TEST BANK for Nutrition and Diet Therapy for Nurses 2nd Edition by Sheila Tucker, Vera

TEST BANK for Nutrition and Diet Therapy for Nurses 2nd Edition

by Sheila Tucker, Vera Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 1 Nursing and Nutrition Care 1.1 To understand nutrition as an aspect of total health care.

1) The nurse instructs an adult client about nutritional needs. Which client statement indicates that teaching has been effective?

1. "A good diet is hard work."

2. "The nutrients I need come from foods."

3. "There are some insignificant nutrients that I don't really need."

4. "If I don't take a multi-vitamin supplement, I will be unable to meet all nutrition needs."

Answer: 2 Explanation: The nurse needs to understand the role of macro- and micronutrients in maintaining health and preventing disease. A client who understands that nutrients come from foods has beginning knowledge of nutrition. There are no insignificant nutrients, nor is a vitamin supplement required for good health. A good diet should not be hard work; it can be implemented with careful planning.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) A client believes that a good diet is the key to a long life. Which response should the nurse make to this client?

1. "It is one aspect of healthy living."

2. "You are well on your way to a long life."

3. "A good diet is most important early in life."

4. "Good genes are a better predictor of long life."

Answer: 1 Explanation: Good nutrition promotes health and may prevent the onset of conditions like cardiovascular disease, some forms of diabetes mellitus, and cancer. Other aspects may include safety, interpersonal relations, coping mechanisms, etc. Good genes may play a role; however, a client cannot ignore the role of nutrition in promoting a healthy life. A good diet is important throughout the lifespan, and it is never too late to make changes. The nurse ignores teaching opportunities when dismissing a client by suggesting that a long life is likely because of eating a good diet.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

3) A client who is obese tells the nurse that malnutrition is not a problem. What should the nurse include when responding to this client?

1. This is correct information.

2. Nutrient deficiency is the best indicator of malnutrition.

3. A lot of research about malnutrition is being conducted.

4. Malnutrition can be an excess or deficiency of nutrients.

Answer: 4 Explanation: Malnutrition includes excess, deficient, or an imbalance of nutrients that lead to disease states. The obese client may be malnourished. The client holds an incorrect assumption about malnutrition. Research is being conducted about all nutrients, but that response is not addressing the client's lack of knowledge.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 4) The nurse prepares nutritional information for a community fair. What should the nurse use as a guide for the recommended intake of nutrients?

1. MyPlate 2. Food labels 3. Healthy People 2020 4. Dietary reference intakes Answer: 4 Explanation: Dietary reference intakes (DRIs) are the standards used in the United States and Canada for the recommended nutrient inN taUkReSoIN f tGhTeBp.CoO puMlation. MyPlate was designed to help nutrition planning by following the 2015-2020 Dietary Guidelines for Americans in providing a pictorial guide to the amounts and kinds of foods that individuals should eat daily to maintain health and to reduce the risk of developing nutrient-related conditions. A food label provides nutrient information about the item within a particular package. Healthy People 2020 provides the national objectives related to health and health promotion. A major subsection of Healthy People 2020 is related to nutrition and weight status.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying

1.2 To categorize appropriate tools to use as guidelines for nutrient intake and nutritional standards.

1) The nurse reviews MyPlate with a client who has a BMI of 30. Which client statement indicates that additional teaching is required?

1. "SuperTracker shows me the amount of foods that I can eat."

2. "The web site has other education resources that I can review."

3. "The serving size depends upon the size of my plates at home."

4. "The web site shows the correct serving size in household measures."

Answer: 3 Explanation: Serving size is often misunderstood by the public and is commonly described as "what I have on my plate," which many times is far larger than a recommended serving size.

SuperTracker is a feature that helps the user track the amount of food that can be eaten according to weight and activity level. The web site has multiple educational resources for the user. The web site provides serving sizes in household measurements.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) The nurse prepares diet teaching on sodium content of foods for a mother with small children.

Which observation guided the nurse to make this teaching decision?

1. Mother drinking bottled water 2. 3-year-old child eating potato chips 3. 5-year-old child eating apple wedges NURSINGTB.COM 4. 2-year-old child eating whole wheat cereal Answer: 2 Explanation: One Healthy People 2020 Nutrition and Weight Status objectives is to reduce the consumption of sodium in the population aged 2 years and older. Since the 3-year-old child is eating potato chips, the children might all be eating foods high in sodium. Bottled water, apple wedges, and whole wheat cereal do not contain high levels of sodium.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 3) A client who is 12 weeks' pregnant is a vegetarian. On which Healthy People 2020 Nutrition and Weight Status objective should the nurse focus when instructing this client?

1. Reduce iron deficiency 2. Reduce consumption of sodium 3. Reduce consumption of saturated fat 4. Reduce consumption of added sugars Answer: 1 Explanation: The Health People 2020 Nutrition and Weight Status objective that targets pregnant clients is to reduce iron deficiency. Reduction in the consumption of sodium, saturated fats, and added sugars are objectives for all people age 2 and over.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying

4) The nurse collects several food labels to be used during a teaching session with high school students. What should the nurse emphasize when discussing macronutrients?

1. Serving size 2. Carbohydrates 3. Sodium content 4. Daily calorie intake Answer: 2 Explanation: Carbohydrates are considered macronutrients. The serving size is used to determine food amount and calorie content. Sodium is considered a micronutrient. Daily calorie intake is provided as a reference value.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 1.3 To use the nursing process to formulate relevant nursing diagnoses for individuals with actual or potential nutritional problems.

1) The school nurse reviews basic information collected during routine health checks of the students. Which action should the nurse take to help reduce the number of students with a body mass index of 30 or greater?

1. Prepare a handout on healthy food choices 2. Send letters to all parents about the obesity epidemic in the school 3. Suggest time for physical activity be increased in the course curriculum 4. Schedule time with each overweight sN tuUdReSnItNaGnTdBc.C ouOnMsel on the hazards of obesity Answer: 1 Explanation: Although all choice might seem appropriate, the one that the nurse can do to help the students is prepare a handout on healthy food choices. Sending letters to all parents would be inappropriate for those students who have a normal body mass index. Changing the curriculum would need to involve the entire school board and teachers. Personal counseling will take a significant amount of time and the nurse may not reach all of the students who would benefit from learning healthier nutritional practices.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

2) The nurse notes that a client does not eat anything from the breakfast and lunch meal tray but asks for a snack after the patient's parish priest visits. What should the nurse comment to the client about this behavior?

1. "Skipping meals is not healthy."

2. "Explain why you didn't eat before your priest arrived."

3. "Is there a different food that you prefer to eat for breakfast and lunch?"

4. "Can you priest come and visit earlier in the day, so you don't skip meals?"

Answer: 2 Explanation: The nurse needs to assess the client's cultural patterns to understand why the client would not eat before the parish priest arrived. Skipping meals may not be healthy but it does not help understand why the meals were skipped in the first place. The client is not skipping meals because of food preferences. The client may have no control over the time the priest can visit.

Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Applying 3) The nurse is concerned that a client is experiencing health problems caused by a nutritional imbalance. Which action should the nurse take first?

1. Add snacks to the client's menu selections 2. Contact the registered dietitian for assistance 3. Offer liquid nourishment supplements between meals 4. Suggest the health care provider prescribe vitamin supplements Answer: 2 Explanation: The nurse should be awareNoUfRtShIeNiGmTpBo.CrtOaM nt role of the registered dietitian (RD) in patient care. The RD completes comprehensive nutritional assessments, writes nutritional diagnoses, plans interventions, and monitors the patient's or family’s response to the nutritional plan. The RD should be consulted when the nurse determines that actual or potential nutritional problems exist. Adding snacks, providing liquid supplements, and using vitamin supplements may be appropriate but not until the RD has an opportunity to complete a thorough nutritional assessment Nursing Process: Implementation Client Need: Basic Care and Comfort Cognitive Level: Applying

1.4 To relate the importance of a nutritional screening during each patient encounter.

1) After completing nutritional screening with a client, the nurse identifies the diagnosis of imbalanced nutrition: less than body requirements. What should the nurse identify as a realistic goal for this client?

1. Increase fat in the diet 2. Replace sweets with high-protein foods 3. Increase weight by one pound per week 4. Decrease physical activity to 2 hours per week Answer: 3 Explanation: A nutrition screening may serve as the basis for nursing diagnoses. When a client has a diagnosis that indicates a client is not meeting body requirements for nutrients, a small weekly weight gain is appropriate. Weight gain is promoted by increasing caloric consumption rather than restricting activity. Increasing intake of fats is rarely recommended. Replacing sweets with protein does not necessarily increase the number of calories consumed.

Nursing Process: Planning Client Need: Basic Care and Comfort Cognitive Level: Applying 2) After gathering and analyzing anthropometric data, the nurse determines that a client has a "pear" body type. Which waist-to-hip ratio caused the nurse to come to this conclusion?

1. 0.78 2. 0.85 3. 0.90 4. 1.05 Answer: 1 Explanation: The waist-to-hip ratio is calculated by dividing the waist measurement by the hip measurement. "Pear" body types have a ratio at or below 0.8; "apple" body types have a ratio near or exceeding 1.0.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing

3) The nurse needs to collect nutrition screening data from elementary school students. What data will the nurse collect?

1. Food frequency information 2. Height and weight to calculate BMI 3. Head circumference of each child to assess for growth 4. How many children receive free or reduced-price lunches Answer: 2 Explanation: Anthropometric data, which include physical characteristics, are part of the screening process. Height and weight are measured quickly and are used to calculate BMI. Head circumference is measured in infants to assess growth. Food frequency is part of a more comprehensive assessment. The nurse does not need to know about school lunch participation for screening purposes.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 4) The nurse reviews assigned clients and plans to have several complete a nutritional screening tool sometime during the shift. Why did the nurse decide to do this?

1. Evaluate the clients' memory 2. Adhere to the organization's policies 3. Provide the clients with something to do 4. Identify clients at risk for poor nutritional health Answer: 4 Explanation: Nutritional screening quickNlUyRiSdIeNnG tiTfiBe.sCiOnM dividuals who may be at risk for poor nutritional health. A nutritional screening tool is not used to evaluate memory. The organization may have a policy about completing a nutritional screening or assessment however this is not the primary reason for having this tool completed. Clients who are hospitalized most likely do not need "something to do."

Nursing Process: Planning Client Need: Reduction of Risk Potential Cognitive Level: Applying

Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 2 Nutrition Recommendations and Standards 2.1 To define the basic components of a healthy diet.

1) The nurse observes a client make menu selections that include all major food groups for each meal. Which aspect of a healthy diet is this client demonstrating?

1. Balance 2. Preference 3. Moderation 4. Concentrated Answer: 1 Explanation: A balanced diet contains a sufficient quantity of each type of food. Balance means consuming all of the essential macronutrients and micronutrients in the recommended quantity through a combination of different food types. Moderation refers to the practice of regularly eating foods high in nutrient content while limiting the frequency and portion of foods with little nutrient value. Preference is a characteristic of food choices but not necessarily an aspect of a healthy diet. Concentrated is not an aspect of a healthy diet.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) An older person reports eating a small amount of meat for lunch and dinner with a salad and NGhTicBh.CaOsM baked potato but only eats dessert on SunNdUaRyS. IW pect of a healthy diet is this client describing to the nurse?

1. Habit 2. Balance 3. Moderation 4. Nutrient dense Answer: 3 Explanation: Moderation refers to the practice of regularly eating foods high in nutrient content while limiting the frequency and portion of foods with little nutrient value. Habit is a characteristic of food choices but not necessarily an aspect of a healthy diet. Balance means consuming all of the essential macronutrients and micronutrients in the recommended quantity through a combination of different food types. A food is nutrient dense if it contains a significant amount of nutrients for the least amount of calories.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing

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3) The nurse prepares educational material on the impact of nutrient excess for a client. Which client health problem caused the nurse to focus on this instructional topic?

1. Diabetes 2. Osteoporosis 3. Diverticulitis 4. Osteoarthritis Answer: 1 Explanation: Diet is implicated in the development and progression of diabetes. Diet is not implicated in the development progression of osteoporosis, diverticulitis, or osteoarthritis.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 2.2 To describe dietary reference intakes and how they are used by health care professionals.

1) The nurse consults the Dietary Reference Index after completing an assessment on an older client. What should the nurse keep in mind when using this index?

1. Only medical providers are trained to use the index.

2. It is easy to use and is individualized for clients based on medical problems.

3. The values are intended as general guidelines for a population group rather than an individual.

4. Age and gender are the two variables needed to individualize recommendations to an individual.

Answer: 3 Explanation: DRI values can be confusiN ngURtoSIhNeGaTltBh.-CcO arM e personnel because they specify levels of nutrients rather than food choices. The recommendations are intended for use with healthy individuals. Five variables must be accommodated in order to successfully translate population suggestion into food choices for an individual: age, body size, daily energy expenditure, any relevant medical conditions, and dietary habits. DRI values are intended as general guidelines for a population group rather than an individual.

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2) After completing a nutritional assessment, the nurse compares a client's intake with the estimated average requirements (EAR). What should the nurse keep in mind about the EAR? 1. It was designed for use with populations and not individuals.

2. It estimates the amount of nutrients needed to meet average daily energy needs.

3. It provides average daily amount of a given nutrient sufficient to meet the nutrient requirement of 97-98% of healthy individuals.

4. It provides average daily nutrient intake amounts to meet the requirements of 50% or more of healthy individuals in a life stage and gender group.

Answer: 4 Explanation: The EAR is the average daily nutrient intake value that is estimated to meet the requirements of 50% or more of healthy individuals in a life stage and gender group. The estimated amount of nutrients needed to meet average daily energy needs is the estimated energy requirement (EER). The average daily amount of a given nutrient sufficient to meet the nutrient requirement of 97-98% of healthy individuals is found in the recommended daily requirement (RDA) of the DRI. The DRI are guidelines for a population rather than an individual.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) When planning a diet for a client who wants to lose weight, the nurse refers to the Dietary Reference Index for recommendations. According to the DRI, what amount of carbohydrates should the nurse instruct the client to consume each day?

1. 5-10% of total daily calories.

NURSINGTB.COM 2. 10-35% of total daily calories.

3. 20-35% of total daily calories.

4. 45-65% of total daily calories.

Answer: 4 Explanation: The DRI recommends that the daily caloric intake include about 45—65% of carbohydrates. Ten to 35% of daily nutrients should be from proteins, 20—35% from fat, and 510% from linoleic acid.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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2.3 To summarize the existing diet-based nutrition recommendations for health, including Dietary Guidelines for Americans.

1) A client is upset about gaining weight and believes it is caused by eating out often because of work. Which information from the Dietary Guidelines for Americans should the nurse review with the client? (Select all that apply.)

1. Healthy snacks.

2. Calories for individual foods.

3. Healthier food choices when eating out.

4. Optimizing intake of nutrient dense foods.

5. Proper transporting of food purchased at take-out restaurants.

Answer: 1, 3, 4 Explanation: The Dietary Guidelines for Americans provides suggestions including: how to choose healthy snacks, optimizing nutrient dense foods, healthier food choices when eating out, and food safety tips. It does not include information on proper processes for transporting food purchased at take-out restaurants or calories for individual foods.

The Dietary Guidelines for Americans provides suggestions including: how to choose healthy snacks, optimizing nutrient dense foods, healthier food choices when eating out, and food safety tips. It does not include information on proper processes for transporting food purchased at takeout restaurants or calories for individual foods.

The Dietary Guidelines for Americans provides suggestions including: how to choose healthy snacks, optimizing nutrient dense foods, healthier food choices when eating out, and food safety tips. It does not include information on proper processes for transporting food purchased at takeout restaurants or calories for individual NfoUoRdSsI.NGTB.COM Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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2) A healthy young adult asks what can be done to improve eating habits. Which information should the nurse emphasize from the U.S. Dietary Guidelines with this client?

(Select all thatapply.)

1. Limit sodium intake to 2,300 mg/day.

2. Limit alcoholic beverages to 4 drinks/day.

3. Only drink beer on the weekends and avoid liquor.

4. Choose fiber rich fruits, vegetables, and grains often.

5. Consume less than 10% of calories from saturated fatty acids.

Answer: 1, 4, 5 Explanation: Key recommendations in the U.S. Dietary Guidelines include: consuming less than 10% of calories/day from saturated fatty acids; limiting sodium intake to 2,300 mg/day; and choosing fiber rich fruits, vegetables, and grains often. Recommendations for consumption of alcoholic beverages are one per day for women and two per day for men. Drinking more than one beer per day is not recommended.

Key recommendations in the U.S. Dietary Guidelines include: consuming less than 10% of calories/day from saturated fatty acids; limiting sodium intake to 2,300 mg/day; and choosing fiber rich fruits, vegetables, and grains often. Recommendations for consumption of alcoholic beverages are one per day for women and two per day for men. Drinking more than one beer per day is not recommended.

Key recommendations in the U.S. Dietary Guidelines include: consuming less than 10% of calories/day from saturated fatty acids; limiting sodium intake to 2,300 mg/day; and choosing fiber rich fruits, vegetables, and grains often. Recommendations for consumption of alcoholic beverages are one per day for women and two per day for men. Drinking more than one beer per NURSINGTB.COM day is not recommended.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) The nurse prepares education material on nutrition for a group of community members. Which tools should the nurse use when conducting this teaching? (Select all that apply.)

1. My Plate 2. Dietary Reference Intakes 3. Recommended Daily Allowance 4. Estimated Average Requirements 5. Dietary Guidelines for Americans Answer: 1, 5 Explanation: Rationale: The nurse should combine the key messages from the Dietary Guidelines for Americans with education that uses the MyPlate icon and its accompanying resources. Together, these guidelines emphasize the crucial point that healthy dietary patterns consumed over time are what positively affect health rather than any impact from a single nutrient, food, or meal. The Dietary Reference Intakes, Recommended Daily Allowance, and Estimated Average Requirements are not recommended to be used a community education session.

Rationale: The nurse should combine the key messages from the Dietary Guidelines for Americans with education that uses the MyPlate icon and its accompanying resources. Together, these guidelines emphasize the crucial point that healthy dietary patterns consumed over time are what positively affect health rather than any impact from a single nutrient, food, or meal. The Dietary Reference Intakes, Recommended Daily Allowance, and Estimated Average Requirements are not recommended to be used a community education session.

Nursing Process: Planning Client Need: Health Promotion and Maintenance NURSINGTB.COM Cognitive Level: Applying

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2.4 To interpret how to read a food label and decipher nutrient content claims 1) The nurse prepares to review reading a food label with a client. Which areas should the nurse include with this teaching? (Select all that apply.)

1. Ingredient list.

2. Nutritional claims.

3. Distribution company.

4. Nutritional facts panel.

5. Amount of food coloring contained in the product.

Answer: 1, 2, 4 Explanation: The nurse should discuss how to read the ingredient list, the nutritional facts panel, and any nutritional claims when providing education on food labels to a client. The distribution company is only significant during a food recall. The addition of food coloring is not a major component of reading a food label.

The nurse should discuss how to read the ingredient list, the nutritional facts panel, and any nutritional claims when providing education on food labels to a client. The distribution company is only significant during a food recall. The addition of food coloring is not a major component of reading a food label.

The nurse should discuss how to read the ingredient list, the nutritional facts panel, and any nutritional claims when providing education on food labels to a client. The distribution company is only significant during a food recall. The addition of food coloring is not a major component of reading a food label.

Nursing Process: Planning Client Need: Health Promotion and MaiNnU teRnSaInNcGeTB.COM Cognitive Level: Applying 2) Each year the school nurse demonstrates how to read the label on a can of carrots to a group of students. Which ingredient should the nurse expect to be listed first on the food label?

1. Water 2. Carrots 3. Sodium 4. Food coloring Answer: 2 Explanation: Ingredients on a food label must be listed in descending order according to weight.

Since the primary ingredient in the can is carrots, they should appear first on the label. Other ingredients would be listed according to weight.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) The nurse plans to review food labels with a client who has type 2 diabetes mellitus. Why should the nurse emphasize the nutrition facts panel with the client?

1. Explains the nutritional claims 2. Specifies food dyes in the item 3. Lists the amount of calories per serving 4. Identifies ingredients associated with food allergies Answer: 3 Explanation: The nutritional facts panel contains information on serving size, calories, and key nutrients. Information on ingredients identified as common food allergens and dyes are listed as ingredients. Nutritional content claim terms often appear in bold or colorful letters in advertisements and on the packaging of common food items.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 4) A client reports only eating food items that are identified as "reduced fat." What should the nurse explain about the "reduced fat" designation?

1. The product has very low amounts of fat.

2. The product has less fat than a similar product, but still is high in fat.

3. The product has less than the recommended daily requirement of fat.

4. The product may have more of different types of fat than similar products.

Answer: 2 Explanation: Reduced refers to at least 25% less of a given nutrient or calories than the comparison food. This characteristic is aNlsUoRlSisIN teGdTaBs.C"lOeM ss" and "fewer." A product labeled as reduced fat has less fat than a similar product, but may still have a significant fat content. Less of an ingredient does not necessarily translate as "little" or "none," only as less. References to the amount of fat contained in a product are in comparison to similar products and do not refer to the U.S. RDA. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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2.5 To formulate nursing interventions that target nutrition misinformation.

1) A client with a body mass index of 32 purchased a weight loss supplement that guarantees a 15-lb. weight loss in 1 week or the money for the supplement will be refunded. Which information should the nurse include when responding to this client's plan to use this weight loss supplement?

1. "It sounds like a good supplement."

2. "Let me know how it works and I might try it too."

3. "Unfortunately claims that sound too good to be true most often are not true."

4. "It is important to have a guarantee for a refund if the product does not work."

Answer: 3 Explanation: If it sounds too good to be true, it probably is. The client should be wary of weight loss products that promise results with no changes needed in diet or exercise or that claim permanent weight loss even when no longer using the product. The product does not sound like a good supplement. The nurse should not reinforce the client's plan to use the product. Having a guarantee for a refund is not a reason to use the product.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) A client who has been using a "spray product" to reduce appetite as a method to lose weight is disappointed after gaining two lbs. over the last week. Which action should the nurse take with this client?

1. Encourage to stick with the spray prodNuUcRt SINGTB.COM 2. Suggest getting a refund for the cost of the product 3. Provide scientific information about appetite control 4. Remind that there is no such thing as a quick fix for weight loss Answer: 3 Explanation: When encountering nutritional misinformation, an idea is to say to the patient: "I have some information about that idea/diet/product. Would you like me to share it with you?"

Providing scientific information about appetite control is the best action for the nurse to take.

The product most likely is not going to work and the client should not be encouraged to continue to use it. Suggest getting a refund or saying that there is no such thing as a quick fix for weight loss may upset the client and hinder further communication between the client and the nurse.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 3 Carbohydrates 3.1 To differentiate the types of carbohydrates and list the dietary sources of each.

1) A client, who is trying to decrease carbohydrate intake, asks how that is possible since sweets have already been eliminated from the diet and there can't be anything left to reduce. What is the best explanation the nurse can give to explain the difference between sugar and carbohydrates?

1. All sugars are very sweet 2. Carbohydrates are harder to digest than sugar 3. All carbohydrates are sugar in their simplest form 4. Carbohydrates are made of carbon, hydrogen, and oxygen and sugars are not Answer: 3 Explanation: The nurse should explain that carbohydrates are classified as simple and complex, and what is commonly thought of as sugar is an example of a simple carbohydrate. Sugars, as a form of carbohydrates, are made of carbon, hydrogen, and oxygen. Not all sugars are sweet; only the simple sugars are sweet. Carbohydrates are not harder to digest than sugars because sugars are a form of carbohydrate.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) A client asks why fiber is a carbohydrate that is good for people and high fructose corn syrup as a carbohydrate is not. What should theNU nuRrSsIeNeGxTpBl.aCinOM to the client?

1. Fiber is a great source of energy 2. Fiber digests slowly and slows the absorption of sugars 3. High fructose corn syrup is only found in soft drink beverages 4. Sugar, in the form of high fructose corn syrup, contributes to weight gain Answer: 2 Explanation: Fiber moves through the gastrointestinal tract slowly, reducing the rate of sugar absorption, which is one of the reasons it is beneficial. Fiber is a slow form of energy. Sugar contributes to weight gain only if consumed in excess; small amounts are acceptable for any diet.

High fructose corn syrup is found in many foods besides soft drinks.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) A client wants to know what why it is good to include starches in the diet. What should the nurse explain about starches?

1. Make a person feel full faster 2. Provide the quickest form of energy 3. Are good only when consumed in moderation 4. Are stored in the liver and can be used for energy Answer: 4 Explanation: Starches are stored in the liver in the form of glycogen, which can be used for energy when glucose levels fall. Starches do not lead to satiety as well as proteins and fats.

Glucose is the quickest form of energy. Starches, in the form of fiber, can be consumed liberally.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3.2 To relate the functions of carbohydrates in the body.

1) The nurse instruct a client about the role of carbohydrates in the diet. Which client statement indicates that teaching has been effective?

1. "I know a food has too much carbohydrate if it is sweet."

2. "Eating excess carbohydrates is the surest way to get sick."

3. "Certain ones can be useful in helping to lower cholesterol levels."

4. "I need to cut back on carbohydrates because they are not good for me."

Answer: 3 B.aCyObMe useful in reducing cholesterol levels.

Explanation: Carbohydrates, in the formNoUfRfSiIbNeG r,Tm Carbohydrates are necessary as an energy source for the body and a balanced diet should include about 50% carbohydrates. A sweet food has carbohydrates, but that does not mean that it has too many carbohydrates; a peach and sweet potatoes have carbohydrates, but only the peach is sweet to taste. There are many reasons for sickness, but excess carbohydrate consumption is not among them.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) A client asks why the intravenous fluid contains glucose. What should the nurse respond to this client?

1. "It is easily digested."

2. "It will help you feel better faster."

3. "Glucose is an energy source for the body."

4. "Glucose aids in the prevention of dehydration."

Answer: 3 Explanation: Glucose provides energy for the body and prevents fats and proteins from being used as an energy source. Water prevents dehydration, not glucose. Glucose moves directly into the blood stream where it can be metabolized as an energy source; it does not move to the intestine, so it is not digested. The glucose does not in and of itself help one feel better.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2

3) The nurse is teaching a client about low glycemic index foods. Which foods should the nurse provide as examples of those with a low glycemic index? (Select all that apply.)

1. Potatoes 2. Oatmeal 3. Corn flake cereals 4. Sesame see bagels 5. Whole grain spaghetti Answer: 2, 5 Explanation: High glycemic index foods like potatoes are made of higher amounts of simple carbohydrates that cause a more rapid rise in blood glucose. Whole wheat spaghetti is an example of a complex carbohydrate that causes a slower elevation in blood glucose after it is eaten. Oatmeal is an example of a complex carbohydrate that causes a slower elevation in blood glucose after it is eaten. Bagels are a high glycemic index food that is made of higher amounts of simple carbohydrates that cause a more rapid rise in blood glucose. Corn flake cereal is a high glycemic index food that is made of higher amounts of simple carbohydrates that cause a more rapid rise in blood glucose.

High glycemic index foods like potatoes are made of higher amounts of simple carbohydrates that cause a more rapid rise in blood glucose. Whole wheat spaghetti is an example of a complex carbohydrate that causes a slower elevation in blood glucose after it is eaten. Oatmeal is an example of a complex carbohydrate that causes a slower elevation in blood glucose after it is eaten. Bagels are a high glycemic index food that is made of higher amounts of simple carbohydrates that cause a more rapid rise in blood glucose. Corn flake cereal is a high glycemic index food that is made of higher amounts of simple carbohydrates that cause a more rapid rise NURSINGTB.COM in blood glucose.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3.3 To counsel individuals about the dietary recommendations for carbohydrate intake.

1) A client is directed to reduce the intake of simple sugar to 5% of the total number of calories consumed per day. If the client consumes 1800 calories per day, how many of these calories should the nurse inform the client can be simple sugar?

1. 75 2. 90 3. 115 4. 145 Answer: 2 Explanation: To determine the number of calories of simple sugar, multiply the total number of calories per day by 5% or 1800 × 5% = 90 calories. The other choices are incorrect calculations.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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2) A client wants to increase the consumption of complex carbohydrates. Which food should the nurse suggest to this client? (Select all that apply.)

1. Peaches 2. Broccoli 3. Fresh apples 4. Fruit yogurt 5. Sourdough rolls Answer: 2, 3 Explanation: Sourdough rolls have more simple carbohydrates than complex carbohydrates, which have soluble and insoluble fibers. Peaches do not have large amounts of soluble or insoluble fiber, so they are considered simple carbohydrates. Broccoli contains soluble and insoluble fibers that move slowly through the intestines and cannot be easily digested, so this is a good example of a complex carbohydrate. Yogurt may be plain or have some fruit added, but it is composed of simple carbohydrates which do not have soluble or insoluble fiber. Apples, with skins, have soluble fiber so they are considered a good source of complex carbohydrates.

Sourdough rolls have more simple carbohydrates than complex carbohydrates, which have soluble and insoluble fibers. Peaches do not have large amounts of soluble or insoluble fiber, so they are considered simple carbohydrates. Broccoli contains soluble and insoluble fibers that move slowly through the intestines and cannot be easily digested, so this is a good example of a complex carbohydrate. Yogurt may be plain or have some fruit added, but it is composed of simple carbohydrates which do not have soluble or insoluble fiber. Apples, with skins, have soluble fiber so they are considered a good source of complex carbohydrates.

Nursing Process: Implementation Client Need: Health Promotion and MaiNnU teRnSaInNcGeTB.COM Cognitive Level: Applying 3) A pregnant client plans to eat twice as many complex carbohydrates because of "eating for two." Which response should the nurse make to this client?

1. "That is correct for later in the pregnancy."

2. "Carbohydrate needs increase, but not by that amount."

3. "That is correct; just make sure it is mostly complex carbohydrates."

4. "Space your carbohydrate intake throughout the day to avoid spikes in blood glucose."

Answer: 2 Explanation: Carbohydrate needs increase throughout pregnancy, but never achieve a doubling of the recommended amount of a non-pregnant female. Carbohydrate needs are elevated during pregnancy and lactation to 175 gm and 210 gm, respectively, to meet the glucose needs of the fetus and to replace the carbohydrate secreted in breast milk. The pregnant woman should increase consumption of complex carbohydrates to prevent constipation. It is wise to prevent spikes in blood glucose by consuming more complex carbohydrates; however, that does not address the correct amount of carbohydrates for a pregnant female.

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3.4 To examine the appropriateness of the use of nutritive and nonnutritive sweeteners.

1) A client asks which of the artificial sweeteners is the best. Which response should the nurse make to the client?

1. "A dietician is the best person to answer that question."

2. "All of them have very few calories so it doesn't matter which you choose."

3. "There are many kinds of sweeteners at varying prices; select the one that best fits your budget."

4. "The sweeteners have different amounts of sweetness; you will need to experiment to see which you prefer."

Answer: 4 Explanation: The artificial sweeteners have varying intensity of sweetness so, depending on the client's planned use, the client will need to try different products to achieve the desired sweetness of a food or beverage. Artificial sweeteners have few calories and the cost for each is not significantly different; the level of sweetness should be the deciding factor for the client. This is a question that the nurse should be able to answer.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) A client finds it impossible to use artificial sweeteners because they are far too sweet and don't taste natural. What advice can the nurse give the client?

1. "That is the nature of artificial sweeteners and you will get used to it."

Ge TdBi.cCaOl M 2. "You may use natural sugar unless theNrU e RisSaINm reason to do otherwise."

3. "Try experimenting with different amounts of the sweeteners to see what works best for you."

4. "The chemicals contribute to the unnatural taste; try a different formulation to see if the taste improves."

Answer: 3 Explanation: Each artificial sweetener has a different intensity of sweetness. If a client uses artificial sweeteners, it is important to experiment with each one to achieve the desired level of sweetness. The nurse should never suggest that a client does not have options, even with artificial sweeteners. The chemical contribution does not contribute to the unnatural taste; it is the amount of the sweetener that is used. It is unwise to suggest use of natural sugar when the client is asking about artificial sweeteners.

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3) A client is concerned about the safety of using a non-nutritive sweetener. Which information should the nurse include when responding to this client?

1. "They are approved by the FDA." 2. "They should not be used by children."

3. "They have been around for years and caused no health problems."

4. "When consumed in appropriate amounts, they are not a health problem."

Answer: 1 Explanation: Five nonnutritive sweeteners are approved for use with guidelines given for Accepted Daily Intake (ADI) based on available evidence on safe levels of consumption. The Food and Drug Administration (FDA) approves non-nutritive sweeteners. Non-nutritive sweeteners have been used for years; however, they have been and continue to be scrutinized for safety and risks. They may be used by children, for example in sugar-free beverages.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3.5 To formulate nursing interventions that will assist individuals in improving intake of dietary fiber.

1) The nurse instructs a client on daily fiber intake. Which client statement indicates that teaching has been effective?

1. "Fiber causes diarrhea."

2. "If I eat fiber, I won't get constipated."

3. "I should eat as much fiber as I can toN leUraRtSeI."NGTB.COM 4. "A bowl of oatmeal for breakfast and an apple with lunch will provide almost all the fiber I need for a day."

Answer: 4 Explanation: The client should consume as much fiber as possible each day; at least 25 grams for females and 35 grams for males. Fiber in the diet helps prevent constipation, but it is not a function of merely consuming fiber-rich foods; it is a function of the quantity that is consumed.

Oatmeal and an apple will contribute less than 10 grams of fiber to the diet, well under the minimum recommended daily amount. Fiber does not cause diarrhea when consumed in recommended amounts, although the amount should be increased gradually in those who are not used to consuming the recommended amount.

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2) A client asks if it is true that a diet high in fiber can help lower cholesterol. What should the nurse respond to this client?

1. "It is true for only some people."

2. "Soluble fiber may help lower cholesterol."

3. "Research has been inconclusive about the role of fiber in lowering cholesterol."

4. "It is effective only when increased fiber consumption starts in young adulthood."

Answer: 2 Explanation: Soluble fibers interfere with enterohepatic recycling of bile, a process that causes the reabsorption of bile acids in the small intestine. Bile acids used in fat digestion contain cholesterol and are normally reabsorbed and transported to the liver. By preventing the reabsorption of bile, cholesterol is excreted bound to the fiber and, therefore, some of the body's pool of cholesterol is reduced It is never too late to increase consumption of a diet higher in fiber, especially soluble fiber.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) The nurse is instructing a client on the importance of increasing soluble fiber in the diet.

Which food should the nurse suggest as being high in soluble fiber?

1. Pita bread 2. Oat bran cereal 3. English muffins 4. Puffed rice cereal NURSINGTB.COM Answer: 2 Explanation: Foods that are made mostly from oats are high in soluble fiber. Examples are oat bran and oatmeal. English muffins, puffed rice, and pita bread are typically made from wheat.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 4 Protein 4.1 To summarize the composition of proteins.

1) The nurse prepares teaching material about nutrition for a community health fair. How should the nurse explain the structure of protein when providing this information?

1. It is structurally like fat 2. It is only available in meats 3. It is made up of amino acids 4. It is structurally like carbohydrates Answer: 3 Explanation: Amino acids are the building blocks of protein. Amino acids have nitrogen which carbohydrates and fats do not have. Protein is found in foods other than meats.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse provides teaching about protein to a group of high school students. Which student statement indicates that teaching has been effective?

1. "I need to avoid fatty fish."

2. "Nonessential amino acids are not important."

3. "Essential amino acids must come from dietary sources."

4. "As long as I consume nitrogen from aNnUyRsSoIN urGcTeBI.CwOilM l have all the amino acids I need."

Answer: 3 Explanation: Essential amino acids are those that cannot be synthesized by the body and must come from food sources. Fatty fish is an excellent source of omega-3 fatty acids which must not be confused with amino acids. Nonessential amino acids are important; however, they can be synthesized by the body as needed. Nitrogen is present in all amino acids, essential and nonessential.

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4.2 To summarize the physiological functions of protein, including its role in tissue growth and maintenance, synthesis of other proteins, regulation of body processes and immune function, and provision of energy.

1) The nurse teaches parents about the dietary needs of their 4-year-old child. What should the nurse explain about protein? (Select all that apply.)

1. Meat is the ideal source of protein 2. Protein is composed of amino acids 3. Protein is essential for tissue growth 4. Protein is an efficient source of energy 5. Consistent lack of protein impairs the immune system Answer: 2, 3, 5 Explanation: A child is in an anabolic state and protein is essential for tissue growth all through adolescence. Consistent lack of protein does impair the immune system. Protein is necessary for optimum functioning of the immune system. When there are depleted protein stores, the immune system does not respond efficiently, leaving the individual more vulnerable to infections. Protein is the least efficient source of energy which is why it should be the smallest percentage of a balanced diet. Meat is one source of protein; vegetarians can get all amino acids and protein from non-meat sources. All protein is composed of amino acids, which include nitrogen.

A child is in an anabolic state and protein is essential for tissue growth all through adolescence.

Consistent lack of protein does impair the immune system. Protein is necessary for optimum functioning of the immune system. When there are depleted protein stores, the immune system does not respond efficiently, leaving the individual more vulnerable to infections. Protein is the least efficient source of energy which is NwUhRySiItNsGhToBu.lC dObM e the smallest percentage of a balanced diet. Meat is one source of protein; vegetarians can get all amino acids and protein from nonmeat sources. All protein is composed of amino acids, which include nitrogen.

A child is in an anabolic state and protein is essential for tissue growth all through adolescence.

Consistent lack of protein does impair the immune system. Protein is necessary for optimum functioning of the immune system. When there are depleted protein stores, the immune system does not respond efficiently, leaving the individual more vulnerable to infections. Protein is the least efficient source of energy which is why it should be the smallest percentage of a balanced diet. Meat is one source of protein; vegetarians can get all amino acids and protein from nonmeat sources. All protein is composed of amino acids, which include nitrogen.

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2) The nurse is caring for a client in a catabolic state following complications caused by major surgery. Which action will the nurse take when planning for this client's food intake?

1. Weighing the client 2. Suggesting the client select eggs rather than oatmeal for breakfast 3. Meeting with the family and finding out the client's favorite foods 4. Telling the client that caloric intake should go up about 10% each day until complete healing is achieved Answer: 2 Explanation: The most immediate need of a client who is in a catabolic state following surgery is increased protein. The easiest way to achieve that is by suggesting high-protein foods when they can be substituted for another choice. The nurse should already be weighing the client daily, but that information will not lead the nurse to develop a plan for increased protein. It is important to keep the family informed and to gather data to contribute to the nutritional or nursing care plans, but favorite foods are not necessarily high-protein foods. The most important thing for this client is extra protein, not increasing caloric intake by a certain percentage.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) The nurse notes edema in the hands and legs of an older client who appears undernourished.

What should the nurse consider as being the reason for this client's edema?

1. Thyroid hormones are out of balance 2. The kidneys are failing, causing fluid retention 3. Lack of adequate protein is causing a N flU uiRdSsIN hiGftTB.COM 4. The client has been drinking large amounts of water to prevent feelings of hunger Answer: 3 Explanation: Oncotic pressure results in fluid balance between the tissue and the capillaries.

When there is inadequate protein, the change in oncotic pressure causes fluid to shift from the blood into the tissue, resulting in edema. If the kidneys are functioning normally, drinking large amounts of fluid results in more urine. The nurse has no reason to suspect kidney failure by appearance only. Proteins are responsible for hormone synthesis, but thyroid hormone imbalance does not cause edema.

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4) The nurse reviews the medical histories for assigned clients. Which client should the nurse identify as most likely to be experiencing a positive nitrogen balance?

1. 13-year-old girl who figure skates 2. 23-year-old college student studying chemistry 3. Older client with a small decubitus on the left heel 4. Middle-aged client recovering from open heart surgery two days ago Answer: 1 Explanation: A positive nitrogen balance exists when nitrogen intake exceeds losses. A growing, active adolescent is likely to have a positive nitrogen balance to meet rapid growth and development needs. A college student is likely to have nitrogen equilibrium since nitrogen is no longer needed for rapid growth and development. The adults who have significant health problems are in a state of negative nitrogen balance.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 4.3 To illustrate the processes by which proteins are metabolized.

1) A client is recovering from surgery to remove 8 inches of the transverse colon. What teaching related to protein digestion should the nurse prepare for this client?

1. Complementary protein to make sure all amino acids are consumed daily 2. Minimal teaching since proteins are digested mostly in the small intestine 3. Avoid eating meat and dairy products together because this may cause indigestion 4. Soft sources of complete protein, suchNaUsReSgIN gsG, TwBi.lCl ObM e preferable to meet protein needs Answer: 2 Explanation: Protein digestion and absorption take place in the stomach and small intestine; therefore, the client will not need teaching because protein will be absorbed. There is no need for the client to consume complementary proteins. There are some religious prohibitions about consuming meat and dairy together, but eating them at the same meal does not cause indigestion.

The client will need to consume additional protein during the post-operative period to promote healing, but special teaching about digestion will not be necessary.

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2) The nurse instructs a client about protein foods that have high biologic value. Which client statement indicates that teaching has been effective?

1. "We should consider becoming vegetarian."

2. "Eggs might be an inexpensive way to get protein."

3. "We only need about 3 ounces of meat per day per person."

4. "Even if I don't eat meat, my children need it grow normally."

Answer: 2 Explanation: The quality of protein is best quantified by calculating its protein digestibilitycorrected amino acid (PDCAA) score. The PDCAA score corrects the amino acid composition of a food protein for digestibility, then compares this value to that of the human requirement for the essential amino acids. Some may refer to this score as the biological value of a protein. In terms of PDCAA scores, a value of 1 is the highest and 0 the lowest. Eggs have a score of 1.0. The client is equating meat with protein; it is incorrect to state that 3 ounces of meat per day will meet protein needs or that children need meat for growth. The client may decide to become vegetarian, but that does not address the need for high biologic value protein.

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3) The nurse instructs a client about complementary proteins. Which client statement indicates that additional teaching is needed? (Select all that apply.)

1. "Eggs are the best source of complementary protein."

2. "I should eat a combination of meat and plant protein each day."

3. "Many vegetarians use complementary proteins to meet protein needs."

4. "If I use combinations of incomplete proteins I will have the amino acids I need."

5. "Using complementary proteins is another way to figure out how to get adequate protein."

Answer: 1, 2 Explanation: Meat contains complete proteins so do not need to be complemented with other sources of protein to ensure adequate intake of essential amino acids. In response to the client's statement that a combination of meat and protein should be consumed daily, the nurse would need to reinforce the difference between sources of complete and incomplete protein. Eggs contain complete protein so do not need to be complemented with other sources of protein to ensure adequate intake of essential amino acids. The nurse would need to reinforce the difference between sources of complete and incomplete protein. Combinations of incomplete proteins consumed over the course of a day can insure adequate protein intake by the combining of amino acids. Many vegetarians skillfully and creatively combine incomplete proteins to meet dietary needs. It is not necessary to consume complete proteins to meet dietary needs, so complementary proteins are another method to ensure adequate protein intake over the course of a day.

Meat contains complete proteins so do not need to be complemented with other sources of protein to ensure adequate intake of essential amino acids. In response to the client's statement that a combination of meat and protein should be consumed daily, the nurse would need to reinforce the difference between sources of complete and incomplete protein. Eggs contain INeGnTteBd.Cw OiM complete protein so do not need to be coNmUpRleSm th other sources of protein to ensure adequate intake of essential amino acids. The nurse would need to reinforce the difference between sources of complete and incomplete protein. Combinations of incomplete proteins consumed over the course of a day can insure adequate protein intake by the combining of amino acids. Many vegetarians skillfully and creatively combine incomplete proteins to meet dietary needs. It is not necessary to consume complete proteins to meet dietary needs, so complementary proteins are another method to ensure adequate protein intake over the course of a day.

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4.4 To classify the current recommendations for protein consumption and how requirements can change with certain diseases or conditions.

1) The nurse reviews the medical histories for a group of clients. Which client should the nurse suggest meet with a dietician to manage protein needs?

1. Middle-aged male client who is overweight 2. Adolescent client recovering from pneumonia 3. Older client who lives alone on a limited income 4. Young adult client recovering from a fractured leg Answer: 3 Explanation: Recommendations for protein intake in older adults are based on nitrogen balance studies in young adults and that muscle loss in the older adult, called sarcopenia, is not prevented with the recommended intake of protein because of a blunted response to protein synthesis that occurs with age. The client should meet with the dietitian to discuss protein needs to prevent the development of sarcopenia. An overweight client does not necessarily need assistance with protein needs, nor does an adolescent recovering from pneumonia. The young adult who has a fractured leg will have increased protein needs for healing, but should not need a dietician to assist with planning for that.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse is caring for a client who weighs 165 pounds (75 kg). How many grams of protein should the nurse suggest the client consuNmUeRiSnINaG n TaBv.eCrOagMe day?

1. 60 grams 2. 75 grams 3. 100 grams 4. 120 grams Answer: 1 Explanation: The average adult needs only 0.8 gm/kg/day to keep the body in a state of protein equilibrium; therefore 60 grams (75 kg × 0.8 gm/kg/day = 60 grams) should be adequate if the client is in good health.

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4.5 To appraise risk factors for protein deficiency and formulate nursing interventions to reduce risk.

1) A client is being treated for kidney disease. What explanation should the nurse provide to the client about the importance of limiting protein intake?

1. It will contribute to weight gain 2. Excess nitrogen causes stress on the kidneys 3. Oncotic pressure changes will cause edema in the lower legs and feet 4. Carbohydrates are the preferred nutrient source for clients with kidney disease Answer: 2 Explanation: Protein has nitrogen molecules that are released to the kidneys during digestion.

Nitrogen puts added stress on the kidneys to excrete it. Protein alone does not contribute to weight gain, which is a function of caloric intake exceeding caloric expenditure. Edema may result from inadequate intake. Clients with kidney disease need more carbohydrate and fat.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse prepares dietary teaching for the family of a child with phenylketonuria (PKU) disease. What needs of the child should the nurse emphasize with the parents?

1. Daily vitamin supplements 2. Foods that have very little phenylalanine 3. Foods with high biologic protein every day 4. A combination of complete and incomNpUleRtSeIN prGoTteBi.nCsOeMvery day Answer: 2 Explanation: PKU disease occurs when there is a deficiency of the phenylalanine hydroxylase enzyme. Untreated, it leads to cognitive delays and other health problems. These children must avoid foods with phenylalanine. Phenylalanine is part of protein; therefore, protein intake from any source must be limited. Vitamins are not protein.

Nursing Process: Implementation Client Need: Physiological Adaptation Cognitive Level: Applying 3) An adolescent client follows a vegan eating plan. Which food should the nurse remove from the recommended food list for this client?

1. Eggs 2. Tofu 3. Rice milk 4. Peanut butter Answer: 1 Explanation: A vegan will not eat eggs, dairy products, meats, or foods containing those ingredients. Tofu, rice mild, and peanut butter do not contain ingredients that a vegan would avoid.

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4) A high school athlete tells the nurse that a protein supplements are necessary for strong muscles. What should the nurse respond to this student?

1. It is not worth the extra expense 2. The additional protein will provide extra energy 3. Strong muscles are developed with exercise, not extra protein 4. Protein supplements will lead to weight loss so should be avoided Answer: 3 Explanation: Athletes are likely to gain most benefit from spending money on eating a nutritionally dense diet that emphasizes variety, balance, and moderation. Sufficient intake of protein from dietary sources, along with adequate calories, can meet the needs of an athlete without reliance on any type of amino acid or protein supplement. Strong muscles are developed with repetitive use of the muscles as part of a training program. A very high-protein diet may lead to weight loss, but that is only in combination with reduced carbohydrate intake. Protein is not used for energy by the body if there is adequate carbohydrate and fat consumption. The nurse should deal with the client's statement, not be judgmental about expense.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 5 Fats 5.1 To differentiate between the three types of lipids in the body and relate their functions.

1) During a community health lecture on nutrition, a member of the audience says that fats are bad and should be eliminated from the diet. What should the nurse explain about fats to the audience?

1. They are a part of a healthy diet 2. They can lead to cardiovascular disease 3. They are the worst of the major nutrients 4. They need to be severely restricted for good health Answer: 1 Explanation: The nurse should explain that fats are necessary to good health and should be part of every good diet. Fats should make up about 30% of an adult diet, preferably unsaturated fats.

Unless there is a medical reason, fats should not be severely restricted. There is no hierarchy of nutrients; all are necessary for good health. Fats do not lead inevitably to cardiovascular disease when consumed in recommended amounts.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse is explaining to a client about cholesterol in foods. Which food item should the NURSINGTB.COM nurse explain is cholesterol-free?

1. Eggs 2. Peanut butter 3. Skinless chicken 4. All-beef hot dogs Answer: 2 Explanation: Cholesterol-free foods are easy to identify. Foods that have cholesterol come from animal sources; cholesterol-free foods do not. Peanut butter is made of creamed peanuts; it does not have butter but is of the consistency of butter, hence the name. Chicken, eggs, and hot dogs come from animal sources.

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3) The nurse learns that a client had the gallbladder removed 3 years ago. What teaching should the nurse reinforce with this client?

1. Carbohydrates are now easier to digest so continue to make them a dietary priority 2. Adequate cholesterol intake is needed since there is no gallbladder to help digest it 3. A lower-fat diet is easier to digest since bile salts are no longer stored in the gallbladder 4. Weight management continues to be a priority to prevent stones from forming in the liver Answer: 3 Explanation: After cholesterol is synthesized, it can be made into bile salts and stored in the gallbladder to be used to emulsify fat during digestion. Since the client's gallbladder was removed, a lower-fat diet would be easier to digest. Weight management is not related to having a gallbladder and its role in fat digestion. The liver manufactures adequate cholesterol without any additional dietary intake. Carbohydrate digestion is not related to the gallbladder.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 5.2 To categorize dietary sources of fat, including saturated and unsaturated fatty acids.

1) The nurse is teaching a class about the role of fats in a healthy diet. What should the nurse explain about this nutrient? (Select all that apply.)

1. The best source is meat 2. They add flavor to foods 3. They spoil within 2 days at room temperature 4. They allow the body to absorb some vNitUaR mSiInNsGTB.COM 5. Most people should consume as little as possible Answer: 2, 4 Explanation: Fats add flavor and texture to foods, thereby making them more palatable to most people. People do not need to consume as little fat as possible; they need to consume the ideal fats, like monounsaturated fats, in the right proportion in the diet. Fats are necessary to promote the absorption of fat-soluble vitamins; A, D, E, and K. Fats come from many sources including plant oils, nuts, wheat germ, among others. Vegetarians can consume adequate fats without eating meat. Most fats, especially poly- and monounsaturated fats, are stable at room temperature.

Fats add flavor and texture to foods, thereby making them more palatable to most people. People do not need to consume as little fat as possible; they need to consume the ideal fats, like monounsaturated fats, in the right proportion in the diet. Fats are necessary to promote the absorption of fat-soluble vitamins; A, D, E, and K. Fats come from many sources including plant oils, nuts, wheat germ, among others. Vegetarians can consume adequate fats without eating meat. Most fats, especially poly- and monounsaturated fats, are stable at room temperature.

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2) A client asks how to avoid trans fats. Which food items should the nurse encourage the client to avoid?

1. Eggs.

2. Donuts.

3. Baked fish.

4. Barbequed pork.

Answer: 2 Explanation: Trans fats are created when polyunsaturated fats are hydrogenated; therefore, they are present when hydrogenated fats are used in the cooking process. Donuts are fried, often in partially hydrogenated fats, so they should be avoided. Eggs, fish, and pork are not significant sources of trans fats.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A client asks if it is possible for a vegetarian to consume too much fat. What should the nurse respond to this client?

1. "No, because they tend to consume only plant-based, healthy fats."

2. "No, because they use complementary proteins which are low in fat."

3. "Yes, because they may consume non-meat or dairy foods that are high in fat."

4. "Yes, because they often use too much oil or fat while cooking or sautéing vegetables."

Answer: 3 Explanation: Anyone, vegetarians included, can consume excess fat by eating products that contain fats. Processed foods, fried foodsN,UaRnSdIN baGkTeBr.yCO prModucts often contain large amounts of fat; when they are consumed in excess, an individual eats too much fat. The sautéing of vegetables requires minimal fat. Vegetarians may use complementary proteins, but that meal planning leads to minimal consumption of fat. Plant-based fats, as found in nuts, are healthier, but a vegetarian may consume too many processed foods and therefore too many fats.

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5.3 To summarize the current recommendations for dietary fat and health.

1) The nurse instructs a client about the need to limit the intake of saturated fats. Which diet selection by the client indicates that teaching has been effective?

1. Macaroni and cheese 2. Beef taco with refried beans 3. Peanut butter and jelly sandwich 4. Bacon, lettuce, and tomato sandwich Answer: 3 Explanation: A peanut butter and jelly sandwich has some fat from the peanuts, but it is not saturated fat, so it is a good choice for the client. Bacon has saturated fat (solid at room temperature) as does the cheese. Beef has saturated fat and refried beans are made with lard, another saturated fat.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) The nurse is assisting a client with planning to meet nutrient needs for a 2000 calorie diet.

How many grams of saturated fat should the nurse recommend to the client?

1. Less than 20 grams 2. 20-25 grams 3. 25-35 grams 4. About 35 grams NURSINGTB.COM Answer: 2 Explanation: According to the Fat Recommendations: Dietary Guidelines for Americans, the intake of saturated fats should be limited to less than 10% of total caloric intake. The calculation for this client would be 2000 calories x 10% divided by 9 calories/gram (200/9 = 22.2 grams of fat).

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) The health care provider recommends that a client increase the intake of omega-3 fatty acids to reduce the risk of cardiac disease. Which food should the nurse recommend to this client?

1. One serving per week of shellfish, like shrimp or oysters 2. Two servings per day of organically grown whole wheat 3. Two servings per week of deep water fish, like salmon or tuna 4. One serving per week of free-range grown chicken that is served skinless Answer: 3 Explanation: Omega-3 and omega-6 fatty acids are found in highest concentrations in deep, cold water fish like salmon or mackerel. Shellfish are found in shallow warmer waters so they do not have high concentration of omega-3 or omega-6 fatty acids. In addition, many people are allergic to shellfish. Plant-based foods and chicken, regardless of how grown or raised, are not good sources of omega-3 and omega-6 fatty acids.

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5.4 To compare the lifespan and medical condition-specific recommendations for dietary fat intake.

1) Parents are concerned about their child becoming obese so want to limit the fat intake of their 2-year-old by switching to skim milk and fat-free foods. What advice should the nurse give to these parents?

1. "Preventing obesity is a good goal; limiting fat is the first step."

2. "Toddlers need fats to grow so this is not a time to severely limit fat."

3. "This is a reasonable goal only if you think obesity is a problem in your family."

4. "As long as your toddler gets about 25% of calories from fats, this is reasonable."

Answer: 2 Explanation: Toddlers need about 30% to 40% of their daily calories from fat to promote growth and development. The fats should come from healthy sources like monounsaturated oils, fish, or reduced fat milk. Trans and saturated fats should be avoided. Obesity can be avoided by providing time for regular activity and modeling healthy eating.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) An adult client consumes about 1800 calories per day. How many calories per day should the nurse counsel the client to consume from fats?

1. 200 calories NURSINGTB.COM 2. 450 calories 3. 800 calories 4. 1000 calories Answer: 2 Explanation: Adults should get about 20% to 35% of their daily calories from fats. The client who consumes about 1800 calories per day needs approximately 360 to 630 calories per day from fat. The calculation is as follows: (1800 calories x 0.20 = 360 calories to 1800 x 0.35 = 630).

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3) The nurse is preparing diet teaching for an older male client. What dietary recommendations should the nurse make regarding intake of linoleic acid?

1. About 17 grams per day will be sufficient 2. A minimum of 10 grams a day is required for good health 3. It should be no more than 5% to 8% of daily caloric intake 4. It is so widely available in foods that it is not a concern for healthy adults Answer: 1 Explanation: The current recommendation for adult males is 17 grams of linoleic acid and 1.6 grams of linolenic acid per day, or a combination of the two equaling about 10% of calories per day. These are fatty acids that are present in foods that contain fats.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 5.5 To develop strategies for nursing interventions that target dietary fat intake.

1) The nurse is caring for a client who has fat malabsorption. On which signs of this disorder should the nurse assess this client?

1. Edema 2. Brittle nails 3. Dehydration 4. Vitamin A deficiency Answer: 4 B.aCyOhM Explanation: Clients who have fat malabNsUoRrpStIiNoGnTm ave signs of fat-soluble vitamin deficiencies. Vitamins A, D, E, and K are fat-soluble vitamins. Edema is associated with protein deficiency. Dehydration occurs with fluid deficiency. Brittle nails may occur for many reasons, such as fungal diseases, not associated with fat intake.

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2) A client explains that meat is still an important component of the family meals and they can't figure out how to reduce the fat if they like meat so much. Which suggestion should the nurse make? (Select all that apply.)

1. Broil meat 2. Avoid gravies 3. Eat smaller portions 4. Remove skin from poultry 5. Reduce total calories per day Answer: 1, 2, 3, 4 Explanation: Meat can be part of a healthy diet. Broiling meat, rather than frying, can reduce the amount of fat. Skin contains a lot of the fat, so the skin should be removed from poultry. Other meats should have the fat trimmed before preparation. A serving that is about the size of a deck of cards or the palm of the hand, 3—4 ounces, is considered a serving of meat. Many people eat more than that as a portion size. Gravies are made from meat drippings which contain fat. They should be avoided unless they can be made without meat drippings. Calorie reduction does not address fat intake, only total energy intake. People who like meat do not necessarily need to reduce caloric intake.

Meat can be part of a healthy diet. Broiling meat, rather than frying, can reduce the amount of fat. Skin contains a lot of the fat, so the skin should be removed from poultry. Other meats should have the fat trimmed before preparation. A serving that is about the size of a deck of cards or the palm of the hand, 3—4 ounces, is considered a serving of meat. Many people eat more than that as a portion size. Gravies are made from meat drippings which contain fat. They should be avoided unless they can be made without meat drippings. Calorie reduction does not address fat intake, only total energy intakNeU. RPSeIoNpGleTBw.ChO oM like meat do not necessarily need to reduce caloric intake.

Meat can be part of a healthy diet. Broiling meat, rather than frying, can reduce the amount of fat. Skin contains a lot of the fat, so the skin should be removed from poultry. Other meats should have the fat trimmed before preparation. A serving that is about the size of a deck of cards or the palm of the hand, 3—4 ounces, is considered a serving of meat. Many people eat more than that as a portion size. Gravies are made from meat drippings which contain fat. They should be avoided unless they can be made without meat drippings. Calorie reduction does not address fat intake, only total energy intake. People who like meat do not necessarily need to reduce caloric intake.

Meat can be part of a healthy diet. Broiling meat, rather than frying, can reduce the amount of fat. Skin contains a lot of the fat, so the skin should be removed from poultry. Other meats should have the fat trimmed before preparation. A serving that is about the size of a deck of cards or the palm of the hand, 3—4 ounces, is considered a serving of meat. Many people eat more than that as a portion size. Gravies are made from meat drippings which contain fat. They should be avoided unless they can be made without meat drippings. Calorie reduction does not address fat intake, only total energy intake. People who like meat do not necessarily need to reduce caloric intake.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) A client who is concerned about fat intake asks what nutritional action to take to reduce the risk of cardiovascular disease. What should the nurse say in response to this client?

1. "Eliminate saturated fat."

2. "Use fat substitutes whenever possible."

3. "Keep fat calories at less than 10% of your daily calories."

4. "Increase intake foods with omega-3 and omega-6 fatty acids."

Answer: 4 Explanation: Omega-3 and omega-6 fatty acids, found primarily in cold water fish, have been shown to reduce the risk of cardiovascular disease and sudden cardiac death. They can also be taken in the form of supplements. Saturated fats should be no more than 10% of daily calories, but a healthy diet should include 20% to 35% of calories from fat. Fat substitutes may be a good idea, but they are not the best way to reduce cardiovascular risk.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 6 Vitamins 6.1 To verbalize the connection between vitamins and health maintenance.

1) The nurse is preparing an educational seminar on nutritional needs for a community group.

What should the nurse say as an introduction to the topic of vitamins?

1. The need for vitamins is greatest in children and diminishes with aging 2. Vitamins are necessary for good health, but are needed in varying amounts 3. Achieving adequate vitamin intake is difficult, but everyone can learn how to do it 4. Vitamins were discovered about 50 years ago and have recently become the subject of intensive research Answer: 2 Explanation: All vitamins are necessary in the right balance for good health. They were discovered and named about a hundred years ago. Research about how they are used by the human body and what constitutes adequate intake has been ongoing since their discovery.

Vitamins are needed across the lifespan, although the amounts vary by age and gender. A diet with variety, balance, and moderation will include adequate vitamins.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse is planning a program about healthy eating for high school students. What should the nurse explain about the role of vitamN inUsR? SINGTB.COM 1. Provide energy 2. Are all synthesized by the body 3. Require ideal foods for maximum absorption 4. Are necessary for proper growth and development Answer: 4 Explanation: Vitamins play many different biological roles in the body. Vitamins are important components of many cellular activities in the body, including metabolism, growth, and repair.

Vitamins are micronutrients which do not provide energy; only macronutrients, like carbohydrates, provide energy. Only some of the vitamins are synthesized by the body; some must be consumed. There are no ideal foods for vitamins; however, some foods contain more of some vitamins than other foods.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) A client asks why some vitamins are antioxidants. What should the nurse explain about an antioxidant?

1. Reduces elevated lipid levels 2. Is synthesized in the skin and acts like a hormone 3. Prevents damage to cells from free radicals, metabolic by-products 4. Is a beneficial form of vitamins that promotes digestion and absorption of nutrients Answer: 3 Explanation: Antioxidants prevent damage to cells from free radicals, the by-products of metabolism or environmental damage to cells. Vitamin D is synthesized in the skin and has hormone-like qualities. Antioxidants have no role in reducing lipid levels, nor do they have a role in digestion or absorption that take place in the small intestine.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 6.2 To evaluate signs and symptoms of vitamin deficiency that can be found when conducting a nursing assessment.

1) A client with a history of alcohol abuse seeks medical attention for the onset of new symptoms. For which signs of a vitamin deficiency should the nurse assess this client? (Select all that apply.)

1. Projectile vomiting and diarrhea 2. Extreme tiredness and irritability 3. Wide fluctuations in blood glucose NURSINGTB.COM 4. Blurred vision and difficulty seeing in the dark 5. Numbness and tingling along with loss of balance Answer: 2, 5 Explanation: Alcoholism is the most frequent cause of thiamine deficiency. Thiamine deficiency alters nervous system functioning, resulting in problems with numbness, tingling in the extremities, loss of balance (ataxia), muscle weakness, and other neurological changes. Early signs of thiamine deficiency include headaches, extreme fatigue, and irritability. Vomiting and diarrhea are not usually related to vitamin deficiency, although prolonged periods of either may produce a fluid and electrolyte deficiency. Visual problems are most often associated with vitamin A deficiency. Blood glucose fluctuations are related to macronutrient intake, especially carbohydrates.

Alcoholism is the most frequent cause of thiamine deficiency. Thiamine deficiency alters nervous system functioning, resulting in problems with numbness, tingling in the extremities, loss of balance (ataxia), muscle weakness, and other neurological changes. Early signs of thiamine deficiency include headaches, extreme fatigue, and irritability. Vomiting and diarrhea are not usually related to vitamin deficiency, although prolonged periods of either may produce a fluid and electrolyte deficiency. Visual problems are most often associated with vitamin A deficiency. Blood glucose fluctuations are related to macronutrient intake, especially carbohydrates.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 2

2) The mother of a newborn asks why the baby received a vitamin shot and what it was. What should the nurse respond to the mother about the vitamin and the purpose?

1. Vitamin A, which prevents vision problems 2. Vitamin E, which is an antioxidant that stimulates growth 3. Vitamin K, which prevents hemorrhagic conditions in newborns 4. Vitamin D, which is necessary for digestion and absorption of milk Answer: 3 Explanation: Newborns have a diminished ability to clot blood and are more prone to hemorrhages; vitamin K injections are given to prevent hemorrhages. Vitamins A, D, and E are not given to newborns.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) The nurse instructs on folate-rich foods to a client planning to become pregnant. Which food selection indicates that teaching was effective?

1. Milk 2. Hamburger 3. Spinach salad 4. Fresh orange juice Answer: 3 Explanation: Leafy green vegetables, legumes, grains, and fortified fruit juices are sources of folate. Fresh orange juice would not be a significant source of folate, nor would hamburgers or NURSINGTB.COM milk.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 4) An older client is experiencing vision problems, dry eyes, and squinting despite wearing corrective lenses. Which vitamin should the nurse suspect is deficient in this client?

1. Vitamin A 2. Vitamin B-6 3. Vitamin C 4. Vitamin D Answer: 1 Explanation: Xerophthalmia, problems seeing well in dim light, or problems with night vision are characteristic of vitamin A deficiency. The nurse would want to question if the client also has problems with night vision. Deficiencies of vitamins B6, C, and D do not cause vision problems.

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6.3 To examine the role of the nurse in identifying individuals at risk for altered health related to poor vitamin status.

1) The nurse is caring for clients with a variety of health problems. Which client should the nurse recognize as most likely to experience a vitamin deficiency?

1. Gastritis 2. Alcoholic 3. Appendicitis 4. Hypercholesterolemia Answer: 2 Explanation: The client who is routine uses or abuses alcohol may have a thiamine deficiency.

The client with elevated cholesterol will have elevated lipid levels, but they are not associated with a vitamin deficiency. Gastritis and appendicitis are rapidly diagnosed and treated so are not likely to lead to a vitamin deficiency.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 2) A client is recovering from a gastrectomy. Which information should the nurse include when providing discharge teaching to this client?

1. There is risk of pernicious anemia so regular vitamin B12 injections will be needed 2. The risk of dehydration can be reduced with vitamin C supplements along with plenty of water 3. The risk of skin changes can be reduced with vitamin E supplements to prevent damage from NURSINGTB.COM free radicals 4. There is a risk for generalized vitamin deficiency so it is important to take a daily vitamin supplement in the morning to promote absorption Answer: 1 Explanation: The client who has had a gastrectomy is at risk for pernicious anemia, a condition in which there is a deficiency of the intrinsic factor responsible for absorption of vitamin B12.

This client will need lifelong regular injections of vitamin B12. A vitamin supplement will not be adequate to meet the need for vitamin B12. Vitamins C and E can easily be obtained from the diet. Dehydration and skin changes are not associated with clients who have had a gastrectomy.

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3) A frail older resident of a long-term care facility is admitted for an acute health problem.

Which symptom should suggest to the nurse that a vitamin deficiency exists?

1. Excessive thirst 2. Muscle pain and weakness 3. Frequent headaches behind the eyes 4. Confusion when awakened in the night Answer: 2 Explanation: The frail older person who has been in a long-term care setting for many years is at risk of vitamin D deficiency. Vitamin D is synthesized during sun exposure or from adequate intake of fortified foods. People who are frail and older frequently do not have adequate food intake and do not spend much time outdoors. Signs of vitamin D deficiency are muscle pain and weakness, which may further compound the frailty. Headaches and thirst are not associated with vitamin deficiencies. Older people who are not in a familiar setting may experience some confusion when awakened during the night, but it is not a sign of vitamin deficiency.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 4) A client lost 35 pounds over the past 3 months on a very low-carbohydrate diet. What physical sign should suggest to the nurse that this client is experiencing a vitamin deficiency?

1. Swollen, shiny tongue 2. Generalized skin lesions 3. Reddened, bleeding gums NURSINGTB.COM 4. Difficulty maintaining balance Answer: 3 Explanation: Reddened, bleeding gums are a precursor to scurvy, a deficiency of vitamin C which is found in fresh fruits and vegetables. An individual who is on a very low-carbohydrate diet will refrain from eating fruits and vegetables and would need a vitamin supplement. If a supplement is not used, a vitamin C deficiency might develop. Skin lesions, or dermatitis, are a potential sign of vitamin B-6 deficiency. A shiny, swollen tongue, or glossitis, is associated with a riboflavin (B-2) deficiency. Balance problems, or ataxia, result from a thiamine (B-1) deficiency. The B vitamins are readily available in high-protein foods which are consumed on a very low-carbohydrate diet.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 7 Minerals 7.1 To examine the role of minerals in maintaining health.

1) The nurse is concerned that a client has a low calcium level. Which symptom caused the nurse to suspect that this client has severe hypocalcemia?

1. Diarrhea 2. Headaches 3. Heart arrhythmias 4. Increased blood glucose Answer: 3 Explanation: Hypocalcemia affects muscle contraction and nerve conduction and can result in cardiac arrhythmias, muscle cramps, and numbness in the extremities and around the mouth.

Tetany is the term used to describe the physical symptoms caused by low levels of calcium.

Hypocalcemia does not cause diarrhea, headaches, or increased blood glucose.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 2) The nurse notes that a client is experiencing changes in sodium, potassium, and calcium regulation. Which mineral should the nurse suspect is causing this client's electrolyte imbalances?

NURSINGTB.COM 1. Iron 2. Zinc 3. Copper 4. Magnesium Answer: 4 Explanation: Magnesium is essential in the regulation of sodium, potassium, and calcium homeostasis in intracellular and extracellular fluids. Excess or deficiency of magnesium can lead to detrimental alterations of these minerals in the body. Iron, zinc, and copper and essential minerals and play an essential role in maintaining health.

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3) A client with a cardiac arrhythmia has a serum glucose level of 239 mg/dL. Which finding should the nurse expect when assessing this client? (Select all that apply.)

1. Hypokalemia 2. Hypocalcemia 3. Hypernatremia 4. Muscle weakness 5. Minimal intake of fresh fruits and vegetables Answer: 1, 4, 5 Explanation: Clients with low levels of serum potassium have hypokalemia. Fresh fruits and vegetables are good sources of potassium. Clients with hypokalemia are more likely to experience cardiac arrhythmias, muscle weakness, increased serum glucose levels, and increased amounts of calcium present in their urine. Clients with hypocalcemia are more likely to experience seizures and tetany. Clients with hypernatremia are more likely to develop hypertension.

Clients with low levels of serum potassium have hypokalemia. Fresh fruits and vegetables are good sources of potassium. Clients with hypokalemia are more likely to experience cardiac arrhythmias, muscle weakness, increased serum glucose levels, and increased amounts of calcium present in their urine. Clients with hypocalcemia are more likely to experience seizures and tetany. Clients with hypernatremia are more likely to develop hypertension.

Clients with low levels of serum potassium have hypokalemia. Fresh fruits and vegetables are good sources of potassium. Clients with hypokalemia are more likely to experience cardiac arrhythmias, muscle weakness, increased serum glucose levels, and increased amounts of calcium present in their urine. Clients with hypocalcemia are more likely to experience seizures RSoIrNeGlT and tetany. Clients with hypernatremia aNreUm ikBe.lCyOtM o develop hypertension.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing

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7.2 To classify good dietary sources of major and trace minerals.

1) The nurse prepares dietary teaching for an older client with Crohn disease. For which mineral should the nurse suggest the client increase the intake of green leafy vegetables, whole grains, seeds, and nuts?

1. Iron 2. Zinc 3. Copper 4. Magnesium Answer: 4 Explanation: Green leafy vegetables, whole grains, seeds, and nuts are good dietary sources of magnesium. Low levels of magnesium in the plasma can lead to neuromuscular hyper excitability resulting in cardiac arrhythmias and muscular contractions. Iron, zinc, and copper are trace minerals. Iron is available from animal sources such as red meat, poultry, and fish but not from in plant food. Zinc can be found in oysters, red meats, wheat germ, wheat bran, and cereals fortified with zinc. Organ meats, seafood, and nuts are good dietary sources of copper.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) An infant in the NICU with acrodermatitis enteropathica is experiencing a scaly rash and failure to thrive. Which trace mineral should the nurse expect to be prescribed for this client?

1. Zinc NURSINGTB.COM 2. Iron 3. Copper 4. Selenium Answer: 1 Explanation: Acrodermatitis enteropathica is a congenital zinc deficiency that usually presents in infants as scaly rash, alopecia, and failure to thrive. Treatment is supplemental zinc in amounts equivalent to 3 mg/kg of body weight. Copper, selenium, and iron are other essential trace minerals needed to maintain health.

Nursing Process: Planning Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying

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3) An adolescent is prescribed fluoride because of issues with water in the home. For which reason should the nurse instruct the client to avoid taking the fluoride supplement with calcium?

1. Increases fluoride absorption 2. Increases calcium absorption 3. Decreases fluoride absorption 4. Decreases calcium absorption Answer: 3 Explanation: Co-administration of calcium and fluoride can result in 10—25% decreased absorption of fluoride since they compete for the same binding sites. Inadequate fluoride has been shown to increase the risk for dental caries. Calcium is needed to maintain bone mineral density, and decreased levels could lead to osteoporosis.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 7.3 To analyze risk factors for poor mineral status, including interactions with foods and other nutrients.

1) The nurse notes that a client follows a strict vegetarian diet. For which deficiency should the nurse assess this client?

1. Copper 2. Sodium 3. Calcium NURSINGTB.COM 4. Magnesium Answer: 3 Explanation: Clients following a strict vegetarian diet are at risk for developing calcium deficiency. Sodium is a common additive in many foods and usually found abundantly in the diet. Magnesium is found in many vegetables. Organ meats, seafood, and nuts are good sources of copper.

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2) The nurse discusses the potential for hypocalcemia with a client who is postmenopausal. For which potential health problem should the nurse caution the client to avoid long-term caffeine intake?

1. Hair loss 2. Skin rashes 3. Fluid retention 4. Urinary loss of calcium Answer: 4 Explanation: Increased calcium excretion through short-term urinary losses associated with long-term high caffeine intake has been associated with bone mineral density loss in older females. Edema is associated by sodium retention. Alopecia, or hair loss, and dermatitis are associated with zinc deficiency.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) The nurse prepares dietary teaching for a client with iron deficiency anemia. Which direction should the nurse provide the client about the prescribed iron-rich meal tea?

1. Tea will cause increased urinary loss of iron 2. Avoid coffee and tea within 1 hour of iron intake 3. Tea can increase the absorption of iron by 50—60% 4. Iron requires an alkaline environment for absorption Answer: 2 Explanation: One cup of tea can reduce NirUoRnSaIbNsGoTrB pt.C ioOnMby 50—60% when consumed within one hour of an iron source. Tea will not cause increased urinary loss of iron. An alkaline gastric environment will reduce iron absorbability because the iron is not converted to the more readily absorbed form that requires an acidic environment.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying

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7.4 To categorize signs and symptoms of mineral deficiency that can be found when conducting a nursing assessment.

1) A client is experiencing fatigue, shortness of breath, and tachycardia. Which deficiency should the nurse suspect in this client?

1. Iron 2. Zinc 3. Sodium 4. Potassium Answer: 1 Explanation: Iron deficiency results in anemia, and can cause symptoms such as shortness of breath, fatigue, and tachycardia. Symptoms of potassium deficiency include cardiac arrhythmias and muscle cramps. Zinc deficiency is more likely to include symptoms of rash or hair loss.

Sodium excess can cause shortness of breath due to a fluid overload but does not cause tachycardia or fatigue. Sodium deficiency is uncommon.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying 2) A toddler is diagnosed with zinc and manganese deficiencies. For which health problem should the nurse assess this toddler?

1. Pica 2. Anemia NURSINGTB.COM 3. Dental caries 4. Slowed growth Answer: 4 Explanation: Deficiencies in both zinc and manganese can result in slowed or stunted growth.

Dental caries are associated with fluoride deficiency. Copper deficiency is associated with anemia. Iron deficiency can result in behaviors such as pica.

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3) An older female client is diagnosed with osteopenia. On which mineral should the nurse focus when assessing this client's diet?

1. Iron 2. Calcium 3. Selenium 4. Potassium Answer: 2 Explanation: Hypocalcemia manifests itself as poor bone mineral density. Decreased bone mineral density causes weak and fragile bones and increases the risk for fractures. Symptoms of hypokalemia include cardiac arrhythmias and muscle contractions. Iron deficiency is associated with the development of anemia. Selenium deficiency is rare, but has been linked with hyperthyroidism.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 4) A client has a potassium level of 3.2 mmol/L. What should the nurse expect when assessing this client? (Select all that apply.)

1. Hypotension 2. Normal sinus rhythm 3. Increased serum calcium levels 4. Complaints of muscle weakness 5. Serum glucose level of 225 mg/dL NURSINGTB.COM Answer: 4, 5 Explanation: Clients with potassium levels less than 3.5 mmol/L have severe hypokalemia.

These clients will most often complain of muscle weakness. They can easily develop hypocalcemia because of losing calcium in the urine due to the hypokalemia. Reduced potassium levels alter the capacity of the pancreas to secrete insulin, so glucose levels increase. The blood pressure will increase and heart rhythm may become erratic.

Clients with potassium levels less than 3.5 mmol/L have severe hypokalemia. These clients will most often complain of muscle weakness. They can easily develop hypocalcemia because of losing calcium in the urine due to the hypokalemia. Reduced potassium levels alter the capacity of the pancreas to secrete insulin, so glucose levels increase. The blood pressure will increase and heart rhythm may become erratic.

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7.5 To appraise the role of the nurse in identifying individuals at risk for altered health related to poor mineral status.

1) The nurse prepares an educational seminar on mineral deficiencies. Which client population should the nurse emphasize as having the greatest risk for this health problem?

1. Poor financial status 2. Children who are picky eaters 3. Adolescents on vegetarian diets 4. Diseases associated with malabsorption Answer: 4 Explanation: One of the greatest risks for the development of mineral deficiency is among clients with diseases that cause malabsorption. Children who are picky eaters still obtain most nutrients through their diets but can also be supplemented with the use of daily vitamins if recommended. Adolescent vegetarians should be counseled on the importance of eating a balanced diet with recommendations for alternative sources of protein. Having a poor financial status may result in few fresh fruits and vegetables in the diet, but is still not as great of a risk as malabsorption.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse prepares to assess for the Trousseau and Chvostek signs in a client. For which health problem is the nurse assessing this client?

NURSINGTB.COM 1. Anemia 2. Hypokalemia 3. Hypocalcemia 4. Hypophosphatemia Answer: 3 Explanation: Trousseau and Chvostek signs can easily be used by the nurse during a physical assessment to test for signs of hypocalcemia. Levels of potassium, phosphorous, and iron are usually measured by serum tests.

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3) A client seeks medical attention for lethargy, weight gain, and a mass under the throat. Which question should the nurse ask when assessing this client?

1. "Have you had this mass since birth?"

2. "Do you have a history of thyroid cancer?"

3. "Do you include regular table salt in your diet?"

4. "Does anyone else in your family have this problem?"

Answer: 3 Explanation: Iodine deficiency can result in lethargy, weight gain, and goiter development. In the U.S., table salt is available fortified with iodine. Seafood is another rich source of dietary iodine. Goiters are not contagious since they develop due to a mineral deficiency and usually occur during adulthood. Goiters are not a form of cancer.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 8 Fluid, Caffeine, and Alcohol 8.1 To examine dietary sources of water and its role in maintaining health.

1) A client with an elevated body temperature and excessive sweating is prescribed intake and output measurements. What should the nurse include when making these measurements? (Select all that apply.)

1. Sensible water loss 2. Insensible water loss 3. Indeterminate water loss 4. Indiscriminate water loss 5. Uncompensated water loss Answer: 1, 2 Explanation: Water lost from the body by sweating is referred to as insensible water loss because it is difficult to measure. Sensible water loss refers to water loss which is measurable such as water eliminated in urine. Both types of water lost are calculated to monitor for dehydration. Indeterminate, uncompensated, and indiscriminate are not terms used to define water loss.

Water lost from the body by sweating is referred to as insensible water loss because it is difficult to measure. Sensible water loss refers to water loss which is measurable such as water eliminated in urine. Both types of water lost are calculated to monitor for dehydration. Indeterminate, uncompensated, and indiscriminate are not terms used to define water loss.

NURSINGTB.COM Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) The nurse is concerned about a critically ill client's fluid intake because intravenous fluids have expired. For which role of water in the human body should the nurse be most concerned in this client?

1. Euhydration 2. Weight stabilization 3. Elimination of fecal material 4. Transport of nutrients and other substances Answer: 4 Explanation: Water has many important roles in the human body including transportation of nutrients and other substances; regulation of the core body temperature; removal of waste products; and lubricant for joints, eyes, and mucous membranes. Water is lost during fecal elimination, but does not cause the process. Weight is affected by the amount of water in the body, but is not stabilized by it. Euhydration refers to a state of water balance.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying

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3) The nurse prepares to care for a group of assigned clients. Which body substance should the nurse recall that helps maintain an even core body temperature?

1. Fat 2. Skin 3. Water 4. Muscle Answer: 3 Explanation: Heat produced by metabolism and physical activity are absorbed by water in the body and dissipated to maintain an even core body temperature. This type of water loss is referred to as insensible since it is difficult to measure.

Nursing Process: Planning Client Need: Physiological Adaptation Cognitive Level: Applying 8.2 To illustrate methods of assessing fluid requirements.

1) A client with Alzheimer disease in an assisted living complex has been treated for dehydration because of not drinking fluid unless it is offered. Which approach should the nurse use to monitor this client's hydration status?

1. Monitor weight daily 2. Monitor input and output 3. Offer coffee several times a day 4. Provide a pitcher of water and track how much is consumed.

NURSINGTB.COM Answer: 2 Explanation: Clients with Alzheimer disease often have a blunted response to thirst and need to be monitored closely to avoid dehydration. Keeping a record of the daily intake and output will provide a tool for determining fluid needs. Coffee has been linked with water loss and may exacerbate the situation. Dependency on others for fluids is always a risk for dehydration, and frequent reminders and coaching is needed even if fluids are in the proximity.

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2) A critically ill younger client has an elevated serum sodium level. Which action should the nurse take after learning of this laboratory value?

1. Evaluate for edema 2. Assess for skin tenting 3. Check body temperature 4. Obtain a pulse oximeter measurement Answer: 2 Explanation: Assessing a client for skin turgor or "tenting" can be used to screen for hydration status. Although this may not be useful in older adults due to subcutaneous tissue loss and changes in skin elasticity related to aging, it may be a good indicator in a younger client.

Hypernatremia refers to elevated serum sodium levels and signals the loss of water from the extracellular fluid. The condition of hypernatremia does not impact the client's oxygenation status, temperature or result in edema.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying 3) A client who experiences fatigue, elevated temperature, and confusion after running a marathon has a urine specific gravity of 1.039. What should the nurse suspect be occurring with this client?

1. Euhydration 2. Dehydration 3. Water toxicity NURSINGTB.COM 4. Overhydration Answer: 2 Explanation: Normal specific gravity values are 1.002—1.028. A urine specific gravity of 1.030 or greater is a sign of dehydration. This diagnosis is supported by complaints of confusion, fatigue, and elevated temperature. Overhydration and water toxicity are terms used to describe an excessive intake of water, a condition usually found in clients with schizophrenia and other mental illnesses. Euhydration is a state of balanced body fluids.

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8.3 To summarize signs and symptoms of altered fluid status that can be found when conducting a nursing assessment.

1) The nurse assesses an older client with altered cognition. Which finding indicates to the nurse the client has an alteration in fluid balance? (Select all that apply.)

1. Dry oral mucosa 2. Dark colored urine 3. Increased heart rate 4. Lower extremity edema 5. Increased respiratory rate Answer: 1, 2, 3 Explanation: Older clients with altered cognition are at risk for dehydration. When performing a physical assessment there are several signs that may indicate that the client has an altered fluid status including: dry oral mucosa, dark colored urine, and increased heart rate. Lower extremity edema is linked to excess fluid volume and increased respiratory rate is not affected by hydration status.

Older clients with altered cognition are at risk for dehydration. When performing a physical assessment there are several signs that may indicate that the client has an altered fluid status including: dry oral mucosa, dark colored urine, and increased heart rate. Lower extremity edema is linked to excess fluid volume and increased respiratory rate is not affected by hydration status.

Older clients with altered cognition are at risk for dehydration. When performing a physical assessment there are several signs that may indicate that the client has an altered fluid status including: dry oral mucosa, dark colored urine, and increased heart rate. Lower extremity edema is linked to excess fluid volume and incrN eaUsReSdIN reGsTpB ir.aCtO orMy rate is not affected by hydration status.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying 2) A client is experiencing confusion, rapid heart rate, and an elevated body temperature. For which health problem should the nurse plan care for this client?

1. Fever 2. Viral infection 3. Altered fluid status 4. Increased heart rate Answer: 3 Explanation: The combination of symptoms indicates an alteration in fluid status. There is not enough information to determine if a virus is causing the client's symptoms. Fever and increased heart rate are symptoms of an altered fluid status.

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3) An older client is experiencing dizziness when moving from a sitting to a standing position.

Which findings should indicate to the nurse that this client may be dehydrated? (Select all that apply.)

1. Slightly confused 2. Increased heart rate 3. Lower extremity edema 4. Blood pressure lower than usual 5. Weight loss of 8 pounds since last month Answer: 1, 2, 4, 5 Explanation: Symptoms of dehydration can include sudden weight loss, increased heart rate, confusion, tachycardia, and hypotension. Older clients are at an increased risk for dehydration due to blunted thirst perceptions. Edema results from a fluid overload rather than dehydration.

Symptoms of dehydration can include sudden weight loss, increased heart rate, confusion, tachycardia, and hypotension. Older clients are at an increased risk for dehydration due to blunted thirst perceptions. Edema results from a fluid overload rather than dehydration.

Symptoms of dehydration can include sudden weight loss, increased heart rate, confusion, tachycardia, and hypotension. Older clients are at an increased risk for dehydration due to blunted thirst perceptions. Edema results from a fluid overload rather than dehydration.

Symptoms of dehydration can include sudden weight loss, increased heart rate, confusion, tachycardia, and hypotension. Older clients are at an increased risk for dehydration due to blunted thirst perceptions. Edema results from a fluid overload rather than dehydration.

Nursing Process: Assessment Client Need: Physiological Adaptation NURSINGTB.COM Cognitive Level: Analyzing 8.4 To translate the current consensus regarding the role of caffeine in overall health.

1) An adolescent student visits the school nurse because of feeling nervous and shaky after drinking several cups of coffee and caffeinated soda throughout the day. Which statement should the nurse make to this student?

1. "Many adults drink more caffeine that that in a day."

2. "Caffeine is a central nervous depressant and can cause you to feel funny."

3. "Caffeine is a form of drug and can cause serious health problems if overused."

4. "You are probably not feeling well because you did not eat breakfast and have low blood sugar."

Answer: 3 Explanation: Caffeine can be found in coffee, tea, soft drinks, chocolate, energy drinks, and medicine. Caffeine content on these products will be listed on the ingredient list or content label and should be checked prior to use. Overuse of caffeine can cause serious health problems.

Caffeine is a central nervous system stimulant and can cause people to feel irritable and/or shaky.

Medications containing caffeine include (but are not limited to) analgesics, cold remedies, and stimulants.

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2) A client with poorly controlled hypertension has a blood pressure of 190/96 mm Hg. Which food item should the nurse identify that may have contributed to this elevated measurement?

1. Coffee 2. Banana 3. Oat meal 4. Scrambled eggs Answer: 1 Explanation: Caffeine is the most widely used central nervous stimulant in the world and can adversely affect blood pressure. Banana, oat meal, and scrambled eggs would not affect blood pressure.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying 3) The nurse prepares an educational pamphlet on caffeine for a community health fair. Which statements should the nurse include in this material? (Select all that apply.)

1. Caffeine increases gastric acid 2. Caffeine can cause toxic side effects in large doses 3. Soda contains more caffeine than either coffee or tea 4. The amount of caffeine found in coffee and tea varies by brand 5. Women and adolescents consume the most caffeine in the United States Answer: 1, 2, 4 Explanation: A high intake of caffeine can cause toxic side effects that include vomiting, seizures, tachyarrhythmias, and even deaNthU.RTShINeG reTiBs.CnO oM evidence that women and adolescents consume the most caffeine in the United States. The amount of caffeine in coffee and tea is affected by the brand, brewing method, and steeping time. Caffeine increases gastric acid production and lowers the esophageal sphincter pressure which can lead to gastroesophageal reflux and gastritis. The amount of caffeine varies between products and can be determined on the ingredient label.

A high intake of caffeine can cause toxic side effects that include vomiting, seizures, tachyarrhythmias, and even death. There is no evidence that women and adolescents consume the most caffeine in the United States. The amount of caffeine in coffee and tea is affected by the brand, brewing method, and steeping time. Caffeine increases gastric acid production and lowers the esophageal sphincter pressure which can lead to gastroesophageal reflux and gastritis. The amount of caffeine varies between products and can be determined on the ingredient label.

A high intake of caffeine can cause toxic side effects that include vomiting, seizures, tachyarrhythmias, and even death. There is no evidence that women and adolescents consume the most caffeine in the United States. The amount of caffeine in coffee and tea is affected by the brand, brewing method, and steeping time. Caffeine increases gastric acid production and lowers the esophageal sphincter pressure which can lead to gastroesophageal reflux and gastritis. The amount of caffeine varies between products and can be determined on the ingredient label.

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8.5 To translate the current consensus regarding the role of alcohol in overall health.

1) A client who drinks 3 to 4 martinis before dinner every night feels that people who drink beer are alcoholics because of the volume of alcohol in each can. Which response should the nurse make to this client?

1. "Beer and martinis have the same alcohol and calorie content."

2. "Only beer drinkers are considered alcoholics if they overindulge."

3. "The alcohol in 4 martinis is equal to about 11 cans of regular beer."

4. "People who drink martinis may consume a smaller amount of alcohol but can still be considered alcoholics."

Answer: 3 Explanation: The average 12-ounce serving of regular beer contains about 14 gm of alcohol.

Depending upon the ingredients, a martini will continue much more than 14 gm of alcohol per drink. This client is consuming 3 to 4 martinis each night. Anyone who drinks to excess and is unable to control the desire for alcohol can be considered an alcoholic. It does not make a difference what type of alcohol is consumed.

Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Applying 2) A client who is pregnant with a first child asks if alcohol can be consumed while pregnant.

Which response should the nurse make to this client?

1. "If having wine with dinner is usually done, you should drink it."

2. "Consider drinking beer instead becauNseURitScIN onGtTaB in.C s OmMore nutrients."

3. "To keep your baby as safe as possible, alcohol should be avoided during pregnancy."

4. "One or two glasses of wine with dinner should not be harmful, but avoid liquor and beer."

Answer: 3 Explanation: Alcohol intake during pregnancy is associated with lifelong neurocognitive deficits, behavior problems, and malformation in offspring called fetal alcohol spectrum disorders. No safe level of alcohol intake has been determined that avoids these consequences.

The other choices are not appropriate responses regarding ingesting alcohol while pregnant.

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8.6 To evaluate the role of the nurse in identifying individuals at risk for altered health related to poor fluid status or excessive intake of caffeine or alcohol.

1) The nurse notes that several students experience muscle weakness, dizziness, and increased heart rate after cross-country practice. Which action should the nurse take? (Select all that apply.)

1. Attend all sports events to ensure students are adequately hydrated 2. Discuss the need for athletes to have extra fluids with the physical education staff 3. Coordinate emergency personnel to be present during every cross-country practice 4. Arrange a special class for athletes to discuss good hydration and symptoms of dehydration 5. Include information about the symptoms and effects of altered fluid status in health class which is mandatory for all students Answer: 2, 4, 5 Explanation: Dehydration is a risk for athletes who participate in sports which include strenuous physical activity. Arranging a class for school athletes, including information for all students, and discussing fluid needs with the physical education staff would all be good interventions for the nurse. The nurse should not have to be present at all sports events. Emergency personnel does not need to be present for every practice session.

Dehydration is a risk for athletes who participate in sports which include strenuous physical activity. Arranging a class for school athletes, including information for all students, and discussing fluid needs with the physical education staff would all be good interventions for the nurse. The nurse should not have to be present at all sports events. Emergency personnel does not need to be present for every practice session.

Dehydration is a risk for athletes who paNrtUicRiSpIaNteGiTnBs.CpO orMts which include strenuous physical activity. Arranging a class for school athletes, including information for all students, and discussing fluid needs with the physical education staff would all be good interventions for the nurse. The nurse should not have to be present at all sports events. Emergency personnel does not need to be present for every practice session.

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2) A pregnant adolescent is not gaining weight and reports having a few beers with friends over the weekends. Which response should the nurse make to this client? (Select all that apply.)

1. "This just shows what kind of a mother you will be."

2. "No amount of alcohol has been proven safe to consume during pregnancy."

3. "An occasional beer may be safe, but why take a chance with your baby's health?"

4. "Alcohol use during pregnancy is toxic to the fetus and can affect normal development."

5. "Alcohol can prevent the absorption of nutrients that are important for fetal development."

Answer: 2, 4, 5 Explanation: The intake of any amount of alcohol is not recommended during pregnancy.

Alcohol acts as a direct toxin on the developing fetal brain and can cause permanent neurocognitive damage. Alcohol constricts blood vessels and limits the amount of blood flowing to the placenta. Any alcohol ingested during pregnancy can lead to fetal alcohol spectrum disorder which causes physical defects and mental and behavioral disabilities. Binge drinking places the fetus at greatest risk. Criticizing the young woman will close the doors of communication.

The intake of any amount of alcohol is not recommended during pregnancy. Alcohol acts as a direct toxin on the developing fetal brain and can cause permanent neurocognitive damage.

Alcohol constricts blood vessels and limits the amount of blood flowing to the placenta. Any alcohol ingested during pregnancy can lead to fetal alcohol spectrum disorder which causes physical defects and mental and behavioral disabilities. Binge drinking places the fetus at greatest risk. Criticizing the young woman will close the doors of communication.

The intake of any amount of alcohol is not recommended during pregnancy. Alcohol acts as a direct toxin on the developing fetal brain and can cause permanent neurocognitive damage.

Alcohol constricts blood vessels and limNitU s RthSeINaGmToBu.C ntOoMf blood flowing to the placenta. Any alcohol ingested during pregnancy can lead to fetal alcohol spectrum disorder which causes physical defects and mental and behavioral disabilities. Binge drinking places the fetus at greatest risk. Criticizing the young woman will close the doors of communication.

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3) A male client has stopped smoking, plays golf twice a week, and drinks two glasses of wine a night because of learning it is good for the heart. Which response should the nurse make to this client?

1. "Any amount of alcohol is bad for your health."

2. "Wine is low in calories so should not cause weight gain."

3. "Wine has definitely been linked with liver cancer and should be avoided."

4. "Two glasses of wine would be considered drinking in moderation, but any more could cause problems such as hypertension or liver disease."

Answer: 4 Explanation: The current recommendation for alcohol intake is one drink per day for small men and women, whereas two drinks would be considered drinking in moderation for larger men.

Moderate intake of alcohol can have some health benefits, but in excess has been linked to cancers, hypertension, depression, insomnia, and disorders of the gastrointestinal tract. Alcohol contains 7 calories/gram and should be identified as a source of calories.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 9 Energy Balance 9.1 To define energy and categorize how it is supplied by the diet.

1) The nurse prepares educational material for a high school class that explains how the components of food are metabolized to create energy. Which type of energy should the nurse explain is created by the metabolism of food?

1. Lactic acid 2. Calcium carbonate 3. Adenosine triphosphate 4. Potassium biphosphate Answer: 3 Explanation: The body derives energy in the form of adenosine triphosphate (ATP) from the metabolism of carbohydrates, fats, protein, and alcohol contained in foods and beverages. Energy is needed in the human body to power our body and to produce heat to maintain body temperature. We obtain this energy from stored chemical energy in foods we eat. Lactic acid, calcium carbonate, and potassium biphosphate do not produce energy for the body.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) An adolescent client with anorexia nervosa asks why eating small amounts of food is a problem. Which response should the nurNseUR mSaIkNeGtToBt.hCiOs M client?

1. "Eating enough food is more important than the quality of the food."

2. "Adolescent females must consume at least 3,000 kcal/day to prevent weight loss."

3. "Food contains chemical energy needed to power our bodies and maintain body temperature."

4. "There is no set amount of food we should consume daily, it depends on the individual's appetite."

Answer: 3 Explanation: Food contains stored chemical energy that provides energy to power the body and produce heat to maintain body temperature. The number of calories needed to meet daily energy expenditures depends on many factors including age, body size activity level, and metabolic rate.

To lose a pound of body fat the energy balance must be altered by approximately 3,500 kilocalories/day. The quality and balance of the diet is more important than the amount of food eaten to ensure that the body has adequate nutrients for proper functioning.

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3) The nurse prepares educational material on nutrition for a community group. Which food item should the nurse explain has the most amount of calories per gram?

1. Fats 2. Protein 3. Alcohol 4. Carbohydrates Answer: 1 Explanation: Foods contain different numbers of calories per gram. Fats contain 9 kcal/gram.

Carbohydrates and proteins contain 4 kcal/gram, and alcohol contains 7 kcal/gm.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 9.2 To summarize the components of energy expenditure.

1) The nurse is calculating the amount of calories a client should consume daily to meet energy needs. What should the nurse consider when making this calculation? (Select all that apply.)

1. Food source 2. Client's appetite 3. Basal metabolic rate 4. Client's body weight 5. Thermic effect of food Answer: 3, 5 GTo Bf.CaO Explanation: Total energy expenditure iN s UthReSIN sum llMenergy requiring processes in the body as well as any physical activity. The basal metabolic rate and the thermic effect of food are included in this equation. The food source and client's appetite determine the number of calories consumed. The patient's current body weight is not considered.

Total energy expenditure is the sum of all energy requiring processes in the body as well as any physical activity. The basal metabolic rate and the thermic effect of food are included in this equation. The food source and client's appetite determine the number of calories consumed. The patient's current body weight is not considered.

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2) A client is concerned about losing weight after joining a gym. Which response should the nurse make to this client?

1. "When you exercise you always lose weight."

2. "You were overweight to begin with so don't worry unless it becomes a problem."

3. "Eat a couple of candy bars before you exercise to give you extra energy and maintain your weight."

4. "Exercise requires extra energy and extra calories, so to maintain your weight you will need to eat more."

Answer: 4 Explanation: Exercise increases the energy demands and calories utilized by the body. If additional calories are not consumed to compensate for the increased use the result will be a weight deficit. Although a person may lose weight when exercising regularly, weight is also determined by the number of calories consumed. One of the benefits of exercise in overweight people is weight loss. Although dense in calories, candy quickly metabolized in the body and is not a long-lasting energy source.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A critically ill client has a fever. By which percent should the nurse adjust the energy expenditure calculation for every degree F for this client?

1. 5% 2. 7% NURSINGTB.COM 3. 12% 4. 15% Answer: 2 Explanation: Fever causes elevated energy expenditure as the body responds with increased heart rate and respirations. The clinical nutrition practice is to increase the energy expenditure calculation by 7% for each 1-degree F that the temperature is elevated to compensate for this increase. This has been shown to be especially helpful for an already critically ill patient with altered metabolic needs because of illness.

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9.3 To examine energy balance and factors that contribute to altered energy balance.

1) The nurse is planning care for a critically ill client with a fever. For which reasons should the nurse adjust the energy expenditure calculation for this client? (Select all that apply.)

1. Weight 2. Appetite 3. Anorexia 4. Shivering 5. Increased temperature Answer: 3, 4, 5 Explanation: Both increased temperature and shivering increase the energy expenditure for the critically ill client. Anorexia should also be considered since a decrease in calories can result in a net weight loss. Weight can be used to monitor the balance of energy expenditure and caloric intake. Appetite determines the amount of food consumed, not the needs of the body for energy.

Both increased temperature and shivering increase the energy expenditure for the critically ill client. Anorexia should also be considered since a decrease in calories can result in a net weight loss. Weight can be used to monitor the balance of energy expenditure and caloric intake.

Appetite determines the amount of food consumed, not the needs of the body for energy.

Both increased temperature and shivering increase the energy expenditure for the critically ill client. Anorexia should also be considered since a decrease in calories can result in a net weight loss. Weight can be used to monitor the balance of energy expenditure and caloric intake.

Appetite determines the amount of food consumed, not the needs of the body for energy.

Nursing Process: Planning Client Need: Physiological Adaptation NURSINGTB.COM Cognitive Level: Applying 2) A female client with a BMI of 35 believes the weight gain is caused by menopause. Which response should the nurse make to this client?

1. "Many women gain significant amounts of weight following menopause."

2. "This may be a good time to discuss diet programs, since you are obviously overweight."

3. "Being overweight is a concern, but since you are healthy otherwise we can just watch for a while to see what happens."

4. "Women tend to gain weight as they get older, but increased exercise and cutting back on fats and sugar could help prevent other medical problems in the future."

Answer: 4 Explanation: Aging can result in decreased physical exercise leading to a positive energy balance and weight gain. With a BMI of 35, the client is obese and at risk for other medical problems such as diabetes and cardiac disease. There is no proven relationship between menopause and weight gain. Dieting alone has not been shown to be as effective as weight loss and exercise. Waiting to act increases the risk for development of other medical problems.

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3) An adolescent with a BMI of 28 asks the school nurse for help in losing weight. Which approach should the nurse recommend for the client to reach a negative energy balance and weight loss?

1. Eating only fruits and vegetables 2. Reducing food portions to one-half of normal and exercising daily 3. Drinking only liquid dietary supplements for one month to change her metabolic rate 4. Decreasing calorie intake and increasing physical activity to promote a slow weight loss Answer: 4 Explanation: Creating negative energy expenditure by decreasing the number of calories consumed daily and increasing physical activity has been shown to be the most effective way to achieve long-term success with weight loss. Radial decreases in food intake produces a negative energy expenditure, but at the cost of adequate nutrition. Reducing food portions by one-half may be an extreme cut unless previous portions are massive. The best diet is one balanced to provide all the nutritional requirements of the body.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 9.4 To formulate nursing interventions that target improving energy balance for weight loss or weight gain.

1) During regular parent-teacher conferences, the school nurse learns that many overweight students spend time at home working at the computer and watching television. Which action B.eCiO should the nurse take to help the studentN sU wRitShINthGeTw ghMt issue?

1. Plan a nutrition class for parents after school 2. Include information on obesity in health classes 3. Have a local athlete speak to students about staying fit 4. Volunteer to supervise after-school games at the playground several days a week Answer: 4 Explanation: Volunteering to supervise outside games on the playground after school would be a way to promote supervised physical exercise in a way that may attract the students. Planning nutrition classes for parents, including information on obesity in health class, or having a speaker would not actively involves the students in exercise.

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2) An older client recovering from a serious illness would like to gain back the weight lost while hospitalized. Which action should the nurse recommend to help this client achieve positive energy expenditure? (Select all that apply.)

1. Limit alcohol consumption 2. Avoid unnecessary strenuous activity 3. Decrease intake of nutrient rich foods 4. Increase the amount of food consumed daily 5. Enhance caloric intake with high protein nutritional supplements Answer: 1, 2, 4, 5 Explanation: To create a positive energy expenditure, the number of calories consumed need to be increased and energy expended through physical activity should be minimized. Calories can be increased by increasing the amount of food consumed daily and enhancing caloric intake with high protein nutritional supplements. Alcohol consumption increases the number of calories consumed, but does not produce energy. Energy expenditure can also be decreased by avoiding unnecessary strenuous activity. Decreasing nutrient-rich foods could create a negative energy balance.

To create a positive energy expenditure, the number of calories consumed need to be increased and energy expended through physical activity should be minimized. Calories can be increased by increasing the amount of food consumed daily and enhancing caloric intake with high protein nutritional supplements. Alcohol consumption increases the number of calories consumed, but does not produce energy. Energy expenditure can also be decreased by avoiding unnecessary strenuous activity. Decreasing nutrient-rich foods could create a negative energy balance.

To create a positive energy expenditure, NthUeRnSuINmGbTeBr .C ofOcMalories consumed need to be increased and energy expended through physical activity should be minimized. Calories can be increased by increasing the amount of food consumed daily and enhancing caloric intake with high protein nutritional supplements. Alcohol consumption increases the number of calories consumed, but does not produce energy. Energy expenditure can also be decreased by avoiding unnecessary strenuous activity. Decreasing nutrient-rich foods could create a negative energy balance.

To create a positive energy expenditure, the number of calories consumed need to be increased and energy expended through physical activity should be minimized. Calories can be increased by increasing the amount of food consumed daily and enhancing caloric intake with high protein nutritional supplements. Alcohol consumption increases the number of calories consumed, but does not produce energy. Energy expenditure can also be decreased by avoiding unnecessary strenuous activity. Decreasing nutrient-rich foods could create a negative energy balance.

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3) A middle-aged female client is upset about not losing weight despite being active with household chores throughout the day. Which response should the nurse make to this client?

1. "As people age they tend to naturally gain weight."

2. "In order to lose weight you must increase physical exercise and reduce calories."

3. "Doing housework only utilizes about 3 calorie/min compared with 6.1 calories/min walking."

4. "Doing housework uses the same amount of calories/min as swimming, so it is a good way to lose weight."

Answer: 2 Explanation: The best way to lose weight is to create negative energy expenditure by reducing calories consumed and increasing physical activity. Housework uses about one-third of the calories/min as swimming uses. Moderate to vigorous activity is needed to promote weight loss.

Weight gain in older adults is usually related to a decrease in physical activity.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 10 Nutritional Assessment 10.1 To identify factors of nutritional health as measured by nutrition screening and nutrition assessment.

1) A client has been diagnosed with undernutrition. Which health problem should the nurse consider as most likely contributing to this nutritional issue?

1. Problem swallowing 2. Too much body fluid 3. Sadness and depression 4. Difficulty voiding urine Answer: 1 Explanation: The client with a problem swallowing would have difficulty taking in adequate amounts of food to maintain nutritional status. Too much body fluid would cause overhydration.

Difficulty voiding urine would contribute to overhydration. Sadness and depression may reduce the appetite and reduce food intake however the most likely reason for undernutrition is the problem with swallowing.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying NURSINGTB.COM

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2) The nurse is concerned that a client is at risk for undernutrition. Which client statement caused the nurse to have this concern? (Select all that apply.)

1. "My dentures don't fit well anymore."

2. "I've been taking chemotherapy for lung cancer."

3. "I have been so sad and lonely since my wife died."

4. "I feel like there are sometimes I cannot stop eating."

5. "Each day, I take two doses of multivitamins instead of one."

Answer: 1, 2, 3 Explanation: People who are prone to developing undernutrition are those that may be unable to eat well due to a medical condition, altered functional status, a poor diet, or a low socioeconomic status. Depression and social isolation place people at risk for undernutrition. Chemotherapy can cause nausea and vomiting which is associated with undernutrition. It is important to have good oral health to be able to chew raw fruits and vegetables and other foods. People who take more than one recommended dose of a multivitamin are more prone to developing overnutrition.

People who eat too much food develop issues with overnutrition due to an increased intake of nutrients, calories, saturated fats, vitamins, and minerals.

People who are prone to developing undernutrition are those that may be unable to eat well due to a medical condition, altered functional status, a poor diet, or a low socioeconomic status.

Depression and social isolation place people at risk for undernutrition. Chemotherapy can cause nausea and vomiting which is associated with undernutrition. It is important to have good oral health to be able to chew raw fruits and vegetables and other foods. People who take more than one recommended dose of a multivitamin are more prone to developing overnutrition. People who eat too much food develop issues with overnutrition due to an increased intake of nutrients, calories, saturated fats, vitamins, and miN neUrRalSsI.NGTB.COM People who are prone to developing undernutrition are those that may be unable to eat well due to a medical condition, altered functional status, a poor diet, or a low socioeconomic status.

Depression and social isolation place people at risk for undernutrition. Chemotherapy can cause nausea and vomiting which is associated with undernutrition. It is important to have good oral health to be able to chew raw fruits and vegetables and other foods. People who take more than one recommended dose of a multivitamin are more prone to developing overnutrition. People who eat too much food develop issues with overnutrition due to an increased intake of nutrients, calories, saturated fats, vitamins, and minerals.

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3) A client develops aspiration pneumonia after a traumatic brain injury produced an impaired ability to swallow. Which activity should the nurse skip when caring for this client?

1. Nutrition history 2. Nutrition screening 3. Head-to-toe physical assessment 4. Laboratory-based diagnostic testing Answer: 2 Explanation: This client has been admitted with aspiration pneumonia and has swallowing difficulties. Nutritional screening activities are provided for clients to determine if a full nutritional assessment is needed. Based on this client's diagnosis and history, this client needs a full nutritional assessment which includes the nutrition history assessment, physical assessment, and laboratory-based diagnostic testing. Nutritional screening activities would only indicate the client needs a full nutritional assessment.

Nursing Process: Assessment Client Need: Safety and Infection Control Cognitive Level: Applying 4) The nurse is performing a nutrition assessment on the client. Which information should the nurse document as laboratory data?

1. "Leukocytosis."

2. "Client using St. John's worst daily."

3. "Dental caries and poor oral health noted."

4. "Client lost 20 pounds during last 2 months."

NURSINGTB.COM Answer: 1 Explanation: Increased white blood cell count would be documented as a laboratory result.

Weight loss would most likely be discovered when assessing the weight history during a nutritional screening, nutrition history, or during a physical assessment. Dental caries and poor oral health would be found during a physical assessment. Dietary supplement use would be discovered during the nutrition history.

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10.2 To relate the components of a nutrition history and techniques for gathering nutrition history data.

1) The nurse plans to complete nutritional assessments for a group of assigned clients. For which client would it be inappropriate for the nurse to complete a dietary recall?

1. Client with dementia 2. Client with polycystic kidney disease 3. Client with a history of Crohn disease 4. Client newly diagnosed with emphysema Answer: 1 Explanation: During a diet recall, the client is prompted to remember all of the foods and beverages that have been ingested over the last 24 hours. The client who has difficulty remembering events may have trouble with this activity. Clients diagnosed with emphysema, Crohn disease, and polycystic kidney disease would be able to provide information about their intake over the last 24 hours; however, the client with early-onset dementia may provide inaccurate or unreliable information during this activity.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) During a nutritional assessment, the nurse learned that a client ate a slice of cake 8-10 times each week. During which component of the assessment was this specific information most likely discovered?

NURSINGTB.COM 1. 24-hour diet recall 2. Nutritional screening 3. Laboratory measurements 4. Food frequency questionnaire Answer: 4 Explanation: The food frequency questionnaires provide information about the variety of foods that have been consumed over time. The nurse probably learned about the client's consumption of cake during this component of the assessment. The 24-hour diet recall provides information about what the client has consumed during the last 24 hours. Laboratory measurements might assist the nurse or other health-care providers about the ingestion of fatty or sweet foods (increased lipid levels, increased blood glucose level), but this specific information would most likely come during a self-report by the client. A nutritional screening is used to quickly assess basic information (weight, weight history, and ability to ingest nutrition orally).

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3) The nurse is performing a nutritional assessment with a client. Which question should the nurse ask during a diet recall activity?

1. "Was the fish fried?"

2. "What did you eat for lunch?"

3. "What dietary supplements do you take each day?"

4. "Compared to this container, how big was your glass of chocolate milk?"

Answer: 4 Explanation: It is important to be open-minded when assessing a patient. It is not appropriate to assume that they ate any meal. Hinting at a correct answer, such as asking "What did you have for lunch?" when the person may have skipped lunch, or appearing to judge a patient can lead to fabricated answers and other misreporting. The nurse should be self-aware of body language, word choices, and tone of voice. The client should be gently prompted. The nurse should clarify what a dietary supplement is and ask questions about their use by this client. The client should be asked how the item was prepared and not given options about which way the food item was prepared. The nurse cannot assume information about serving sizes.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 10.3 To distinguish the anthropometric measurements and physical findings that comprise the physical assessment portion of the nutritional assessment.

1) A client has been diagnosed with anorexia nervosa and is currently receiving treatment.

During a physical assessment, which finN diUnRgSiInNdGicTaBt.eCsOthMe client may be noncompliant with therapeutic interventions?

1. Urine specific gravity of 1.002 2. Weight gain of 1 pound since the previous week 3. The client opts to wear only a gown when weighed 4. The client verbalizes that treatment is making the client feel better Answer: 1 Explanation: The client with a low urine-specific gravity is most likely drinking large quantities of water prior to being weighed. This client is displaying noncompliant behavior. A weight gain of 1 pound over the course of a week for the client indicates treatment may be effective. The client who decides to only wear a gown while being weighed indicates treatment may be effective. Clients with eating disorders who wear heavy clothes or weights in their pockets and underwear exhibit noncompliant behaviors. The client who verbalizes that they feel treatment is making them feel better is possibly receiving effective treatment.

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2) The nurse completes a nutritional assessment with assigned clients. For which client is an unplanned change in weight the most significant and has the highest priority for nursing interventions?

1. The client weighed 111 and lost 5 pounds in the last month 2. The client weighed 200 pounds and lost 9 pounds in the last month 3. The client weighed 135 pounds and lost 14 pounds during the last 6 months 4. The client weighed 155 pounds and lost 14 pounds during the last 6 months Answer: 3 Explanation: An unplanned weight loss for a client of 5% or more over the course of 1 month, or 10% or more over the course of 6 months, is significant and requires interventions. The client, who weighed 135 pounds and lost 14 pounds during the last 6 months, had a weight loss of 10.4%. This client's weight loss is significant and would require immediate intervention. The client, who weighed 155 pounds and lost 14 pounds over 6 months, had a weight loss of 9%. The client, who weighed 200 pounds and lost 9 pounds during the last month, had a weight loss of 4.5%. The client, who weighed 111 pounds and lost 5 pounds in the last month, had a weight loss of 4.5%.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 3) The nurse is measuring and evaluating waist circumferences to screen for cardiovascular disorders and type 2 diabetes mellitus. For which client should the nurse use waist circumference for this purpose?

NURSINGTB.COM 1. Client with cirrhosis 2. Pregnant female client 3. Client with pancreatic cancer 4. Client with peripheral arterial disease Answer: 4 Explanation: It is not appropriate to use a client's waist circumference to screen for cardiovascular diseases and type 2 diabetes mellitus if the client has a medical condition that produces a rotund abdomen. Clients with cirrhosis may have ascites due to low albumin levels.

Nurses should not screen pregnant female clients for these disorders with this method. It would be appropriate to screen clients with peripheral arterial disease with this method. It would not be appropriate to use this screening method in clients with pancreatic cancer. Their abdomen may be larger due to the tissue mass within the abdomen.

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10.4 To illustrate appropriate laboratory data for use in an assessment.

1) The healthcare provider prescribed several laboratory tests for a client as part of a nutritional assessment. Which laboratory test provide the most accurate information regarding current nutritional status?

1. Albumin 2. Transferrin 3. Prealbumin 4. Total lymphocyte count Answer: 3 Explanation: Albumin, prealbumin, and transferring are classified as plasma proteins. Each of these proteins has a different half-life. Plasma proteins with short half-lives provide more current information about a client's nutritional status. Albumin has a long half-life, so it is not a very sensitive marker. Transferrin has a shorter half-life than albumin, but it is still not the best marker for nutritional status. The half-life of prealbumin is the shortest of the three plasma proteins and it can be used to evaluate a client's current nutritional status. The total lymphocyte count is more useful to measure immunocompetence and is not used to measure a client's nutritional status.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) A client who takes ginseng for stress and a baby aspirin each day reports increased bruising SIN and a decreased ability to clot after injurN ieUs.RW hiGcThBi.nCtO erMvention should be included in this client's nursing care plan?

1. Encourage to discuss emotional stressors 2. Encourage to discontinue use of baby aspirin 3. Encourage to begin consuming foods that are rich in vitamin K 4. Encourage to discuss the use of dietary supplements with the health-care provider Answer: 4 Explanation: This client is taking aspirin and ginseng. Both substances increase bleeding times which result in bruising and an inability to clot after injuries. The client should be encouraged to discuss the use of supplements with the primary healthcare provider in order to prevent further interactions between medications and dietary supplements. The client should not be encouraged to consume foods rich in vitamin K to induce better clotting. The greatest priority rests with reducing the problems presented by the dietary supplement. The client should be encouraged to discuss emotional stressors later, but at this time it is most important to address the decreased ability to clot.

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3) The nurse is performing a nutritional assessment with an older client who takes no medications. Which laboratory value should cause the nurse the most concern?

1. Albumin 4.2 gm/L 2. Prealbumin 322 mg/L 3. Transferrin 175 mg/dL 4. Cholesterol 114 mg/dL Answer: 3 Explanation: Normal transferrin is above 200 mg/dL. The half-life of transferrin is 8 to 10 days, reflecting a more current picture of nutrition status than with albumin but less current than prealbumin. Transferrin levels are altered during physiological stress because of its role as an acute phase reactant protein, limiting its use as a true indicator of nutrition status under such conditions. Normal albumin levels are 3.5—5.0 gm/L. Normal prealbumin levels are 150-350 mg/L. The client's cholesterol level is below 200 mg/dL. Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 10.5 To strategize how to incorporate a nutritional assessment into the nursing process.

1) A client with severe weight loss is diagnosed with anorexia nervosa. Which issue should the nurse identify as the priority when planning care for this client?

1. Altered body image 2. Impaired swallowing NURSINGTB.COM 3. Self-destructive behavior 4. Insufficient caloric intake Answer: 4 Explanation: A client with anorexia nervosa and severe weight loss is restricting caloric intake.

This is the priority problem. The reason for the illness might be an altered body image however this would not be the priority. It is unlikely that the client has impaired swallowing because of the medical diagnosis of anorexia nervosa. Anorexia nervosa might be viewed as self-destructive behavior however this is not the priority at this time.

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2) A client requests information on weight loss approaches. Which goal should the nurse identify for this client?

1. Participate in 75 minutes of aerobic activity each day 2. Weight loss of 12% of current body weight in 6 months 3. Weight loss of 6% of current body weight in one month 4. Verbalize methods to reduce weight through dietary planning Answer: 4 Explanation: Losing more than 5% in one month or more than 10% of body weight in 6 months is too drastic. Thirty minutes of aerobic activity each day is enough to help a client lose weight.

Not every client can tolerate 75 minutes of physical activity each day. It would be appropriate to expect the client to verbalize methods to reduce weight through dietary planning.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A client who is overweight asks for assistance with weight loss approaches. Which intervention should the nurse implement for this client?

1. Obtain daily laboratory values 2. Assist to maintain a food and activity diary for 6 months 3. Assist to plan for ways to reduce the amount of time that is spent sitting each day 4. Assist in developing a dietary plan that reduces caloric intake by 750 calories per day Answer: 3 Explanation: The client should be assisted to plan ways to decrease the amount of time that is spent sitting each day. Physical activity cNaUnRbSeINinGcTrBe.aCsO edMper advisement of the client's healthcare provider. This client should be assisted to initially reduce dietary intake by 500 calories per day. Laboratory values do not need to be obtained this frequently. A food and activity diary should be maintained for one week. There is no reason to assess this information for 6 months.

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10.6 To differentiate between normal and abnormal findings in a nutritional assessment.

1) The nurse is assessing a client using the Nutritional Screening Initiative Tool. Which information would increase the client's score on this screening tool?

1. Takes atenolol daily 2. Requires assistance of one person to bathe 3. Maintained weight over last 7 years within 5 pounds 4. Receives visits from daughter and grandchildren three times each week Answer: 2 Explanation: An increased score on this screening tool may indicate undernutrition. The client who requires assistance with self-care does have an increased risk for undernutrition. The client who takes multiple medications, not one medication daily, is at a higher risk for undernutrition.

The client who has maintained their weight does not have an increased risk for undernutrition.

The client who has adequate social contact does not have an increased risk for undernutrition.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) An older client receives Medicare and lives in a Medicare-certified long-term care facility.

Which tool should the nurse used to assess this client's nutritional status?

1. MyPyramid 2. Minimum Data Set 3. Nutrition Screening Initiative 4. Malnutrition Universal Screening TooNl URSINGTB.COM Answer: 2 Explanation: All clients receiving Medicare and living in a Medicare-certified health-care facility must be assessed using the Minimum Data Set. The Nutrition Screening Initiative is used for older adults. The Malnutrition Universal Screening Tool is used in adults for screening purposes only. MyPyramid is not an assessment or screening tool. It is used to quickly assess food intake and compare to dietary recommendations.

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3) Parents ask for information about proper nutrition for their child. Which response should the nurse make to these parents?

1. "The Mini Nutrition Assessment is easy to use and it is online."

2. "The Nutrition Screening Initiative would be just right and it's easy to use."

3. "MyPyramid would be a great way to find out if your child is getting the right amount of food and nutrients."

4. "The Malnutrition Universal Screening Tool would be good to use with your child and it is really easy to perform."

Answer: 3 Explanation: The only appropriate way to quickly assess a child's nutritional intake is with MyPyramid based on the Dietary Guidelines for Americans. All other assessment screening tools are for use with adults or older adults. The Malnutrition Universal Screening Tool, the Nutrition Screening Initiative, and the Mini Nutrition Assessment are all easy to use. The Mini Nutrition Assessment is online.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 4) A young client has a smooth, bright red tongue, sores on the lips and in the corners of the mouth, and pallor. Which dietary deficiency should the nurse expect to discover during the nutritional assessment? (Select all that apply.)

1. Iron 2. Niacin NURSINGTB.COM 3. Vitamin A 4. Vitamin D 5. Riboflavin Answer: 1, 2, 5 Explanation: An iron-deficiency is associated with pale skin and mucous membranes. Dietary deficiency of niacin would account for the smooth, bright red tongue and sores on the client's lips. Dietary deficiency of riboflavin would account for the smooth, bright red tongue and sores on the client's lips. Vitamin A deficiency is associated with skin disorders such as follicular hyperkeratosis. Vitamin D deficiency is associated with rickets and poor bone and teeth development.

An iron-deficiency is associated with pale skin and mucous membranes. Dietary deficiency of niacin would account for the smooth, bright red tongue and sores on the client's lips. Dietary deficiency of riboflavin would account for the smooth, bright red tongue and sores on the client's lips. Vitamin A deficiency is associated with skin disorders such as follicular hyperkeratosis.

Vitamin D deficiency is associated with rickets and poor bone and teeth development.

An iron-deficiency is associated with pale skin and mucous membranes. Dietary deficiency of niacin would account for the smooth, bright red tongue and sores on the client's lips. Dietary deficiency of riboflavin would account for the smooth, bright red tongue and sores on the client's lips. Vitamin A deficiency is associated with skin disorders such as follicular hyperkeratosis.

Vitamin D deficiency is associated with rickets and poor bone and teeth development.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 11 Nutrition and Health Promotion 11.1 To examine the powerful influence of community on individual health behaviors.

1) The nurse is preparing an educational program for parents of children with celiac disease. To develop a successful program for this community, which concept is important for the nurse to employ?

1. Treat the relationship with the community as a partnership.

2. The nurse alone has the power to shape and influence the behaviors of the community members.

3. Current community values only play a small role in changing behaviors of community members.

4. There is usually no need to include community leaders when developing a program for the community.

Answer: 1 Explanation: It is very important for the nurse to understand that community members must be worked with in partnership. Community leaders and members must be included when developing programs with ultimately successful outcomes. Behaviors of individuals within a community are influenced and shaped by community values and social norms. Communities can change individual behavior by promoting desirable behaviors and environments.

Nursing Process: Planning Client Need: Health Promotion and Maintenance NURSINGTB.COM Cognitive Level: Applying 2) A community member asks the difference between primary, secondary, and tertiary health prevention activities. Which statement by the nurse is an accurate interpretation?

1. "Tertiary health prevention activities are used to prevent health conditions from occurring."

2. "Primary health prevention activities are often very individualized and focus on disease management."

3. "Secondary health prevention activities are provided to detect the early development of a health condition."

4. "Tertiary health prevention activities are often provided for a community and not used to target individuals."

Answer: 3 Explanation: Primary health prevention activities are prevention-oriented activities that are delivered to a community. Secondary health prevention activities are used to screen for potential or actual health problems that are developing or have developed. Tertiary health prevention activities are provided for individuals to help manage an existing health condition.

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3) The nurse is performing a community needs assessment. Which concept is accurate regarding the influence that an individual's peers can have on health promotion behaviors?

1. Peers are more often associated with negatively influencing individual health promotion behaviors.

2. Only adolescents and the elderly are susceptible to peer influences regarding health promotion behaviors.

3. Peers can positively influence health promotion behaviors, especially if the peer is experiencing benefits from the behavior.

4. Celebrity spokespersons have been found to have very little impact on individual health promotion behaviors.

Answer: 3 Explanation: Peers can have a powerful and positive influence on individual health promotion behaviors. Peers are especially influential when they have experienced improvements in their health that can be visualized by others. Peers can exert more influence during specific life stages.

Celebrity spokespersons are often seen by community members as their peers and they do have the power to promote positive lifestyle changes.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 11.2 To evaluate the relationship between healthy living behaviors and decreased risk of chronic diseases.

1) The nurse is providing education for aNcUoRmSImNuGnTiBty.CrOegMarding risk factors for chronic diseases.

Which statement from the audience indicates that more teaching is required?

1. "A diet with lots of fruits and vegetables will help reduce my risk."

2. "I need to get my blood pressure under control and stop drinking so much to help cut my risk."

3. "I didn't know how much my bad diet could increase my risk for developing a chronic disease."

4. "So, I don't have to lose my extra weight. I just need to stop smoking to prevent a chronic disease from developing."

Answer: 4 Explanation: Reducing the number of identified risk factors dramatically reduces the individual's risk for developing a chronic disease. Increasing the amount of fruits, vegetables, and whole grains reduces risk. Smoking, a poor diet, a sedentary lifestyle, and alcohol intake have been identified as strong risk factors for chronic disease development in the United States.

A poor diet has been associated with the development of circulatory problems, diabetes, and cancer.

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2) A client reports scoring high on the Healthy Eating Index. What should the nurse recall about this index?

1. A low score indicates a healthy eating pattern 2. A high score increases the risk for developing chronic diseases 3. A high score decreases the risk for developing chronic diseases 4. A low score indicates compliance with Healthy People 2020 nutrition guidelines Answer: 3 Explanation: A score of 100 means complete compliance with these guidelines, and a score of 0 means the respondent completely ignored the dietary recommendations. The total score is comprised of evaluating the amount and type of intake in each food group. The HEI is often used as a tool to evaluate the dietary quality of individuals who are subjects in observational research and later correlated to the risk of chronic disease. The index is not correlated with Healthy People 2020.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) The nurse examines the leading indicators included in Healthy People 2010. Which is measured as a leading indicator?

1. Pollution levels 2. Underweight people 3. H1N1 influenza cases 4. People with endocrine disorders NURSINGTB.COM Answer: 1 Explanation: The leading indicators in Healthy People 2020 are: Physical activity, Overweight and obesity, Tobacco use, Substance abuse, Responsible sexual behavior, Mental health, Injury and violence, Environmental quality, Immunization, and Access to healthcare.

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11.3 To differentiate between food intolerances and food allergies and summarize nutrition care for each.

1) A young client has developed a possible food allergy. What should the nurse anticipate being prescribed for this client?

1. A food diary 2. Cytotoxic testing 3. Oral food challenge test 4. Provocation-neutralization testing Answer: 1 Explanation: Prior to developing a treatment plan, the healthcare provider would ask the child or parent to keep a food diary, detailing every food product ingested and the amount. There are other alternative food allergy testing methods such as provocation-neutralization testing and cytotoxic testing, but these are not recognized by leading professional allergy organizations as reliable tools for identifying a food allergy. The oral food challenge test is not identified as a testing method to identify a food allergy.

Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Applying 2) A young client experiences nausea and vomiting after eating peanut butter. Which additional symptom should indicate to the nurse that the client is experiencing an allergic reaction?

1. Hives NURSINGTB.COM 2. Diarrhea 3. Constipation 4. Abdominal bloating Answer: 1 Explanation: Hives, gastrointestinal symptoms, and itching indicate that the client has released histamine because of an immune response and has had an allergic reaction. Food intolerance is associated with abdominal bloating, constipation, diarrhea, and gas production. Food intolerances do not involve an immune system response.

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3) The nurse is preparing teaching for the parents of a child with a food allergy. Which topic should the nurse identify as important for this family?

1. Dealing with food intolerance 2. How to administer epinephrine 3. The importance of avoiding milk 4. The importance of avoiding shellfish Answer: 2 Explanation: Clients with food allergies should avoid any form of the offending food. However, if the client accidentally ingests the offending food and experiences an allergic reaction, it will be important for the client or people close to the client, to be able to give the client an injection of epinephrine. Food allergies are very different from food intolerance problems and this information would not be included in the nursing care plan. For adults, the most common allergens are shrimp, lobster, crab, and other shellfish; fish; peanuts; tree nuts such as walnuts and other nuts; and eggs. For children, cow's milk, peanuts, eggs, and tree nuts are the primary allergens. It is important for the client to avoid only the foods that produce an allergic reaction.

In the question, there is no mention of which food has produced an allergic reaction in this client.

Nursing Process: Planning Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 11.4 To categorize how America's food safety is regulated and monitored.

1) While educating a client regarding food safety in the United States, the client names the Centers for Disease Control and preventiNoUnRaSsIN thGeToBr.gCaOnM ization that publishes a list of recalled food products. Which response should the nurse make to this client?

1. "Yes, the Centers for Disease Control is involved in monitoring food safety."

2. "No, the United States Department of Agriculture provides this information."

3. "No, the Food and Drug Administration provides this service and produces its own research about nutrition."

4. "No, the Environmental Protection Agency provides this service and other online resources about the foods that we eat."

Answer: 2 Explanation: The United States Department of Agriculture ensures the meat, eggs, and poultry are safe and wholesome and can be consumed by people living in the United States. Also, they provide resources and online information about nutritional values of the foods we eat. They conduct their own research about nutrition and offer a current listing of recalled food products.

The Food and Drug Administration monitors safety of dietary supplements and processed foods (except poultry, meat, and eggs). The Centers for Disease Control and Prevention monitors foodborne illnesses and provides information about infectious disease epidemics. The Environmental Protection Agency regulates pesticide use on food products and has established water quality standards.

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2) A client is requesting healthy recipes made with vegetables and an online basal metabolic index calculator. To which online resource should the nurse direct this client to use?

1. Environmental Protection Agency 2. The Food and Drug Administration 3. United States Department of Agriculture 4. Centers for Disease Control and Prevention Answer: 4 Explanation: The Centers for Disease Control and Prevention provides these online resources.

Also, they publish the Morbidity and Mortality Weekly Report. The Food and Drug Administration monitors dietary supplements and processed foods (except meat, poultry, and eggs). The United States Department of Agriculture monitors safety and quality of meat, poultry, and eggs. Also, they provide nutritional information about nutritional values of thief foods. The Environmental Protection Agency regulates water quality and pesticide use on food items.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A client develops vomiting and diarrhea after eating at a local restaurant. Which intervention should the nurse include in this client's plan of care?

1. Teach the importance of avoiding seafood 2. Teach the importance of eating fresh fruits and vegetables 3. Teach the importance of washing hands after coughing or sneezing 4. Teach the importance of refrigerating leftover items within two hours after a meal is served NURSINGTB.COM Answer: 4 Explanation: This client may have developed a foodborne illness. There are several ways that the client can help prevent this from happening again. All leftovers should be refrigerated within two hours after a meal or they should be thrown away. Washing hands appropriately after sneezing or coughing is important but only protects others from the client's germs. Avoiding seafood may prevent exposure to methylmercury but will not necessarily prevent foodborne illnesses. Ingestion of raw fruits and vegetables has been associated with the development of foodborne illnesses.

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11.5 To relate common causes of foodborne illness and formulate nursing interventions toprevent it.

1) The nurse suspects that a client with severe abdominal cramps and diarrhea has a possible foodborne illness. Which client statement should indicate to the nurse that the client may be experiencing food intoxication?

1. "I drank some unpasteurized juice."

2. "We picked some blackberries in the country and ate them."

3. "I canned my own tomatoes, but when I ate them, they just didn't taste right."

4. "We went camping, and I don't think I cooked my fish long enough before I ate it."

Answer: 3 Explanation: Raw fruits, vegetables, and animal products can cause foodborne illnesses. The nurse would be most alarmed to hear that the client ate home-canned food and is now suffering from gastrointestinal signs and symptoms. This history indicates that the client may be suffering from food intoxication. Clostridium botulinum is associated with home canned foods and it is known to produce a deadly toxin.

Nursing Process: Assessment Client Need: Safety and Infection Control Cognitive Level: Analyzing 2) A client has developed memory problems, difficulty hearing, and tremors. Which food should the nurse consider as possibly causing these symptoms?

1. Fish NURSINGTB.COM 2. Raw vegetables 3. Unpasteurized milk 4. Improperly cooked poultry Answer: 1 Explanation: Ingesting foods that are contaminated with methylmercury can result in these types of neurological problems. When mercury is dumped into water sources, it turns into methylmercury and sinks to the bottom. Plants and small animals that dwell at the bottom of the water source will become contaminated. Fish eat these plants and small animals. Humans eat the contaminated fish and can develop neurological problems, kidney damage, brain damage, and possibly cancer. Raw vegetables, unpasteurized milk, and improperly cooked poultry are not likely sources of methylmercury.

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3) A client reports using bottled water to mix formula for an infant. Which health problem is this infant prone to developing later in life?

1. Cancer 2. Diabetes 3. Dental caries 4. Hypertension Answer: 3 Explanation: Bottled water does not typically contain adequate levels of fluoride, which is commonly added to municipal water supplies to protect community members' dental health. Tap water often contains fluoride and it would be better to mix formula with tap water for this reason.

Bottled water use does not predispose the client to cancer, hypertension, or diabetes.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 4) The nurse is assessing a client who developed nausea, vomiting, and diarrhea after eating undercooked meat. Which organism should the nurse suspect that the client ingested? (Select all that apply.)

1. Shigella 2. Salmonella 3. Norwalk Virus 4. Campylobacter 5. Giardia intestinalis NURSINGTB.COM Answer: 2, 4 Explanation: Salmonella is most frequently found in undercooked eggs, meats, raw milk products, shrimp, coconut, chocolate, and yeast. Campylobacter is most frequently found in raw and undercooked poultry meat, unpasteurized milk, and contaminated drinking water. Shigella is found in raw foods, salads, sandwiches, and contaminated water. Norwalk virus is found in raw foods and salads. Giardia intestinalis is found in contaminated water and undercooked foods.

Salmonella is most frequently found in undercooked eggs, meats, raw milk products, shrimp, coconut, chocolate, and yeast. Campylobacter is most frequently found in raw and undercooked poultry meat, unpasteurized milk, and contaminated drinking water. Shigella is found in raw foods, salads, sandwiches, and contaminated water. Norwalk virus is found in raw foods and salads. Giardia intestinalis is found in contaminated water and undercooked foods.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 12 Cultural Considerations in Nutrition 12.1 To explain the influence of culture on food practices and health beliefs regarding diet.

1) While assessing the nutritional status of a client from a non-English speaking culture, the nurse asks about specific food habits. Which aspect of culture is the nurse addressing at this time?

1. Foodway 2. Food roles 3. Health beliefs 4. Eating etiquette Answer: 1 Explanation: Each culture defines its own foodway or the rules and expectations about food habits important to that culture. Food roles refers to foods that are considered staples or secondary food items in the diet. The vital functions of food are seen differently in various cultures beyond the nutritional needs of our body. Certain foods are felt to have properties that can promote wellness, cure disease, or rebalance body systems. Eating etiquette refers to physical behaviors when eating and are culturally dictated.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Applying Bi.C 2) The nurse is invited to a celebration bN eiUnRgShIN elGdTw thOinMthe Latino community. What should the nurse expect to be present at this celebration?

1. Food 2. Music 3. Games 4. Alcohol Answer: 1 Explanation: Every culture uses food when they celebrate. Depending upon the reason for the celebration, music, games, or alcohol may or may not be included.

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3) The nurse observes a female client ask the male spouse if he's eaten before the client opens the containers on a meal tray. What should this observation indicate to the nurse about the client's culture?

1. Males eat first 2. Women eat first 3. Women need permission to eat 4. Women share food with the men Answer: 1 Explanation: In some cultures, the men in the family gather at the table and are served first. The women do not eat until the men have left the dining area. Asking if the male spouse has already eaten would indicate that the client should wait until the male eats before opening the containers on the meal tray. There is no cultural determination identified where women eat first. There is no cultural determination that states women need permission to eat or that women should share the food with men.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Analyzing 12.2 To discuss guidelines for incorporating cultural sensitivity into nutrition care.

1) The nurse is caring for a client who shares the same culture as other assigned clients. Which action should the nurse take when addressing this client's nutritional needs?

1. Assume that the client has no particular dietary issues 2. Ask the client about any particular nutNriUtiRoSnIaNlGpTrB ef.C erOeM nces 3. Provide routine dietary actions unless the client asks otherwise 4. Follow the same nutritional practices as the other clients from the same culture Answer: 2 Explanation: While the nurse might possess general knowledge about traditional cultural practices, it should not be assumed that a patient belongs to any certain cultural group or holds certain cultural beliefs. Asking questions rather than assuming answers is important. The nurse should ask questions regarding food and nutrition in a manner that demonstrates respect and is free from judgment. The nurse should not assume that the client has no particular dietary issues.

The client should not be expected to report nutritional preferences.

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2) The nurse prepares to provide nutritional education to a client from a different culture. Which action should the nurse take prior to providing this teaching?

1. Ask about the client's dietary practices 2. Assess reading ability and language preference 3. Identify any foods used or omitted for religious reasons 4. Determine any foods that the client prefers when feeling unwell Answer: 2 Explanation: When preparing nutritional education, the nurse should assess the client's ability to read any printed material and language preference. Asking about dietary practices, foods used or omitted for religious reasons, or foods eaten when unwell would be used when developing the nutritional care plan.

Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive Level: Applying 3) During the nutritional assessment, the nurse learns that a client with uncontrollable type 2 diabetes mellitus consumes a boiled wheat mixture soaked with sugar and cinnamon for breakfast every day as part of a cultural preference. What should the nurse suggest to this client?

1. Eat less of the item every day 2. Eliminate the item from the diet 3. Eat the item only on the weekends 4. Make the item with artificial sweetener Answer: 4 Explanation: The nurse should assess hoNwURoSftIeNnGaTBfo.CoOdMis consumed to determine the potential impact of that food. Since the food is eaten daily, the best suggestion is for the item to be made with artificial sweetener to help with the client's blood sugar control. Eating less of the item may not be sufficient for the client's health problem. Eliminating the item would not take the client's cultural needs into consideration. Limiting the item to the weekends also does not take the client's cultural needs into consideration.

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12.3 To discuss how acculturation and cultural background influences eating patterns.

1) A client from a different culture reports eating fast food every day for lunch but enjoys traditional foods which the spouse prepares for dinner at home. Which term should the nurse use when documenting this client's eating preferences?

1. Integration 2. Food desert 3. Assimilation 4. Acculturation Answer: 1 Explanation: Acculturation of dietary practices occurs when eating patterns of immigrants change to resemble those of the host country. Acculturation occurs when a person transitions to a new community, regardless of a geographical change. The acculturation process and the retention of original culture occur independently of one another, meaning even as new beliefs or behaviors are adopted, traditional beliefs and behaviors can be maintained. When acculturation is in the form of retention of traditional culture along with acceptance of some beliefs and behaviors of the new community, it is referred to as integration. When the traditional culture is lost and instead beliefs and behaviors are only those of the new community, it is referred to as assimilation. Places where fresh foods are not offered or are hard to find are called food deserts.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Applying 2) The nurse notes that a client from a diNffUeRreSnIN t cGuTlBtu.CreOhMas gained 15 lbs. over the last 6 months.

What should the nurse suspect as the reason for this client's change in weight?

1. Adoption of Western eating habits 2. Poor acculturation into the community 3. Inability to find culturally acceptable foods 4. Depression from being separated from home Answer: 1 Explanation: In some situations, acculturation can result in a transition from a previously healthy diet to a nutritionally imbalanced and potentially excessive diet. This is what the nurse should consider first as the reason for the client's weight gain. Additional evidence is needed to determine if the client is not acculturating into the community or if culturally acceptable foods are unavailable. There is no evidence to support that the client is depressed.

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12.4 To identify common dietary practices of traditional ethnic groups.

1) A client form the Mesoamerican culture refuses to eat a specific food when recovering from an infection. What should the nurse consider as the reason for the client's refusal?

1. The food is not acceptable within the client's culture 2. The temperature of the food is not culturally acceptable 3. The perceived effect of the food is not acceptable for the health problem 4. The amount of the food provided is more than what the client typically eats per meal Answer: 3 Explanation: Traditionally, Mexican Americans believe in the four humors (fluids) of the body (blood, phlegm, yellow and black bile), which are kept in balance through use of heat, cold, moisture, and dryness. Foods are given based on the perceived effect it has on the body, not based on the actual temperature of the food. A hot disorder is treated with a cold and thus balancing food. Patients may refuse foods based on these beliefs. There is not enough information about the food to determine if the food is not acceptable within the client's culture.

The amount of the food is not an issue.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Analyzing

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2) The nurse visits the home of an African American who is recovering from major surgery.

Which food items should indicate to the nurse that the client is implementing specific health beliefs? (Select all that apply.)

1. Okra 2. Garlic 3. Sassafras 4. Sweet potato pie 5. Herbal hot toddy Answer: 1, 2, 3, 5 Explanation: Some Black Americans may believe certain foods have spiritual and healthful properties. Okra, sassafras, herbal hot toddies, and garlic may be used in the treatment of illness or injury. Sweet potato pie is viewed by some of this culture as being a soul food and not a food with any particular medicinal properties.

Some Black Americans may believe certain foods have spiritual and healthful properties. Okra, sassafras, herbal hot toddies, and garlic may be used in the treatment of illness or injury. Sweet potato pie is viewed by some of this culture as being a soul food and not a food with any particular medicinal properties.

Some Black Americans may believe certain foods have spiritual and healthful properties. Okra, sassafras, herbal hot toddies, and garlic may be used in the treatment of illness or injury. Sweet potato pie is viewed by some of this culture as being a soul food and not a food with any particular medicinal properties.

Some Black Americans may believe certain foods have spiritual and healthful properties. Okra, sassafras, herbal hot toddies, and garlic may be used in the treatment of illness or injury. Sweet potato pie is viewed by some of this cultN urUeRaSsINbG eiTnBg.CaOsM oul food and not a food with any particular medicinal properties.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Analyzing 3) A client who immigrated from Asia has an elevated blood pressure. Which food item should the nurse ask if the client routinely consumes?

1. Rice 2. Pork 3. Chicken 4. Soy sauce Answer: 4 Explanation: In particular, the use of salty foods and condiments, such as soy sauce, may affect blood pressure control because of the influence of high sodium intake on hypertension. Rice, pork, and chicken are not identified as food items that adversely effect blood pressure.

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4) A client from an Indian culture documents "extra pepper" on the menu for every meal. For which reason should the nurse realize the client is using this condiment?

1. Warm the body 2. Induce sweating 3. Counteract karma 4. Eliminate bad actions Answer: 1 Explanation: During cool weather, cooking is done with black pepper to warm the body. During hot weather, Indian clients cook with garlic to induce sweating, an effect felt to cool the body.

People within this culture may believe that disease is caused by karma and that bad actions bring about suffering.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Analyzing 12.5 To identify common dietary practices related to various faith traditions.

1) The nurse learns that a client practices Buddhism. Which question should the nurse include when assessing this client's nutritional practices?

1. "How often do you eat pork?"

2. "How many days a week do you routinely fast?"

3. "Do you abstain from food from noon to the next day?"

4. "Do you prefer your meat cooked well-done or medium-well?"

NURSINGTB.COM Answer: 3 Explanation: Individuals who practice Buddhism commonly abstain from food at night or from noon to sunrise for purposes of purification and self-discipline. Long periods of fasting are not part of the traditions. As a general tenet, Buddhists may not take a life; as a result, they are often lacto-ovo-vegetarian and will not eat pork or meat.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Applying 2) A client is a practicing Orthodox Christian. What should the nurse expect the client to document on the menu for a meal on a Friday?

1. Meatloaf, mashed potatoes, bread, and butter 2. Green salad, baked potato, margarine, and green tea 3. Lasagna, green salad with ranch dressing, dinner roll, and butter 4. Baked chicken, wild rice, macaroni and cheese, dinner roll, and butter Answer: 2 Explanation: Wednesday and Friday are fasting days all year long, avoiding meat and meat products, poultry, fish with a backbone, dairy and products, olive oil, and wine. The menu selection of a salad, potato, and tea would be expected by this client. The other menu choices include meat, poultry, or dairy products that this person would avoid eating on Fridays.

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3) A client recovering from a fractured limb practices Islam. What should the nurse expect the client to request during the month of Ramadan?

1. Rice for breakfast 2. No food after sundown 3. Snacks during the night 4. Water to wash before eating Answer: 3 Explanation: Muslims fast during the month of Ramadan, abstaining from all food and drink between sun-up and sundown. A pre-fast meal, known as suhur, and a meal after sundown, called iftar, are permitted as well as snacks during the night. The client will not eat breakfast and will eat after sundown. There is no requirement for water to wash before eating.

Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive Level: Applying 4) The nurse notices that a client who follows a Kosher diet has a hamburger for lunch. Which item should the nurse remove before providing the tray to the client?

1. Green salad 2. Peas and carrots 3. Container of milk 4. Container of orange juice Answer: 3 Explanation: Individuals who follow a Kosher diet do not eat meat or milk at the same meal.

The container of milk should be removedNUfrRoSmINtG heTBtr.C ayO.MThe salad, peas and carrots, and orange juice do not need to be removed because of the Kosher diet.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 13 Nutrition in Sports 13.1 To differentiate the roles of carbohydrate, protein, and fat in the diet of the athlete.

1) A client who is a short-distance sprinter asks about anaerobic and aerobic exercise. Which response should the nurse make to this client?

1. "Aerobic energy is created solely from fat metabolism."

2. "Long-distance running and sprinting are both classified as aerobic exercises."

3. "Glucose is required to perform anaerobic energy for sprinting short distances."

4. "Long-distance running is an anaerobic exercise and sprinting is an aerobic exercise."

Answer: 3 Explanation: Glucose provides energy for anaerobic exercise. Anaerobic exercises are those that involve short bursts of energy expenditure that last up to 2 minutes. Aerobic exercises are those that require oxygen and metabolism of glucose and fat. Long-distance running is classified as an aerobic exercise and sprinting for short distances is typically an anaerobic exercise.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) A client in training for a marathon requests information about carbohydrates. Which client statement indicates that teaching about this topic has occurred?

1. "Glucose is stored in the kidneys as glycogen."

2. "My carbohydrate needs are based on NmUyRbSIoNdGyTwBe.CigOhMt." 3. "I need to eat all of my carbohydrates for the day just prior to exercising."

4. "High-fiber foods often have a higher glycemic index than foods with low-fiber content."

Answer: 2 Explanation: Carbohydrate intake during training should be based on body weight and not on a percentage of total caloric intake. High-fiber foods often have a low glycemic index and lowfiber foods typically have a high glycemic index. Carbohydrates should be eaten throughout the day to maintain glycogen stores. Glucose is stored as glycogen in the muscles and liver and can be converted back to glucose when the need arises.

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3) The nurse is evaluating a young client's risk for developing the "female athlete triad." Which client statement indicates the client is at high risk for developing this problem?

1. "I play field hockey on a mostly male team."

2. "I'm not a very competitive soccer player. I just really like to play."

3. "I'm a gymnast and my coach thinks I need to lose another 5 pounds."

4. "I can't keep up with this training schedule. I'm going to take some time off of training."

Answer: 3 Explanation: Athletes who play sports that emphasize thinness are more likely to develop the female athlete triad. The athlete who suffers from this develops low levels of available energy, decreased bone density, and amenorrhea. Gymnastics, ballet dancing, and figure skating are sports that place an emphasis on thinness. Field hockey and soccer emphasize toughness and endurance in athletes, not thinness. If the athlete has developed the issue, then it is important to decrease their training intensity and eat more food.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 4) A client has developed the female athlete triad. Which health problem is this client most at risk of developing when aging?

1. Skin problems 2. Difficulty breathing 3. Physical mobility issues 4. Changes with tissue perfusion NURSINGTB.COM Answer: 3 Explanation: This client is most at risk for developing osteoporosis due to poor bone mineral density based upon inadequate food intake and intense exercise. The client is least likely to develop problems with skin, breathing, or tissue perfusion.

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13.2 To formulate nursing interventions to promote adequate intake of nutrients by physically active patients.

1) The nurse reviews information about protein intake with a client who is an athlete. Which client statement indicates that teaching has been effective?

1. "I should have a glass of milk after working out."

2. "Most of us need to eat more protein to help build muscle."

3. "Many athletes overly restrict protein to decrease body fat."

4. "Collegiate athletes benefit the most from protein supplements."

Answer: 1 Explanation: Dairy protein in particular is felt to trigger muscle protein synthesis more quickly than other protein sources because of the amino acid leucine found in these foods. Proteins supplements are not usually recommended. When advising an athlete about protein needs for training, the nurse should stress that first adequate calorie intake is required for protein in the diet to be used for muscle-building or recovery. Instead of restricting protein to decrease body fat, athletes will decrease fat intake.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) A client who is a body builder has noticed a decrease in muscle mass. What should the nurse suspect as the reason for this client's muscle mass change?

1. Fat restriction NURSINGTB.COM 2. Protein restriction 3. Use of ergogenic aids 4. Carbohydrate restriction Answer: 1 Explanation: A common practice among body builders is to restrict fat intake to decrease body fat levels. However, this can lead to decreased growth and development in younger athletes, deficiency of essential fats, and decreased muscle mass. Athletes do not typically restrict carbohydrate levels or protein levels. The use of ergogenic aids is associated with stimulation of the central nervous system and would not produce these symptoms.

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3) The nurse prepares information on sports and nutrition for a group of community members.

Which population is most likely to use fat instead of carbohydrates as an energy source during exercise?

1. Ballet dancers 2. Adolescence athletes 3. Athletes who run marathons 4. Athletes with chronic diseases Answer: 3 Explanation: Athletes, who train for endurance sports like long-distance runners, are more likely to oxidize fat to provide energy instead of relying on glycogen and glucose. This ability is a product of aerobic conditioning. It is unrelated to a client's age and a diagnosis of a chronic disease. Ballet is not necessarily classified as an endurance sport and this is not the best answer.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 13.3 To relate the effect of mineral nutrition on athletic performance.

1) The nurse is preparing to educate a group of athletes about their dietary intake. Which concept regarding dietary intake of vitamins and minerals should the nurse teach an ice hockey player but would not necessarily be as important to teach to a field hockey player?

1. Importance of vitamin A 2. Importance of vitamin C NURSINGTB.COM 3. Importance of vitamin D 4. Importance of vitamin E Answer: 3 Explanation: Vitamins A, C, and E are antioxidants and are being marketed to athletes to help with muscle stress associated with exercise. However, there is little evidence to show that this actually helps. All of these vitamins (A, C, E) could be used for people who exercise indoors and outside. Vitamin D and calcium intake are important for athletes, but even more important for the athlete that exercises indoors because they have less exposure to sunlight, which is a source of vitamin D. People who do not get enough calcium and vitamin D have weak bones.

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2) An adolescent female athlete has been menstruating at irregular intervals and does not have an adequate amount of calcium in the diet. Which health problem is this client at risk for developing?

1. Arthritis 2. Osteoporosis 3. Multiple sclerosis 4. Hyperparathyroidism Answer: 2 Explanation: This client is experiencing menstrual irregularities and is not receiving an adequate source of dietary calcium. These two factors together place this client at an increased risk for developing stress fractures, bone loss, and osteoporosis. Due to high-impact training exercises, this client may be at risk for developing arthritis, but not as a result of low calcium intake combined with menstrual irregularities. This client does not have an increased risk for developing multiple sclerosis or hyperparathyroidism.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 13.4 To develop hydration strategies for athletes of all levels and ages.

1) A high school student who is on the wrestling team has been trying to drop weight before the next match and is now experiencing swollen fingers and a headache. Which laboratory finding should the nurse expect for this client?

NURSINGTB.COM 1. Sodium 127 mEq/ L 2. Potassium 5.5 mEq/ L 3. Respiratory rate is 10 per minute 4. Temperature 97. 2 degrees Fahrenheit Answer: 1 Explanation: A sodium level of 127 mEq/L is consistent with hyponatremia due to dehydration.

The normal range of sodium is 135—145 mEq/ L. When clients are dehydrated, their potassium level would be decreased and their respiratory rate would increase. Their temperature would increase due to their inability to cool themselves through sweating and evaporation.

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2) A client wants to know how to adequately prevent dehydration and hyponatremia when running long distances. Which response should the nurse make?

1. "Avoid ingesting salty foods on the day of the race."

2. "You should drink at every opportunity during the race."

3. "Liberally salt your food and drink just to maintain your weight during the race."

4. "Focus on increasing your consumption of potassium-rich foods during the race."

Answer: 3 Explanation: This client can prepare for the long-distance race by routinely eating foods with a liberal amount of salt. The diet should include fresh fruits, fresh vegetables, and whole grains.

People who drink to gain fluid weight during races have a higher risk of developing hyponatremia. Potassium rich foods ingestion can help prevent hypokalemia but will not help prevent dehydration and hyponatremia.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) A client who is an athlete requests information about ergogenic aids. Which substance should the nurse include in the discussion?

1. Alcohol 2. Gatorade 3. Bitter orange 4. Peanut butter Answer: 3 Explanation: Ergogenic aids are substanNcU esRtShIN atGiTnBcr.CeaOsM e athletic performance. An example of ergogenic aids are caffeine-containing pills and bitter orange. Alcohol negatively impacts athletic performance because it is difficult to replace energy stores and difficult to rehydrate. Gatorade is used as to help fluid lost during exercise but is not considered to boost performance. Peanut butter is a high-protein food and is not considered to be an ergogenic aid.

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4) A client who is an athlete uses alcohol on the weekends and makes several claims about the impact of alcohol on performance. Which client statement about alcohol is a misconception that the nurse should correct?

1. "Alcohol has been linked with sports-related injuries."

2. "Alcohol increases my heart rate and can cause insomnia."

3. "Alcohol makes it difficult to rehydrate because it has diuretic effects."

4. "Alcohol is a central nervous system depressant and will negatively impact my performance.

Answer: 2 Explanation: Alcohol is a central nervous system depressant. Athletes use central nervous system stimulants like caffeine to positively impact their athletic performance. Alcohol has been related to sports-related injuries. Alcohol is a central nervous system depressant and would decrease the heart rate and may induce sleep. Alcohol does make it difficult to rehydrate and recover from training because it prevents carbohydrate uptake and acts as a diuretic.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 13.5 To apply guidelines for nutrition in exercise to individuals in unique stages of the lifespan.

1) A prepubescent client who is a gymnast trains for many hours every day and is concerned about eating a nutritious diet. Which is the best response by the nurse?

1. "You should probably quit."

2. "You just need to eat three good meals every day."

3. "If you don't eat enough, you have a hNigUhReSr IrNisGkToBf.CdOeM veloping bone cancer."

4. "Could we talk about some of the barriers that prevent you from eating well?"

Answer: 4 Explanation: This client has a busy schedule and little time to eat adequate amounts of food and nutrients. This client has a higher risk of developing osteoporosis, stress fractures, injuries, and a delayed onset of puberty. The client does not have a higher risk of developing bone cancer. The nurse needs to explore the client's issues that may prevent eating a nutritious diet and then suggest some ways to improve the intake of food and nutrients. This client should snack more often because of not being able to sit down to eat three meals each day. At this stage, there is no reason to suggest that the young athlete should quit the sport.

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2) A child becomes dehydrated while playing soccer and needs medical attention. Which statement by the parents indicates understanding for the reason why the child became ill during a sports activity?

1. "Children aren't able to sweat as much as an adult."

2. "I lose a lot more heat than my child can because of my body size."

3. "I can take more air into my lungs than my child can, and I get rid of a lot more heat that way."

4. "Children always have a higher normal temperature than adults, so they're more prone to overheating."

Answer: 1 Explanation: Children have a greater surface area relative to their body mass when compared to adults. They lose and gain heat more easily than adults. Children produce more heat during exercise than adults and they are unable to sweat as much. Sweating allows for heat dissipation.

Children don't necessarily always have higher body temperatures than adults. Heat can be dissipated with breathing, but sweating is the best way to dissipate heat.

Nursing Process: Evaluation Client Need: Physiological Adaptation Cognitive Level: Analyzing 3) The nurse is creating a care plan for an older adult client who is regularly physically active.

Which topic should the nurse include?

1. The older adult can rely on their level of thirst to know when they need to replace fluids.

2. The older adult does not require as much fluid for rehydration when compared to a younger NURSINGTB.COM athlete.

3. The older adult may need to eat more than the younger athlete during training to help restore depleted energy stores.

4. The older adult has typically lost some muscle as a result of age and will have a lower basal metabolic rate than the younger athlete.

Answer: 4 Explanation: The older adult requires as much fluid as any other athlete who is training at the same intensity. The older client should stick to a schedule when drinking fluids because their kidneys and sense of thirst have been altered as a result of age. This client has lost some muscle as a result of age and will most likely have a lower basal metabolic rate due to the muscle loss.

They need to eat as much as anyone else who is training at the same intensity.

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13.6 To evaluate the role of dietary supplements marketed for sports performance.

1) The nurse reviews the use of dietary supplements with a client who is an athlete. Which client statement indicates additional teaching is required?

1. "I hardly get sick anymore. I am so healthy."

2. "I use it to treat my stress fracture in my ankle."

3. "My endurance is so much better than it used to be."

4. "It helps me maintain my muscles strength and I don't have to train as hard."

Answer: 2 Explanation: Common reasons that athletes use dietary supplements are that they help maintain strength, help the client avoid injury, and improve endurance. Companies who produce and market these products are not permitted to make any statements that indicate that users of the product can use it to treat or prevent any health condition such as a stress fracture.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) A client is upset after being disqualified from a race. Which nutritional action most likely caused the client to be disqualified?

1. Dehydration 2. Low iron levels 3. Increased carbohydrate intake prior to the race 4. Use of a dietary supplement with an unlisted banned substance as an ingredient NURSINGTB.COM Answer: 4 Explanation: Dietary supplements can include unlisted ingredients that have been banned in competition. Dehydration and low iron levels are not monitored but can have a negative impact on athletic ability. Carbohydrate intake is not regulated by race officials.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 3) A client who participates in athletic events asks about the use of dietary supplements. Which statement should the nurse make to this client?

1. "They can prevent certain health conditions."

2. "There is no actual proof that they are safe or effective."

3. "The Food and Drug Administration regulates their product testing procedures."

4. "Much of the research done with these dietary supplements can be generalized to the public."

Answer: 2 Explanation: Unfortunately, research about dietary supplements often involves only very small groups of participants and so the research shouldn't be generalized. Dietary supplements cannot be marketed to state that they prevent or treat any health condition. The Food and Drug Administration does not regulate product testing procedures for these types of products. The best answer is that there is no actual proof that these products are safe or effective, because this information is not required to be proven.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 14 Pregnancy and Lactation 14.1 To examine the nutrient and diet recommendations for during preconception, pregnancy, and lactation.

1) The nurse is counseling a client with a body mass index (BMI) of 22 who is concerned about additional weight gain during pregnancy. Which approach should the nurse take?

1. "At your current weight you should expect to see a weight gain less than 20 lbs. during your pregnancy."

2. "At your current weight you should expect to see a weight gain 15—25 lbs. during your pregnancy."

3. "At your current weight you should expect to see a weight gain 28—40 lbs. during your pregnancy."

4. "At your current weight you should expect to see a weight gain 25—35 lbs. during your pregnancy."

Answer: 4 Explanation: It is recommended that a client with a normal body mass index (BMI) gain between 25—35 lbs. during pregnancy. Inadequate maternal weight gain is a health risk, often associated with small-for-gestational age, or low-birth-weight infant. Therefore it is important to counsel clients on desired weight gain in relation to their pre-pregnancy BMI in order to assure essential fetal growth and appropriate infant birth weight. It is recommended that underweight clients (BMI less than 19.8) gain 28-40 lbs., whereas clients that are overweight (BMI 26-29) NURSINGTB.COM gain 15 - 25 lbs.

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2) The nurse is counseling a woman about the consumption of herbal supplements during pregnancy. Which statement is appropriate for the nurse to make?

1. It is safe to ingest herbal supplements during pregnancy since they are natural substances 2. The Food and Drug Administration (FDA) has established guidelines about the safety of herbal use during pregnancy 3. It is important that you quit taking any botanical, vitamin, or mineral supplements during your pregnancy, but you can resume taking them after the baby is born 4. Dietary supplements during pregnancy have not been well researched so it is important to discuss ingestion of specific supplements with your healthcare provider Answer: 4 Explanation: The use of dietary supplements during pregnancy is not well studied. Herbs and other botanicals especially have not been well researched regarding safety. Some botanical supplements are characterized as uterine stimulants or lead to altered blood clotting, which are dangerous complications during pregnancy, while others can cause drug interactions or are teratogens or mutagens. The client the supplements with the healthcare provider because herbal supplements are not currently regulated by the Food and Drug Administration (FDA). Although herbal supplements are natural substances, many may be considered harmful to consume during pregnancy. The client should collaborate with the nurse to help determine which dietary supplements are safe versus harmful for the individual. A consultation with the health-care provider is needed to determine if the supplements may be continued during the pregnancy.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying NURSINGTB.COM

3) The nurse is assessing a client during the first prenatal visit. For which reason should the nurse conduct an additional assessment with this client?

1. BMI of 21 2. Maternal age 31 years 3. History of diabetes for 10 years 4. Drinking 1 small cup of coffee/day Answer: 3 Explanation: Maternal diabetes places both the mother and infant at risk during pregnancy.

Uncontrolled diabetes during pregnancy is associated with increased risk for miscarriages, stillbirth, macrosomia, obstetric complications, and intrauterine developmental and growth abnormalities. Maternal age of 31 is not considered a risk factor. BMI of 21 is within normal limits. The American College of Obstetricians and Gynecologists recommends that pregnant women limit caffeine intake to 200 mg/day because of health risks associated with intake higher than that amount Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Analyzing

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4) A client who is pregnant with twins is concerned about the amount of weight to gain during the pregnancy. Which response should the nurse make to this client? (Select all that apply.)

1. "You should plan on gaining 1.5 pounds each week."

2. "You can expect to gain between 35 and 45 pounds during this pregnancy."

3. "You need to eat about 300 extra calories each day when compared to what you ate prior to becoming pregnant."

4. "Let's talk about some nutrient-dense foods that will help your babies develop well."

5. "It is important to avoid eating seafood with high levels of mercury."

Answer: 2, 3, 4 Explanation: All women who are pregnant should be encouraged to eat foods with high levels of nutrients and avoid seafood that contains high levels of mercury. Women pregnant with twins can expect to gain 35-45 pounds during their pregnancies. Clients who are pregnant with twins need to eat 500-952 extra kilocalories each day, when compared to what they ate prior to becoming pregnant. Clients who are pregnant with twins should eat approximately 150-500 kilocalories more than a client pregnant with one baby. Women who are pregnant with one baby require 350-452 extra kilocalories each day. Women who are pregnant with triplets should gain approximately 1.5 pounds each week and can expect to gain 50 pounds.

All women who are pregnant should be encouraged to eat foods with high levels of nutrients and avoid seafood that contains high levels of mercury. Women pregnant with twins can expect to gain 35-45 pounds during their pregnancies. Clients who are pregnant with twins need to eat 500-952 extra kilocalories each day, when compared to what they ate prior to becoming pregnant. Clients who are pregnant with twins should eat approximately 150-500 kilocalories more than a client pregnant with one baby. Women who are pregnant with one baby require 350452 extra kilocalories each day. WomenNwUhRoSIaNreGTpB re.C gnOaMnt with triplets should gain approximately 1.5 pounds each week and can expect to gain 50 pounds.

All women who are pregnant should be encouraged to eat foods with high levels of nutrients and avoid seafood that contains high levels of mercury. Women pregnant with twins can expect to gain 35-45 pounds during their pregnancies. Clients who are pregnant with twins need to eat 500-952 extra kilocalories each day, when compared to what they ate prior to becoming pregnant. Clients who are pregnant with twins should eat approximately 150-500 kilocalories more than a client pregnant with one baby. Women who are pregnant with one baby require 350452 extra kilocalories each day. Women who are pregnant with triplets should gain approximately 1.5 pounds each week and can expect to gain 50 pounds.

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14.2 To compare the nutritional recommendations for pregnant women who have unique needs, such as adolescents or vegetarians, with general nutrition recommendations.

1) A pregnant client follows a vegan eating plan. Which vitamin supplement should the nurse emphasize as essential for this client during the pregnancy?

1. B1 2. B2 3. B6 4. B12 Answer: 4 Explanation: A pregnant client who consumes exclusively a vegan diet should be encouraged to supplement with vitamin B12. Vitamin B12 is found most in animal products such as meat, dairy, and eggs. Those consuming a vegan diet do not consume animal products, and the vitamin is not in most nonanimal source, therefore it is recommended that a vegan supplement be added.

Taking too little of vitamin B12 can lead to anemia and nervous system disorders. In addition, vitamin B12 deficiency interferes with the cellular use of folate; supplementation would further reduce the risk of neural tube defects. Vitamins B1 and B6 are found in grains and enriched flours. Vitamin B2 is found in green leafy vegetables.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse compares the nutrient requirements of an adolescent with those of a pregnant client.

Which nutrient should the nurse identifyNaUs RhSaIvNiG ngTBd.iCfO feM rent requirements for these populations?

1. Iron 2. Calcium 3. Folic acid 4. Vitamin C Answer: 2 Explanation: An adolescent requires 1,300 mg calcium/day as linear height and bone mass gains are crucial in this age span. Recommended calcium intake for a healthy pregnancy adult is 1,000 mg/day. Recommended daily intake of iron, folic acid and vitamin C are the same in both adolescents and adults.

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3) The nurse prepares to assess a group of clients arriving for prenatal care. Which client should the nurse identify as having the greatest need for nutrition counseling during the first prenatal visit?

1. A client with phenylketonuria 2. A client entering a third pregnancy 3. A 42-year-old client with a BMI of 22 4. The vegan client who has had preconception counseling Answer: 1 Explanation: Phenylalanine crosses the placenta and leads to higher levels in the fetus than the mother. Maintenance of maternal phenylalanine levels within and acceptable range during pregnancy is associated with greatly diminished risk of poor infant outcomes. The nurse should reinforce nutritional teaching the vegan client received before becoming pregnant. Although the 42-year-old client is advanced for maternal age, a BMI of 22 is considered a healthy weight and the client should be encouraged to maintain a healthy diet.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 14.3 To translate appropriate nutrition interventions for medical conditions that affect both diet and pregnancy outcome.

1) A pregnant client reports the desire to eat non-food items. For which health problem should the nurse prepare teaching for this client?

NURSINGTB.COM 1. Pica 2. Geophagia 3. Pagophagia 4. Amylophagia Answer: 1 Explanation: Pica is the term used to describe the consumption of nonfood items. It is often associated with a decreased iron deficiency during pregnancy, but is also a cultural practice which has been practiced for centuries. There are specific classifications of pica which are associated with specific substances eaten. Geophagia is the consumption of soil, dirt, or baked clay. Pagophagia is the consumption of ice and freezer frost. Amylophagia is the consumption of laundry starch, corn starch, or other similar starches.

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2) The nurse prepares nutritional material for a pregnant client with preeclampsia. What should the nurse include when teaching this client?

1. "Restrict sodium intake."

2. "Increase the intake of fluids."

3. "Avoid consuming simple sugars."

4. "Increase the amount of calcium in your diet."

Answer: 4 Explanation: Dietary interventions for preeclampsia include calcium supplementation. It is unclear whether or not limiting sodium intake would have an impact on preeclampsia. There is no need to increase fluid intake. Simple sugars may not be of much nutritional value, but there is no evidence to support restriction.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) The nurse notes that a pregnant client arriving for an initial prenatal visit has a BMI of 35. For which complication is this client at risk for developing during the pregnancy?

1. Macrosomia 2. Placenta previa 3. Gestational diabetes 4. Chromosomal defects Answer: 3 Explanation: Women who are obese before pregnancy are at additional risk of pregnancy complications, such as gestational diabetNeU s.RISnIfNaG ntTsBo.Cf OoM bese mothers are at high risk to develop macrosomia. Obese clients are at no greater risk for developing placenta previa than women of a lower BMI. Obese clients are not at a high risk for chromosomal defects.

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14.4 To formulate nursing interventions for improving nutritional intake during pregnancy and lactation.

1) A client in the first trimester of pregnancy is experiencing persistent nausea throughout the day. What should the nurse recommend to this client?

1. Consume noncarbonated beverages 2. Increase foods with a high fat content 3. Eat large meals frequently throughout the day 4. Eat dry toast and crackers before getting out of bed Answer: 4 Explanation: In the first trimester of pregnancy, nausea affects up to 75% of all women. It has been found to be helpful to incorporate dry carbohydrates such as: crackers, toast, rice, and plain noodles in small amounts throughout the day. Consuming small frequent meals may help with nausea. There is no reason to limit fluid intake to noncarbonated beverages. High-fat foods can further slow the movement of food through the gastrointestinal tract and should be avoided unless tolerated and appropriate for weight loss goals.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) A pregnant client is planning to breastfeed after delivery. How many additional calories per day should the nurse instruct the client to consume during the first 6 months of breastfeeding?

1. 430 kcal NURSINGTB.COM 2. 500 kcal 3. 630 kcal 4. 730 kcal Answer: 2 Explanation: During the first 6 months after birth, the energy cost for milk output is estimated as an extra 500 kcalories/day after accounting for maternal fat stores to contribute almost 200 additional kcalories/day toward that need. The number of calories decreases to 400 kcalories/day after 6 months of lactation. The client does not need to consume 630 or 730 calories a day during breastfeeding.

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3) The nurse provides nutritional teaching to a client who is breastfeeding. Which client statement indicates that additional instruction is required?

1. "I need to increase my intake of iron."

2. "I should drink at least 8-10 glasses of fluid/day."

3. "I need to make sure I have enough calcium in my diet."

4. "I need make sure I have and adequate intake of vitamin B12."

Answer: 1 Explanation: Breast milk does not contain high amounts of iron; therefore the needs of the breastfed infants are met with iron supplementation or iron-fortified foods at 6 months of age.

Maternal need for iron returns to pregnancy amounts. The breastfeeding client needs to drink at least 8 to 10 glasses of fluid. Breastfeeding women need adequate calcium for blood clotting and strong bones and teeth. Lack of adequate maternal intake can lead to neurological problems in the infant because of negative effects on myelin development.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 15 Infants, Children, and Adolescents 15.1 To examine the growth and development patterns occurring during infancy, childhood, and adolescence.

1) A baby weighting 6 lbs. 2 ounces and 18 inches at birth weighs 18.5 lbs. and is 36 inches in length at age 1 year. What should the nurse say to the mother about this baby's growth and development?

1. "The baby is below desired weight."

2. "Weight and height are on target for the baby's age."

3. "The baby is overweight and needs to have intake restricted."

4. "The baby is failing to thrive and needs nutritional counseling."

Answer: 2 Explanation: A child's weight should triple and length should double by the first birthday. The baby is at acceptable weight and height for the age. The baby is not below or above desired weight. The baby is not failing to thrive.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse notes that a young child has slow growth, learning disabilities, and behavioral problems. For which health problem should this child be tested?

NURSINGTB.COM 1. Lead toxicity 2. Iron overload 3. Excess vitamin D 4. Calcium deficiency Answer: 1 Explanation: The presence of lead in a child's body can lead to slow growth or iron-deficiency anemia. Lead toxicity can also lead to learning disabilities, behavior problems, and even mental retardation. Iron deficiency is associated with negative effects on cognitive function. Adequate intakes of calcium and vitamin D are essential for mineralization of bones and teeth. Calcium is needed for mineralization of bones and teeth.

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3) The nurse prepares teaching material regarding nutrient needs in adolescence. For which reason should the nurse emphasize that adolescent males need more protein that adolescentfemales?

1. A preoccupation with appearance 2. An increase in lean body tissue and muscle mass 3. Differences in daily activities and attitudes towards health 4. The development of needed fat stores in their buttocks and hips Answer: 2 Explanation: Increased protein needs supports muscle growth. The daily requirement for protein among adolescent males increases to about 50 grams per day. This increase is needed to support increases in muscle mass. A preoccupation with appearance does not impact the nutritional needs of adolescents. Adolescent females, not males, develop appropriate fat stores needed for the breasts, hips and buttocks.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Applying 15.2 To compare the normal nutrient requirements and special nutrition issues for each stage of growth.

1) An adolescent female student is concerned about gaining weight. How many calories per day should the nurse explain that the student will need for normal growth and development?

1. Much greater than adolescent males 2. 2,200 kcalories/day with 45 grams of N prUoRteSiInNGTB.COM 3. About 3,000 kcalories/d because of rapid growth periods 4. Limited to about 1,500 kcalories/day to avoid becoming overweight Answer: 2 Explanation: The average caloric requirement for adolescent females is about 2,200 kcalories/day with 45 grams of protein. Male adolescents have a higher daily caloric requirement than females of about 2,500-3,000 calories with 50 grams of protein. The adolescent should not restrict intake to 1,500 kcalories per day.

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2) The mother of a 1-year-old client has placed the child on a low-fat diet to prevent the development of obesity. What should the nurse explain to this mother?

1. It is never too early to worry about childhood obesity 2. Children should be switched to a low-fat diet when they reach their first birthday 3. Fat is an extremely important component in the diet of children under the age of two 4. Studies have shown that children who are not on a low-fat diet often develop coronary disease as adults Answer: 3 Explanation: Children under the age of two years require a high-fat diet for proper development of the brain and nervous system. Childhood obesity has been linked with adult coronary disease, but a high-fat diet is essential for development in children age two and younger. Children on a low-fat diet have shown a measurable decrease on mental and psychomotor scores.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A parent is concerned that a 3-year-old child only wants to eat peanut butter and jelly at every meal. What should the nurse encourage the parent to do?

1. Allow the child to get up and move around while eating 2. Insist the child eat whatever food is prepared for the meal 3. Provide the child with peanut and butter and jelly only if that is what the child wants 4. Continue to offer a variety of foods but allow the child to eat the peanut butter and jelly if it is preferred NURSINGTB.COM Answer: 4 Explanation: Insisting that toddlers eat certain foods does not usually lead to compliance.

Providing the child with peanut butter and jelly only will limit food choices and decrease the likelihood of trying other foods. Parents should continue to offer a variety of foods but allow the child to consume their single choice. Remaining seated at a table can affect the quality of a toddler's food intake.

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4) A client is planning to return to work and wants to switch a 7-month-old baby from breastfeeding to cow's milk. What should the nurse explain to the client about cow's milk?

1. It is a natural and adequate substitute for breast milk 2. It is nutritionally more similar to breast milk than formula 3. It is not recommended for children under the age of one year 4. It is higher in fat content and may lead to an overweight baby Answer: 3 Explanation: Cow's milk has different proportions of casein and whey and is not recommended for the infant's immature kidneys. High amount of fats are required for the development of the brain and nervous system in infants. Consumption of cow's milk is not recommended for children under one year old. Unmodified cow's milk does not contain the required amounts of vitamins and minerals for infants.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 15.3 To evaluate the potential effects of nutrient insufficiency on growth and development.

1) A pregnant adolescent ingests a poor diet and rarely takes prenatal vitamins as prescribed.

What should the nurse explain as the consequences to the baby of not ingesting an adequate amount of iron while pregnant?

1. Delay in muscle formation 2. The development of neutropenia 3. Delayed mineralization of bones and tNeU etRhSINGTB.COM 4. Delays in cognitive and motor development Answer: 4 Explanation: When mothers consume sufficient iron during pregnancy the infant is born with iron stores to last for several months. Insufficient stores of iron may result in delays in motor and cognitive development. Iron insufficiency also results in anemia. Fluoride, not iron, is needed for mineralization of bones and teeth.

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2) A pregnant client plans to deliver the baby at home. For which reason should the nurse emphasize that the newborn will need an injection of vitamin K after birth?

1. Newborn infants have insufficient vitamin K stores 2. Breast milk does not contain an adequate supply of vitamin K 3. Lack of vitamin K can result in bone formation issues after birth 4. Only small amounts of vitamin K are innately inherited from the mother Answer: 1 Explanation: At birth, infants have an insufficient amount of vitamin K stored to protect them from excessive bleeding. Lack of vitamin K in the newborn is due to the sterility of the newborn's intestinal tract. Vitamin K is needed for the production of prothrombin, which is an important component of blood clotting. The infant receives vitamin K from breast milk or infant formula. Vitamin K is not required for bone formation.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A new mother is concerned that her 3-month-old infant is receiving an adequate amount of calories per day. Which amount of calories should the nurse instruct the mother that the babyneeds for growth and development?

1. 450 kcalories/day because of rapid growth 2. 50 kcalorie/kg/day because of low energy expenditure 3. Use few calories/day to maintain core body temperature 4. Fewer calories per kilogram than adults because of high respiratory and heart rate NURSINGTB.COM Answer: 1 Explanation: Infants up to 6 months require about 108 kcalories/kg/day. Infants up to age 6 months require about 450 kcalories/day to support rapid growth and meet metabolic demands.

Higher respiratory and heart rates require more kcalories/kg/day than those required for adults.

The amount of energy needed to maintain the core body temperature increases the kcalories/kg/day required for infants.

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15.4 To formulate specific nursing interventions that target improved nutritional health in this lifespan group.

1) The nurse provides care to clients in a rural health clinic. What should the nurse emphasize to new mothers when providing well baby care?

1. Keep pets away from the child 2. The importance of supplemental fluoride 3. The importance of enrolling in the WIC program 4. Measure the child's length and plot on a growth chart Answer: 2 Explanation: Fluoride is essential for the mineralization of bones and teeth and supplementation may be necessary for children living in rural areas not having a fluorinated water supply.

Measuring length and plotting it on a growth chart is a normal part of all well baby clinics.

Inquiring about family pets is important regardless of geographic location of the clinic. All mothers are who qualify for WIC should be referred regardless of the area where they live.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The school nurse realizes that many children do not eat breakfast before going to school. What should the nurse encourage the teachers to do?

1. Ask mothers to send in doughnuts for morning snacks 2. Allow children to eat an early lunch if they become hungry 3. Encourage children to bring in an extrNa UsnRaScIN kGtoTBe.aCtOfoMr breakfast 4. Refer children who have not eaten to the school's breakfast program Answer: 2 Explanation: Eating breakfast provides important nutrients for growth and is linked with good outcomes at school. Doughnuts are not a nutritional snack and contain high-sugar content. Eating lunch early may satisfy the feeling of hunger but children will not have food at lunchtime.

Snacks are usually high in carbohydrates and sugar and do not provide the nutrients needed for growth.

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3) The school nurse notices that overweight students are bullied by their peers and often have low self-esteem. Which action should the nurse take?

1. Monitor the food they eat at lunch 2. Suggest the overweight students increase their physical activity 3. Call the students' parents and discuss their after-school activities 4. Implement a weight loss program specifically designed for adolescents at the school Answer: 4 Explanation: Having students participate in a program at school could promote peer support and allow a safe environment to promote change. Knowing what the students do after school may help to understand reasons for weight gain, but the knowledge alone won't change behaviors.

Informing students to increase their activity may not be well perceived and only adds to feelings of low self-esteem. Monitoring food intake of specific students is not an appropriate intervention and may lead to additional bullying by other students.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 4) The parents of a child with anemia follow a vegetarian eating plan. Which suggestion should the nurse make to the parents to increase the child's iron intake? (Select all that apply.)

1. "Dried fruits are a good source of iron."

2. "You can eat beans because they are a good source of iron."

3. "Ingest dairy products with the meal to increase absorption."

4. "Drinking citrus juice with an iron-rich meal will help with iron absorption."

5. "Unfortunately, the only good way to NinUcRreSaIN seGiTrBo.nCiOnM take is to provide meat for your child."

Answer: 1, 2, 4 Explanation: Beans are a good source of iron and can be suggested for people who do not wish to consume meat. Dried fruits and breakfast cereals are good sources of iron. There are many ways for people to ingest iron from nonmeat sources. It is important to drink citrus juices when ingesting iron to aid in absorption. Citrus juices contain vitamin C. Animal meat is a good source of iron but vegetarians can ingest adequate amounts of iron without eating meat. Milk inhibits iron absorption and should be avoided when attempting to achieve maximal iron absorption.

Beans are a good source of iron and can be suggested for people who do not wish to consume meat. Dried fruits and breakfast cereals are good sources of iron. There are many ways for people to ingest iron from nonmeat sources. It is important to drink citrus juices when ingesting iron to aid in absorption. Citrus juices contain vitamin C. Animal meat is a good source of iron but vegetarians can ingest adequate amounts of iron without eating meat. Milk inhibits iron absorption and should be avoided when attempting to achieve maximal iron absorption.

Beans are a good source of iron and can be suggested for people who do not wish to consume meat. Dried fruits and breakfast cereals are good sources of iron. There are many ways for people to ingest iron from nonmeat sources. It is important to drink citrus juices when ingesting iron to aid in absorption. Citrus juices contain vitamin C. Animal meat is a good source of iron but vegetarians can ingest adequate amounts of iron without eating meat. Milk inhibits iron absorption and should be avoided when attempting to achieve maximal iron absorption.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 16 Adult and Older Adult 16.1 To relate nutritional health goals for the adult and older adult.

1) The nurse is performing nutritional assessments on four older adult clients. What assessment data should indicate to the nurse a potential complication associated with a compromised nutritional status?

1. The client who routinely eats meals with a spouse.

2. The client who eats several small meals a day.

3. The client who drinks a milkshake-like dietary supplement with every meal.

4. The client who has two snacks daily of cheese and almonds.

Answer: 4 Explanation: Milkshake-like dietary supplements are routinely prescribed when weight loss occurs, but there is some concern that these drinks cause satiety and diminish intake at mealtime.

Older clients who eat alone are more at risk for malnutrition. Eating frequent small meals can minimize the problem of early satiety. Nutrient dense foods will offer more calories per bite.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) An older client is demonstrating signs of a vitamin B6 deficiency. Which foods should the nurse encourage the client to ingest to help address this deficiency? (Select all that apply.)

NURSINGTB.COM 1. Fish 2. Pork 3. Kale 4. Chicken 5. Whole grains Answer: 1, 2, 4, 5 Explanation: Fish, pork, chicken, and whole grains are food sources high in Vitamin B6. Kale is a rich source of calcium.

Fish, pork, chicken, and whole grains are food sources high in Vitamin B6. Kale is a rich source of calcium.

Fish, pork, chicken, and whole grains are food sources high in Vitamin B6. Kale is a rich source of calcium.

Fish, pork, chicken, and whole grains are food sources high in Vitamin B6. Kale is a rich source of calcium.

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3) The nurse instructs a middle-aged female client on ways to increase the daily calcium intake.

Which food selections by the client indicate that the teaching has been successful?

1. Eggs, meat, fish 2. Chicken, fish, eggs 3. Sardines, kale, mustard greens 4. Legumes, dried fruit, enriched grains Answer: 3 Explanation: Sardines, kale, and mustard greens are all food sources high in calcium. Eggs, meat, and fish are good sources of phosphorus. Chicken, fish, and eggs are good sources of Vitamin B6. Legumes, dried fruit, and enriched grains are good sources of iron.

Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 16.2 To differentiate between changes in nutritional health because of normal aging and health conditions.

1) The nurse notes an older client has lost lean muscle mass. How should the nurse document this finding?

1. Dysphasia 2. Sarcopenia 3. Pagophagia 4. Xerostomia NURSINGTB.COM Answer: 2 Explanation: The loss of lean muscle mass in older adults is called sarcopenia. The biological process of aging also brings bout changed in adipose, bone mineral content, and total body water.

Dysphagia is difficulty swallowing which can contribute to an altered intake. Pagophagia is the consumption of ice and freezer frost. Xerostomia is the insufficient saliva production which occurs naturally.

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2) An older client experiences difficulty swallowing whole wheat bread and crackers. For which age-related change should the nurse assess this client?

1. Dysomia 2. Dyskinesia 3. Xerostomia 4. Leukoplakia Answer: 3 Explanation: Xerostomia is the development of insufficient saliva production which occurs with the adding process. A dry mouth can lead to altered taste perception and difficulty swallowing.

Dysomia is the sensation of unpleasant smell. Dyskinesia is a movement disorder characterized by severe, dystonic, involuntary movement of the facial, oral, and cervical musculature.

Leukoplakia is used to describe a thickened, white plaque the will not rub or strip off and is not identifiable clinically or pathologically as any other disease.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) An older client is experiencing diarrhea and a fever. Which assessment finding indicates that this client is dehydrated? (Select all that apply.)

1. Agitation and restlessness 2. Dark yellow urine 3. Orthostatic hypotension 4. Three-pound weight gain NURSINGTB.COM 5. Mucous membranes moist Answer: 1, 2 Explanation: The client with diarrhea and fever has an increased risk of developing dehydration.

Many clients complain of a headache and will be lethargic with dehydration. They are less likely to become restless and agitated. A dehydrated client's urine is more concentrated and darker in color. The client's fluid balance is decreased, and the blood pressure may reflect orthostatic hypotension with postural changes. Clients lose weight with dehydration due to fluid losses.

Mucous membranes will be dry due to dehydration.

The client with diarrhea and fever has an increased risk of developing dehydration. Many clients complain of a headache and will be lethargic with dehydration. They are less likely to become restless and agitated. A dehydrated client's urine is more concentrated and darker in color. The client's fluid balance is decreased, and the blood pressure may reflect orthostatic hypotension with postural changes. Clients lose weight with dehydration due to fluid losses. Mucous membranes will be dry due to dehydration.

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16.3 To summarize the nutritional recommendations that are unique for older adults.

1) The nurse reviews the Dietary Reference Intakes (DRIs) for a young adult client. Which nutrients have significant changed from adolescence for this client?

1. Protein, magnesium, and folate 2. Calcium, vitamin B6, vitamin D 3. Vitamin A, vitamin K, and vitamin C 4. Magnesium, vitamin A, and phosphorous Answer: 2 Explanation: The Dietary Reference Intakes for adults between 19 years and 50 years do not change significantly form adolescence with the exception of the recommendations for calcium, phosphorus, and iron. Daily calcium recommendations decrease to 1000 mg from 1300 mg as an adolescent, and phosphorus recommendations drop to 700 mg from 1250 mg. Iron recommendations increase in the adult female.

Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) The nurse is reviewing vitamin supplements with an older client. Which vitamin should the nurse recommend because of an age-related change in secretion of hydrochloric acid and poor absorption?

1. B2 2. B3 NURSINGTB.COM 3. B6 4. B12 Answer: 4 Explanation: The diminished secretion of hydrochloric acid that occurs with aging affects the digestion and absorption of nutrients that require a more acid medium in the stomach including vitamin B12. The other vitamins are not altered because of hydrochloric acid changes in the stomach.

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3) An older female client reports having an alcoholic beverage every day. What should the nurse respond to this client?

1. "Alcohol has tonic benefits in the older person."

2. "There is no limit to the amount of alcohol you can ingest in a day."

3. "An older person needs to drink more alcohol before feeling the effects."

4. "There are no benefits to consuming more than one alcoholic drink per day."

Answer: 4 Explanation: There are no demonstrated benefits to consuming more than one standard drink/day in women and two/day in men. Alcohol is referred to as both a tonic and a toxin because of its health benefits and risks. An age-related change in alcohol dehydrogenase, an enzyme involved in alcohol metabolism, increases the bioavailability of alcohol in this population. This enzyme alteration can lead to increased blood alcohol levels when coupled with the decreased total body water associated with aging.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 16.4 To assess risk factors for poor nutritional health in the older adult.

1) An older client with lethargy and a headache has dry mucous membranes, sunken eyes, skin tenting over the sternum, and is oriented to person and place. Which health problem should the nurse suspect this client is experiencing?

NURSINGTB.COM 1. Xerostomia 2. Edentulism 3. Dehydration 4. Constipation Answer: 3 Explanation: The client's symptoms indicate dehydration in an older client. Edentulism is missing or loose teeth. Xerostomia is insufficient saliva production. Severe dehydration may a precipitating factor for constipation.

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2) An older client who is a recent widow has lost 20 lbs. over the past three months. What should the nurse consider as being the most likely explanation for this client's weight loss?

1. Food insecurity 2. Multiple medications 3. Decrease in opportunities for social interactions 4. Depression and sense of loss over spouse's death Answer: 4 Explanation: Loss of appetite because of pain, medication side effects, gastrointestinal symptoms, sadness, or depression can all lead to decrease dietary intake. The other choices can lead to undernutrition in the older adult, but would have most likely existed before the passing of the spouse. In addition, there is no information to support these conditions.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Analyzing 3) An older client reports consuming at least 3 - 4 alcoholic beverages a day for the past 15 years. For which health problem is this client at the greatest risk for developing?

1. Obesity 2. Chronic disease 3. Increase in negative side effects 4. Decrease interaction between alcohol and medications Answer: 3 Explanation: When alcohol is consumed in excess by the elderly client there is an increase in the bioavailability of alcohol related to the aNgU e-RreSlIaNtG edTBc.hCaOnM ge in alcohol dehydrogenase, an enzyme involved in alcohol metabolism. This enzyme alteration can lead to increased blood alcohol levels when coupled with the decreased total body water associated with aging which leads to negative side effects. Weight gain can be a consequence of excess alcohol consumption, but if alcohol is substituted for food, nutritional health can become compromised. Although alcohol abuse can contribute to chronic diseases, alcohol-related problems in the elderly often go unrecognized and can contribute to misdiagnosis and treatment of many chronic diseases. With excess alcohol consumption, interactions between alcohol and medications are more likely.

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16.5 To formulate nursing interventions for maintaining or improving nutritional health in the older adult.

1) The nurse instructs the spouse of a client who is experiencing dysphagia. which statement indicates that teaching about strategies to help with dysphagia were effective?

1. "I should encourage liquids as often as possible."

2. "Foods like gelatin and pasta will be easy to swallow."

3. "We should have a casual conversation during meals."

4. "It is necessary to sit in a 90-degree angle to the lap when eating."

Answer: 4 Explanation: Aspiration is the most profound and dangerous problem for older adults experiencing dysphagia. Maintaining a 90-degree position during meals will help avoid aspiration. Liquids are usually the most difficult to swallow for person with dysphagia. Slippery foods are often difficult to control and either triggers reflexive swallow too quickly or run out of oral cavity before the swallow. Disruptions should be minimized during meals.

Nursing Process: Evaluation Client Need: Safety and Infection Control Cognitive Level: Analyzing 2) The nurse reviews with nursing assistive personnel (NAP) strategies to assist an older client with a cognitive impairment eat lunch. Which statement by the NAP indicates that teaching has been effective?

1. "I will stand at the right of the patient when I am assisting them to eat."

GTtB 2. "I will feed the patient in the main dinNinUgRrSoIN om o.CpO roMmote socialization."

3. "I will encourage the patient to independently feed himself when appropriate.

4. "I will place several food choices in front of the person to ensure adequate intake."

Answer: 3 Explanation: Self-feeding should be encouraged whenever possible. When feeding the client, it is important to sit at eye level. When feeding an individual with a cognitive impairment it is recommended to minimize disruptions by others during the meal to avoid distractions. Placing the food in front of the patient one dish at a time helps to simplify presentation. Also. it would be important to offer the most nutrient-sense items first to maximize intake.

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3) The nurse is planning interventions for a client with impaired vision. Which intervention should the nurse select when assisting this client with meals?

1. Assist as much as possible to avoid frustration 2. Encourage to eat with others to promote social interaction 3. Utilize the analogy of a clock face to help locate specific foods on the plate 4. Utilize plates with decorative patterns to aid in making the meal more pleasurable Answer: 3 Explanation: The nurse should use the clock analogy to orient the person to the location of food on the plate. Independence with meals should be encouraged. Social interaction is important for older clients but too many distractions may hinder the feeding process. Decorative patterned plates would not be helpful for a client with impaired vision.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 17 Nutrition Care and Support 17.1 To categorize components of standard and texture-modified hospital diets and summarize the indication for their use.

1) An older client recovering from aspiration is not scheduled for a swallowing evaluation for several days. Which action should the nurse to help this client?

1. Provide a can of liquid nutritional supplement.

2. Allow the family to bring in favorite foods to support nutritional needs 3. Provide clear liquids and try to reschedule the swallowing test for the next available time slot.

4. Inform the healthcare provider that the test has not been done and discuss concerns about malnutrition Answer: 4 Explanation: The nurse should first inform the healthcare provider that the test was not performed as scheduled and discuss concerns about the potential for malnutrition. Clear liquids should not be used as the only source of nutrition for someone who aspirated. Providing the client with a liquid nutritional supplement could cause further aspiration. Until the swallowing evaluation is completed, oral intake should be closely monitored. The family should withhold bringing in foods until the evaluation is completed.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying NURSINGTB.COM

2) A client is prescribed a mechanical soft diet. When preparing the diet at home, what should the nurse emphasize to the family?

1. Avoid meats which could cause choking or aspiration 2. Add extra salt and fat to improve the taste of the foods 3. Add extra fiber to prevent the material from becoming too soft 4. Include all food groups in the diet to assure that it is nutritionally adequate Answer: 4 Explanation: Including all food groups in appropriate proportions will assure a balanced nutritional intake. Meats that are not tough or include casings or other sources of protein are an essential component in a balanced diet. Extra salt or fat should be avoided since neither is beneficial in excess. Low-fiber diets may be easier to prepare in the consistency required for a mechanical soft diet.

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3) The family of a client with a history of a stroke reports only providing the client with nutritional supplements instead of other food to prevent choking. Which response should the nurse make to the family?

1. "It's better to give the client desired foods instead of forcing to eat a diet of solid food."

2. "We will get an evaluation by a nutritionist and speech pathologist to identify the best diet."

3. "Nutritional supplements are high is salt and sugar content and are not a healthy choice for people who can still eat."

4. "Nutritional supplements contain all of the components of a regular diet in liquid form, and are a good option for people who are at risk for aspiration or choking."

Answer: 2 Explanation: A client who has had a stroke may be at risk for choking or aspiration, and should be evaluated by a nutritionist and speech pathologist who can recommend an appropriate diet.

Nutritional supplements are designed to be a source of additional nutrients but aren't adequate as the sole source of food. Nutritional supplements contain balanced amounts of proteins, fats, and carbohydrates.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 17.2 To formulate nursing interventions for the hospitalized patient with malnutrition.

1) A resident in a skilled nursing facility eats nutritional pudding supplements throughout the day and refuses and is too full to eat regular meals. Which action should the nurse take?

INaGllTp Bo.CrtOioMns of meals since they are discarded 1. Ask the kitchen to provide the client wNiUthRSsm anyway 2. Ignore the problem since the client probably gets more nutrients eating the supplements than eating the meals 3. Inform the client that too many servings of pudding are not good and meals are a better nutritional option 4. Post a chart that staff must sign when they give the client pudding, and limit the servings to twice a day at least two hours before or after meals Answer: 4 Explanation: Posting a chart to help staff monitor how often and how much pudding the client is given each day along with specifying the amount allowed. Since nutritional supplements are not designed to meet daily nutritional requirements, eating them in place of food is not recommended. Informing the client that eating only supplements does not provide a balanced diet is an important part of client education, but may not result in a behavior change. Asking for a nutritional evaluation may be beneficial to identify client preferences in foods, but smaller portions of the same foods will not make a difference.

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2) The nurse manager plans to improve the nutritional status of clients while receiving hospitalized care. What should each nurse be reminded to do when caring for assigned clients?

1. Offer nutritional supplements when requested 2. Provide all clients with a regular diet unless changed by the healthcare provider 3. Instruct dietary staff just to leave food trays in the vestibule for clients who need help with feeding 4. Carefully evaluate the diet order for each client based on individual needs and discuss the cause of inadequate or over adequate intake with the client, caregiver, healthcare provider and nutritionist Answer: 4 Explanation: Careful evaluation of diets is important to assure clients receive food that they will eat. Nutritional supplements should only be provided when there is a medical order for them, since many clients have special nutritional needs. Dietary staff should not be instructed to leave food trays outside the room because this habit often results in delays. Specific diets are ordered by the medical provider based on the metabolic and physical needs of the client.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) A client is prescribed peripheral parenteral nutrition. For signs of which complication should the nurse monitor this client?

1. Edema 2. Nausea NURSINGTB.COM 3. Diarrhea 4. Thrombophlebitis Answer: 4 Explanation: Clients who are expected to receive parenteral nutrition for longer than 10 days should do so through a central vein since thrombophlebitis may result from the infusion of a hypertonic solution in a small vein. If infused properly, diarrhea, nausea, and edema are not common side effects of parenteral nutrition since the solution is carefully formulated to contain a balanced amount of nutrients and vitamins.

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4) A client with a vision problem needs assistance with meals. Which statement should the nurse make to help this client during meals? (Select all that apply.)

1. "Let's hurry this up a little."

2. "Are you anxious about something?"

3. "Feel free to use your fingers to pick up your chicken."

4. "Your carrots are at the 11 o'clock position on your tray."

5. "I'm going to mix your spaghetti and green beans together."

Answer: 3, 4 Explanation: It is best to let the client with poor vision know where the foods are located on the meal tray and plate. It is not appropriate to mix foods together. It is best to talk about pleasant things with the client and family, not things that may upset the client. Upsetting conversation topics can reduce hunger. It is fine to encourage the client to eat with their fingers. It is not appropriate to encourage the client to shorten their meal time. The nurse should provide ample time for the client to eat.

It is best to let the client with poor vision know where the foods are located on the meal tray and plate. It is not appropriate to mix foods together. It is best to talk about pleasant things with the client and family, not things that may upset the client. Upsetting conversation topics can reduce hunger. It is fine to encourage the client to eat with their fingers. It is not appropriate to encourage the client to shorten their meal time. The nurse should provide ample time for the client to eat.

Nursing Process: Implementation Client Need: Basic Care and Comfort Cognitive Level: Applying NURSINGTB.COM

17.3 To differentiate between the indications, risks, and benefits for enteral and parenteral nutrition support.

1) A client with a critical illness is prescribed parenteral nutrition. Which action should the nurse take when caring for this client?

1. Decrease the amount of infusion slowly based on the oral intake of the client 2. Stop the infusion in the morning and resume oral feeding beginning with clear liquids 3. Follow the facility protocol for tapering the solution, especially monitoring blood glucose levels 4. Follow the facility protocol for tapering the infusion and monitor the input and output for the client each shift Answer: 3 Explanation: Each facility has a protocol or policy for tapering parenteral nutrition that must be followed closely. Parenteral nutrition must be tapered slowly since sudden cessation of high dextrose solutions can lead to hypoglycemia which can be life-threatening. Careful monitoring of blood glucose levels is important. Parenteral nutrition should never be abruptly stopped.

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2) The nurse is caring for a client receiving chemotherapy and radiation to treat neck cancer.

What should the nurse keep in mind when this client's nutritional support is being determined?

1. Parenteral nutrition would be the easiest to manage in an outpatient setting 2. Enteral nutrition would be more difficult to administer on an outpatient basis 3. Clients receiving parenteral nutrition require daily monitoring by a home care nurse 4. Enteral nutrition would be the best choice because the client has a functional digestive tract Answer: 4 Explanation: Parenteral nutrition requires close monitoring and administration must follow a strict protocol. Because of the components of parenteral nutrition, regular blood glucose measurements to avoid hypo- or hyperglycemia episodes are needed. Enteral nutrition has been shown to have economic and health benefits over parenteral nutrition among clients with functional digestive tracts. Most clients can manage self-feeding with enteral nutritional supplements following education and demonstration by a nurse.

Nursing Process: Planning Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) A client with chronic pancreatitis is prescribed enteral nutritional supplements with a polymeric formula. For which reason should the nurse question this prescription?

1. Isotonic formulas can cause diarrhea and should be avoided 2. Modular formulas would better address nutritional requirements 3. Clients with chronic pancreatitis require formulas with predigested macronutrients 4. Polymeric formulas contain nutrients which are partially digested and easy to absorb NURSINGTB.COM Answer: 3 Explanation: Clients with chronic pancreatitis may have malabsorption problems and benefit from formulas that contain predigested nutrients. Isotonic formulas are less likely to cause diarrhea than hypertonic formulas. Modular formulas are not designed to fully meet daily nutritional requirements. Polymeric formulas contain macronutrients that are intact and require the presence of digestive enzymes to be fully digested.

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17.4 To relate the role of the nurse in providing palliative nutrition care.

1) The daughter of a client with terminal brain cancer wants a feeding tube placed so that the client will have nutrition to be cured of the disease. Which response should the nurse make to this daughter?

1. "What does your father want?"

2. "If your father is hungry he will find a way to eat without a stomach tube."

3. "Intravenous fluid contains enough nutrients to meet his nutritional needs."

4. "Palliative nutrition is focused on relieving discomfort and symptoms rather than cure."

Answer: 4 Explanation: The goal of palliative nutrition is to relive symptoms and prevent discomfort.

Decisions made by a health-care proxy should support the client's autonomy. Loss of appetite is common in clients who are terminally ill. A liter of intravenous fluid (D5W) only contains about 170 calories and will not meet daily nutritional requirements.

Nursing Process: Implementation Client Need: Basic Care and Comfort Cognitive Level: Applying 2) The nurse is providing palliative nutrition to a client with a terminal illness. Which intervention should the nurse include on the client's plan of care?

1. Scheduled rest periods 2. Mouth care and lip lubrication 3. A regular balanced diet with snacks 4. Range-of-motion exercises every 4 hoNuU rsRSINGTB.COM Answer: 2 Explanation: The goal of palliative nutrition is to aid in the relief of symptoms and promote comfort. Mouth care and lip lubrication helps to relive dryness of the oral cavity. The need for rest should be at the discretion of the client. Loss of appetite is not uncommon among clients with terminal illness. Although massage and gentle stretching may help to provide comfort, range-of-motion exercises do not need to be done every 4 hours.

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3) The nurse notes that a client receiving enteral feedings has a residual volume of 315 mL. Which action should the nurse take?

1. Hold tube feeding formula 2. Change tube feeding setup 3. Add blue food dye to formula 4. Increase the head-of-bed to a 45-degree angle Answer: 4 Explanation: This client has an increased risk of aspirating the tube feeding formula because of the large gastric residual volume. The head of the bed should be increased to a 45-degree angle to reduce the risk of aspiration. Holding tube feedings for residuals < 500 mL are not advised.

The tube feeding setup should be changed each day to help prevent a foodborne illness, but it is not important to change it at this point related to the increased gastric residual. Blue dye should not be added to the tube feeding formula.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 18 Food, Nutrient, and Drug Interactions 18.1 To classify mechanisms responsible for drug interactions with food and nutrients.

1) The nurse notes that a client is prescribed a medication that inhibits the absorption of some nutrients. Which characteristic pharmokinetics is this medication affecting?

1. Excretion 2. Chelation 3. Metabolism 4. Bioavailability Answer: 4 Explanation: Certain components of food such as fats and minerals can change the bioavailability of drugs, and some drugs can change the availability of nutrients, by fostering or interfering with absorption. Excretion refers to the elimination of the byproducts of metabolism.

Chelation is a type of binding that occurs between a metal ion and another molecule which results in reduced bioavailability. Metabolism occurs after absorption is complete and the substances are in route to the tissues.

Nursing Process: Assessment Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Analyzing 2) The nurse is concerned that a client is at risk for an interaction that affects drug or nutrient metabolism which occurs after the digesN tiU veRSaInNdGaTbBs.oCrOpM tive processes are complete. Which alteration in pharmokinetics is this client at risk for experiencing?

1. Inhibition 2. Excretion 3. Metabolism 4. Bioavailability Answer: 3 Explanation: Interactions that affect drug or nutrient metabolism occurring after digestion and absorption are complete and the substances are in the circulation en route to tissues are referred to as alterations in metabolism. Inhibition results from alteration in the use of enzymes during metabolism and results in increased drug absorption. Alterations in excretion refer to the elimination of metabolic byproducts. Alterations in bioavailability are the result of a change in absorption of drugs or nutrients.

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3) A client is prescribed medication that can interact with nutrients in the kidney. Which alteration in pharmokinetics is this client at risk for developing?

1. Excretion 2. Metabolism 3. Polypharmacy 4. Bioavailability Answer: 1 Explanation: Interactions between drugs and nutrients in the kidney can cause increased excretion or reabsorption of the by-products of metabolism. Alterations in metabolism refer to alterations that occur once after digestion and absorption when substances are in the circulation.

Polypharmacy refers to the use of many drugs which can increase the likelihood of drug/nutrient or drug/drug interactions. Alterations in bioavailability refer to changes in the absorption of drugs and nutrients.

Nursing Process: Assessment Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Analyzing 4) A client is prescribed a medication that requires the cytochrome P450 3A4 enzyme system for absorption. Because of this, what should the nurse instruct the client when taking this medication?

1. Take on an empty stomach 2. Avoid all use of grapefruit juice 3. Take this medication with grapefruit juice 4. Avoid eating for several hours after taNkU inRgSINGTB.COM Answer: 2 Explanation: Grapefruit juice inhibits the cytochrome P450 3A4 enzyme system responsible for "first-pass metabolism" of many drugs. The inhibition of the enzyme allows more drug to be absorbed than normally would occur, elevating plasma drug levels. The cytochrome P450 3A4 enzyme is not identified as being affected by the presence or absence of food.

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18.2 To examine the potential negative effects of certain medications on nutrition status.

1) A client is prescribed a loop diuretic. Which nutrient should the nurse instruct the client to increase in the diet?

1. Iron 2. Potassium 3. Vitamin A 4. Vitamin B12 Answer: 2 Explanation: Clients taking loop diuretics are at risk for urinary loss of potassium, calcium, magnesium, and thiamine, and should be encouraged to add foods that are good sources for these nutrients into their diet. Vitamins A and B12 and iron are important nutrients but are not affected by loop diuretics.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 2) An older client has been overusing alcohol for 25 years. Which nutrients should the nurse recommend that this client increase ingesting?

1. Vitamin D 2. Potassium and iron 3. Potassium and calcium 4. Thiamine and folic acid NURSINGTB.COM Answer: 4 Explanation: Clients who ingest large amounts of alcohol experience a decreased absorption of thiamine and folate and a urinary loss of magnesium. Vitamin D status should be monitored in clients taking antiepileptic drugs. Iron can be affected by chelation with certain antibiotics.

Changes in calcium and potassium excretion occur with the use of loop diuretics.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 3) A client takes a corticosteroid for control of a chronic health problem. Which nutrient is most affected by this medication?

1. Iron 2. Calcium 3. Potassium 4. Vitamin A Answer: 2 Explanation: Corticosteroid use can result in decreased absorption and increased urinary losses of calcium which can cause the loss of bone mineral density. Iron, vitamin A, and potassium are not affected by corticosteroid use.

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18.3 To distinguish patients at increased risk for clinically significant drug, food, and nutrient interactions.

1) An older client with multiple health problems including diabetes sees several different healthcare providers and recognizes a medication by color and shape. Why should the nurse be concerned about drug-drug interactions in this client?

1. Age 2. Multiple health problems 3. High risk for polypharmacy.

4. Drug-food interactions with a diabetic diet Answer: 3 Explanation: An older client who takes many medications from multiple health care providers and only recognizes a medication by color and shape, the client is at risk for possible drug-drug interactions. The nurse should not assume the client is at risk based on age. Having multiple health problems is not a risk in itself; the risk comes from the multiple medications that may be needed to treat the problems. A client following a diabetic diet is not necessarily at greater risk than the client following a regular diet.

Nursing Process: Assessment Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Analyzing 2) A client who takes metoprolol, furosemide, and terazosin is experiencing a new onset of leg cramps. Which reason should the nurse suspect as causing this client to have this symptom?

NURSINGTB.COM 1. Hypokalemia 2. Iron deficiency 3. Folate deficiency 4. Vitamin D deficiency Answer: 1 Explanation: Clients taking loop diuretics, in this case would be furosemide, are at increased risk for loss of potassium resulting in hypokalemia. Iron is lost during chelation with certain antibiotics. Folate is lost with excessive use of alcohol. Vitamins D levels can be decreased in clients using anticonvulsant medication.

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3) A client taking warfarin after aortic valve replacement surgery reports taking gingko biloba every day. For which reason should the nurse report this information to the healthcare provider?

1. Warfarin may increase the production of clots 2. Ginkgo biloba plays a role in synthesis of clotting factors and can increase the risk of clot formation 3. Warfarin may decrease the effect of ginkgo biloba and decrease the international normalized ratio (INR) 4. Ginkgo biloba alters blood clotting and when combined with warfarin could lead to prolonged bleeding times Answer: 4 Explanation: Ginkgo biloba also alters blood clotting and when combined with warfarin could lead to prolonged bleeding times. Warfarin potentiates the effect of ginkgo biloba, resulting in increased bleeding times rather than the formation of clots. Vitamin K plays a role in the synthesis of clotting factors and can increase the risk of clot formation.

Nursing Process: Assessment Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Analyzing 18.4 To delineate classes of medications and specific drugs associated with food or nutrient interactions.

1) A client is prescribed a monoamine oxidase inhibitor (MAOI). Which food item should the nurse instruct this client to avoid?

NURSINGTB.COM 1. Fish 2. Poultry 3. Spinach 4. Aged cheese Answer: 4 Explanation: MAOI inhibitors block the normal metabolism of tyramine, a substance found in aged foods such as cheese, resulting in increased levels in the blood that can cause a hypertensive crisis. Spinach is a source of Vitamin A. Poultry and fish are good sources for protein.

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2) A client is prescribed a thiazide diuretic. Which nutrient should be monitored in this client?

1. Calcium 2. Phosphate 3. Vitamin D 4. Magnesium Answer: 4 Explanation: Clients taking thiazide diuretics should be monitored for urinary loss of potassium and magnesium. Calcium is lost with the use of loop diuretics. Vitamin D loss is usually limited to interactions with anticonvulsant medications. Phosphate levels can decrease when clients take antacids.

Nursing Process: Assessment Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 3) A client is prescribed anticoagulants. The client should be instructed to avoid eating large portions of which foods?

1. Meat and poultry 2. Aged meat and cheese 3. Green, leafy vegetables 4. Yellow vegetables and squash Answer: 3 Explanation: Large portions of green, leafy vegetables should be avoided when taking an anticoagulant because of the vitamin K content. Meat and poultry are good sources of protein and do not affect anticoagulants. Aged mNeUaRt SaInNdGcThBe.eCsOeMshould be avoided with the use of monoamine oxidase inhibitors. Yellow vegetables and squash are good sources of vitamin A and do not affect blood clotting.

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4) A client taking lithium has been altering the daily intake of sodium to reduce high blood pressure. What should the nurse realize this client is at risk for developing? (Select all that apply.)

1. Hypocalcemia 2. Increased risk of lithium toxicity 3. Increased urinary losses of lithium 4. Increased urinary losses of magnesium 5. Increased lithium reabsorption in the kidneys Answer: 2, 5 Explanation: When clients use lithium and restrict sodium intake, the kidneys reabsorb more lithium from the urine which increases the risk of lithium toxicity. Hypocalcemia, urinary losses of magnesium, and urinary losses of lithium are not associated with sodium restrictions.

Hypocalcemia is often the result of an endocrine disorder but also can occur as a result of using loop diuretics. Increased fluid intake can increase urinary losses of lithium. Alcohol intake increases urinary losses of magnesium.

When clients use lithium and restrict sodium intake, the kidneys reabsorb more lithium from the urine which increases the risk of lithium toxicity. Hypocalcemia, urinary losses of magnesium, and urinary losses of lithium are not associated with sodium restrictions. Hypocalcemia is often the result of an endocrine disorder but also can occur as a result of using loop diuretics. Increased fluid intake can increase urinary losses of lithium. Alcohol intake increases urinary losses of magnesium.

Nursing Process: Assessment Client Need: Pharmacological and Parenteral Therapies NURSINGTB.COM Cognitive Level: Analyzing 18.5 To formulate nursing interventions to prevent or treat common drug, food, and nutrient interactions.

1) A client is experiencing diarrhea after starting a new medication. Which additive in the medication most likely is causing this client's new symptom?

1. Gluten 2. Sodium 3. Sorbitol 4. Yellow dye #5 Answer: 3 Explanation: Sorbitol is a sugar alcohol used as filler in medication that can act as a laxative.

Gluten should be avoided with clients who may have an allergy or who have celiac disease.

Hidden sodium can produce an adverse effect on clients with a sodium-restricted diet. Yellow dye #5 is used as a coloring agent is some medications and can cause dermatologic symptoms in clients with an allergy.

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2) A client is prescribed a fluoroquinolone to be taken for 10 days. What should the nurse instruct the client to avoid while taking this medication?

1. Gluten 2. Dairy products 3. High-sodium foods 4. Soda with citrus juice Answer: 2 Explanation: Products containing calcium should be avoided with fluoroquinolones because calcium can decrease their absorption and result in treatment failure. Gluten has no effect on fluoroquinolone absorption. Foods high in sodium do not affect absorption. Citrus juice alone has been linked with poor absorption of certain medications, but sodas containing citrus juice have not been shown to have the same effect.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 3) A client taking a protease inhibitor has a detectable HIV viral load and reports taking St. John's wort to help with feelings of depression. What should the nurse explain about St. John's wort?

1. It can be used in small amounts with few side effects 2. It is a natural product which rarely have adverse effects 3. It causes decreased absorption of protease inhibitors and should be avoided 4. It has been reported to be helpful with depression and is better than taking chemicals NURSINGTB.COM Answer: 3 Explanation: St. John's Wort has been shown to decrease levels of protease inhibitors and contribute to treatment failure. Even all-natural products can cause adverse side effects or interactions with drugs or nutrients. Although there are some reports of successful treatment of depressive symptoms, natural supplements are rarely evaluated using controlled clinical trials, and so claims are usually based on anecdotal reports. Even a small amount may cause adverse effects.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 19 Dietary Supplements in Complementary Care 19.1 To translate the definition of dietary supplements and illustrate the varied types of these products.

1) A client reports taking "all natural" echinacea daily to prevent colds and the flu. Which response should the nurse make to this client?

1. "I've heard many people say that it helps to prevent the flu."

2. "All-natural products are safe to use so you don't have to worry about it."

3. "Some dietary supplements may interact with other medications, but since echinacea is a plant you don't have to worry."

4. "Before taking any dietary supplement you should discuss potential adverse side effects with your healthcare provider."

Answer: 4 Explanation: No dietary supplement is a substitute for medical treatment. Supplements should not be taken/recommended without conferring with the primary healthcare provider. A dietary supplement is defined as any product taken by mouth that contains a dietary ingredient intended to supplement the diet. The list of ingredients may include: an herb or botanical substance, a mineral, a vitamin, or an amino acid. Dietary supplements may not be labeled as drugs or medications. Although clients may refer to substances used in their natural from as being nonchemical, about 25% of modern medications originated from plants originally used in traditional medicine.

NURSINGTB.COM Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 2) A client experiencing hot flashes from menopause wants to take an all-natural dietary supplement but wonders if the healthcare provider should be consulted first. What should the nurse respond to this client?

1. "Since the product is all natural it should be OK." 2. "Natural products are only a problem when they aren't used as directed."

3. "I wouldn't bother the healthcare provider with this when you can ask your pharmacist."

4. "Even all-natural products can produce adverse side effects or be toxic, so use should always be discussed with your healthcare provider."

Answer: 4 Explanation: Use of all dietary supplements should be discussed with the healthcare provider to avoid possible drug interactions or toxicities. Products may be labeled as containing all-natural ingredients, but these ingredients may still cause adverse side effects or toxicity. The label "all natural" does not imply that there are no pharmacodynamic effects since many approved drugs were produced from plants and herbal remedies first used by traditional healers. The healthcare provider should be consulted over the pharmacist.

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3) A client will be starting anticoagulant therapy. Which dietary supplement should the nurse instruct this client to avoid?

1. Garlic 2. Guarana 3. Gotu kola 4. Glucosamine Answer: 1 Explanation: Garlic contains anticoagulation properties and can potentiate the effects of warfarin. Guarana is used to promote weight loss. Gotu kola is used as an anti-anxiety treatment.

Glucosamine is used for cartilage repair.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 4) A client reports taking licorice root to help with hot flashes caused by menopause. Which assessment finding should the nurse consider as being caused by this dietary supplement? (Select all that apply.)

1. Edema 2. Hypertension 3. Hypothermia 4. Decreased apical heart rate 5. Serum potassium is 5.4 mEq/L Answer: 1, 2 GaTyB.eCxOpM Explanation: The client who uses licoricNeUrRoSoItNm erience clinical manifestations associated with mineralocorticoid excess. The client may have hypertension, hypokalemia, and edema. The client's serum potassium level will be low. The client may experience edema associated with mineralocorticoid excess. The nurse would not expect to find that the client has a decreased apical pulse. The nurse would not expect to find that the client is experiencing hypothermia.

The client who uses licorice root may experience clinical manifestations associated with mineralocorticoid excess. The client may have hypertension, hypokalemia, and edema. The client's serum potassium level will be low. The client may experience edema associated with mineralocorticoid excess. The nurse would not expect to find that the client has a decreased apical pulse. The nurse would not expect to find that the client is experiencing hypothermia.

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19.2 To examine the limits of the federal regulations that govern the manufacturing and sale of dietary supplements.

1) A client plans to start taking dietary supplements to help with health problems. What should the nurse emphasize about the control of dietary supplements?

1. They are closely regulated by the FDA 2. They are not evaluated by the FDA prior to sale 3. They are allowed to claim to cure or treat conditions 4. They are marketed under the umbrella of natural drugs Answer: 2 Explanation: Dietary supplements are not evaluated by the FDA prior to being offered for sale to the public. All dietary supplements are placed under a special umbrella of "food" by the Dietary Supplement Health and Education Act and are required to be labeled as dietary supplements.

Product marketers cannot claim to cure, treat, or prevent a disease or condition.

Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying 2) A client prefers to use dietary supplements to treat health problems instead of medications containing chemicals. What should the nurse explain about the role of the federal government regarding the safety of dietary supplements?

1. They establish stringent criteria for content labeling 2. They closely regulates manufacturing and marketing 3. They require safety to be established iNnUcRliSnIiNcG alTtBri.aClOs M 4. The do not conduct a pre-market review of label claims Answer: 4 Explanation: The federal government does not conduct a pre-market review of label claims for dietary supplements. In fact, most dietary supplements are not evaluated by the FDA prior to being offered for sale to the public. No clinical trials are required since products are not FDA approved. The FDA is responsible for regulating package label claims.

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3) A client is planning to take a dietary supplement believed to prevent the development of respiratory illnesses. Which statement should the nurse assess for when examining the dietary supplement?

1. Cure arthritis 2. Prevent colds 3. Support immune health 4. Prevent high glucose levels Answer: 3 Explanation: Dietary supplements can claim to support, restore, or regulate conditions such as immune health. They cannot claim implicitly or explicitly to cure, treat, or prevent a disease or condition. Claims to prevent a disease or condition are not allowed because that is restricted to medications, not dietary supplements.

Nursing Process: Assessment Client Need: Safety and Infection Control Cognitive Level: Applying 19.3 To develop appropriate questions to determine dietary supplement use when conducting a nursing assessment.

1) The nurse prepares to assess a client. Which question should the nurse use to assess for dietary supplement use?

1. "In addition to your prescribed medication, are you using any over-the-counter remedies, herbs, vitamins, minerals, or other supplements you purchase?"

2. "Are you or your family members usinNgUdRiSeItNaG ryTB su.CpO plM ements?"

3. "Do you take any other pills to help treat or prevent certain diseases or illnesses?'

4. "Have you ever tried any all-natural weight loss products?"

Answer: 1 Explanation: Clients should be reminded that dietary supplements include many types of products and can be purchased from many sources. Dietary supplements can include herbs, botanicals, vitamins, minerals and other products. They come in many forms including liquids, capsules, tablets, tinctures, teas, etc. dietary supplements may claim to help many conditions including (but not limited to): weight loss, hot flashes, arthritis, joint pain, blood glucose.

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2) A client reports not taking any dietary supplements but later says that glucosamine is taken three times a day for arthritis pain. What should the nurse respond to this client?

1. "Other clients have told you how much glucosamine helps pain."

2. "Glucosamine is considered a dietary supplement, not a medication."

3. "Glucosamine has not received any negative reports so should be OK to use."

4. "You should discuss all dietary supplements with your healthcare provider before using them to avoid adverse effects."

Answer: 4 Explanation: Dietary supplements are not regulated by the FDA and are sold under an umbrella of food, not medication. Clients should discuss the use of any dietary supplement with the healthcare provider to avoid potential drug-drug interactions or toxic effects. Although some clients may report using a dietary supplement with no problems, safe use depends on the medical condition of the client and possible drug-drug interactions with other medications.

Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying 3) The nurse prepares to assess a client's medication history. Why should the nurse ask about the use of common supplements?

1. Clients may not consider sports bars to be a dietary supplement 2. Clients may misinterpret the question and consider only supplements sued for weight loss 3. Clients may not consider products used for a specific condition to be a dietary supplement 4. Many clients do not consider herbs, botanicals, vitamins, or minerals as dietary supplements NURSINGTB.COM Answer: 4 Explanation: There are multiple products including herbs, botanicals, vitamins, minerals, and other products classified as dietary supplement. Clients may not be aware of the many products that are considered dietary supplements. They may also not be aware of the many forms the supplements can be marketed in. Being as specific as possible can be helpful to educate the client about dietary supplements and to elicit information about their use.

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4) A client seeks medical attention for symptoms of an allergic response to ragweed. The use of which dietary supplement should the nurse specifically ask about since it may cause the same symptoms? (Select all that apply.)

1. Garlic 2. Feverfew 3. Echinacea 4. Chamomile 5. Black Cohosh Answer: 2, 4 Explanation: Clients who have an allergy to ragweed are more likely to experience allergic reactions to chamomile and feverfew. Garlic would not have been implicated in this type of cross-allergy reaction. Echinacea would not have been implicated in this type of cross-allergy reaction. Black cohosh would not have been implicated in this type of cross-allergy reaction.

Clients who have an allergy to ragweed are more likely to experience allergic reactions to chamomile and feverfew. Garlic would not have been implicated in this type of cross-allergy reaction. Echinacea would not have been implicated in this type of cross-allergy reaction. Black cohosh would not have been implicated in this type of cross-allergy reaction.

Nursing Process: Assessment Client Need: Safety and Infection Control Cognitive Level: Applying 19.4 To translate the existing limited research findings on the safety and efficacy of popular dietary supplements.

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1) A client reports taking a dietary supplement that is considered "natural." What should the nurse include when responding to this client?

1. Only organic substances are used 2. The ingredients in the product are not processed 3. The active ingredients are found naturally in the environment 4. The product is not proven to be safe or without harmful effects Answer: 4 Explanation: The claim that products are made of all-natural ingredients does not mean that they are safe or have no harmful side effects. Most ingredients have been processed during manufacturing. All natural does not mean that they are sold in the same form that they are found in the environment or that only organic substances are included.

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2) A client who is HIV positive plans to start using dietary supplements to improve health.

Which supplement should the nurse instruct this client to avoid?

1. Fish oil 2. Vitamin A 3. Chamomile 4. St. John's wort Answer: 4 Explanation: St. John's wort has been reported to have numerous negative effects because it uses a similar drug metabolism pathway common to many drugs. Adverse side effects have been reported with numerous antiretroviral medications, especially protease inhibitors. Vitamin A has not been reported to have serious adverse effects, nor has chamomile. Fish oil adversely effects blood clotting.

Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying 3) A client reports vomiting after taking several doses of chitosan. Which type of allergy might this client be demonstrating by the response after taking this dietary supplement?

1. Gluten 2. Sodium 3. Shellfish 4. Bee pollen Answer: 3 Explanation: Some ingredients in dietarN y UsuRpSpINleGmTeBn.CtsOcMan cause allergic or anaphylactic reactions if clients are unaware of their contents. Chitosan is sold to promote weight loss but is made from shellfish and should be avoided by clients with that allergy. Chitosan does not contain gluten, sodium, or bee pollen.

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19.5 To educate patients about side effects and precautions associated with dietary supplements.

1) A client reports a stuffy head and lung congestion after drinking chamomile tea. What should the nurse respond to the client after learning of the new symptoms?

1. "I wouldn't worry about it, wait to see what happens."

2. "Chamomile is an herb that helps to promote sleep and relaxation."

3. "Chamomile is an all-natural product and should not cause any adverse symptoms."

4. "People who are allergic to ragweed can have symptoms when using chamomile tea."

Answer: 4 Explanation: The use of dietary supplements containing chamomile can cause allergic reactions in clients who are allergic to ragweed. Even though chamomile is an herb easily grown in any garden, and as such a natural product, it can still cause allergic reactions. If a client experiences a reaction to any product the product should not be used again because a more severe reaction could occur in the future.

Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying 2) A client is prescribed anticoagulant medication for an acute health problem. For which reason should the nurse assess the client's use of dietary supplements?

1. Enhance bone health 2. Explain the potential of weight gain 3. Identify the development of muscle cramps 4. Prevent the development of excessiveNbUleReSdIiNnGgTB.COM Answer: 4 Explanation: Dietary supplements containing vitamin K, horse chestnut, gingko, and ginseng have anticoagulation effects and can result in excessive bleeding. Clients using dietary supplements with these ingredients may not be aware of their anticoagulant properties which could present a danger. Muscle cramps, weight gain, and bone health are not related to the use of anticoagulation medications.

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3) A client with a history of allergies to environmental allergens wants to start taking echinacea.

For which allergy should the nurse counsel the client to avoid taking this dietary supplement?

1. Dust 2. Ragweed 3. Cat dander 4. Strawberries Answer: 2 Explanation: Clients with allergies to ragweed should be informed about a possible allergic reaction when taking echinacea to prevent colds and boost the immune system. Dust, cat dander, and strawberries are common sources of allergens but do not cause cross-reactivity with echinacea.

Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 20 Weight Management 20.1 To analyze risk factors for the development of overweight and eating disorders.

1) The nurse prepares an educational seminar about eating disorders for a community group.

Which should the nurse emphasize as a common risk factor for the development of eating disorders among adolescents?

1. Fad diets 2. Peer pressure 3. Bullying in school 4. Weight loss programs Answer: 2 Explanation: Peer pressure can result in a desire to conform to the group and can result in low self-esteem, depression, and eating disorders. Fad diets focus on unique ways to consume foods, but are usually a passing trend. Being the target of bullying in school would be more likely to promote depression or acting out rather than eating disorders. Weight loss programs promote healthy food choices and lifestyle changes.

Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Applying 2) A recently widowed client has lost 20 lbs. over the last few months. Which question should the nurse ask when assessing the client aNbU ouRtStIhNiGs TwBe.CigOhM t loss?

1. "Who cooks for you at home?"

2. "Would you like me to set up meals on wheels?"

3. "How are you adjusting to the loss of your spouse?"

4. "Can you afford to buy food on your social security income?"

Answer: 3 Explanation: Depression can lead to weight loss, isolation, and change in eating habits and should be treated either through counseling or antidepressant medications. Inquiring about the preparation of food is important but will not be helpful if the underlying cause is an eating disorder resulting from depression. Home-delivered meal programs for the elderly can be helpful in assuring that they have affordable meals available to them, although the meals are not cooked according to individual preferences. Financial problems can be a factor for eating disorders among clients on fixed incomes, but more often results in weight gain since foods that are inexpensive are often filled with calories while having little nutritious value.

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3) A middle-aged female client with a BMI of 29 and a history of hypertension and coronary heart disease reports binging on fast food when experiencing stress. What should the nurse include when counseling this client?

1. Start on medication to treat hypertension 2. Only keep fruits and vegetables in the house to avoid eating junk foods 3. Increase daily exercise and not worrying about occasional binges with fast food.

4. Attend a behavior modification class to learn new coping strategies to help resist eating when stressed.

Answer: 4 Explanation: Newly acquired coping skills and alternative activities need to be incorporated into healthy lifestyle changes for successful weight loss programs. There is no evidence to suggest that the client is not taking medication for hypertension. Home food stores may be helpful but are not a guarantee that the client will change their eating behaviors. Exercise is an important component of weight loss programs but must be coupled with healthy eating habits.

Nursing Process: Implementation Client Need: Psychological Integrity Cognitive Level: Applying 4) A client being treated for several health problems is gaining weight. For which health problems might prescribed medications be causing this client's increase in body weight? (Select all that apply.)

1. Asthma 2. Epilepsy NURSINGTB.COM 3. Hypothyroidism 4. Raynaud's disease 5. Rheumatoid arthritis Answer: 1, 2, 5 Explanation: Medications used to treat seizure disorders, depression, allergies, and inflammatory disorders often result in weight gain by clients taking these medications. Clients taking medications used to treat hypothyroidism often experience weight loss. Medications used by the client to treat Raynaud's disease do not result in weight gain.

Medications used to treat seizure disorders, depression, allergies, and inflammatory disorders often result in weight gain by clients taking these medications. Clients taking medications used to treat hypothyroidism often experience weight loss. Medications used by the client to treat Raynaud's disease do not result in weight gain.

Medications used to treat seizure disorders, depression, allergies, and inflammatory disorders often result in weight gain by clients taking these medications. Clients taking medications used to treat hypothyroidism often experience weight loss. Medications used by the client to treat Raynaud's disease do not result in weight gain.

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20.2 To formulate a treatment plan using lifestyle management for overweight.

1) The mother of an adolescent is upset and criticizes the client's lack of self-control. What should the nurse include when responding to the mother?

1. Closely monitor food intake and restrict high calories foods 2. Criticism results in low self-esteem and can promote eating disorders 3. During puberty children gain weight but lose it again during adolescence 4. Talk with the teachers and make sure that junk food is not eaten when at school Answer: 2 Explanation: Frequent criticism of children results in low self-esteem and can promote eating disorders. Restricting food choices can be seen as a punishment unless the child is included in planning. Childhood obesity is related to poor eating habits and lack of exercise rather than age.

Talking with teachers could make the child feel worse and monitoring of food at school is an improbable solution.

Nursing Process: Implementation Client Need: Psychological Integrity Cognitive Level: Applying 2) A client reports being on a popcorn diet to lose weight. What should the nurse include when responding to this client?

1. Restricting food choices is an excellent way to lose weight 2. Popcorn diets work by filling the stomach without adding calories 3. Weight loss is best accomplished by following a balanced diet with exercise 4. Popcorn is a natural food containing aNllUtR heSInNuGtrTiBen.CtO sM needed for a balanced diet Answer: 3 Explanation: Restricting food choices results in a diet that has limited nutrients. Plain popcorn adds fiber and carbohydrates to the diet, but if eaten with butter also adds calories from fat.

Weight loss is best accomplished by following a balanced diet and including regular exercise.

Popcorn contains mostly carbohydrates and is not an adequate energy source.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A client reports giving upon on a weight loss plan because of feeling hungry all of the time.

Which substitution should the nurse suggest for this client?

1. Ice cream in place of yogurt 2. Low fat in place of skim milk 3. Pretzels in place of potato chips 4. A bagel instead of two English muffin halves Answer: 3 Explanation: A portion of pretzels contains less fat and calories than an equivalent portion of potato chips. Substituting foods that have a lower content of fat decreases the calorie value. Ice cream may have more calories than yogurt. Skim milk contains less fat and calories than low-fat milk. Two English muffin halves in place of a bagel can eliminate up to 100 calories.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3

20.3 To examine nutritional concerns following bariatric surgery.

1) The nurse prepares teaching for a client recovering from metabolic surgery. The nurse should encourage the client to continue to take vitamin and mineral supplements to avoid the development of which health problems?

1. Diabetes, weight gain, and vitamin D deficiency 2. Hypertension, dementia, and vitamin C deficiency 3. Low levels of iron, hyperlipidemia, and vitamin A deficiency 4. Anemia, metabolic bone disease, and vitamin B12 deficiency Answer: 4 Explanation: Following restrictive surgery for weight loss, it is important to remind the client to continue to take the recommended vitamin and mineral supplements prescribed to avoid anemia, metabolic bone disease, and vitamin B12 deficiency. Type 2 diabetes mellitus is less likely to develop since it is usually related to obesity. Hypertension is usually improved with weight loss.

Hyperlipidemia should improve since client's follow a low-fat diet after surgery.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse prepares to assess a client recovering from metabolic surgery. For which reason should this client's bone mineral density be closely monitored?

1. Low levels of vitamin B12 cause bones to lose density 2. Clients are advised to avoid milk and milk products after surgery NU 3. Vitamin D is only absorbed in the stom acRhS,IN noGtTiBn.CthOeMlower jejunum 4. Metabolic bone disease is more likely in clients who lose weight rapidly Answer: 4 Explanation: Metabolic bone disease is more likely to occur with rapid weight loss since stores prior to surgery are sequestered in adipose tissue and not readily available in the body. Vitamin B12 does not contribute to bone mineral density. Clients follow a low-fat diet after surgery but are allowed to eat smaller portions of all food groups. Nutrients, including vitamins and minerals, are absorbed in the intestines not the stomach.

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3) A client who had a biliopancreatic diversion about one year ago demonstrates an attitude change. After learning that the client stopped taking prescribed vitamin and mineral supplements, which problem should the nurse suspect that this client is experiencing?

1. Vitamin B3 deficiency that resulted in pellagra 2. Vitamin B6 deficiency that resulted in increased stress 3. Vitamin D deficiency that results in bone demineralization 4. Vitamin C deficiency that resulted in wet beri beri Answer: 1 Explanation: Restrictive surgery can decrease absorption of vitamins and minerals in the diet including niacin, the cause of pellagra. Although vitamins B6, D, and C are essential components of a balanced nutritional intake, deficiencies will not result in changes of the client's emotional status.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 20.4 To define and differentiate between the clinical parameters and treatment approaches of each type of eating disorder.

1) A client has a BMI of 42. How should this client's body weight be classified?

1. Obese 2. Overweight 3. Underweight NURSINGTB.COM 4. Morbidly obese Answer: 4 Explanation: A client with a BMI > 40 is classified as morbidly obese. A client with a BMI > 30 is classified as obese. A client with a BMI > 25 is considered to be overweight. Normal weight is classified as having a BMI 25. The classification of underweight can vary with the most extreme being a BMI < 15.

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2) A client asks for a diet to lose 80 lbs. How should the nurse respond to this request?

1. "Losing 80 pounds is easy, it's keeping it off that is difficult."

2. "If you were really motivated you would not be asking for help."

3. "Come back when you can show me that you are ready to lose weight."

4. "Weight loss is about more than diet alone and must also include behavioral change to be successful" Answer: 4 Explanation: New behaviors that promote weight loss need to be integrated into long-term lifestyle change. Weight loss goals should be reasonable and achievable to increase the likelihood of success. Clients should seek help in developing a weight loss program that is individualized to their needs. The client is demonstrating motivation by seeking the assistance of the nurse. Telling the client to come back when they are motivated is demeaning and should not be done. Modification of behaviors that resulted in weight gain is important for weight management.

Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Applying 3) The nurse plans care for a client with anorexia nervosa. Which should the nurse identify as a focus for this client?

1. High-calorie, high-fat foods to promote weight gain 2. Emphasize a strict eating program and daily exercise 3. Improvement in eating behaviors and psychological and emotional health 4. Quick weight gain and providing a coN mUpRreShIN enGsTivBe.CeOxM planation of the problem Answer: 3 Explanation: Weight gain of 0.5 to 1 pounds/week for outpatients and 2 to 3 pounds/week for inpatients is recommended. More rapid weight gain will result in increased fat stores rather than accumulation of lean body mass. The long-term goal of treatment should focus on improvement of eating behaviors and psychological and emotional health. Clients should be encouraged to eat a balanced diet of foods individualized to their preference and exercise only in moderate amounts to regain strength. Foods should be chosen for nutritional value rather than providing foods with empty calories.

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4) The nurse is assessing a client diagnosed with an eating disorder. Which findings indicates that the client is experiencing bulimia nervosa? (Select all that apply.)

1. BMI is 17 2. Lanugo noted 3. Absent gag reflex 4. Potassium level is 3.3 mEq/L 5. Apical pulse is 56 beats per minute Answer: 3, 4 Explanation: Clients with bulimia nervosa often have low serum levels of potassium and chloride related to laxative abuse and vomiting. The gag reflex may be poor or absent. Heart rate is more likely to be increased because of central nervous system stimulants to avoid weight gain.

Clients with anorexia have low BMIs. People with anorexia nervosa frequently develop a fine hair growth across their body called lanugo.

Clients with bulimia nervosa often have low serum levels of potassium and chloride related to laxative abuse and vomiting. The gag reflex may be poor or absent. Heart rate is more likely to be increased because of central nervous system stimulants to avoid weight gain. Clients with anorexia have low BMIs. People with anorexia nervosa frequently develop a fine hair growth across their body called lanugo.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 20.5 To relate the assessment parameters used in formulating nursing nutritional interventions for overweight patients and those with eaNtU inRgSdINisGoTrB de.CrsO.M 1) An adolescent client is losing weight and is following a vegetarian eating plan. What should the nurse suspect is occurring with this client?

1. Anorexia nervosa 2. Loss of weight due to diet 3. Natural weight loss due to peer pressure 4. Loss of weight because of a growth spurt Answer: 1 Explanation: Anorexia results from a fear of gaining weight and may result from restrictive eating. A change to healthy eating habits or even following a balanced vegetarian diet should not result in excessive weight loss. Peer pressure is a common underlying cause for weight loss among adolescents, but excessive weight loss is a sign of a medical or psychological problem. It is unlikely that the client's weight loss is due to a growth spurt.

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2) A client with a BMI of 33 is experiencing increasing fatigue which is attributed to a sedentary job and lifestyle. Which question should the nurse ask when beginning to assess this client and current body weight?

1. "How do you feel about your current weight status?"

2. "Do you have other family members who are obese?"

3. "Do you think that being obese contributes to your fatigue?"

4. "Have you noticed that you are more tired now that you have gained an extra 50 pounds?"

Answer: 1 Explanation: Making statements about a client's size or weight may cause them to react defensively or feel stigmatized. Most clients are aware that they are overweight so restating an obvious fact is not necessary. Asking how the client feels about current weight allows the client to share perceptions of body weight and provides direction about what intervention might be most helpful. Although a family history of obesity could be a factor related to the client's eating disorder, it should not be the first question that is examined.

Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Applying 3) An older client with a BMI of 33 has hypertension and hyperlipidemia. What should the nurse emphasize when discussing this client's weight and health problems?

1. Considering metabolic surgery for weight loss 2. A no-fat diet to decrease fat and cholesterol intake 3. Adhering to a low-protein diet to ensure weight loss 4. The role of weight loss and exercise inNU blRoSoIdNG prTeBs.sCuOreMregulation Answer: 4 Explanation: Weight loss and exercise play an important role in blood pressure management.

Metabolic surgery is reserved for obese clients who have failed conventional weight loss programs. Diets that completely restrict certain food groups do not promote a healthy diet and can result in a lack of essential nutrients. Proteins are an integral component of metabolism and a source of energy.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 21 Cardiovascular Diseases and Lipid Disorders 21.1 To summarize the risk factors for coronary heart disease, comparing which factors are amenable to dietary intervention.

1) The nurse is explaining to a client that some risks for cardiovascular disease (CVD) can be minimized by nutritional change. What should the nurse recommend to reduce the client's risk of developing atherosclerosis?

1. Maintaining lower cholesterol levels 2. Daily supplementation with vitamin E 3. The addition of selenium to the daily diet 4. Adding foods rich in beta carotene to the diet Answer: 1 Explanation: Vitamin E, beta carotene, and selenium are marketed as beneficial to heart health but there have been no clinical studies that support these findings. In fact, there is some evidence that they may be a potential risk. Elevated cholesterol and low-density lipoprotein (LDL) levels have been linked to an increase in CVD in numerous studies.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) A client wants to know the difference between good and bad cholesterol. What should the NURSINGTB.COM nurse respond to this client?

1. Good cholesterol builds fat stores that can be used for energy if needed by the body, whereas bad cholesterol has no real purpose 2. Bad cholesterol causes a buildup of adipose tissue in the abdomen and can lead to heart attacks but good cholesterol is used by the body to produce energy 3. Good cholesterol is needed by the body to build cell walls and other functions, whereas bad cholesterol builds up in blood vessels and causes cardiovascular disease 4. Bad cholesterol is difficult to absorb in the intestines and ends up being eliminated in the stool with little nutritional value but good cholesterol is used to build cell walls Answer: 3 Explanation: Cholesterol is used by the body to synthesize steroid hormones, vitamin D, and bile acids as well as building cell walls. In moderation all cholesterol is considered "good" because it helps the body function properly. Cholesterol is considered to be "bad" when there is an overabundance that builds up in blood vessels and causes them to narrow. LDL is most often referred to as "bad cholesterol" by consumers because it has been linked with CVD. Fat stores are used for energy in the absence of sufficient glucose to supply the body's energy needs.

Cholesterol is readily absorbed by the intestines.

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21.2 To differentiate between saturated, monounsaturated, polyunsaturated, and trans fatty acids and accompanying food sources.

1) The nurse reviews the role of trans fats in elevating LDL levels. Which food should the nurse identify that contains this type of fat?

1. Walnuts 2. Olive oil 3. Fatty fish 4. Margarine Answer: 4 Explanation: Olive oil is a source of Cis-monounsaturated fat which has been shown to produce a modest decrease in LDL and a modest increase in HDL. Margarine contains trans fats which lead to increased levels of LDL and reduction in HDL. Fatty fish and walnuts are sources of n-3 polyunsaturated fat, which is linked with reduction of LDL cholesterol and a possible modest increase in HDL. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) The nurse provides diet teaching to a client with an elevated cholesterol level. Which food should the nurse identify that contains linolenic acid and α-linolenic acid?

1. Fatty fish and pork 2. Margarine and butter NURSINGTB.COM 3. Soybean oil and walnuts 4. Baked goods and chocolate Answer: 3 Explanation: Margarine and butter are sources for elaidic acid (a trans-monounsaturated fat) and myristic acid (a saturated fat). Baked goods and chocolate contain elaidic acid (a transmonounsaturated fat) and stearic acid (a saturated fat). Soybean oil is a source of linoleic acid (n6 polyunsaturated fat) and walnuts contain α-linolenic acid (an n-3-polyunsaturated fat). Fatty fish are a source of eicosapentaenoic acid (an n-3 polyunsaturated acid) and pork contains stearic acid (a saturated fat).

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3) A client, concerned about fat intake, wants to know the difference between transmonounsaturated fats and cis-monounsaturated fats. What should the nurse explain to this client?

1. Trans-monounsaturated fats decrease LDL and increase HDL, whereas cis-monounsaturated fats decrease LDL and HDL. 2. Trans-monounsaturated fats increase both LDL and HDL, whereas cis-monounsaturated fats increase LDL and HDL. 3. Trans-monounsaturated fats increase LDL and decrease HDL, whereas cis-monounsaturated fats may mildly decrease or not effect LDL or mildly increase or not affect HDL. 4. Trans-monounsaturated fats decrease LDL but have no effect on HDL, whereas cismonounsaturated fats decrease LDL but have no effect on HDL. Answer: 3 Explanation: The effect of monounsaturated fats depend if they are in the trans or cis configuration. Trans-monounsaturated fats increase LDL and decrease HDL levels, two negative effects. Cis-monounsaturated fatty acids may produce a mild decrease in LDL levels or have no effect, and produce a mild increase or have no effect on HDL levels.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 21.3 To relate the current evidence-based practices for reducing risk of coronary heart disease through diet.

1) A client desires to lower LDL cholesterol level. Which percentage of calories should the nurse recommend that this client ingest each dN ayUR ofSIsNaG tuTrB at.eCdOM fats?

1. At least 20% of total calories 2. Limited to < 7% of total calories 3. Limited to < 15% of total calories 4. At least 8% but < 20% of total calories Answer: 2 Explanation: The American College of Cardiology and the AHA recommend an intake of no more than 5-6% of calories from saturated fats and overall a reduced intake of trans fats. The other choices are not recommendations by the American College of Cardiology and the AHA. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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2) A client desires to lost 20 lbs. Which option should the nurse suggest to this client?

1. Eliminate foods containing polyunsaturated fats such as fatty fish and nuts.

2. Restrict intake to calories from high-protein sources while eliminating carbohydrates.

3. Include calories from all forms of fat including saturated, monounsaturated, and polyunsaturated fats.

4. Maintain fat intake to the lower range of daily recommendations and including primarily monounsaturated and polyunsaturated fats.

Answer: 4 Explanation: Saturated fats lead to increases of LDL. Polyunsaturated fats such as fatty fish have been linked with decreases in LDL and increases in HDL cholesterol. Dietary restrictions contribute to an imbalanced intake of nutrients and are not recommended. Based on TLC, weight loss can be achieved by decreasing the amount of fat in the diet, which also reduces the daily caloric intake, and limiting fat sources to food containing monounsaturated and polyunsaturated fats.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 3) A client wants to increase the amount of viscous fiber in the diet. Which foods should the nurse recommend to this client?

1. Wheat, oats, and nuts 2. Flaxseed, wheat, and oats 3. Broccoli, barley, and legumes 4. Benecol and Take Control spreads NURSINGTB.COM Answer: 3 Explanation: Sources of viscous fiber include broccoli, barley, legumes, oats, and various fruits and vegetables. Wheat and nuts are other sources of dietary fiber but are not considered viscous fiber. Benecol and Take Control spreads are sources of plant stanol/sterols which have also been shown to reduce LDL levels when included regularly in the diet. Flaxseed is a source of n-3 polyunsaturated fats.

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21.4 To strategize lifestyle modifications to manage hypertension.

1) A client logs blood pressure and dietary intake as a method to help hypertension. Which food item should the nurse note is associated with an increase in blood pressure?

1. Fats 2. Fiber 3. Protein 4. Sodium Answer: 4 Explanation: Foods high in sodium can result in fluid retention and an accompanying increase in blood pressure. Dietary protein does not affect blood pressure. A low-fat diet is recommended for clients with hypertension to reduce the risk of cardiac disease. High-fiber diets aid in lowering LDL and weight loss and would not have a negative effect on blood pressure management.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 2) The nurse provides teaching to a client with hypertension who is overweight. What should the nurse emphasize during this teaching?

1. Weight loss, exercise, and smoking cessation 2. Blood sugar monitoring, exercise, and weight loss 3. Alcohol abuse counseling, exercise, and PSA testing 4. Reduction of alcohol consumption, exNeU rcRisSeI,NaGnTdBd.CieOtM ary fiber Answer: 1 Explanation: The most important factors for the nurse to discuss with the client would be weight loss, exercise, and tobacco cessation. Alcohol abuse counseling is always appropriate for any client, but PSA testing is used to screen for prostate cancer and has no value in hypertension management. Blood sugar monitoring is helpful to screen for diabetes. Dietary fiber has been linked to reductions in LDL. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) A client is prescribed the Dietary Approaches to Stop Hypertension (DASH) diet to reduce risk factors for heart disease. What foods should the nurse recommend that this client ingest when following this diet?

1. 5 servings of fruits, vegetables, and dairy products daily 2. 4 servings of fruits and vegetables and 1 serving of dairy products daily 3. 3 servings of fruits, 5 servings of vegetables, and 3 servings of dairy products daily 4. 5 servings of fruit, 3 servings of vegetables, and 2 servings of low-fat dairy products daily Answer: 4 Explanation: Clients using the DASH diet should consume 5 servings of fruits, 3 servings of vegetables, and 2 servings of low-fat dairy products daily. Foods should include whole gains, poultry, fish, and nuts with limited amounts of red meat and foods containing simple carbohydrates and high fat snacks.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 21.5 To translate the medical nutrition therapy for the patient with metabolic syndrome.

1) A client wants to know what metabolic syndrome means. What should the nurse explain as the risk factors for this disease process?

1. Obesity and inactivity 2. Abdominal fat and hypertension 3. Hypertension and lack of exercise NURSINGTB.COM 4. Diabetes and elevated blood sugar Answer: 1 Explanation: Obesity and inactivity are the underlying risk factors for metabolic syndrome.

Hypertension, lack of exercise, and buildup of abdominal fat are all risks of CVD. Poorly controlled diabetes is a risk factor for end organ damage including cardiovascular disease (CVD).

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2) A male client with a blood pressure of 124/82 mm Hg has a triglyceride level of 220 mg/dL, fasting glucose of 240 mg/dL, HDL level of 23 mg/dL, and waist circumference of 38 inches.

For which health problem should the nurse prepare teaching for this client?

1. Pre-diabetes 2. Morbid obesity 3. Metabolic syndrome 4. Poorly controlled essential hypertension Answer: 3 Explanation: A BP of 124/82 mm Hg would be considered within normal range. A fasting glucose of 240 mg/dL requires close monitoring and possible testing to determine if the client has diabetes, since a diagnosis should not be made on a one-time variation in laboratory results.

Obesity should be determined based on the client's height, weight, and BMI rather than weight alone. Since the client has a poorly controlled fasting blood sugar, an abdominal circumference of > 35 inches, and triglycerides > 150 mg/dl the client meets the diagnostic criteria for metabolic syndrome.

Nursing Process: Planning Client Need: Reduction of Risk Potential Cognitive Level: Applying

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3) The nurse assesses a male client with metabolic syndrome. Which findings should the nurse expect to assess? (Select all that apply.)

1. Blood pressure 110/70 2. Triglycerides 175 mg/dL 3. HDL cholesterol 35 mg/dL 4. Waist circumference 44 inches 5. Fasting serum glucose 142 mg/dL Answer: 2, 3, 4, 5 Explanation: Clients who have been diagnosed with metabolic syndrome must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL. Clients who have been diagnosed with metabolic syndrome must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL. Clients who have been diagnosed with metabolic syndrome must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL. Clients who have been diagnosed with mNeUtaRbSoIN licGTsyBn.CdOroMme must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL. Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying

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21.6 To analyze and prioritize nutrition-related issues in the patient with heart failure.

1) A client with heart failure experiences an increase in lower extremity edema and weigh gain.

Which change in the client's behavior most likely contributed to the edema and weight gain?

1. Increased activity 2. Water retention due to increased protein intake 3. Worsening cardiac ejection fraction due to age 4. Excess sodium from ingesting processed foods Answer: 4 Explanation: The sudden onset of weight gain and development of edema points to an increased consumption of dietary sodium resulting in water retention and worsening heart failure. The likely cause of the increased sodium is processed foods which have high sodium levels.

Worsening cardiac ejection fraction due to age is unlikely given the sudden onset of symptoms.

Water retention is caused by sodium rather than an increase in dietary protein.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 2) The nurse reviews a low-sodium diet with a client with heart failure. Which non-sodium food seasoning should the nurse recommend to this client?

1. Sauces 2. Marinades 3. Garlic with sea salt NURSINGTB.COM 4. Alternative spice mixtures Answer: 4 Explanation: Salt substitutes, spices, and low-sodium marinades or sauces may be a good substitution for patients who use salt often at the table. Commercially prepared sauces and marinades may contain hidden sources of sodium and should be avoided. Sea salt is not an alternative for table salt in a sodium-restricted diet.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 22 Diabetes Mellitus 22.1 To differentiate between classifications of diabetes in terms of age of onset, etiology, risks, typical symptoms, and treatment plans.

1) An adolescent client has a BMI of 28 and fasting glucose level of 125 mg/dL. Which recommendation should the nurse expect for this client?

1. No action since a fasting blood sugar of 125 mg/dL is not abnormal 2. Immediate referral to an endocrinologist for further evaluation 3. A high-fiber diet, strenuous exercise daily, and weight loss of > 20% 4. Weight loss of 7%, low-fat diet, and moderate exercise for prevention of type 2 diabetes Answer: 4 Explanation: The ADA recommends a weight loss of 7% of body weight and at least 150 minutes/week of moderate activity such as walking to prevent the development of type 2 diabetes. In the Nurses' Health study, a healthy diet high in cereals and polyunsaturated fats was more strongly associated with lower risk of diabetes among minorities. An immediate referral to the endocrinologist is not warranted. Pre-diabetes is defined as a fasting blood sugar between 100 and 125 mg/dL. Nursing Process: Planning Client Need: Reduction of Risk Potential Cognitive Level: Applying CaOnM 2) A school-age client with type 1 diabetNeU s RmSeIN lliGtuTsB.w ts to know why the medication is in an injection instead of a pill. Which response should the nurse make to this client?

1. "The type of medication you need depends on your blood sugar levels, and yours meet the criteria for insulin."

2. "Medications available in pill form can be used for type 1 diabetes if the treatment is started early enough in the disease."

3. "Younger clients diagnosed with diabetes are prescribed insulin because it is long lasting and easier to keep track of than pills."

4. "Medications available in pill form only work if your body makes some insulin, and in type 1 diabetes the cells that make insulin do not work."

Answer: 4 Explanation: Medication available in pill form works with the endogenous insulin that is present in the body. People with type 1 diabetes mellitus are always treated with insulin because their bodies do not have a supply of endogenous insulin. Types of insulin with a range of rapid acting to long acting are available and can be prescribed alone or in combination according to the metabolic needs of the individual. Age at diagnosis does not affect the type of treatment used for type 1 diabetes.

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22.2 To compare carbohydrate, fat, and protein metabolism occurring in diabetes mellitus to that of normal metabolism.

1) A client with newly diagnosed diabetes asks when the frequent urination will stop. Which response should the nurse make to this client?

1. "Once your blood sugar is less than 200 you won't be as thirsty and so won't urinate as frequently."

2. "Limiting the amount of fluids in the evening may help to decrease the number of times you wake up during the night to urinate."

3. "Frequent urination is a common event with diabetes and should be expected to continue regardless of how well your blood sugar is controlled."

4. "Without enough insulin, glucose is not absorbed into the cells but is excreted by the kidneys along with large amounts of water causing frequent urination."

Answer: 4 Explanation: High amounts of glucose without sufficient insulin from endogenous or chemical sources result in excessive glucose circulating in the blood without being absorbed into cells which the kidneys need to eliminate along with large amounts of water resulting in frequent urination. Polyuria is a symptom of hyperglycemia and does not occur when there is a balance between glucose intake and insulin availability. Limiting the amount of fluids consumed in the evening will usually help to decrease nocturia in the absence of pathology.

Nursing Process: Implementation Client Need: Physiological Adaptation Cognitive Level: Applying NURSINGTB.COM

2) A client with diabetes has a blood glucose level of 320 mg/dL and ketones in the urine. What should the nurse explain about these findings?

1. Ketones are naturally found in large numbers in the urine and are not a sign of pathology.

2. Uncontrolled glucose resulting in ketoacidosis is a very serious medical problem that can lead to comma or even death.

3. Ketones are a by-product of glucose metabolism and occur in varying amounts in the urine depending on the caloric intake of the client.

4. Ketoacidosis results when there is an over compensation of insulin by the body in response to a large consumption of complex carbohydrates.

Answer: 2 Explanation: Uncontrolled ketoacidosis is a serious medical problem that can lead to coma and/or death if not corrected. Ketones are a by-product of fat metabolism, a source of energy used by the body when glucose is not available due to insufficient amounts of insulin or starvation. Ketones are eliminated by the kidneys at a rate that is slower than they are produced and can be measured in the blood and/or urine as an indicator of fat catabolism. Ketoacidosis refers to a state in which there are metabolic alterations including altered blood pH and fluid and electrolyte imbalances.

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3) The nurse notes that a client with diabetes has muscle wasting. What should the nurse consider as being the reason for this finding?

1. Fat catabolism 2. Protein catabolism 3. Ketone metabolism 4. Glucose metabolism Answer: 2 Explanation: Fat catabolism occurs when the body can't use or lacks a supply of glucose for energy and results in weight loss. Protein catabolism also occurs under the same circumstances, but in this case, skeletal muscle is broken down and the resulting amino acids are used to meet energy needs. Glucose metabolism is the preferred energy source for the body, but depends on an adequate supply of carbohydrates and insulin. Ketones are a by-product of fat catabolism and are eliminated by the kidneys, not metabolized in the body.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Analyzing 22.3 To summarize the specific dietary recommendations across the lifespan for individuals with type 1 or type 2 diabetes, including those with comorbid conditions.

1) The nurse is helping a client with diabetes mellitus with meal planning. What should the nurse emphasize about carbohydrate intake?

1. Low-fiber foods are needed to improve insulin sensitivity.

2. There is no set amount of carbohydratNesUR toSIiN ngGeTsBt .eCaOcM h day 3. Eat a small amount of foods with high fiber content to avoid constipation.

4. No fewer than 100 grams of simple carbohydrates because complex carbohydrates take much longer to metabolize.

Answer: 2 Explanation: The American Diabetic Association does not specify a maximum amount of carbohydrates to be consumed daily, but the minimum recommendation is 130 grams/day from various fruits, vegetables, legumes, and whole grains. The addition of high-fiber foods is an important component in healthy bowels. Complex carbohydrates are recommended over simple carbohydrates which are high in calories and low in nutritional value. High-fiber foods are highly recommended as a source of complex carbohydrates and have been associated with improved insulin sensitivity.

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2) The nurse is discussing diet planning with a client who takes insulin as treatment for type 2 diabetes mellitus. What should the nurse encourage this client to do?

1. Adjust carbohydrates for snacks, but only eat them if hungry between meals.

2. Eat a larger snack if hunger occurs in the middle of the day and skip the next meal 3. Subtract several servings of carbohydrates from the daily meals and use them for snacks.

4. Add several servings of carbohydrates as snacks throughout the day without adjustments to meals.

Answer: 3 Explanation: Daily insulin doses are calculated on the number of calories consumed per day, so snacks should be subtracted from the carbohydrates allowed for meals to maintain the same intake. Adding additional calories throughout the day may necessitate an insulin adjustment to maintain good glucose control. Skipping meals can result in an overabundance of insulin and result in a hypoglycemic episode. Calorie intake should be as consistent as possible to maintain optimized levels of blood sugar.

Nursing Process: Applying Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) A 60-year-old male client who is African American has diabetes, a BMI of 27, blood pressure 150/90 mm Hg, cholesterol 242 mg/dL, triglycerides 240 mg/dL, LDL 200 mg/dL, and HDL 23 mg/dL. Which factors should the nurse identify as placing this client at risk for cardiovascular disease?

1. Race, age, and moderate weight 2. Obesity, low LDL, and diabetes 3. Diabetes, tobacco cessation, and obesity 4. Diabetes, hypertension, and age Answer: 3 Explanation: Being African American, being male, and increasing age are all risk factors for developing heart disease. Obesity and diabetes are also risk factors, but can be modified with diet, exercise, and good blood sugar control. The current recommendation for LDL in clients with other risk factors for heart disease is 70-100 mg/dl.

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22.4 To assess cultural and lifespan variations when assisting patients to set goals and manage change in their nutritional patterns.

1) The nurse learns that a client of Asian descent uses ginseng to help control diabetes. Which action should the nurse take with this client?

1. Review possible interactions with current medications 2. Inform that ginseng has been shown to be effective in clinical trials 3. Advise to only take the amount prescribed by the traditional healer 4. Remind that ginseng is a natural plant-based remedy with no side effects Answer: 1 Explanation: Asian ginseng has not been reported to improve blood glucose control over the course of 2 months any better than a placebo. Caution is given for this herb because of a number of drug interactions and its effect on prolonging blood clotting by affecting platelet function. The effects and appropriate dosing are not clearly understood even by traditional healers. Plant-based remedies can have both positive and negative effects on the client and are not well understood.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 2) The school nurse develops a health plan for a student with diabetes. Which direction is appropriate for the nurse to include in this plan?

1. Closely monitoring eating habits at school 2. Providing the student a snack before gym period 3. Monitoring immunizations to be sure N thUeRcShIiNldGTisBu.CpOtM o date 4. Storing any medication that will be administered during school hours in a safe place.

Answer: 2 Explanation: Students with diabetes should be encouraged to eat a snack before strenuous activity to prevent hypoglycemia. The nurse is not responsible for monitoring eating habits at school. The school nurse is responsible for monitoring the immunization status of all students.

Storing medication in a safe place refers to medication for all students, not only those with diabetes.

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22.5 To develop nursing interventions to assist the patient and family in self-management of diabetes in aspects of nutritional intake, carbohydrate counting, weight loss strategies, maintenance of good health, and food intake during exercise.

1) The nurse prepares an educational handout for overweight clients with diabetes. Which strategy should the nurse include that focuses on weight loss?

1. High-fiber diet, surgery, and exercise 2. Low-carbohydrate diet, increased exercise, and surgery 3. Low-protein diet, coping strategies to avoid overeating, and exercise 4. Increased exercise, reduction of daily calories, and ways to avoid behaviors that have been barriers in the past for weight loss Answer: 4 Explanation: Low-carbohydrate diets should be avoided in clients with diabetes to avoid increases in LDL cholesterol since they are already at risk for cardiac disease. The best initial strategy for clients with or without diabetes is increased exercise, reduction of daily calories, and developing ways to avoid behaviors that have been barriers to past attempts at weight loss.

Clients wanting to lose weight should continue to eat a balanced diet that includes the recommended calories for each food group rather than restricting calories from specific food groups. High-fiber diets are recommended for clients with diabetes based on the metabolism rate for fiber, but surgical intervention should be reserved for clients who have repeatedly been unsuccessful at weight loss attempts and are morbidly obese.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance NURSINGTB.COM Cognitive Level: Applying 2) A client with diabetes has been following a low-carbohydrate low-fat diet to lose weight but has been feeling dizzy and tired in the afternoons at work. What should the nurse explain to this client?

1. A low-carbohydrate diet is good for diabetics and has been shown to improve glucose control 2. Increased exercise is beneficial for clients with diabetes but should be increased very slowly over time 3. A low-fat diet has been proven to increase the rate of metabolism in diabetic clients and help with weight control 4. Diets that restrict calories from specific food groups are not recommended for diabetics and could result in hypoglycemia especially with increased exercise Answer: 4 Explanation: Diets that restrict calories from specific food groups are not recommended for diabetics and could result in episodes of hypoglycemia especially with the increased energy demands during increased exercise. Low carbohydrate diets should be avoided by clients with diabetes because of the increase of LDL cholesterol that results and the increased risk for developing heart disease Increased exercise, reduction in daily calories, and developing strategies to avoid barriers to previous weight loss attempts are the recommended initial steps for a successful weight loss program.

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3) A school-age client with diabetes experiences episodes of hyperglycemia despite receiving teaching about foods and snacks. Which food choice that the client makes indicates to the nurse that additional teaching is required?

1. Popcorn 2. Hot dogs 3. Peanut butter 4. Orange juice Answer: 4 Explanation: Orange juice has high-fructose content and may contain added sugar and would be classified as a carbohydrate. Hot dogs contain protein, fat, and a moderate amount of filler that could include carbohydrates. Peanut butter is considered fat and protein, but can also have added sugar. Popcorn is a carbohydrate but because of the high-fiber content will be metabolized slower than orange juice.

Nursing Process: Evaluation Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 22.6 To relate the strategies for prevention and treatment of hypoglycemia and hyperglycemia.

1) At school, a client with type 1 diabetes mellitus sees the school nurse because of feeling sweaty and shaky. Which action should the nurse take?

1. Call the ambulance if the blood glucose is less than 200 2. Provide a large candy bar and send the client back to class 3. Provide a bottle of soda for the client N toUdRrSinINkGuTnBti.C l sOyMmptoms subside 4. Provide 15 grams of glucose and recheck blood glucose in 15 minutes Answer: 4 Explanation: Episodes of hypoglycemia should be treated by administering 15 grams of glucose and rechecking blood glucose levels until stable. A candy bar and soda contain more than 15 grams of glucose, and either could result in a hyperglycemic episode. Blood glucose levels should be checked every 15 minutes until stable to assess if the correction for the additional carbohydrates is only temporary, and if so additional doses of 15 grams of carbohydrates should be given. A blood sugar of 200 is considered hyper- not hypoglycemia.

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2) The parents of a child with type 1 diabetes mellitus ask how to prevent episodes of hypoglycemia. Which recommendation should the nurse make to these parents?

1. Provide three large meals daily but avoid snacks 2. Provide snacks during the day and prior to exercise 3. Avoid extra calories and closely maintain the prescribed diet plan 4. Send candy bars to school with the student in case hypoglycemia symptoms occur Answer: 2 Explanation: Children with diabetes should adjust their calories to include three meals a day plus snacks to maintain a balanced glucose level. The student should have glucose in their possession to use in the case of hypoglycemia, but candy bars might be a temptation to eat and could cause hyperglycemia. Providing snacks during the day and before exercise, such as gym, will help to ensure a steady supply of glucose. Extra calories may be needed for children because of the additional calories needed for growth but should be recommended by their dietician.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) A client with diabetes has a blood glucose level of 480 mg/dL and is experiencing weakness and confusion. Which information would be helpful to identify the reason for the client's symptoms?

1. Drank a bottle of beer last night before bed 2. Skipped breakfast because of being late for work 3. Takes insulin as prescribed and follows a healthy diet 4. Has not taken insulin for the past fourNdUaR ysSIbNeGcTauBs.CeOoM f a flu-like illness Answer: 4 Explanation: Illness is the most likely cause of hyperglycemic episodes among clients with usual good glucose control. Not taking insulin as prescribed for 4 days will cause the blood glucose level to raise dangerously high. Although alcohol in excess may result in a hypoglycemia episode, one bottle of beer would not be considered excessive even for a diabetic client. Skipping meals after taking insulin could result in a hypoglycemia episode. The fact that the client always takes his insulin as prescribed and follows a healthy diet does not provide any clues for the current condition.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 23 Disorders of the Gastrointestinal Tract, Liver, Pancreas, and Gallbladder 23.1 To analyze the role of nutrition intervention as a central part of managing intestinal disease.

1) The nurse prepares education for the family of a client with dysphagia. Which food should the nurse encourage the family and client to avoid?

1. Very thin 2. Spicy or contain garlic 3. Frozen or concentrated 4. Hard, crunchy, or sticky Answer: 4 Explanation: A client with dysphagia should avoid foods that are hard, crunchy, or spicy to decrease the likelihood of aspiration or choking. Foods should be prepared to the client's taste before being processed to the recommended consistency, and spices in moderation should only be avoided if there is a reason, such as the need for a low-sodium diet. Thin liquids are usually postponed until a full evaluation is complete and recommendations are made for texture and consistency.

Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying B.iC 2) A client is experiencing frequent nausNeU a RaSnIdNvGoTm tiO nM g. Which dietary suggestion should the nurse make to this client?

1. Move around as much as possible after eating to speed digestion 2. Eat foods high in fat and protein to provide ample calories for energy 3. Consider total parenteral nutrition (TPN) because of the amount of nausea and vomiting 4. Limit intake to high-carbohydrate liquids and foods in small amounts throughout the day Answer: 4 Explanation: If a client is experiencing intermittent nausea and vomiting, a high-carbohydrate diet consisting of foods or liquids in small portions throughout the day will promote adequate nutrition and hydration. TPN is reserved for clients who are unable to tolerate any intake for several days. Clients should be advised to avoid or limit physical activity just before and after eating. High-fat foods should be avoided since they take longer to empty from the stomach and may promote nausea.

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3) The nurse is preparing teaching material for a client with gastroesophageal reflux disease (GERD). Which food item should the nurse urge the client to avoid?

1. Rice 2. Pasta 3. Alcohol 4. Ice cream Answer: 3 Explanation: Symptoms of GERD can be exacerbated by foods/drinks that contribute to increase gastric acid or decrease the competence of the lower gastric sphincter when consumed. Alcohol causes increased gastric acid production, decreased lower esophageal sphincter pressure, and also delays gastric emptying, all factors that contribute to symptoms. Ice cream, rice, and pasta are bland foods that should not cause irritation in the gastrointestinal tract.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 23.2 To evaluate risk factors for malnutrition associated with intestinal diseases.

1) The nurse is concerned that a client with Crohn disease continues to lose weight. Which reason should the nurse identify as increasing this client's risk for malnutrition?

1. Migration of bacteria from the gut to other locations in the body increase metabolism and accounts for weight loss with Crohn disease 2. A low-fat, low-carbohydrate diet along with an increase in exercise is the standard treatment for Crohn disease so clients naturally losNeUwReSiIgNhGt TB.COM 3. Patients do not understand the physiological basis for inflammatory bowel disease and may avoid foods that could contribute to healing and good health 4. Poor nutritional intake can continue even when the disease is not active due to ongoing avoidance of foods that can cause symptoms associated with a disease to flare up Answer: 4 Explanation: Poor nutritional intake can continue even when disease is not active due to ongoing avoidance of foods that can cause symptoms associated with a disease to flare up. During inactive disease, clients are at nutritional risk because of malabsorption resulting from inflammation of the bowel's absorptive surface. Dietary adjustments may be needed to promote healing of the mucosal surfaces and fistulas that develop during active disease states. Adequate nutrition is necessary to promote intestinal integrity and to prevent migration of intestinal bacteria to other parts of the body which can result in infection.

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2) A client has less than 100 cm of small intestine after surgery to remove a malignancy. For which reason should the nurse suspect that is client is at risk for malnutrition?

1. Gallstones 2. Malabsorption 3. Fluid abnormalities 4. Delayed gastric emptying Answer: 2 Explanation: Short bowel syndrome results in malabsorption of nutrients, vitamins, and bile salts in the small intestine and is not affected by gastric emptying which precedes the delivery of gastric contents to the intestines. Without a terminal ileum, fats, fat soluble vitamins, and bile salt are delivered directly to the colon where they are poorly absorbed. Colon resection can result in problems with absorption of fluid and electrolytes. Gall and kidney stones are the result of poor absorption of bile salts in the absence of a terminal ileum but do not directly cause malnutrition.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying 3) A client with abdominal pain, diarrhea, and weight loss is diagnosed with celiac sprue. For which reason should the nurse plan interventions to help prevent this client from developing malnutrition?

1. Steatorrhea resulting from poor fat absorption 2. Large losses of intestinal fluid causing the loss of zinc 3. Malabsorption caused by atrophy of thNeUiRnSteIN stGinTaBl .C viOllM i 4. Poor nutritional absorption as a result of inflammation of the mucosal surfaces Answer: 3 Explanation: Celiac sprue is an autoimmune disease that causes atrophy rather than inflammation to intestinal villi. Large losses of intestinal fluid and loss of zinc result from inflammatory bowel disease. Steatorrhea, or fatty diarrhea, causes malabsorption of calcium.

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23.3 To examine the indications for various therapeutic diets in treating intestinal diseases.

1) A client with diabetes is being treated for weight loss, nausea, vomiting, and loss of appetite caused by gastroparesis. What should be included when providing this client with a pureed diet?

1. High fiber to stimulate peristalsis 2. High fat to provide calories for energy 3. No spices to avoid gastrointestinal upset 4. Liquid nutritional supplements three times a day Answer: 4 Explanation: Gastroparesis is a motility disorder of the stomach that causes low gastric emptying and results in nausea, vomiting, and loss of appetite which can lead to malnutrition.

Liquid nutritional supplements may be used to ensure adequate caloric and nutritional intake.

High-fiber foods are avoided to prevent obstructions. High-fat foods are avoided due to slower gastric emptying. The addition of spices has no effect on this condition.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) A child is diagnosed with lactose intolerance. For which reason should the nurse expect this client to be prescribed calcium and vitamin D supplements?

1. Muscle tissue 2. Adequate blood clotting 3. Bone mineralization and growth 4. Fat stores in the buttocks and breasts NURSINGTB.COM Answer: 3 Explanation: Adequate amounts of calcium and vitamin D are needed for growth and bone mineralization among children. An injection of vitamin K at birth supplies the needed stores to avoid bleeding until the infant is able to obtain a supply through breast milk or formula. Vitamin D and calcium do not contribute to fat stores or muscle development in the body.

Nursing Process: Planning Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) A client is diagnosed with inflammatory bowel disease. For which reason should the nurse expect this client to be prescribed additional calories in the diet?

1. Prevent bleeding 2. Slow inflammation 3. Promote mucosal healing 4. Discourage fistula closure Answer: 3 Explanation: A client with inflammatory bowel disease often develops inflammation in the bowel wall which promotes bleeding and fistula formation. Increased calories are needed to promote mucosal healing and fistula closure as well as provide nutritional support to meet the normal caloric and nutritional requirements for energy.

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23.4 To summarize the role of fiber in the treatment of diverticular disease, irritable bowel syndrome, and constipation.

1) A client with diverticular disease asks what can be done to prevent the development of diverticulosis. What should the nurse respond to this client?

1. Eliminate fruits, whole grains, and legumes from the diet 2. A high-fiber diet will help to reduce the development of diverticulosis 3. Avoid fiber from plant sources as it can be too coarse to digest properly 4. A low-fat diet will decrease the development of diarrhea and inflammation Answer: 2 Explanation: The goal of nutritional therapy to prevent diverticulosis is the intake of adequate fiber to prevent symptoms. Fruits and vegetables are good sources of dietary fiber. A low-fat diet may contribute to control of diarrhea but does not impact the diverticula. Whole grains and legumes are an additional source of dietary fiber.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) The nurse is developing an eating plan for a client with constipation. What action should the nurse suggest for the client?

1. High fiber and adequate fluid 2. Avoidance of fruits and vegetables 3. Stool softeners and laxatives on a daily basis 4. Addition of white bread, white rice, anNdUpReSeIN leGdTpBo.C taOtoMes Answer: 1 Explanation: The goal of nutritional therapy for constipation is to maximize the intake of dietary fiber and fluids to promote normal intestinal transit. The addition of natural dietary fiber such as fruits, vegetables, whole grains, and legumes should be encouraged. Stool softeners and laxatives should be used sparingly and only as needed, since a balanced nutritional intake contains the necessary fiber to promote normal bowel movements. Highly processed foods such as white bread, white rice, and peeled potatoes should be avoided.

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23.5 To formulate nursing interventions that reduce the symptoms of digestive diseases through dietary alterations.

1) An older client with gastroesophageal reflux disease (GERD) experiences heartburn at night and insomnia. What should the nurse recommend to this client?

1. Limit food seasonings to garlic, red pepper, and sea salt 2. Substitute a noncaffeinated diet soda before bed in place of tea 3. Avoid caffeine at bedtime and sleep with the head of his bed elevated 4. Continue hot tea at bedtime and sleep with the foot of his bed elevated Answer: 3 Explanation: Avoiding caffeinated beverages and sleeping with the head of the bed elevated are recommended to decrease symptoms of GERD. Carbonated beverages, which can cause gastric distention, should also be avoided including those that are noncaffeinated. Spicy seasonings such as garlic and red pepper may cause irritation to the lower portion of the esophagus. Sleeping in a position that elevates the feet will increase symptoms and should be avoided.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) An obese client with nonalcoholic fatty liver disease asks for suggestions to lose weight. What should the nurse recommend to this client?

1. A low-fiber diet 2. Bariatric surgery NURSINGTB.COM 3. A rapid weight loss program 4. A modified diet for slow weight loss Answer: 4 Explanation: In an overweight or obese client with fatty liver disease, slow weight loss should be recommended. Rapid weight loss through excessive dieting or bypass surgery should be avoided since it contributes to fatty liver disease. A high-fiber diet is recommended for weight loss and bowel health.

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3) A client with dumping syndrome experiences abdominal cramps, bloating, and diarrhea one hour after eating a large meal. Which suggestion should the nurse make to this client?

1. Drink extra fluids with meals 2. Increase activity following a meal 3. Eat a diet high in simple carbohydrates to delay gastric emptying 4. Eat small meals and snacks throughout the day rather than several large meals Answer: 4 Explanation: Eating small meals and snacks throughout the day promotes slower gastric emptying allowing foods to be more efficiently absorbed in the intestines. Rest and staying in a recumbent position has been shown to slow peristalsis. Fluid should be taken between rather than with meals. Foods high in simple sugars promote rather than delay rapid gastric emptying.

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4) The nurse prepares to assess a child with inflammatory bowel disease. Which comments by the parents should the nurse expect when discussing the child's health history? (Select all that apply.)

1. "We don't give him anything that contains wheat, rye, or barley."

2. "It seems like after he developed this condition, he just continues to get thinner."

3. "It seems like he has more abdominal cramping and diarrhea after drinking milk."

4. "He knows that chewing gum and foods that contain sorbitol will make this condition worse."

5. "Two years ago, he was in the 75th percentile for his height, and now he's in the 25th percentile."

Answer: 2, 3, 5 Explanation: Children who have inflammatory bowel disease often experience growth failure in response to treatment with corticosteroids. They lose weight and are not as tall as their peers.

Corticosteroids are prescribed to people with inflammatory bowel disease to decrease inflammation in their intestine and colon. Many people who have inflammatory bowel disease develop lactose intolerance. They develop an increased level of discomfort after ingesting products that contain lactose. People with celiac sprue should not ingest anything that contains wheat, barley, or rye. People with inflammatory bowel disease do not have to avoid wheat, barley, and rye. Chewing gum and eating foods that contain sorbitol, raffinose, and fructose should be avoided by people who have problems with intestinal gas.

Children who have inflammatory bowel disease often experience growth failure in response to treatment with corticosteroids. They lose weight and are not as tall as their peers. Corticosteroids are prescribed to people with inflammatory bowel disease to decrease inflammation in their intestine and colon. Many people who have inflammatory bowel disease develop lactose intolerance. They develop an increased lN evUeRl SoIfNdGiTsB co.CmOfM ort after ingesting products that contain lactose. People with celiac sprue should not ingest anything that contains wheat, barley, or rye.

People with inflammatory bowel disease do not have to avoid wheat, barley, and rye. Chewing gum and eating foods that contain sorbitol, raffinose, and fructose should be avoided by people who have problems with intestinal gas.

Children who have inflammatory bowel disease often experience growth failure in response to treatment with corticosteroids. They lose weight and are not as tall as their peers. Corticosteroids are prescribed to people with inflammatory bowel disease to decrease inflammation in their intestine and colon. Many people who have inflammatory bowel disease develop lactose intolerance. They develop an increased level of discomfort after ingesting products that contain lactose. People with celiac sprue should not ingest anything that contains wheat, barley, or rye.

People with inflammatory bowel disease do not have to avoid wheat, barley, and rye. Chewing gum and eating foods that contain sorbitol, raffinose, and fructose should be avoided by people who have problems with intestinal gas.

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23.6 To relate the important role of the nurse in providing nutrition assessment and education to patients who have intestinal diseases and disorders.

1) An older client with dumping syndrome is embarrassed by frequent diarrhea and bloating after meals and has stopped going out for lunch or dinner with friends because of it. What should the nurse recommend to this client?

1. Eat smaller portions and avoid extra fluid with meals 2. Eat foods with simple rather than complex carbohydrates 3. Avoid eating all day before going out and then eat a large meal 4. Eat food cooked at home since many restaurants have additives that can cause diarrhea Answer: 1 Explanation: Clients with dumping syndrome should be advised to eat several small meals portions throughout the day with snacks to avoid rapid gastric emptying. Avoiding food promotes a poor nutritional intake resulting in numerous problems including a fatty liver and malnutrition, but does not prevent rapid transit of food into the intestines following a large meal.

Foods high in simple carbohydrates also promote rapid transit and poor absorption of food in the intestines. Avoiding going out to eat may adversely affect this client's socialization and should not be recommended.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 2) A client has been experiencing intermitted diarrhea with constipation. How should the nurse assess the amount of fiber that this clientNiUnR geSsIN tsG? TB.COM 1. Avoid plant based proteins 2. Closely monitor weight gain or loss 3. Conduct a brief diet history of plant-based foods 4. Recommend the addition of refined flour products Answer: 3 Explanation: The best way for the nurse to asses if there is sufficient fiber in a client's diet is to conduct a brief diet history of plant based foods. Recommendations of dietary alterations or substitutions are not beneficial in the assessment of dietary fiber since there is no reason to assume the client will follow those suggestions. Weight loss or gain is not an adequate indication of dietary fiber content.

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3) A client suspected of having celiac sprue is scheduled for a bowel biopsy. What should the nurse instruct this client to prepare for this procedure?

1. Eat products containing oats rather than wheat 2. Eat a high-gluten diet for two days prior to surgery 3. Follow a normal diet to avoid false negative results 4. Avoid eating foods that contain wheat flour or by products Answer: 3 Explanation: Clients preparing for a bowel biopsy to establish a diagnosis of celiac sprue should be instructed to continue their normal diet to avoid false negative results that could occur if gluten is removed from their diet. Products containing oats should be closely examined since some cross-contamination can occur during the processing of grains. Eating additional foods containing gluten should be avoided to prevent an exacerbation of gastrointestinal symptoms if celiac sprue if suspected. Excessive intake of foods containing wheat or wheat by-products should be avoided until after biopsy results are available.

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 24 Renal Disease 24.1 To classify the nutritional and metabolic complications of acute and chronic renal failure.

1) A client receiving renal replacement therapy over 5 years has lost 40 lbs. and has significant muscle wasting. How should the nurse document this finding?

1. Fat catabolism 2. Dry weight loss 3. Metabolic acidosis 4. Protein-energy wasting Answer: 4 Explanation: Protein-energy wasting is the term used to describe malnutrition in dialysis patients. Fat catabolism is the use of fat for energy in states of starvation. Dry weight refers to the client's post-dialysis weight which reflects a true weight since excess fluid accumulation has been removed. Metabolic acidosis results from an increase in pH which causes protein catabolism and decreased synthesis of albumin.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying 2) A client with chronic kidney disease has elevated C-reactive protein and tumor necrosis factors. Which action should the nurse take for this client?

NURSINGTB.COM 1. Refer to rheumatology 2. Suggest vitamin supplements 3. Instruct to follow a low-protein diet 4. Assess for signs of wasting syndrome Answer: 4 Explanation: Elevated levels of C-reactive protein and tumor necrosis factor are markers for an inflammatory state common among clients with chronic kidney disease and contribute to anorexia and wasting syndrome. Protein stores are depleted in clients on dialysis due to the loss of amino acids into the dialysis fluid, and can result in compromised nutritional health. The benefit of vitamin supplementation for clients with chronic kidney disease is not well established, but may be beneficial in replacing water-soluble vitamins lost during dialysis.

Markers for inflammation are also present in clients with arthritis, but since this client is already diagnosed with chronic kidney disease it is most likely that is the cause.

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3) A client is being treated for acute kidney injury. Which laboratory value should the nurse closely monitor in this client?

1. Increased glucose 2. Decreased blood urea nitrogen 3. Increased albumin 4. Decreased serum creatinine Answer: 1 Explanation: Clients with acute kidney injury should be monitored for glucose intolerance resulting from insulin resistance. Serum levels of both BUN and serum creatinine increase during acute and chronic kidney injury. Albumin levels decline due to fat catabolism.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Applying 4) A client with a kidney injury is experiencing muscle cramps, itchy skin, and a metallic taste in the mouth. Which additional finding should the nurse expect when assessing this client? (Select all that apply.)

1. Malaise and fatigue 2. Generalized weakness 3. Decreased creatinine levels 4. Increased serum amylase levels 5. Increased blood urea nitrogen levels Answer: 1, 2, 5 Explanation: The client is experiencing NsiUgRnSs IaNnGdTsBy.C mOpM toms of uremia associated with renal failure. Nausea, vomiting, and a decreased intake of protein often accompany these signs and symptoms. The client will complain of malaise, fatigue, weakness, and muscle cramping. Their blood urea nitrogen and creatinine levels will be increased. Amylase levels can increase with pancreatic disorders.

The client is experiencing signs and symptoms of uremia associated with renal failure. Nausea, vomiting, and a decreased intake of protein often accompany these signs and symptoms. The client will complain of malaise, fatigue, weakness, and muscle cramping. Their blood urea nitrogen and creatinine levels will be increased. Amylase levels can increase with pancreatic disorders.

The client is experiencing signs and symptoms of uremia associated with renal failure. Nausea, vomiting, and a decreased intake of protein often accompany these signs and symptoms. The client will complain of malaise, fatigue, weakness, and muscle cramping. Their blood urea nitrogen and creatinine levels will be increased. Amylase levels can increase with pancreatic disorders.

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24.2 To translate the rationale for the various dietary modifications indicated in the treatment of renal failure.

1) A client is being treated for chronic kidney disease. When monitoring this client's nutritional status, for which health problem is the nurse assessing?

1. Hypertension 2. Fat catabolism 3. Hyperglycemia 4. Hyperlipidemia Answer: 2 Explanation: Hyperglycemia, hypertension, and hyperlipidemia are frequent problems for clients post-kidney transplant, and are usually the result of adverse effects from immunosuppressive therapy. For clients on dialysis, fat catabolism occurs in the absence of adequate nutritional intake and can result wasting and the loss of lean muscle mass.

Nursing Process: Assessment Client Need: Physiological Adaptation Cognitive Level: Applying 2) The healthcare provider prescribes an iron supplement for a client with chronic kidney disease. Which health problem is this medication intended to prevent?

1. Edema 2. Uremia 3. Anemia NURSINGTB.COM 4. Oliguria Answer: 3 Explanation: Iron supplementation is important to maintain hemoglobin levels and prevent anemia for clients on dialysis. Edema results from protein leakage into the capillaries. Uremia refers to the buildup of nitrogenous waste in the blood resulting from the progressive decline in renal function. Oliguria is a decrease in urine production and is a natural progression in end-stage renal disease.

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3) A client with chronic kidney disease has lower extremity edema despite following a no-added salt diet. Which sources of dietary sodium should the nurse identify when analyzing this client's diet?

1. Canned soup, hot dogs, and pickles 2. Canned fruit, ice cream, and cookies 3. Lunch meat, frozen foods, and cereal 4. Hamburgers, ketchup, and tossed salad Answer: 1 Explanation: Foods that are processed or pickled are high in sodium content. These foods include hot dogs, canned soup, lunch meats, cheese, pickles, condiments, sausages, and salted snacks. Hamburgers, salad, cereal, canned fruit, ice cream, and cookies have a lower amount, or in some cases, no sodium. The client should be encouraged to read the content labels on all processed foods and avoid any with high amounts of sodium. Sodium from all sources should not exceed 1 to 3 grams per day for clients on dialysis.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Applying 24.3 To assess the risk factors for malnutrition in the individual with chronic renal failure and formulate nursing interventions.

1) When counseling a client with chronic kidney disease the nurse recommends that 50% of dietary protein come from sources with high biological value. Which food should the nurse NURSINGTB.COM suggest to this client?

1. Eggs 2. Pasta 3. Dried beans 4. Peanut butter Answer: 1 Explanation: Eggs, milk, meat, and fish are considered foods with high biological value. Dried beans and peanut butter are sources of protein but do not contain all of the necessary amino acids necessary to sustain life. Pasta is a carbohydrate and does not contain protein.

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2) A client receiving hemodialysis treatments wants to take a multivitamin supplement several times a day. Which direction should the nurse provide to this client?

1. "All water-soluble vitamins are removed by dialysis."

2. "The most common vitamin deficiency is B12, so take that."

3. "Vitamins are not toxic and extra amounts will not cause harm."

4. "Avoid vitamins that are fat soluble because they are not removed by dialysis."

Answer: 4 Explanation: Fat-soluble vitamins are not removed during dialysis and should not need to be replaced. There can be some deficiencies in water-soluble vitamins and there is some evidence that one multivitamin a day may be beneficial, but there are no recommendation for more than one a day. Excess amounts of vitamins are not recommended and can be harmful. Not all watersoluble vitamins are lost during dialysis. Vitamin B12 is protein bound and not removed by dialysis.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 3) A client with anemia receives erythropoietin. Foods containing which nutrient should the nurse encourage the client to ingest?

1. Iron 2. Calcium 3. Potassium 4. Magnesium NURSINGTB.COM Answer: 1 Explanation: Sufficient iron stores are needed to prevent anemia. Treatment with erythropoietin and adequate oral or intravenous iron supplementation has been successful in helping clients achieve target hemoglobin levels. Dietary sources of iron should also be included. Adequate supplies of calcium, potassium, and magnesium are essential is maintaining health, but have no role in the treatment of anemia.

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24.4 To examine the potential consequences of kidney transplant on nutritional health.

1) A client recovering from a kidney transplant is not on a protein-restricted diet. What should the nurse consider as the reason for this dietary change?

1. A regular diet should be followed 2. A change in diet may discourage eating 3. Restriction can result in protein catabolism 4. A high-protein, low-carbohydrate diet is recommended Answer: 3 Explanation: The physiological stress of surgery and the additional nutritional needs to promote healing result in an increased need for calories and protein following kidney transplantation.

There is a high prevalence of malnutrition among clients with chronic kidney disease, and efforts should be made to promote healthy eating and a balanced diet that includes adequate amounts of carbohydrates, proteins, vitamins, minerals, and fats even if this is a change from the usual diet.

Nursing Process: Planning Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 2) A client receiving form a kidney transplant is diagnosed with hyperlipidemia. Which health problem will be prevented when this client is treated with a lipid-lowering agent and a therapeutic diet?

1. Diabetes 2. Hypertension NURSINGTB.COM 3. Peripheral neuropathy 4. Cardiovascular disease Answer: 4 Explanation: Clients who are identified post—kidney transplant to have hyperlipidemia should be treated with a lipid-lowering agent and a therapeutic diet to prevent cardiovascular disease.

Medication and a low-fat diet will not prevent the development of diabetes. Hypertension, which may result from sodium retention caused as an adverse side effect of medications, may also contribute to cardiac risk along with diabetes. Peripheral neuropathy is not caused by hyperlipidemia.

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3) A client recovering from a kidney transplant is prescribed corticosteroids. For which potential health problem should the nurse identify interventions for this client?

1. Weight loss 2. Bone fracture 3. Hypoglycemia 4. Peripheral vascular disease Answer: 2 Explanation: Bone health is often compromised in clients who are prescribed long-term corticosteroids placing them at risk for metabolic bone disease and bone fractures. The nurse should carefully assess the risk for falls to prevent injury. Because of malnutrition in these clients, they may have decreased muscle strength post-transplantation. As many as 33% of clients are hyperglycemic in the late post-transplant phase due to insulin resistance resulting from corticosteroids and other immunosuppressive drugs. Weight gain is common among clients recovering from renal transplant.

Nursing Process: Planning Client Need: Reduction of Risk Potential Cognitive Level: Applying 24.5 To differentiate between dietary interventions for renal failure and nephrotic syndrome.

1) A client recovering from nephrotic syndrome asks why medication for hypertension has been prescribed. Which response should the nurse make to this client?

1. " ACE-I inhibitors also reduce protein loss into the urine."

2. " ACE-I inhibitors increase urination aNnUdRpSrIeNvGeTnBt .eCdOeM ma."

3. "The medication is prescribed to prevent hypertension from developing."

4. " Without an ACE-I inhibitor, increased dietary protein would be needed."

Answer: 1 Explanation: Nephrotic syndrome is characterized by a massive loss of protein in the urine resulting from damage to the renal glomeruli. Although primarily used to control hypertension, ACE-inhibitors also reduce the loss of protein into the urine and can allow for a more liberal dietary protein intake. Moderate protein restriction with adequate caloric intake can reduce proteinuria without contributing to malnutrition. Excessive protein loss results in decreased plasma albumin and edema.

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2) A client with nephrotic syndrome is prescribed 0.8 gm/kg/day of protein. What should the client receive in addition to this daily protein amount?

1. 1-3 grams of sodium 2. 2-3 grams of potassium from dietary sources 3. An additional 20 kcals/kg of calories from other sources 4. Additional protein equal to the amount of protein lost in the client's 24-hour urine collection Answer: 4 Explanation: The daily recommendation for protein is 0.8 gm/kg/day for clients with nephrotic syndrome with the additional amount of protein equal to the amount lost in the client's 24-hour urine collection. Clients with nephrotic syndrome should have sodium intake adjusted based on the degree of resulting edema. There are no potassium recommendations for clients with nephrotic syndrome.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) A Latino client receiving hemodialysis for chronic kidney disease has an elevated potassium level. Which food item most likely contributed to this elevated level?

1. Fish tacos 2. Beef burritos 3. Rice and chicken 4. Red tomato sauce Answer: 4 URaS Explanation: Dietary potassium is foundNm inIN lyGiTnBf.rCuOitM s, vegetables, and dairy products.

Tomatoes have high potassium content. Rice and tortilla and taco shells are a source of carbohydrates. Chicken, beef, and fish are protein-rich foods.

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24.6 To develop nursing interventions to reduce the dietary risk factors for kidney stones.

1) A client has experienced kidney stones several times over the last few years. Which information should the nurse emphasize to help prevent the recurrence of stones in this client?

1. Increase fluid intake 2. Maintain a high sodium diet 3. Avoid calcium containing foods 4. Increase proteins from animal sources Answer: 1 Explanation: The primary dietary intervention to prevent kidney stones is the increase of fluid intake since precipitation and aggregation of crystals is less likely in dilute urine. Normal calcium intake is appropriate in the diet and should not be restricted to avoid the development of osteoporosis. Sodium should be limited to 2,300—3,450 mg/day to avoid competition at the renal tubule for calcium reabsorption. Protein from animal sources should be limited in clients prone to calcium oxalate and uric acid stones.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 2) A client is diagnosed with renal stones composed of calcium oxalate. Which food item should the nurse instruct this client to avoid?

1. Oranges 2. Broccoli NURSINGTB.COM 3. Ice cream 4. Chocolate Answer: 4 Explanation: Chocolate should be limited in the diet of clients who have had calcium oxalate stones since it has a high oxalate content. Dairy products such as milk, ice cream, and yogurt bind to oxalate in the intestine and prevent its absorption. Oranges and broccoli have high potassium content but do not affect calcium oxalate calculi formation.

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3) A client is at risk for kidney stone formation. Which type of diet should the nurse recommend for this client?

1. High-purine 2. Low-sodium 3. High-protein 4. Low-potassium Answer: 2 Explanation: A low-sodium diet is recommended because sodium and calcium compete for reabsorption at the renal tubule and excessive sodium will result in increased calcium excretion in the urine. Animal proteins, also known as purines, should be limited since metabolism results in uric acid formation. Potassium does not have a role in kidney stone formation.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 24.7 To evaluate the current evidence regarding diet influences on risk of urinary tract infection.

1) A client with a history of urinary tract infections asks if probiotic dietary supplements can prevent the infections. Which response should the nurse make to this client?

1. "Probiotic dietary supplements have not been proven beneficial for UTI treatment."

2. "Yogurt and fermented dairy products have been shown to be more useful for treating UTIs." 3. "Cranberry juice has shown more efficacy than probiotic dietary supplements for treating NURSINGTB.COM UTIs." 4. "Raisins have been shown to be as beneficial as dried cranberries and probiotic dietary supplements in treating UTIs." Answer: 1 Explanation: Probiotic dietary supplements have not been shown to be effective in treating or preventing UTIs. Cranberry juice has shown some positive results in preventing UTIs, but has not been shown to be helpful in treatment. Yogurt and fermented dairy products are not useful in treating UTIs. Cranberry juice and extract may be helpful in preventing UTIs, but other cranberry products and raisins have not shown sufficient efficacy.

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2) A client who prefers complementary treatments reports drinking cranberry juice to prevent UTIs. What should the nurse respond to this client?

1. "There is no proof that cranberry juice can help to prevent UTIs." 2. "Dried cranberries are more effective in preventing UTIs than cranberry juice."

3. "Cranberry juice has high amounts of added sugar and is more likely to cause than prevent UTIs." 4. "Cranberry juice may help to prevent UTIs when combined with adequate fluid intake and good personal hygiene."

Answer: 4 Explanation: In a limited number of studies, there was evidence that women who drank cranberry juice had fewer UTIs than women who did not. Dried cranberries and other products containing cranberries were not effective. Cranberry juice should be used along with adequate fluid intake and proper personal hygiene to prevent UTIs. Sweeteners used in juice have not been shown to contribute to UTI development.

Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying 3) The nurse reviews the use of cranberry juice to prevent urinary tract infections. What additional information should the nurse emphasize with this client?

1. Probiotic dietary supplements 2. Eating yogurt daily if possible 3. Adequate fluid intake and proper personal hygiene 4. Integrating cranberry containing produNcUtsRSinIN toGtThBe.CdO ieM t Answer: 3 Explanation: Some evidence exists that suggests that cranberry juice may help to prevent UTIs when consumed along with an adequate fluid intake and proper personal hygiene. Cranberry products and dried cranberries have not been shown to prevent UTIs. Eating yogurt and using probiotic dietary supplements are not proven to be beneficial in treating UTIs. Nursing Process: Implementation Client Need: Safety and Infection Control Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 25 Physiological Stress 25.1 To analyze how the body's response to physiological stress can lead to risk of malnutrition.

1) The nurse is concerned that a critically ill client is experiencing mobilization of fat stores and skeletal muscle and tissue proteins are being catabolized. Which metabolic state is this client experiencing?

1. Hyperkalemia 2. Hyperglycemia 3. Hyperlipidemia 4. Hypermetabolism Answer: 4 Explanation: The body's defense against physiologic stress is the "fight or flight" response, which initiates a cascade of physiologic reactions requiring additional energy. To provide this energy, the body uses glucose generated from glycogen stores in liver and muscle, and if needed, catabolizes skeletal muscle proteins and fat stores. This process is known as hypermetabolism.

Hyperkalemia refers to elevated potassium levels. Hyperglycemia may occur during this process and is the result of increased glucose with insulin resistance limiting the uptake into the liver and peripheral cells. Hyperlipidemia refers to elevations in cholesterol and triglycerides are not related to the "fight or flight" process.

Nursing Process: Assessment Client Need: Physiological Adaptation NURSINGTB.COM Cognitive Level: Analyzing 2) A client recovering from injuries sustained in a motor vehicle crash is on a regular diet but has no appetite and is not eating. What could be the result of this client taking in an inadequate amount of calories?

1. Anemia and result in hypoxia in the damaged cells 2. Hypoglycemia leading to polyuria, polydipsia, and polyphagia 3. Fatigue which would limit the client's ability to attend physical therapy 4. Loss of lean body mass which could lead to complications, infection, and poor wound healing Answer: 4 Explanation: During times of physiologic stress, including recovering from physical trauma, the demand for glucose increases significantly resulting in the need for increased energy. Lack of oral intake could result in catabolism of fats and proteins. Loss of even 10% of lean body mass can contribute to poor health outcomes and increased morbidity. Fatigue, hypoglycemia, and anemia may be present following trauma, but may be the result of causes other than malnutrition.

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3) A client with a critical illness is demonstrating signs of the fight-or-flight response. What occurs in the client's body during this response?

1. Fat burned to produce fuel 2. Glucose produced to provide amino acids 3. Protein catabolized to provide reactant proteins 4. Muscle tissue broken down to provide essential vitamins and minerals Answer: 1 Explanation: During the fight-or-flight response, the body uses all available resources to provide for the additional energy needs of the body. It mobilizes fat stores to provide fuel for the body's needs. Glucose is generated from stores in the liver and muscles to provide energy. Skeletal muscle tissue is sacrificed to provide a source of glucose. Proteins are catabolized into amino acids.

Nursing Process: Implementation Client Need: Physiological Adaptation Cognitive Level: Analyzing 25.2 To distinguish factors affecting a patient's need for calories, protein, vitamins, minerals, and fluid during critical illness.

1) A client is being treated for extensive burns over much of the body. For which reason should the nurse expect to administer extra fluids to this client?

1. The wounds are exudative and contribute to fluid loss 2. The client has lost a significant amount of body weight 3. The remaining skin is dry from heat exNpUoRsSuIrNeGaTnBd.CnO eeMds moisture 4. The client is confined to bed and must rely on nursing care to meet essential needs Answer: 1 Explanation: Large exudative wounds and burn injuries contribute to fluid losses and can result in fluid and electrolyte imbalances during metabolic stress. Loss of body weight, especially lean body mass, usually results from fat and protein catabolism during stress. Dry skin results from causes other than fluid loss related to physiologic stress and would benefit from a moisturizer.

The client's needs in this situation exceed the normal fluid intake that would be routinely provided by a nurse at the bedside.

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2) The nurse is caring for a client with a pressure ulcer. For which nutrient should the nurse assess that this client is receiving an adequate amount?

1. Fat 2. Protein 3. Magnesium 4. Carbohydrates Answer: 2 Explanation: Core nutrients essential to wound healing include proteins, vitamins A and C, and copper. Carbohydrates are a good source of energy. Magnesium is an essential nutrient needed for the body to function. Fat is a source of energy.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Applying 3) An older client with an acute exacerbation of chronic obstructive pulmonary disease (COPD) has a low oxygen saturation level and becomes short of breath when eating. Why should the nurse recommend that this client be on a high-fat high-protein diet?

1. The risk of heart disease is low because of the client's age 2. Allows a weight gain and develop muscle to aid with recovery 3. Provides more calories per bite to permit less food intake but with more calories 4. Foods high in protein and fats are easier to digest and less likely to cause indigestion Answer: 3 Explanation: Frail clients with COPD should be encouraged to eat a diet that is high in calories T Be.aClO to avoid fatigue and excessive energy usN e UdRuSriInNgGm s.MIn this case, a choice of high-protein and high-fat foods are appropriate to provide the client with more calories per bite, and will allow more food to be consumed with less shortness of breath. Although it is true that weight gain may help to speed recovery and heart disease is not a worry, the immediate concern is to provide the nutrients that are needed while minimizing the energy needed to eat. Foods containing high amounts of protein and fat take longer to digest.

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4) A client is recovering from traumatic injuries. Which foods should the nurse encourage the client to eat to maximize wound healing?

1. Soda 2. Spinach 3. Oranges 4. Popsicles 5. Tomatoes Answer: 2, 3, 5 Explanation: To enhance healing, clients should eat foods that are good sources of vitamins A and C and zinc. Green and orange vegetables contain vitamin A. Oranges and spinach contain vitamin C. Protein-rich foods contain zinc. Clients wishing to enhance their ability to heal should increase their intake of protein- and nutrient-dense foods. Popsicles and soda contribute to early satiety and poor intake of nutrient-dense foods. Popsicles and sodas should be avoided.

To enhance healing, clients should eat foods that are good sources of vitamins A and C and zinc.

Green and orange vegetables contain vitamin A. Oranges and spinach contain vitamin C. Protein-rich foods contain zinc. Clients wishing to enhance their ability to heal should increase their intake of protein- and nutrient-dense foods. Popsicles and soda contribute to early satiety and poor intake of nutrient-dense foods. Popsicles and sodas should be avoided.

To enhance healing, clients should eat foods that are good sources of vitamins A and C and zinc.

Green and orange vegetables contain vitamin A. Oranges and spinach contain vitamin C. Protein-rich foods contain zinc. Clients wishing to enhance their ability to heal should increase their intake of protein- and nutrient-dense foods. Popsicles and soda contribute to early satiety and poor intake of nutrient-dense foods. Popsicles and sodas should be avoided.

NURSINGTB.COM Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 25.3 To relate the nutritional care of a perioperative patient.

1) The nurse completes a nutritional assessment with a client scheduled for surgery. For which BMI should the nurse suggest that this client have enteral therapy for 2 weeks prior to the surgery?

1. > 25 2. < 25 3. > 30 4. < 18.5 Answer: 4 Explanation: It is recommended that preoperative clients who are malnourished be considered for two weeks of enteral nutritional therapy prior to surgery. A BMI < 18.5 considered underweight which makes this client a candidate for enteral therapy before surgery. Preoperative malnutrition is associated with postoperative complications such as infection, poor wound healing, and delayed hospital release. A BMI of 25 is normal, whereas a client with a BMI > 30 is considered obese and would not need nutritional supplementation.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Applying 4

2) During a preoperative assessment, the nurse learns that a client takes all-natural nutritional supplements. Which response should the nurse make to this client?

1. "Discuss this with the anesthesiologist the day of surgery."

2. "Skip the supplements the day of surgery, but resume afterwards."

3. "Since the dietary supplements are "all natural" there should not be a problem."

4. "Even all-natural dietary supplements may interact with anesthesia, medications, or alter blood clotting."

Answer: 4 Explanation: Even all-natural dietary supplements can interact with anesthesia, medications, and alter blood clotting. Because of this, these supplements should be carefully checked by a medical provider or pharmacist to be sure they are safe for everyday use. These supplements should be discontinued in accordance with advice given for medications with similar properties to allow clearance from the bloodstream and to avoid possible complications. Waiting to determine if a nutritional supplement can cause a risk for surgical outcomes or complications could be dangerous and this should be determined in advance of the surgery.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying 3) The nurse notes that a client is not expected to abstain from food or fluids before a surgical procedure. Which possible postoperative complication is avoided by this action?

1. Daily headaches 2. Increased fatigue NURSINGTB.COM 3. Delayed blood clotting 4. Depletion of glucose stores Answer: 4 Explanation: Pre-operative fasting is not recommended in most cases and can result in diminished glucose stores post-operatively. Fatigue and daily headaches are not common side effects of preoperative fasting. Delayed blood clotting is not associated with fasting during the preoperative period.

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25.4 To summarize the role of nutrients essential to wound repair, including following trauma, burn injury, or treatment for pressure ulcers.

1) The nurse notes that a client with several leg wounds is prescribed additional protein in the diet. For which reason is it important for this client to ingest additional protein at this time?

1. It is used as a source of energy 2. It is needed to synthesize new tissue 3. It can be used in place of glucose for tissue repair 4. It reduces the need for frequent wound dressing changes Answer: 2 Explanation: Protein plays an important role in wound healing and is used in the synthesis of new tissue, wound remodeling, and maintenance of the immune system. Adequate intake of dietary protein eliminates the need for muscle catabolism and allows protein to be used for tissue repair rather than energy. Additional protein is not a substitute for wound care.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Analyzing 2) A client is being treated for burns over the torso and lower extremities. Which supplement is the priority when providing care to the client at this time?

1. Fats 2. Fluids 3. Proteins NURSINGTB.COM 4. Vitamin A Answer: 2 Explanation: Excessive burn injuries can result in an excessive loss of fluids, resulting in fluid and electrolyte imbalances. Increased proteins may be needed to synthesis tissue for wound healing and repair. Vitamin A is also need for wound healing, but is not lost as a result of burn injuries. Fats are not affected with burn injuries unless adequate calories are not available to meet the body's requirements for energy and tissue synthesis, in which fat stores would be mobilized to be used as energy.

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3) The nurse caring for a client with pressure ulcers. What should the nurse consider as the role of vitamins and minerals in this client's care?

1. Promoting weight gain 2. Maintaining fluid balances 3. Replacement of muscle mass 4. Encourage the healing process Answer: 4 Explanation: Vitamins and minerals play an important role in each stage of the healing process and are necessary to promote wound healing. Vitamins and minerals do not promote weight gain or play a role in maintaining a fluid balance in the body. Proteins are needed for replacement of lean muscle mass.

Nursing Process: Assessment Client Need: Reduction of Risk Potential Cognitive Level: Applying

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Nutrition and Diet Therapy for Nurses, 2e (Tucker) Chapter 26 Cancer and Human Immunodeficiency Virus (HIV) Infection 26.1 To relate current nutrition recommendations for reducing cancer risk.

1) The nurse completes a health history with a client. For which reason should the nurse identify this client has an increased risk for prostate cancer?

1. Diet high in fat 2. Poor dental hygiene 3. Heavy consumption of alcohol 4. Long-term consumption of soy Answer: 1 Explanation: An increase in intake of saturated fatty acids associated with some cancers, such as prostate. There is limited clinical data on humans that soy consumption over time, especially early in life, may decrease risk of breast cancer. Controversy existed surrounding a possible increase risk of breast cancer with increased intake of soy and soy isoflavones in women at high risk for breast cancer, but current research suggests no adverse effects. Poor dental hygiene does not affect the development of colon cancer. Heavy alcohol consumption is associated with cancer of the mouth, esophagus, pharynx, larynx, liver, and breast.

Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) The nurse prepares information aboutNcUanRcSeIN rG prTeBv.eCnOtM ion for a community group. For which reason should the nurse emphasize exercise and normal body weight?

1. Increased adipose tissue causes cancerous tumors such as lipomas 2. Thin individuals will also choose other healthy lifestyle behaviors 3. People with low BMI have increased defense against cellular mutation 4. Dietary fat and obesity promote cancer growth, increasing the risk of cancer Answer: 4 Explanation: It is estimated that up to one-third of all cancers in the Unites States are related to poor diet, physical inactivity, and overweight and obesity. Having a low Body Mass Index does not increase immunity against cellular mutation. Assuming thin individuals will choose healthy lifestyle behaviors is not a fact. The development of a lipoma, a benign tumor, is not related to exercise and normal body weight.

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3) A client reports eating grilled meat several times a week. What should the nurse include when explaining why foods cooked at high temperatures increase the risk of cancer?

1. Ionizing radiation 2. Toxic ferritin levels 3. The high saturated fat content 4. Polycyclic aromatic hydrocarbons Answer: 4 Explanation: High temperature cooking are believed to produce polycyclic aromatic hydrocarbons that may play a role in the risk of cancer. An increase in high saturated fat intake is not problematic as a result of the high temperatures. Ferritin levels and ionizing radiation are not associated with increased risk of cancer from cooking at high temperatures.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying 26.2 To analyze risk factors for malnutrition in the patient with cancer or HIV infection because of the condition or its treatment.

1) A client who received chemotherapy and radiation for head and neck cancer is experiencing profound dysphagia. What actions can the nurse suggest help with this condition?

1. Encourage hot or warm beverages 2. Avoid foods that have a metallic taste 3. Use peanut butter as a spread on bread 4. Avoid foods that are dry, coarse, or stiNcUkR y SINGTB.COM Answer: 4 Explanation: A client experiencing dysphagia, difficulty swallowing, should choose soft, moist foods. Hot beverages are not recommended in the client with dysphagia. Peanut butter has no special significance but is sticky and may be difficult for the client to eat. Avoiding sticky or lumpy food is advised. Some clients may report a metallic taste related to chemotherapy treatments. Avoiding metallic-tasting foods may be helpful but will not impact dysphagia.

Nursing Process: Implementation Client Need: Basic Care and Comfort Cognitive Level: Applying

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2) A client who is HIV positive has lost 10% of body weight over the last 3 months and attributes this to diarrhea caused by the medication. What should the nurse suggest to this client?

1. Maintain good mouth care 2. Encourage foods high in insoluble fiber 3. Take medications on an empty stomach 4. Eliminate caffeine and lactose from the diet Answer: 4 Explanation: Treatment of noninfectious diarrhea, whether from a drug side-effect or enteropathy, is not found to respond well to diet manipulation, though a reduction in caffeine and a trial of low fat and lactose diet is often recommended along with inclusion of soluble fiber to provide a bulking effect. Foods high in insoluble fiber may increase transit time through the colon exacerbating diarrhea. Many antiretroviral medications have specific food-medication instructions that need be followed by HAART protocol. Maintaining good mouth care will have little effect on diarrhea.

Nursing Process: Intervention Client Need: Basic Care and Comfort Cognitive Level: Applying 3) A client who is HIV positive feels socially isolated and avoids eating out because of the risk for foodborne illness. Which response should the nurse make to this client?

1. "Avoid salad bars and buffets."

2. "Avoiding public restaurants is a good idea."

3. "Always bring food from home when going out."

4. "Limiting social interactions prevents NfoUoRdSIcNoGnTtaBm.CinOaMtion."

Answer: 1 Explanation: Foodborne illness is preventable when eating out or traveling. Safe food practices include avoiding salad bars and buffets. Salad bars and buffets allow for multiple individuals to handle the food. In addition, foods may not be maintained at safe temperatures, allowing bacteria to grow. Limiting social interaction, avoiding public restaurants, and bringing food from home does not necessarily prevent foodborne illness and will increase the client's feelings of isolation.

Bringing food from home for each meal in not necessarily realistic.

Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Applying

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4) A client receiving chemotherapy experiences a metallic taste when eating. Which intervention should the nurse review with this client? (Select all that apply.)

1. Avoid orange juice 2. Use plastic silverware 3. Provide frequent oral care 4. Avoid alcohol-based mouthwash 5. Provide deli meats as protein source Answer: 2, 3, 5 Explanation: Metallic eating utensils should be avoided. Plastic utensils are preferred. They should be provided with frequent oral care. The client who complains of a metallic taste in their mouth can be assisted by providing cold proteins (deli meats, canned meats) to meet protein needs. Mouthwash should not be provided for the client with poor saliva production. However, mouthwash can be utilized with this client during their oral care. Clients should be provided with salt and sugar with their meals to allow them to attempt to alter the taste of their food. The client should be encouraged to increase their fluid intake. Citrus juices should not be provided for clients with mouth sores. Citrus juices can be provided to the client who complains of a metallic taste in their mouth.

Metallic eating utensils should be avoided. Plastic utensils are preferred. They should be provided with frequent oral care. The client who complains of a metallic taste in their mouth can be assisted by providing cold proteins (deli meats, canned meats) to meet protein needs.

Mouthwash should not be provided for the client with poor saliva production. However, mouthwash can be utilized with this client during their oral care. Clients should be provided with salt and sugar with their meals to allow them to attempt to alter the taste of their food. The client should be encouraged to increase their flNuU idRiSnItNaG keT.BC.CiO trM us juices should not be provided for clients with mouth sores. Citrus juices can be provided to the client who complains of a metallic taste in their mouth.

Metallic eating utensils should be avoided. Plastic utensils are preferred. They should be provided with frequent oral care. The client who complains of a metallic taste in their mouth can be assisted by providing cold proteins (deli meats, canned meats) to meet protein needs.

Mouthwash should not be provided for the client with poor saliva production. However, mouthwash can be utilized with this client during their oral care. Clients should be provided with salt and sugar with their meals to allow them to attempt to alter the taste of their food. The client should be encouraged to increase their fluid intake. Citrus juices should not be provided for clients with mouth sores. Citrus juices can be provided to the client who complains of a metallic taste in their mouth.

Nursing Process: Implementation Client Need: Basic Care and Comfort Cognitive Level: Applying

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26.3 To formulate nursing interventions for the prevention or treatment of symptoms and side effects from cancer or HIV infection that negatively impact nutrition status.

1) A client receiving chemotherapy expresses food aversion to meals. Which action should the nurse take to support this client's nutritional needs?

1. Offer only foods the client likes 2. Administer dietary supplements 3. Provide an antiemetic before eating 4. Offer small portions more frequently Answer: 4 Explanation: Learned food aversions can occur in patients who have experienced adverse effects of treatment and have come to associate those effects with the food consumed at that time. Small meals are not overwhelming and do not upset the stomach as easily. Antiemetics are given for nausea. Providing only the foods that the client likes does not ensure adequate nutrition.

Administration of dietary supplements is not an independent nursing intervention, nor does it manage the client's primary complaints.

Nursing Process: Implementation Client Need: Physiological Adaptation Cognitive Level: Applying 2) A client who is immunocompromised is returning home after receiving extensive treatment for HIV. Which food safety precautions should the nurse teach the client?

1. Throw away leftovers NURSINGTB.COM 2. Drink only bottled beverages 3. Boil the dishes for 10 minutes after each use 4. Wash food preparation items between each use Answer: 4 Explanation: A client who is immunocompromised is at risk for infection. Bacteria accumulate on food surfaces which should be washed between each use. Boiling dishes is not indicated. A client may drink pasteurized milk or juice and bottled water. Leftovers when refrigerated within two hours may be consumed.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) A client with metastatic breast cancer experiences severe nausea following each administration of chemotherapy. Which action should the nurse take to help this client avoid nausea?

1. Schedule chemotherapy administration for bedtime 2. Provide full meals with liquids when nausea is not present 3. Administer prescribed antiemetics 1 hour before the treatments 4. Offer dry crackers and carbonated fluids immediately following the treatments Answer: 3 Explanation: Administration of a prescribed antiemetic is an appropriate nursing intervention.

When given prior to the chemotherapy treatment it may lessen the nausea experienced. The nurse does not have the authority to schedule chemotherapy administration, nor will this eliminate the nausea. Small frequent meals and avoiding liquids with meals are appropriate interventions.

Large meals may cause distention and bloating resulting in nausea. Offering dry crackers and carbonated fluids may be helpful but are not the most important intervention.

Nursing Process: Implementation Client Need: Basic Care and Comfort Cognitive Level: Applying 26.4 To examine the recommendations regarding the use of dietary supplements as part of treatment for HIV infection or cancer.

1) A client taking protease inhibitors for HIV treatment wants to take the supplement St. John's wort. What should the nurse reply to this client?

NU 1. "St. John's Wort has been used to prom otReSsIaNtG ieTtB y.."COM 2. "Take this supplement 1 hour after the protease inhibitor."

3. "St. John's Wort neutralizes the effects of damage to cells."

4. "This supplement has been shown to decrease the effects of protease inhibitors."

Answer: 4 Explanation: St. John's Wort is known to jeopardize the success of conventional treatment such as with the concomitant use of protease inhibitors. St. John's Wort has been used to treat mental disorders and depressions. It is not used to promote satiety. Taking this supplement is not advised with the HAART protocol. Antioxidants function to neutralize the effects of damage to cells.

Nursing Process: Implementation Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Applying

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2) The nurse notes that a client scheduled to begin radiation therapy takes vitamins A, C, and E. What side effects of taking these supplements during treatment should the nurse be alert to?

1. Altered bleeding 2. Immunosuppression 3. Increased chemotherapy levels 4. Hinder the effects of radiation treatments Answer: 4 Explanation: Antioxidant vitamins, such as A, C, and E, may prevent the oxidizing effect of free radicals deliberately formed by radiation and some chemotherapies and thus have the potential to hinder the efficacy of these treatments. Use of antioxidant supplements during treatment is discouraged unless specifically prescribed by the oncologist. In some unique circumstances, antioxidants are used as treatment adjuvant therapy and it is imperative that their use be reserved only for these prescribed circumstances until further research is available. Garlic supplementation is noted to alter platelet function and coagulation. Echinacea can cause immunosuppression. A variety of other herbs affect chemotherapy levels, which can lead to toxicity.

Nursing Process: Planning Client Need: Safety and Infection Control Cognitive Level: Analyzing 3) The nurse is planning care for a client with cancer. For which reason should the nurse recommend that the client increase the intake of omega-3 fatty acids?

1. Reduce diarrhea NURSINGTB.COM 2. Improve cachexia 3. Heal mouth ulcers 4. Prevent immunosuppression Answer: 2 Explanation: Some research evidence demonstrates a benefit to adding EPA such as omega-3 fatty acids to other measures when treating clients with cachexia. Omega-3 fatty acids are not helpful to reduce diarrhea, heal mouth ulcers, or prevent immunosuppression.

Nursing Process: Planning Client Need: Pharmacological and Parenteral Therapies Cognitive Level: Analyzing

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26.5 To translate the current recommendations for nutrition treatment of metabolic consequences of HIV infection.

1) A client who is HIV positive has an elevated fasting blood glucose. What dietary recommendation is important for this client?

1. Limit the intake of unsaturated fats 2. Reduce the intake of carbohydrates 3. Increase the amount of omega-6 fats 4. Aim for meals with high glycemic index Answer: 2 Explanation: Management of insulin resistance follows the same lifestyle advice for the nonHIV-infected population which would include reducing the intake of carbohydrates. Sugars have the highest glycemic index. Limit the intake of saturated fats; emphasize omega-3 fatty acids and unsaturated fats within a controlled kilocalorie intake.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing 2) A client with HIV is taking multiple ART medications. Which vitamin supplement should the nurse recommend to prevent the development of osteoporosis?

1. Iron 2. Folate 3. Vitamin D NURSINGTB.COM 4. Vitamin E Answer: 3 Explanation: Bone disorders in the form of osteopenia and osteoporosis are associated with ART. The nurse should assist the client in modifying risk factors for low bone density and encourage adequate intake of calcium and vitamin D. Iron is a trace mineral which carries oxygen. Folate is a water-soluble vitamin important in new cell formation. Vitamin E functions as an antioxidant.

Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Applying

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3) A client with HIV is diagnosed with hyperlipidemia. What diet instruction should the nurse provide to this client?

1. Limit all meat intake 2. Remove the skin from meat 3. Limit exercise to avoid fatigue 4. Avoid low-fat milk, cheese, and yogurt Answer: 2 Explanation: Saturated fats contribute to the development of hyperlipidemia. Removing the skin from meat will reduce saturated fat content. Limit red meats and choose lean meats (turkey, chicken). Instruct the client on practical methods of exercise for 30 minutes most days of the week to increase HDL-C. Low-fat milk, cheese, and yogurt all contain low saturated fat content.

Nursing Process: Implementation Client Need: Reduction of Risk Potential Cognitive Level: Applying

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