevent fatigue.

b. spare protein for tissue synthesis. c. are low in sodium. d. are metabolized before they reach the kidney.

ANS: B Carbohydrate and fat must supply sufficient nonprotein kilocalories to supply energy and spare protein for tissue synthesis.

DIF: Cognitive Level: Knowledge REF: 434 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 23. The cleaning solution used in hemodialysis is called the a. filtrate. b. plasma. c. urine. d. dialysate.

ANS: D The cleaning solution used in hemodialysis is called the dialysate.

DIF: Cognitive Level: Knowledge REF: 434 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. The method of dialysis that allows patients to be mobile is a. hemodialysis. b. renal dialysis. c. peritoneal dialysis. d. continuous dialysis.

ANS: C Peritoneal dialysis is an alternative form of treatment for dialysis that allows patients to be mobile. In this process, the patient introduces the dialysate solution directly into the peritoneal cavity 4 or 5 times a day, where it can be exchanged for fluids that contain the metabolic waste products.

DIF: Cognitive Level: Knowledge REF: 437 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. The patient treated by peritoneal dialysis can increase intake. a. protein b. phosphorus c. caloric d. fat ANS: A The patient treated by peritoneal dialysis can increase protein intake to 1.2 to 3 g/kg body weight as a result of a more liberal diet.

DIF: Cognitive Level: Knowledge REF: 437 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. For patients with uric acid stones, health practitioners may recommend a diet low in a. calcium. b. vegetable protein. c. animal protein. d. fat.

ANS: C Excess excretion of uric acid may be caused by some impairment with the metabolism of purine, a nitrogen end product of dietary protein from which uric acid is formed.

DIF: Cognitive Level: Knowledge REF: 443 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. One of the first recommendations for any type of kidney stone is to a. increase the fiber in the diet. b. reduce calcium intake. c. increase fluid intake. d. decrease protein intake.

ANS: C A large fluid intake is a primary therapy that helps produce more dilute urine and prevent accumulation of materials that form stones.

DIF: Cognitive Level: Knowledge REF: 444 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. The most common type of kidney stone is composed of a. calcium. b. uric acid. c. cystine. d. magnesium.

ANS: A The most common type of kidney stone (approximately 80%) is composed of calcium oxalate or calcium phosphate.

DIF: Cognitive Level: Knowledge REF: 440 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. The type of diet recommended for a person with a calcium stone depends on a. body weight. b. the composition of the stone. c. fiber intake. d. fluid intake.

ANS: B Medical nutrition therapy for calcium stones depends on the composition of the stone. If a stone is composed of calcium phosphate, additional sources of phosphorus should be controlled. If a stone is calcium oxalate, foods high in oxalate should be avoided.

DIF: Cognitive Level: Knowledge REF: 444 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. Patients with chronic renal disease may need to restrict their intake of foods high in phosphorus, such as a. milk, nuts, and legumes. b. meat, chicken, and fish. c. bread, cereal, rice, and pasta. d. fruit and potatoes.

ANS: A Phosphorus-containing foods include milk, nuts, and legumes.

DIF: Cognitive Level: Application REF: 433-434|444 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. For patients treated with dialysis, a good source of protein could be a. sherbet. b. green beans. c. scrambled egg. d. apple crisp.

ANS: C Eggs are a high-biologic value protein for patients on dialysis.

Chapter 20. Diet in Digestive Diseases MULTIPLE CHOICE 1. The lower esophageal sphincter muscle controls entry of food into the a. esophagus. b. stomach. c. small intestine. d. rectum.

ANS: C The lower esophageal sphincter muscle controls entry of food into the small intestine.

DIF: Cognitive Level: Knowledge REF: 355-356 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The term used to describe difficulty in swallowing is a. pyrosis. b. polydipsia. c. dysphagia. d. dyspepsia.

ANS: C Dysphagia means difficulty swallowing.

DIF: Cognitive Level: Knowledge REF: 354-355 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Many people who have gastroesophageal reflux are a. underweight. b. obese. c. male. d. children.

ANS: B Gastrointestinal reflux is more common in people who are obese or pregnant or who have pernicious vomiting or nasogastric tubes.

DIF: Cognitive Level: Knowledge REF: 355-356 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. A resident who has Parkinsons disease and resides in a long-term care facility has recurring pneumonia and coughs while eating. This may be evidence of a. dysphasia. b. dysphagia. c. achalasia. d. dyspnea.

ANS: B

Dysphagia can cause persons to aspirate food particles, sometimes without evidence of coughing or choking. Aspiration of food contents into the lung causes pneumonia and other serious problems.

DIF: Cognitive Level: Application REF: 354-355 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Small outpouchings in the lower gastrointestinal tract are called a. hernias. b. lesions. c. diverticula. d. epiploic appendages.

ANS: C The small outpouchings that can develop in the lower intestine are called diverticula.

DIF: Cognitive Level: Knowledge REF: 366 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. An eroded mucosal area in the central portion of the gastrointestinal tract describes a a. hiatal hernia. b. diverticulum. c. peptic ulcer. d. Crohns lesion.

ANS: C A peptic ulcer is an eroded mucosal area in the central portion of the gastrointestinal tract.

DIF: Cognitive Level: Knowledge REF: 357-358 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Most ulcers occur in the a. esophagus. b. stomach. c. duodenal bulb. d. ileum.

ANS: C Most ulcers occur in the duodenal bulb.

DIF: Cognitive Level: Knowledge REF: 357 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. A food that should be omitted from the diet of a patient with peptic ulcer disease is a. black pepper. b. apple juice. c. milk. d. popcorn.

ANS: A Current diet therapy is based on individual response to foods, but a few foods have been shown to affect acid secretion, such as black pepper, hot chili peppers, and chili powder. Other food items that stimulate acid secretion are coffee, chocolate, and alcohol.

DIF: Cognitive Level: Knowledge REF: 360-361 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

Maintenance 9. Which of the following describes general nutrition guidelines for a patient with a peptic ulcer? a. General, well-balanced diet as tolerated b. High-protein, low-fiber diet with no seasonings c. High-protein diet and regularly scheduled meals d. Low-fiber diet with no seasonings and no milk or cream ANS: A A patient with a peptic ulcer should receive a general, well-balanced diet as tolerated. Current diet therapy is based on a liberal diet approach guided by individual responses to food.

DIF: Cognitive Level: Application REF: 359-361 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 10. A food that appears to reduce symptoms of irritable bowel syndrome is a. white bread with butter b. peanut butter pretzels c. sesame seed crackers d. whole grain wheat toast ANS: D Whole grain wheat toast is a high-fiber food that may help reduce symptoms of irritable bowel syndrome. Dietary fiber can help regulate bowel function.

DIF: Cognitive Level: Application REF: 366-367 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 11. To reduce the incidence of constipation, an appropriate dietary intervention would be to a. encourage daily use of over-the-counter laxatives. b. include 2 servings of ice cream twice a week between meals. c. include servings of natural laxatives such as dried apricots and prunes. d. decrease fluid intake since this may interfere with bowel regularity.

ANS: C Natural laxative type of fruits such as dried apricots and prunes can help reduce the incidence of constipation by helping increasing the fiber content of the diet.

DIF: Cognitive Level: Application REF: 367 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 12. A cause of diarrhea is a. drinking too much liquid with a meal. b. lactose intolerance. c. excessive intake of protein. d. swallowing air while eating.

ANS: B Lactose intolerance occurs in people who lack the digestive enzyme lactase and is a cause of diarrhea. Lactase deficiency causes malabsorption, which results in diarrhea.

DIF: Cognitive Level: Knowledge REF: 365 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. A patient with a history of diverticulosis who complains of severe left lower quadrant pain with diarrhea, nausea, and vomiting should be evaluated for a. diverticulitis. b. obstruction. c. diarrhea. d. celiac disease.

ANS: A Diverticulitis develops when the small pouches or pockets in the muscular mucosal lining of the small intestine (diverticula) become infected. The infected area is painful and can present with diarrhea, nausea, and vomiting.

DIF: Cognitive Level: Application REF: 366 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. Treatment for diverticulosis includes a diet that is a. bland. b. low in fiber. c. high in fiber. d. full liquid.

ANS: C The diet for diverticulosis should be high in fiber, void of foods that may cause gas or intolerance (such as lactose), and low in fat.

DIF: Cognitive Level: Knowledge REF: 366 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The characteristic symptoms of celiac disease are a. vomiting and diarrhea. b. diarrhea and steatorrhea. c. abdominal pain and constipation. d. chronic, bloody diarrhea.

ANS: B Celiac disease is characterized by diarrhea and steatorrhea. Hypersensitivity to the protein gluten in certain grains causes mucosal surface damage to the intestine. The villi are malformed, which reduces the absorbing surface by as much as 95%.

DIF: Cognitive Level: Knowledge REF: 368-369 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. Hepatitis is usually the result of a. a viral infection or alcohol or drug abuse. b. a bacterial or viral infection. c. excessive fat and protein intake. d. chronic malnutrition.

ANS: A Hepatitis is an inflammatory condition caused by viruses, alcohol, drugs, or toxins.

DIF: Cognitive Level: Knowledge REF: 371 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. Viral hepatitis can be contracted through

a. ingestion of contaminated food or water. b. airborne viruses from coughing and sneezing. c. physical contact with an infected person. d. alcohol abuse.

ANS: A Viral hepatitis can be contracted through contaminated food or water.

DIF: Cognitive Level: Knowledge REF: 371 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. The treatment of hepatitis includes a. rest and optimal nutrition. b. antibiotics and optimal nutrition. c. fluid restriction and rest. d. diuretics and optimal nutrition.

ANS: A Hepatitis is treated by rest and optimal nutrition with a high-carbohydrate, moderate-fat, highenergy, and high-protein diet.

DIF: Cognitive Level: Knowledge REF: 371-372 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. Nutrition therapy for hepatitis includes a diet that is in protein, in carbohydrate, and in fat. a. high, high, high b. low, high, low c. low, low, high d. high, high, moderate ANS: D Optimal nutrition should consist of a diet that is high in protein, high in carbohydrate, and moderate in fat. The amount of carbohydrate depends on individual needs and condition. A maximum of 30% of total calories should come from fat; as the disease progresses, more energy is supplied from this nutrient. Protein is essential for building new cells and tissues of the liver.

DIF: Cognitive Level: Application REF: 371 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. A major difficulty in treating hepatitis is that a. the person must stay in isolation for a long time. b. the person can have only a clear liquid diet. c. the person usually has a poor appetite. d. typically only one kind of antibiotic will cure it.

ANS: C Symptoms of hepatitis include anorexia, jaundice, and underlying malnutrition. The person usually has a poor appetite associated with these symptoms.

DIF: Cognitive Level: Application REF: 371 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. Pathologic changes in the liver caused by cirrhosis include a. fatty infiltration. b. spongy tissue formation. c. gallstone formation.

d. edema and swelling.

ANS: A Pathologic changes in the liver caused by cirrhosis include fatty infiltration caused by a state of liver disease where the liver is damaged beyond repair.

DIF: Cognitive Level: Knowledge REF: 372 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. The major nutrition problem related to development of ascites is a. protein deficiency. b. excessive fat intake. c. deficiency of digestive enzymes. d. excessive sodium intake.

ANS: A Low plasma protein levels contribute to ascites, or abdominal fluid accumulation.

DIF: Cognitive Level: Knowledge REF: 372 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Nutrition therapy for the patient with cirrhosis includes a diet that is a. low in sodium, high in protein, and low in carbohydrates. b. soft textured and high in energy. c. high in protein, high in carbohydrates, and high in fat. d. adequate in calories, low in sodium, and soft textured.

ANS: D Nutrition therapy for the patient with cirrhosis is one that provides a balanced diet with energy intake equal to basal plus 20% low-sodium, soft-textured diet. Sodium is often restricted to 500 to 1000 mg/day with cirrhosis to help reduce fluid retention (ascites). Soft texture is necessary in the presence of esophageal varices to help prevent the danger of vessel rupture and hemorrhage.

DIF: Cognitive Level: Comprehension REF: 372-373 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Of the following, a food item that may be restricted in the patient with cirrhosis is a. apple slices. b. orange sherbet. c. hotdog. d. peas.

ANS: C Hotdogs are high in sodium. Sodium often is restricted to 500 to 1000 mg/day in a patient with cirrhosis to help reduce fluid retention (ascites).

DIF: Cognitive Level: Application REF: 372-373 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. The primary objective of treatment of hepatic encephalopathy is to a. encourage the patient to eat. b. feed the patient parenterally to give the liver a rest. c. remove sources of excess ammonia. d. encourage the patient to exercise and maintain mental functions.

ANS: C The primary objective of treatment for hepatic encephalopathy is to remove the excess ammonia.

One of the main functions of the liver is to remove ammonia and therefore nitrogen from the blood by converting it to urea for urinary excretion. When cirrhosis continues and fibrous scar tissue replaces more and more functional liver tissue, the blood can no longer circulate normally through the liver. Therefore other vessels develop around the scar tissue, bypass the liver, and proceed to the brain, producing ammonia intoxication.

DIF: Cognitive Level: Knowledge REF: 372 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. Bile is produced by the a. gallbladder. b. pancreas. c. liver. d. intestine.

ANS: C Bile is produced by the liver. The basic function of the gallbladder is to concentrate and store bile, then release the concentrated bile into the small intestine when fat is present.

DIF: Cognitive Level: Knowledge REF: 370 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 27. The most important function of the gallbladder is to a. produce bile. b. synthesize cholesterol. c. release lipase enzymes. d. concentrate and store bile.

ANS: D The most important function of the gallbladder is to concentrate and store bile, then release the concentrated bile into the small intestine when fat is present.

DIF: Cognitive Level: Knowledge REF: 373 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. The presence of gallstones in the gallbladder is called a. cholecystitis. b. cholelithiasis. c. cholecystectomy. d. cholecystokinin.

ANS: B Cholelithiasis refers to the presence of gallstones in the gallbladder. When continued infection alters the solubility of the bile ingredients, cholesterol separates out and forms gallstones.

DIF: Cognitive Level: Knowledge REF: 373 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. A clinical symptom of gallbladder inflammation or gallstones is a. pain and distention after eating. b. jaundice. c. anorexia. d. weakness and apathy.

ANS: A A clinical symptom of gallbladder inflammation is pain and distention after eating. When infection, stones, or both are present, the normal contraction of the gallbladder, triggered by fat

entering the intestine, causes pain.

DIF: Cognitive Level: Knowledge REF: 373 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. Nutrition therapy for gallbladder disorders includes a. reducing cholesterol intake. b. eliminating gas-forming foods. c. lowering fat intake. d. increasing caloric intake.

ANS: C A low-fat intake may help avoid pain and discomfort because the presence of fat entering the small intestine stimulates the contraction of the gallbladder.

DIF: Cognitive Level: Application REF: 373-374 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. Of the following, a food choice that would help provide adequate protein for recovery from hepatitis is a. grilled chicken. b. apple turnover. c. fruit salad. d. English muffin.

ANS: A Grilled chicken provides a good source of dietary protein which is essential for tissue repair, which is an important part of recovery from hepatitis.

DIF: Cognitive Level: Application REF: 371 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 32. Ascites, a localized edema of the peritoneal cavity, is caused by a. low plasma protein levels. b. inadequate intake of carbohydrate. c. too much fat in the diet. d. excessive fluid intake.

ANS: A In patients with liver failure, low plasma protein levels may lead to ascites, or abdominal fluid accumulation.

DIF: Cognitive Level: Knowledge REF: 372 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 33. Crohns disease is a(n) a. disorder of protein metabolism. b. chronic enzyme deficiency. c. excess in the production of insulin. d. inflammatory bowel disease.

ANS: D Crohns disease and ulcerative colitis are inflammatory bowel diseases.

DIF: Cognitive Level: Knowledge REF: 364-365 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 34. An elemental diet provides

a. all necessary vitamins and minerals. b. all nutrients needed in a bland, low-residue form. c. all nutrients needed in their simplest absorbable form. d. a diet high in mineral elements.

ANS: C An elemental diet formula provides nutrients needed in their simplest absorbable form.

DIF: Cognitive Level: Knowledge REF: 365 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 35. Patients with cystic fibrosis need to take a. enzymes and supplements. b. large doses of vitamins and minerals. c. antidiarrheal agents. d. hormones and enzymes.

ANS: A Enzymes and supplements are necessary for treatment of cystic fibrosis. Pancreatic enzymes are ingested orally along with vitamin supplements, especially fat-soluble vitamins.

DIF: Cognitive Level: Knowledge REF: 362-363 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 36. A food that is considered a common food allergen is a. peanut butter. b. rice crackers. c. lemonade. d. chocolate.

ANS: A Milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, soy, and sesame are the most common food allergens.

DIF: Cognitive Level: Application REF: 368 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 37. A food that individuals with celiac disease might need to avoid is a. malted milk. b. buttermilk. c. rice. d. prune juice.

ANS: A Malted milk and all other products that contain dietary sources of gluten including wheat, barley and rye products, and any other products that may be processed in facilities that process wheat products can result in cross-contamination.

DIF: Cognitive Level: Application REF: 370 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 38. A food that individuals with celiac disease would need to eliminate is a. cream of wheat. b. homemade applesauce. c. vanilla yogurt. d. buttermilk.

ANS: A Individuals with celiac disease eliminate any food prepared with wheat, rye, oat, or barley products.

Chapter 21. Diet and Cancer MULTIPLE CHOICE 1. Ordinarily the cell operates in an orderly fashion under the influence of the a. genetic code. b. outside environment. c. endoplasmic reticulum. d. nutrients taken into the cell.

ANS: A Cell operation is guided by a cells genes and genetic code.

DIF: Cognitive Level: Knowledge REF: 472 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The point at which a mutagen causes irreversible damage to DNA is referred to as a. neoplasms. b. promotion. c. initiation. d. Progression.

ANS: C Initiation is the point at which a mutagen causes irreversible damage to the DNA. DIF: Cognitive Level: Knowledge REF: 472 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Factors associated with the development of cancer include a. processed foods. b. radiation exposure. c. food-borne disease. d. diabetes mellitus.

ANS: B Causes of cancer include mutations or changes in a cells genes; chemical carcinogens such as cigarette smoke; radiation from x-rays, radioactive materials, sunlight, or atomic wastes; viruses; epidemiologic factors; stress factors; and some dietary factors linking deficiencies of specific nutrients with and increased risk of DNA damage and cancer.

DIF: Cognitive Level: Knowledge REF: 473 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The capacity of the immune system is compromised by a. increased metabolism of water-soluble vitamins. b. increased metabolism caused by emotional stress. c. severe malnutrition with atrophy of organs and tissues. d. increased hormonal levels associated with stress.

ANS: C Severe malnutrition compromises the capacity of the immune system as a result of the atrophy of the organs and tissues that are involved in immunity.

DIF: Cognitive Level: Knowledge REF: 473 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The cellular component of the immune system that is derived from the thymus is the a. T cell. b. cell. c. phagocyte. d. lymphocyte.

ANS: A T cells are lymphocytes derived from the thymus cells, and cells are lymphocytes derived from the bursal intestinal cells.

DIF: Cognitive Level: Knowledge REF: 473 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The cells responsible for synthesis and secretion of antibodies are the a. immunoglobulins. b. T cells. c. cells. d. lymphocytes.

ANS: C The cells produce proteins known as antibodies, which also kill antigens.

DIF: Cognitive Level: Knowledge REF: 473 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nutrient primarily responsible for maintaining tissue integrity and immunocompetence is/ are a. carbohydrate. b. protein. c. vitamins. d. minerals.

ANS: B Antibodies, the core of the immune system, are proteins in structure. A direct and simple example of the important role of nutrition in immunity is the link between protein energy malnutrition and suppressed immune function.

DIF: Cognitive Level: Knowledge REF: 473 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. Cancer therapy that uses radioactive isotopes is a. surgery. b. radiation. c. chemotherapy. d. x-rays.

ANS: B Radiation therapy involves treatment with high-energy radiography targeted on the cancer site to kill or shrink cancerous cells.

DIF: Cognitive Level: Knowledge REF: 474 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Which of the following describes a disadvantage of abdominal radiation? a. The structure and function of the bowel may be adversely affected. b. The radiation can be dispersed to all the abdominal organs once it passes into the cavity.

c. It is hard to pinpoint the precise area to target the radiation. d. There are no disadvantages.

ANS: A Radiation to the bowel affects the intestinal mucosa, causing loss of villi and absorbing surface; therefore malabsorption problems may follow. Ulcers or inflammation and obstruction or fistulas also may develop from tissue breakdown.

DIF: Cognitive Level: Application REF: 474 TOP: Nursing Process: Intervention MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. Patients who receive chemotherapeutic drugs often develop a. tremors. b. anemia. c. hypertension. d. abnormal heart rhythms.

ANS: B Chemotherapeutic drugs affect bone marrow and interfere with the production of red blood cells, causing anemia.

DIF: Cognitive Level: Knowledge REF: 475 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. A major systemic effect of cancer is a. edema. b. hypoglycemia. c. dehydration. d. negative nitrogen balance.

ANS: D Negative nitrogen balance is a major systemic effect of cancer.

DIF: Cognitive Level: Knowledge REF: 476 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. Of the following, a side effect of protrease inhibitors is a. hyperglycemia. b. hypoglycemia. c. yachycardia. d. stroke.

ANS: A Hyperglycemia is a major side effect of protease inhibitors. Food intolerances result from chemotherapy, which causes nausea and vomiting, loss of normal taste sensations, lack of appetite, diarrhea, ulcers, malabsorption, and stomatitis.

DIF: Cognitive Level: Knowledge REF: 491 TOP: Nursing Process: Intervention MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. Patients who receive chemotherapy drugs often develop anemia because the drugs a. damage the bone marrow. b. prevent iron absorption. c. interfere with folate metabolism.

d. destroy hemoglobin.

ANS: A Chemotherapy affects the bone marrow. Reduced red blood cell production causes anemia.

DIF: Cognitive Level: Knowledge REF: 475 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The primary goal in nutrition care of patients with cancer is to a. prevent further growth of the tumor. b. reduce nutrients that the tumor feeds on. c. prevent malnutrition. d. promote weight gain.

ANS: C The primary goal of nutrition care in cancer is to prevent malnutrition. Negative nitrogen balance is a major systemic effect of cancer. Adequate calories are necessary to spare protein for tissue building.

DIF: Cognitive Level: Knowledge REF: 477 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. To counteract the hypermetabolic state of cancer, it is important to increase the intake of a. protein. b. kilocalories. c. vitamins. d. fats.

ANS: B It is important to increase the intake of kilocalories to supply adequate energy and spare protein to be used for tissue healing. The hypermetabolic nature of the disease and its healing requirements place great energy demands on a cancer patient.

DIF: Cognitive Level: Application REF: 478 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 16. For patients with cancer, a good source of dietary protein could be a. scrambled eggs. b. applesauce. c. orange sherbet. d. green grapes.

ANS: B Scrambled eggs are a good source of dietary protein, which is necessary for tissue synthesis for healing.

DIF: Cognitive Level: Application REF: 478 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 17. Given a functional gastrointestinal tract, the preferred method of feeding a patient with cancer is a. normal oral intake. b. a liquid formula diet.

c. tube feeding. d. total parenteral feeding.

ANS: A With a functional gastrointestinal tract, the preferred method of feeding is a normal oral diet supplied with adequate kilocalories and protein sources along with adequate fat, vitamins, and minerals.

DIF: Cognitive Level: Knowledge REF: 479 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. If salivary secretions are reduced or absent, it may be most helpful to a. serve a clear liquid diet. b. use a tube feeding. c. serve food in semiliquid form. d. serve water with the meal.

ANS: C Food served in a semiliquid form may be better accepted by patients with decreased salivary secretions.

DIF: Cognitive Level: Application REF: 482 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. Mr. T has been undergoing treatment for cancer and has not felt like eating all day and complains of much discomfort and pain. Of the following, which may be an initial intervention to assist in increasing his appetite? a. administering medication to increase appetite as soon as possible b. assessing for weight loss and speaking with the physician regarding tube feeding c. assessing pain and discomfort and providing pain relief measures d. changing the diet plan to all liquids to make it easier to ingest food items ANS: C Patients are more able to eat if pain is controlled and if they are positioned as comfortably as possible.

DIF: Cognitive Level: Application REF: 482 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. An appropriate intervention for a patient with neutropenia would be to a. serve only packaged food items. b. cook food items immediately after thawing. c. not serve any fresh fruits or vegetables. d. serve soy-based milk rather than cows milk.

ANS: B For those with neutropenia, foods should be cooked right after thawing to avoid possible microbial contamination.

DIF: Cognitive Level: Application REF: 482 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 21. The cells that activate the phagocytes are the a. T cells. b. B cells.

c. lymphocytes. d. antigens.

ANS: A T cells are derived from thymus cells and activate the phagocytes, special cells that destroy invaders, as well as act as killer cells that attack and kill disease-carrying antigens.

DIF: Cognitive Level: Knowledge REF: 473 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. Mucositis is an inflammation of the a. stomach mucosa. b. intestinal mucosa. c. oral mucosa. d. pancreas.

ANS: C Mucositis is an inflammation of the tissues around the mouth or other orifices of the body.

Chapter 22. Nutrition in Critical Care MULTIPLE CHOICE 1. Before any diet tray is delivered to a patient, the nurse has the responsibility of: a .

determining if the patient needs assistance to eat.

b .

confirming the diet on the tray with the diet sheet.

c .

assessing if the food is of the appropriate temperature.

d .

adding extra salt and sugar packets.

ANS: B The diet tray should be checked against the diet order to be sure that the patient receives the proper diet. No matter who actually delivers the tray, it is the nurse who confirms the accuracy of the diet.

2. The nutritional documentation that is most informative is: a .

ate all of lunch.

b .

ate 50% of lunch without difficulty. Refused all solid food.

c .

drank most of liquids without difficulty.

d .

assisted feeding liquid diet, choked frequently.

ANS: B Nutritional documentation should include percentage of intake and how it is tolerated.

3. When assisting a patient with a severe visual impairment who wishes to feed himself, the nurse could best facilitate the patients eating by: a .

placing the plate on his lap.

b .

seating the patient in a chair and placing the over-the-bed table appropriately.

c .

orienting the patient to the position of foods on the plate using a clock-face description.

d .

placing each food in a separate container or bowl.

ANS: C It is best to orient a visually impaired patient to the position of the foods on the plate by describing the plate as if it is a clock face (3 oclock, 6 oclock, and so on).

4. A patient who underwent surgery has an order to begin a clear-liquid diet and can be offered: a .

tea with milk.

b .

Jell-O.

c .

cream soup.

d .

fruit sherbet.

ANS: B A clear-liquid diet consists of foods that are liquid at room temperature and are clear, have a low residue, and are easily digested. Gelatins are part of a clear liquid diet.

5. A nurse caring for a patient with bulimia should add to the care plan to assess for: a .

hiding food in napkins or under plate.

b .

inducing self to vomit.

c .

refusal to eat.

d .

flushing food down commode.

ANS: B With bulimia, along with binge eating, there is purging, fasting, and the use of laxatives. These patients may eat everything on their tray then purge by inducing themselves to vomit.

6. An obese clinic patient who is in the latter part of the first trimester of a pregnancy asks how much weight she should gain. The nurses best response is to say that the total weight gain should be no more than pounds. a .

35

b .

30

c .

20

d .

10

ANS: C Total weight gain for an obese patient should be no more than 20 pounds.

7. The nurse takes into consideration that a patient who abuses alcohol is at risk for a vitamin deficiency in: a .

thiamine.

b .

cyanocobalamin.

c .

ascorbic acid.

d .

iron.

ANS: A Thiamine deficiency is often present in patients who abuse alcohol.

8. A patient who is on a low-cholesterol diet verbalizes that he enjoys eating meats and doesnt intend to stop. The nurses most helpful response would be, You can enjoy your meat if you will concentrate on such meats as: a .

broiled sirloin steak.

b .

fried catfish.

c .

baked turkey breast.

d .

sausage patties.

ANS: C Red meat, eggs, and high-fat dairy products contain large amounts of saturated fat; poultry (such as turkey breast) and fish are low-fat items and therefore are desirable when trying to reduce serum cholesterol. Fried foods also contain extra cholesterol.

9. An older male patient is concerned about his cholesterol lab report that shows an elevated high-density lipoprotein (HDL) level. The nurse explains that such a report indicates that: a .

he should go on a strenuous low-cholesterol diet.

b .

he is at risk for hypertension.

c .

is developing atherosclerosis.

d .

his vessels are being cleansed of fatty deposits.

ANS: D

High-density lipoprotein (HDL) is the good cholesterol that tends to cleanse the vessels of fatty deposits.

10. An outpatient clinic nurse assesses a blood glucose level of 75 mg/dL in a patient who has been on a low-carbohydrate diet for the last 10 days. The nurse should: a .

notify the physician about the ineffectiveness of the diet.

b .

document the finding.

c .

suggest a moderate increase carbohydrate intake.

d .

arrange a dietician consultation to discuss a more effective diet.

ANS: B Document the finding. Normal blood sugar is between 70 and 120 mg/dL. MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 11. Because of the patients dysphagia, the nurse recommends to the physician that the patient be placed on a Level II texture level diet, which means that the food is: a .

thickened to prevent aspiration.

b .

pureed to a pudding consistency.

c .

mechanically altered, moist, minced helpings.

d .

minced into bite-size pieces.

ANS: C Level II texture is a diet in which the food has been mechanically altered to moist, -inch pieces.

12. A nurse positions a patient for the insertion of a nasogastric (NG) tube by: a .

turning the patient to a right side-lying position.

b .

sitting the patient upright and hyperextending the patients head.

c .

lowering the head of the bed to a flat position.

d .

raising the head of the bed to 30 degrees.

ANS: B The head of the bed should be raised and the patient asked to hyperextend his head to facilitate the passage of the NG tube.

13. The nurse who is preparing to give a feeding per a nasogastric (NG) tube tests the placement of the tube most safely by: a .

checking the lungs for rhonchi.

b .

instilling 10 mL of normal saline and checking for cough.

c .

aspirating stomach contents.

d .

injecting 20 mL of air and listen at the tip of the xiphoid.

ANS: C The safest and most assured method to test for NG tube placement is to aspirate stomach contents and check fluid for pH. Using the air method is not as accurate as the stomach aspiration.

14. Stopping the infusion and checking for residual, the nurse aspirates 155 mL of gastric contents. The nurse should next: a .

replace the aspirate and continue with the feeding.

b .

throw the aspirate away and flush the tubing.

c .

replace the aspirate and stop feeding for 1 to 2 hours.

d .

throw the aspirate away and stop feeding for 2 hours.

ANS: C If the residual volume is greater than 150 mL, the fluid should be replaced, and further feeding

should be delayed by 1 to 2 hours, or agency policy should be followed.

15. A patient is scheduled to receive an intermittent tube feeding. This feeding should be allowed to flow in over how many minutes? a .

1

b .

2

c .

5

d .

10

ANS: D An intermittent feeding should take approximately 10 minutes to flow into the tube.

16. When the patient has just finished receiving a tube feeding, the nurse leaves the head of the patients bed elevated for 30 to 60 minutes after feeding in order to: a .

facilitate stomach emptying and prevent aspiration.

b .

maintain skin integrity to the buttocks.

c .

facilitate lung drainage and promote ventilation.

d .

prevent feeding tube from clogging.

ANS: A The head of the bed should be left elevated at a 30- to 90- degree angle for 30 to 60 minutes after the feeding to help reduce the risk of aspiration.

17. The nurse caring for the patient receiving total parenteral nutrition (TPN) should monitor the flow rate every hours. a .

2

b .

3

c .

4

d .

6

ANS: C Both the IV site and the flow rate should be monitored every 4 hours and the site assessed for infection.

18. The nurse explains that adequate vitamin D can be acquired by: a .

eating 2 oranges a day every week.

b .

eating fish 3 times a week.

c .

having 10 minutes of sunshine on the limbs.

d .

eating green leafy vegetables.

ANS: C Exposing the limbs to 10 minutes of sunshine daily can provide adequate vitamin D. 19. The nurse is caring for a patient who has total parenteral nutrition (TPN) running finds that the infusion is behind by 200 mL. The nurse should: a .

increase the flow rate 5% until the infusion has caught up.

b .

check the patients stomach residual.

c .

elevate the head of the bed 30 degrees.

d .

document the discrepancy and report to the charge nurse.

ANS: D The rate of a TPN is never increased because of the danger of causing hyperglycemia or circulatory overload. The discrepancy is to be documented and reported to the charge nurse or physician.

20. A patient recently started on enteral tube feedings starts complaining of nausea and having diarrhea. The best nursing action is to: a .

check the enteral tube for placement.

b .

slow down the feedings and monitor.

c .

perform a fingerstick blood glucose test.

d .

stop the feedings and inform the physician.

ANS: D Nausea, constipation, and diarrhea are concerns following institution of tube feedings.

21. A patient has a new order to have an NG tube removed. The nurse should initially: a .

wash her hands and apply clean gloves.

b .

encourage mouth care as needed.

c .

explain the procedure to the patient.

d .

pinch the tube while removing it.

ANS: C Explaining the procedure to the patient before starting helps in gaining the patients confidence.

22. A nurse is instructing a family member who will be caring for a patient receiving enteral feedings after discharge to home. The nurse would emphasize: a .

taping the gastrostomy tube so that it does not hang lower than the stomach.

b .

discarding unused opened refrigerated formula after 3 to 4 days.

c .

administering tube feedings while they are still cold from the refrigerator.

d .

mixing all medications together for administration at the same time.

ANS: A The tube should be taped so that it is higher than the entry point into the body.

23. The nurse inserting an NG tube through the nostril into the back of the throat of a patient would instruct the patient to: a .

hyperextend the head.

b .

cough forcefully.

c .

drop head forward and begin to swallow.

d .

open mouth and extend tongue.

ANS: C The patient should be instructed to tip the head forward and begin to swallow to help advance the tube through the esophagus.

24. The nurse caring for a patient receiving enteral feedings would assess for tolerance of the feeding by monitoring: a .

for gastric tube patency.

b .

for duodenal tube patency.

c .

for abdominal distention.

d .

the rate of the feeding.

ANS: C Assessing the abdomen for distention helps the nurse identify intolerance of tube feedings.

25. While the nurse is explaining the procedure for inserting a tube for enteral feedings, the patient interrupts and asks why there is a need for this tube. The nurses best response is:

a .

Your physician has ordered this to help your condition.

b .

Tell me what your doctor told you about this procedure.

c .

Are you telling me you dont want this tube inserted?

d .

This tube placement will only be temporary.

ANS: B In assessing the patients understanding, the nurse should assess the level of the patients understanding and knowledge about the procedure.

26. When caring for a patient receiving total parenteral nutrition, the nurse knows that it is essential to: a .

check for flow rate every shift.

b .

order electrolytes daily.

c .

monitor IV site every shift.

d .

monitor for blood glucose.

ANS: D Total parenteral nutrition contains a high concentration of glucose, and monitoring blood glucose every 6 to 8 hours will determine patient tolerance.

COMPLETION 27. The correct anatomic landmarks to follow when inserting a nasogastric tube is to measure from the to the and then to the .

ANS: tip of the nose; tip of the ear; xiphoid process Using landmarks individualizes the tube length.

28. The nurse recommends to a patient who desires weight reduction to engage in a minimum of minutes of exercise most days of the week.

ANS: 30 minutes Thirty minutes Physical exercise of moderate intensity for 30 to 60 minutes most days of the week is an effective support to weight reduction

29. The nurse takes into consideration that excessive intake of saturated and trans-fat leads to the development of fatty deposits being laid down in the walls of the blood vessels and causing .

ANS: atherosclerosis Excessive intake of saturated and trans-fat leads to the development of fatty deposits being laid down in the walls of the blood vessels called atherosclerosis.

30. A nurse instructs a patient who is to receive a soft diet that the diet will include: (Select all that apply.) a .

eggs.

b .

multigrain bread.

c .

baked potato.

d .

soups.

e .

fruit juices.

f .

milk products.

ANS: A, D, E, F Soft diets are low in fiber, and foods have a soft consistency. Foods allowed on a soft diet include eggs, breads without seeds, boiled or mashed potatoes, soups, fruit, juices, tender cooked vegetables, ground meats or meats cooked until soft, cooked cereals, and milk products.

Chapter 23. Diet in HIV and AIDS 1. Symptoms that may occur during the asymptomatic HIV infection stage include a. persistent fatigue, night sweats, thrush, and diarrhea. b. a short bout of flulike syndrome. c. pneumonia, lymphoma, Kaposis sarcoma, and tuberculosis.

d. hyperglycemia, heart arrhythmias, and loss of appetite.

ANS: B Approximately 2 to 4 weeks after initial exposure and infection, a mild flulike episode lasting about 1 week may occur. This brief, mild response reflects the initial development of antibodies to the viral infection.

DIF: Cognitive Level: Application REF: 487 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. Category 2 CD4 T-Lymphocyte values are defined as a. less than 200 cells/L. b. more than 200 cells/L. c. 200 to 499 cells/L. d. 800 to 1000 cells/L. ANS: B Category 2 CD4 T-Lymphocyte values are defined as 200 to 499 cells/L. DIF: Cognitive Level: Knowledge REF: 487 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Protease inhibitors work by a. inhibiting the enzyme protease. b. preventing reverse transcriptase. c. binding to HIV. d. enhancing the enzyme lipase.

ANS: A Protease inhibitors work by inhibiting the basic enzyme protease, which is essential to HIVs development.

DIF: Cognitive Level: Application REF: 490 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. Nutrition support is a vital care component throughout the progression of HIV infection because of its role in a. controlling involuntary weight loss and tissue wasting. b. maintaining cardiac function. c. preventing the spread of the HIV virus. d. preventing anemia and constipation.

ANS: A The role of nutrition support is a vital component of care for the patient with HIV infection to control involuntary weight loss and tissue wasting.

DIF: Cognitive Level: Application REF: 493 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion 5. A fundamental effect of HIV infection is a. nausea. b. vomiting. c. major weight loss. d. cirrhosis.

ANS: C Patients with HIV typically have a decreased appetite and insufficient energy intake coupled

with elevated resting energy expenditure. Major weight loss follows and eventually leads to extreme cachexia, similar to that seen in cancer patients.

DIF: Cognitive Level: Knowledge REF: 493 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. An HIV-positive patient should be referred to the clinical dietitian on the AIDS team a. at the first contact with a health professional. b. at stage 2 (AIDS-related complex). c. at stage 3 (final stage of AIDS). d. when the patient has nutrition-related problems.

ANS: A An HIV-positive patient should be referred to the clinical dietitian at the first contact with a health professional. The initial evaluation is critical in providing guidelines for ongoing care.

DIF: Cognitive Level: Application REF: 493 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nutrition care plan for AIDS patients is a. the same as for all patients. b. consistent throughout the course of the disease. c. based only on clinical observations and anthropometry. d. individualized and continually adjusted throughout the course of the disease.

ANS: D The nutrition care plan for patient with AIDS, as any other medical nutrition therapy, is individualized and adjusted throughout the course of the disease.

DIF: Cognitive Level: Application REF: 493|495 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. Guidelines for counseling a person with HIV infection include a. recommending intake of specific combinations of food. b. expecting significant changes in lifestyle behaviors. c. promoting optimal nutrition while making the fewest food changes. d. acting as a catalyst for selecting appropriate lifestyle changes.

ANS: C Guidelines for counseling a person with HIV infection include promoting optimal nutrition while making the fewest food changes. Changing behavior in any area requires the motivation, desire, and ability to achieve ones goals, and AIDS is no exception. All information or actions should proceed in manageable steps, as small as necessary.

Chapter 24. Nutritional Care of the Terminally Ill MULTIPLE CHOICE 1. The nurse is instructing a client on the types of carbohydrates to include in the diet. The nurse should include that the main groups of carbohydrates are: 1.

glucose and fructose.

2.

monosaccharides and disaccharides.

3.

fats and proteins.

4. sucrose and cellulose.

ANS: 2 Carbohydrates should make up 45% to 65% of our calories. Carbohydrates are consumed in the form of monosaccharides and polysaccharides. This is what the nurse should include in the instructions to the client. Glucose, fructose, and sucrose are monosaccharides. Fats and proteins are not carbohydrates. Cellulose is a nondigestible form of a carbohydrate.

PTS:1DIF:ApplyREF:Carbohydrates 2. The nurse is instructing a client on the purpose of eating indigestible carbohydrates such as fiber. These undigestible carbohydrates are used to: 1.

make fat.

2.

thin the blood.

3.

provide bulk to the stool.

4.

help with digestion of meals.

ANS: 3 These indigestible compounds provide bulk to the stool and assist in the process of elimination.

Indigestible carbohydrates do not make fat, thin the blood, or help with the digestion of meals.

PTS:1DIF:ApplyREF:Carbohydrates 3.A client is diagnosed with a disorder that affects his ability to digest fat. The nurse realizes that the digestion of fat or lipids requires an enzyme called gastric lipase and: 1.

bile and insulin.

2.

bile and pancreatic lipase.

3.

pancreatic lipase and cholesterol.

4.

bile and amino acids.

ANS: 2 Most fat digestion takes place in the small intestines through the actions of pancreatic lipase and bile. Insulin does not digest fat. Cholesterol is a type of lipid. Amino acids are elements of protein.

PTS: 1 DIF: Analyze REF: Lipids (Fats) 4.A client is diagnosed with a protein deficiency. The nurse realizes this client may have a disorder that is affecting which of the following?

1.

Pancreas

2.

Gallbladder

3.

Small intestines

4.

Colon

ANS: 3 Protein digestion begins in the stomach. Further digestion of this nutrient takes place in the small intestine. The pancreas, gallbladder, and colon do not digest protein.

PTS: 1 DIF: Analyze REF: Proteins 5. The nurse, instructing a client on the best way to maintain a healthy diet and proper nutrition, would encourage the client to: 1 .

eat foods in appropriate portion size and from all the food groups.

2 .

eat twice as much meats as grains.

3 .

eat mostly fruits.

4 .

skip milk products.

ANS: 1 According to the American Dietetic Association, all foods can fit in a healthy diet if the portion sizes are appropriate, foods are consumed in moderation, and regular physical activity is included. Eating twice as much meat as grains does not contribute to a healthy diet. Eating mostly fruits and skipping milk products does not contribute to a healthy diet.

PTS: 1 DIF: Apply REF: Components of a Nutritionally Adequate Diet 6. The nurse is discussing an elderly clients diet and nutritional status with the hospital dietitian because this client is at risk for: 1.

obesity.

2.

malnutrition.

3.

sodium imbalance.

4.

a blood disorder.

ANS: 2 Causes of malnutrition during a hospital stay include disease state or inadequate food intake because of pain, nausea, and the different types of foods available in the hospital. An elderly client in the hospital is not at risk for obesity. A sodium imbalance can occur both prior to or during a hospital stay. The nurse would not be discussing a clients nutritional status with a dietitian because a client is a risk for a blood disorder.

PTS: 1 DIF: Apply REF: Malnutrition: Etiology 7. The nurse, instructing a group of community members regarding diet and exercise, should instruct healthy adults and children to exercise for: 1.

120 minutes a week.

2.

240 minutes a week.

3.

80 minutes a week.

4.

150 minutes a week.

ANS: 4 Exercise and nutrition go hand-in-hand to prevent chronic disease. Most Americans can enhance their health by moderate aerobic exercise for at least 150 minutes each week. The other choices are either too little exercise or too much exercise to enhance health.

PTS: 1 DIF: Apply REF: Components of a Nutritionally Adequate Diet 8. While instructing a client on the bodys nutritional needs, the nurse would include that the majority of calories consumed daily should be supplied from: 1.

vitamins.

2.

fats.

3.

carbohydrates.

4.

proteins.

ANS: 3 To meet the bodys nutritional needs, 45% to 65% of calories should come from carbohydrates.

Fat intake should be limited to 20% to 35% of daily calories. Protein intake should be limited to 10% to 35% of total calories. There is no percentage of caloric intake each day for vitamins.

PTS: 1 DIF: Apply REF: Components of a Nutritionally Adequate Diet 9.A client is instructed to avoid specific foods while prescribed a specific medication because of the potential for cytochrome P450 3A to be blocked, which will affect metabolism. Which of the following foods should the client be instructed to avoid?

1.

Apple juice

2.

Prune juice

3.

Grape juice

4.

Grapefruit juice

ANS: 4 Grapefruit juice can block P-glycoprotein, and it inactivates cytochrome P450 3A for up to 24 hours. Other foods that can also block these enzymes include red wine, cyclosporine, St. Johns wort, and herbal teas. Apple, prune, and grape juice do not block these enzymes.

PTS:1DIF:ApplyREF:Cytochrome P450 10.A client who has completely eliminated fats from the diet should be assessed for a deficiency of: 1.

bile.

2.

minerals.

3.

salt.

4. vitamins A, D, E, and K. ANS: 4 Fat is used to transport digested substances and fat-soluble vitamins. The client who has eliminated fats from the diet should be assessed for a deficiency of the fat-soluble vitamins, or vitamins A, D, E, and K. PTS: 1 DIF: Analyze REF: Metabolism 11. The nurse should instruct a client who is prescribed warfarin to limit or avoid foods that are: 1.

high in proteins.

2.

high in sugars.

3.

high in vitamin K.

4.

low in proteins.

ANS: 3 Significant changes in the intake of foods high in vitamin K can interfere with the anticoagulation properties of warfarin. These foods include bananas; celery; broccoli; green, leafy vegetables; spinach; and liver. The client who is prescribed warfarin does not need to avoid foods that are high in protein or sugar. The client does not need to avoid foods that are low in protein.

PTS: 1 DIF: Apply REF: Warfarin 12. While obtaining the health history, it is important for the nurse to ask the client about the use of herbal products, over-the-counter remedies, and dietary supplements because: 1 .

they should be stopped during admission to the hospital.

2 .

they should be increased during a time of illness.

3 .

these are not important items to talk about and should not be asked about.

4 .

these products may have potential interactions with medications that are being prescribed.

ANS: 4 Herbal products, over-the-counter remedies, and dietary supplements may have potential interactions with medications that are being prescribed, and a history of use of these products is necessary to avoid possible drug interactions.

PTS:1DIF:ApplyREF:Natural Products 13.A client is diagnosed as being obese. The nurse realizes that this clients body mass index (BMI) is most likely: 1.

between 15 and 19.

2.

between 20 and 24.

3.

between 25 and 29.

4. greater than 30.

ANS: 4 A BMI of 25 to 29 is considered overweight. A BMI greater than 30 is considered obese. A BMI less than 18.5 is considered underweight. A BMI between 18.5 and 24.9 is considered normal weight.

PTS: 1 DIF: Analyze REF: Box 48-3 BMI Categories 14.A client with a BMI of 30 has set a goal to lose 10% of her current body weight within 6 months. The nurse realizes that the safest level of weight loss for this client would be: 1.

1 to 2 pounds each week.

2.

3 pounds each week.

3.

4 to 5 pounds each week.

4.

6 pounds each week.

ANS: 1 To reduce body weight by 10% for a person with a BMI of 30 would be to lose 1 to 2 lbs each week. The other amounts of weekly weight loss might lead to nutritional disorders.

PTS: 1 DIF: Analyze REF: Obesity: Planning and Implementation 15.While caring for a client with a gastrostomy (GT) tube, it is important for the nurse to: 1.

clean it weekly.

2.

flush it with water before and after the feeding.

3.

change the GT tube daily.

4.

not give medications through the tube.

ANS: 2 The GT site should be cleaned daily, and it is important that the nurse flush the tube with water before and after the feedings and medication administration to avoid tube obstruction. The site of the tube should be cleaned daily. The GT is not changed daily. The GT is used for medication administration.

PTS: 1 DIF: Apply REF: Gastrostomy Feedings 16.A client, diagnosed with renal failure, is prescribed enteral nutrition. The enteral food product will contain which of the following ?

1.

Lower protein content

2.

Higher fat content

3.

Lower calorie content

4.

Lower carbohydrate content

ANS: 1

Enteral feedings to support a client diagnosed with renal failure will have a lower protein content. Feedings for these clients will not have a higher fat content, lower calorie content, or lower carbohydrate content.

PTS: 1 DIF: Apply REF: Table 48-2 Enteral Nutrition Formulary MULTIPLE RESPONSE 1. The nurse is instructing a client on the advantages of following a nutritionally adequate diet.

Which of the following should be included in these instructions? (Select all that apply.)

1.

Varies during the life cycle

2.

Supports key body systems

3.

Supports a healthy weight

4.

Tastes good

5.

Helps prevent chronic disease

6.

Is low in carbohydrates and proteins

ANS: 1, 2, 3, 5 A nutritionally adequate diet is one that meets the needs of the individual at that stage of his life cycle, supports the body systems, and maintains proper weight. A nutritionally adequate diet will also help prevent the onset of chronic disease. A nutritionally adequate diet is not low in carbohydrates and proteins.

PTS: 1 DIF: Apply REF: Components of a Nutritionally Adequate Diet 2. The nurse is helping a dietitian determine a clients resting energy expenditure (REE). Which of the following will influence this clients REE? (Select all that apply.)

1.

Age

2.

Diet

3.

BMI

4.

Chronic illnesses

5.

Urine output

6.

Appetite

ANS: 1, 2, 3, 4 The resting energy expenditure (REE) is the amount of calories needed to maintain body weight at rest. The REE is influenced by age, diet, BMI, and chronic illness. Urine output and appetite are not known to influence a clients REE. PTS:1DIF:AnalyzeREF:Metabolic Rate 3. The nurse is concerned that a client with a gastrostomy feeding tube is developing a complication. Which of the following are considered complications associated with this type of feeding tube? (Select all that apply.)

1.

Nausea

2.

Vomiting

3.

Aspiration

4.

Abdominal distention

5.

Leg cramps

6.

Muscle pain ANS: 1, 2, 3, 4 Complications of a gastrostomy tube include nausea, vomiting, malabsorption, aspiration, abdominal distention, tube obstruction, diarrhea, and constipation. Leg cramps and muscle pain are not complications of a gastrostomy tube.