Nutrition B 2016 Rationales: 1. A Nurse is planning dietary interventions for a client who is prescribed external radiation for laryngeal cancer. The client reports manifestations of stomatitis. Which of the following interventions should the nurse include? Provide meals at room temperature. o The nurse should plan to offer the clients foods at room temperature or colder. Foods at these temperatures are less irritating to the mucosa. o The nurse should tell the client to avoid spices and salty foods because they can irritate the oral mucosa. o The nurse should instruct the client to avoid citrus and other acidic foods because they irritate the oral mucosa. Citrus fruits are an appropriate food recommendation for a client who has dry mouth. o Encourage the client to drink high calorie, high protein drinks as meal substitutes. The intervention provides adequate nutrient intake with minimal irritation to the oral mucosa. The client should avoid tomato juice because it is acidic and salty. 2. A nurse is caring for a client who has diabetes mellitus and reports feeling dizzy, weak and skaky. Which of the following is the priority action by the nurse? Check the clients glucose levels. o The 1st action should the nurse take is using the nursing process to assess the client. Therefore, checking the clients blood glucose level is priority. 3.A home health nurse is reviewing the medical record of a client who has an open reduction internal fixation on the tibia. Which of the following findings should the nurse identify as a risk factor for impaired wound healing? The client consumes 1,00 k/cal daily. o Adults who have surery require at least 1,500 k/cal daily to meet energy needs and build protein for tissue healing. The nurse should recognize that a 1,000 k;cal day intake is below the clients needs. o A hemoglobin level below the expected reference range is a risk factor for impaired wound healing. o Pulses +3 strength are an expected finding. The nurse should identify tissue perfusion as risk factor for impaired wound healing. o The body uses zinc to build proteins and aid the immune response. The nurse should identify this finding as a factor that will promote wound healing. 4. A nurse is assessing the meal pattern of a client who has diverticular disease and a prescription for a high-fiber diet. Which of the following food choices by the client contains the most fiber? ½ cup bran cereal. o Contained 8.8 g per serving. o One medium apple with skin contains 3.3 g of fiber. o ½ cup of cooked oatmeal contains 2g of fiber. o One medium banana contains 3 g of fiber. 5. A nurse is reviewing the laboratory data of four clients. The nurse should identify that which of the following clients is experiencing fluid overload? A client who has a sodium level of 130. o Reference range of sodium is 136 to 145. A decreased sodium level is an indication of a lack of sodium intake or hemodilution from fluid overload. o Hct of 55% indicated fluid volume deficit. (Reference range 37 to 47% for woman and 42 to 52% for men.) o Specific gravity of 1.035 is greater than the expected reference range of 1.005 to 1.030. An elevated urine specific gravity indicates fluid volume deficit. o Albumin of 5.5 is greater than expected reference range of 3.5 to 5g. Indicating dehydration, fluid volume deficit. 6. A nurse is teaching a client who has chronic kidney disease about limiting her calcium intake. Which of the following food choices should the nurse inform the client contains the highest amount of calcium and should be limited in her diet? 1 cup low-fat yogurt. o Contains 314 mg of calcium per cup. o 1 oz of cheddar cheese contains 214 mg of calcium per ounce. o 1 egg contains 25 mg of calcium. o 1.2 cup spinach contains 122 mg of calcium per half cup. 7. A nurse is providing teaching to a client who is lactating about increasing her protein intake. Which of the following foods should the nurse recommend as the best source of protein? Cottage cheese. o It’s a complete protein. Contains all nine essential amino acids and provide the best support for human growth and nourishment. 8. A nurse is teaching about nutritional requirements for a client who is starting a vegetarian diet. Which of the following information should the nurse include in the teaching? Include two servings per day of nuts when on a vegetarian diet. o The nurse should instruct the client to eat two servings of nuts or flaxseed per day to receive the daily requirement of omega-3 fatty acids. o Require decreased intake of dietary fat rather than fewer calories. o Instruct the client to take vitamin b12 supplements or consume foods fortified with b12 to compensate for a potential deficiency. o Low fat cheese as a protein substitute. 9. A nurse is performing a comprehensive nutritional assessment for a client. After reviewing the clients lab results, which of the following findings should the nurse report to the provider? Prealbumin 8 mEq/L. o Critical value that indicates severe malnurtion and requires reporting to the provider. 10. A nurse is providing discharge teaching to a client who has Parkinson’s disease and prescription for levodopa- carbidopa. Which of the following foods should the nurse instruct the client to consume with the medication? 1 slice of wheat toast. o Absoption decreases with protein. Wheat toast consumes 3g. o 6 peanut butter crackers contain 6g. o Cheddar chesse contains 7g. o 6 oz greek yogurt contains 17g. 11. Which of the following foods items should the nurse include as containing the highest amount of folate? 3.5 oz chicken liver. o Contains highest amount of folate. 770 mcg. o Chick peas contains 141 mcg. o 1 medium oange contains 47 mcg. o 1 slice white bread contains 38 mcg. 12. A nurse is teaching an adolescent who has a new diagnosis of celiac disease. Which of the following statements by the client indicates an understanding of the teaching? I need to eliminate rye from my diet. o Eating sources of gluten such as barley or rye, increases the manifestations of celiac disease. o Oil content of food night need to be decreased in a client who is on a low fat diet. o Acidic foods do not affect the manifestations of celiac disease. o Client who can not tolerate lactose should avoid milk products. 13. A nurse I providing teaching to a client who has diabetes mellitus and hba1c of 8.7%. Which of the following statements by the client indicates an understanding of his laboratory value? This shows that I have not been following my diet. o 8.7% is not within expected reference range. The goal for a client who has diabetes is between 6.5% and 7%. o Exercise does not effect hbac1 level. 14. A nurse is teaching a client who is preparing for bowel surgery about a low0residue diet. Which of the following food choices by the client indicates an understanding of the teaching? Two poached eggs and a banana. o Low residue diet limits the amount of stool traveling through the intestinal tract. The nurse should teach the client to avoid foods high in fiber. o Avoid whole grains, fruits with seeds. 15. A nurse is caring for a client who is receiving continuous enteral feedings via an NG tube. The nurse notices that the tube feeding has stopped infusing. Which of the following actions is the nurse priority? Flush the tube with warm water. o The 1st action the nurse should take when a tube feeding stops infusing is to flush the tube with 30 to 50 ML of water to re-establish flow. Other interventions might be required if flushing does not remove the clog. 16. A nurse is teaching an older adult about nutritional recommendations. Which of the following statements should the nurse make? You should increase your daily protein intake. o To increase his daily intake of protein to increase strength and enhance immune function and wound healing. Protein intake of 20% to 25% of the clients daily calorie intake. o Add a calcium supplement to his diet to maintain healthy bones and prevent osteoporosis. o Add vitamin D supplement to his diet to promote calcium absorption. 17. A nurse is providing dietary instructions for a client who has a prescription for warfarin. Which of the following foods should the nurse recommend the client to eat in moderation while taking this medication? Green leafy vegetables. o Maintain consistent intake of green leafy vegetables, which contain a natural form of vitamin K that can negate the anticoagulation effect of warfarin. 18. A nurse is teaching an older adult client about measures to reduce the risk of osteomalacia. Which of the following instructions should the nurse include in the teaching? Consume 20 mcg of vitamin D daily, o Recommended for clients age 65 and older to decrease bone loss and maintain bone mineralization. o Eat foods rich in antioxidants. Protects cells from being destroyed by free radicals. o Client who has gout to decrease intake of foods that contain purine, such as organ meats and certain types of seafood. These foods increase uric acid levels, which exacerbate the possibility of an acute attack. o Recommended dose of vitamin E is 15 mg per day. It decreases platelet aggregation, which can interfere with blood clotting in an older adult client. 19. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The current bag of tpn is empty and a new bag is not available on the unit. Which of the following solutions should the nurse infuse until a new bag of TPN is available? Dextrose 10% in water. o Prevents hypoglycemia. o 0.45% sodium chloride, dextrose 5% in lactated ringers, and 0.9% sodium chloride will not prevent adverse effects. 20. A nurse is providing dietary teaching for a client who is postoperative following gastric bypass. Which of the following instructions should the nurse include? Start each meal with a protein. o The client should consume 60 to 120 g of protein each day. o Instruct the client to eat three meals and two snacks of a limited portion size each day. o Eat slowly, and to stop eating when he begins to feel full. o Chew food well, plan for meals to last between 30 to 60 mins. 21. A nurse is initiating an enternal feeding for a client who has chronic bronchitis. Which of the following types of formula should the nurse anticipate administering to the client? High calorie. o Pulmonary disease requires a formula that is high in calories and protein to maintain energy demands. o Prevents malnutrition and maintain muscle and lung strength. 22. A community health nurse is planning to teach a class about weight management for cardiovascular health. Which of the following statements should the nurse plan to make to the participants? Plan to lose weight gradually at ½ to 1 pound per week. o Vitamin supplements are not necessary. Multivitamin supplements do no decrease or prevent cardiovascular disease. o Adequate protein is important for maintaining muscle mass. o Client should limit their sodium intake to 1,500 mg/day. 23. A nurse is caring for a client who receiving continuous enternal tube feedings. Which of the following actions should the nurse take to prevent aspiration? Monitor gastric residuals every 4 hr. o Delayed gastric emptying places the client at risk for aspiration. o The head of the clients bed should be elevated to between 30 degrees and 45 degrees during the feeding and for at least 1 hr. afterward. o Flushing the tube with 30 to 50ml of water before and after medication administer helps maintain tube patency but does not prevent aspiration. 24. A nurse is providing teaching of a client who is at 24 weeks of gestation and reports constipation. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) Drink eight 240 ml (8oz ) glasses is water daily is correct. Increase daily fiber intake. Perform exercises regularly using large muscle groups. o Eating small amounts of food is give to a client who has nausea and vomiting. o Glycerin should not be used cause it can cause the client to become dependent on stimulation to have a bowel movement. 25. A nurse I caring for an older adult who has a pressure ulcer. The client practices orthodox Judaism and strictly follows kosher dietary laws. Which of the following foods should the nurse provide for this client? Macaroni and cheese. o Compliance with kosher dietary laws. Contains protein which contributes to wound healing. o Only seafood that can be consumed is fish with fins and scales. o Dairy and meat cannot be eating together. o Pork and pork products can not be eaten. 26. A nurse is caring for a client who develops diarrhea while receiving a continuous enteral tube feeding. Which of the following actions should the nurse take? Warm the formula to room temp. o Client can develop diarrhea if the formula being infused is too cold. o Elevating the head of the clients bed to 30 prevents aspiration rather than diarrhea. o Provide a low fat formula for a client who has diarrhea. 27. o The nurse should identify that lower extremity edema is manifestation of malnutrition and inactive of a protein deficiency in the client. o Decreased reflexes and weak hand grasps are manifestations of malnutrition. o Dry conjunctiva and corneal vascularization are manifestations of malnutrition. o Dry skin is a manifestation of malnutrition. 28. o The nurse should explain to the client that her restrictions and privileges would be dependent on treatment compliance and direct weight gain. This approach involves the client in development of the plan of care and gives her control in achieving desires privileges. o The nurse is in charge of making meal times. Allowing the client to schedule her own mealtimes does no ensure that will consume enough calories for increased weight gain. o The nurse should remain with the client during meals and for at least 1 hr after meals. o The nurse should weight the client at the same time each day. 29. o The nurse should instruct the client that consuming skin on fruits and vegetables adds fiber to the diet. o Instruct the client to add a small amount of bran to her daily diet. Working up to 3 tablespoons daily, which is less than 1.4 cup. Adding fiber gradually should prevent abdominal distention and excessive flatus. o Replave meat entreets with a main dish that features dried peas or beans to add fiber to her diet. o Increase fluid intake as fiber intake increases to prevent constipation. 30. o Lip emulsions are isotonic and are composed of soybean or safflower plus soybean oil, with egg phospholipid used as an emulsifier. Clients who are allergic to eggs can have a reaction to the emulsifier. Therefore, the nurse should report this finding to this provider. 31. 32. 33. 34. 35. 36. o Whole grains are a healthy choice of carbohydrate as they contain ingredients that lower the risk of cardiovascular disease, including the improvement of blood pressure. o Moderate daily intake of alcohol for hypertension is one for women and 2 for men. o Increased potassium levels decrease blood pressure levels. o The client should limit intake of food high in sodium, including dairy products. To lower blood pressure, the nurse should instruct the client to choose low fat dairy products. o Potassium level is 3.5 to 5.0 o Calcium is 9.0 to 10.5 o Sodium is 136-145. o A client who eats more than half of most meals, occasionally refuses a meal, and has four servings of protein each days scores a 3 (adequate) in the nutrition category of the braden scale. o A client who scares a 2 ( probably inadequate) in the nutrition category of the braden scale only eats about half of meals or snacks and only occasionally takes dietary supplements. o A client who scores a 1 ( very poor) in the nutrition category of the braden scale never finishes a complete meal, drinks little fluid and does not drink any dietary supplements. o A client who scores a 4 ( excellent) in the nutrition category of the braden scale eats most of every meal, eats plenty of protein, and occasionally eats between meals. o To decrease fluid retention, a client who has cirrhosis should limit his daily sodium intake to 2,000 mg. o To decrease fluid retention, a client who has cirrhosis should limit fluid intake to 1.5 L per day. o To prevent malnutrition, a client who has cirrhosis should consume 0.8 to 1.2 g/kg of protein daily. o Client who has cirrhosis should consume foods that contain vitamin K. o A feature of the DASH diet is a reduction in total cholesterol. This lab finding is within the expected reference range and indicates that the client has achieved one of the goals of the dash diet. o Fasting glucose 130 is expected reference range and indicates that the client has not reached a goal of dash diet. o Chloride 106 is within the expected reference range but is not an indication that the client has not reached a goal of dash diet. o Sodium 150 is an above the expected reference range and indicates that the client has not reached a goal of dash diet. 37. 38. 39. 40. 41. 42. o The nurse should recognize that cantaloupe is a food source high in potassium. The client should avoid cantaloupe as well as other foods that are high in potassium for the medication captopril. o Watermelon does not create a potential food and medication interaction for the client because it is not high in potassium. o Lettuce does not create a potential food and medication interaction for the client because it is not high in potassium. o Carrots are high in beta-carotene and do not create a potential food and medication because it is not high in potassium. o A client who had mucositis should increase fluid intake to promote hydration and peristalsis. o A client who has mucositis should be provided with room temp or cooled liquids to reduce irritation. o Avoid glycerin-based swabs because they cause dryness and irritation. o Avoid acidic foods to prevent further irritation. o Pinto beans are the best food source to recommend because the contain the highest amount of zinc per serving. o Math. o 0.8 ( 2.2/116). o lowering solid fat intake to an adolescent who is overweight. o Instruct the client to limit her meat intake to 5oz per day. o Limit egg yolk consumption to three per week. o Select cheeses that contain no more than 3g of fat per serving. o Choose margarine that contains no more than 2g of saturated fat per tablespoon. o The nurse should instruct the client that completely thawed breast milk can be stored in the refrigerator, but must be used within 24 hrs. Breast milk that has been previously frozen should not be refrozen once it has thawed completely. Thawing creates possibility for bacterial growth and causes a decrease in antibacterial activity, which destroys antibodies in the milk. o Any milk left in a bottle from a feeding should be immediately discarded. o Recommended duration of time for safely storing expressed breasts milk is 6 months. o Place the container of breast milk under warm, running water. Should not be thawed in microwave. o Manifestations for sodium deficit: confusion, headaches, nausea, dizziness, and abdominal cramps. Sodium toxicity include confusion, thirst, weakness. o Phosphorous toxicity manifestations: numbness tingling around the mouth and extremities and tetany. 43. 44. 45. 46. o Manifestations of potassium deficiency are an irregular heart rate, muscle weakness, leg cramps, and anorexia. Toxicity are vomiting, diarrhea, cardiac dysrhythmias, and muscle weakness. o Manifestations of chloride deficiency are lack of emotion, anorexia, and muscle cramps. o The nurse should recommend yogurt as a snack for a 2 year old toddler. Yogurt prevents no choking hazard and increased activity level, toddlers require 13 to 16 g of protein each day to meet the demands of muscle growth. At 8g/cup, yogurt is a high quality source of protein. o A hot dog is too large for a 2 year old to chew and swallow. Be cause their chewing skills are not yet mature, children are at high risk for choking until they reach 4 years of age. o A peanut butter is thick and bread if hard to swallow. Be cause their chewing skills are not yet mature, children are at high risk for choking until they reach 4 years of age. o Fruit gel bites vary in size and sugar content. Makes it hard for the 2 year old to swallow and chew. o Infant has cleft lip and palate. Which position should the nurse place? o Upright position with the caregiver supporting the infants head. The nipple should be directed to the side of the infants mouth to prevent the formula from entering the nasal passage. o Supine, football hold, and lateral can enter the nasal passage through the cleft in the palate. o Citrus fruits stimulate the production of more saliva, which helps diminish the metallic taste. o Pickles as a snack stimulate the production of more salivas, helps diminish the metallic taste. o Gargling with mouthwash stimulates the production of more saliva, which helps diminish the metallic taste. o The nurse should provide small, frequent meals for a client who is experiencing altered tase. o Plastic utensils should be used to avoid increasing the metallic taste in foods. o To prevent diarrhea, the nurse should decrease the rate of the tube feeding, which allows for better absorption of the enteral formula. o Check the clients gastric residual routinely to reduce the risk for aspiration and monitor the absorption of the feeding, but this action will not reduce the clients diarrhea. o Promethazine is administered for the treatment and prevention of nausea and vomiting, rather than diarrhea. o The nurse should flush the clients feeding tube before and after giving medications or if the tube is clogged. 47. 48. 49. 50. o Lutein, a carotenoid found in vitamin A, slows the progression of AMD and is found in kale, spinach, collards and mustard greens. o Foods with low glycemic index can aid clients who have diabetes mellitus in managing postprandial hyperglycemia, but foods that have a high glycemic index have no effect on AMD. o Niacin aids in lowering LDL and triglycerides, but it has no effect on AMD. o Soy products do not contain antioxidants, lutein, or vitamins E and b12, all of which can slow age –related vision loss. Soy products are used as meat substitutes in veg diets. o Client with difficulty swallowing after stroke. o Tilting the head forward promotes swallowing by pushing the clients epiglottis downward and opening the esophagus. o The client should avoid consuming thin liquids because this can increase the risk of aspiration and choking. o The client should place food on the unaffected side of the mouth to prevent aspiration and choking. o Taking moderate bites when eating increase the client’s risk of choking. The client should take small bites when he is eating. o Limit disruptions during mealtimes allow the client to take his time eating which reduces the risk for choking. The nurse should allow the client at least 30 min for each meal. o Avoid taking atorvastatin with grapefruit juice because it can increase serum levels of the medication. o Orange juice, coffee, and milk is safe to take with atorvastatin. o o o o 51. 52. The nurse should ask if the client fasting is exempt during illness. Ask if fasting means refraining from drinking liquids. Ask if there are certain hours of the day fasting occurs. Ask if fasting means eating only a certain type of food. o A mechanical soft diet is a diet of foods with altered texture. It includes cooked fruits and vegetables, foods that are softened with liquids, and foods that are thickened for consistency. o Cooked fruits and vegetables. o Thickener added to thin liquids like skim milk o Prevention of cancer. o Instruct the clients to consume four to five servings or about 2.5 cups of fruits and vegetables daily. o Limit their daily intake of alcohol to one drink for women or two drinks for men. o Instruct the clients to choose whole grain foods over refined foods to prevent gastro cancer and to help maintain a healthy weight. o Limit their consumption of processed meats they contain increased amounts of sodium and are high in saturated trans fats. 53. 54. 55. o Hydrolyzed formula provides protein and other nutrients in their simplest form, requiring little or no digestion and decreasing stimulation of the bowel. This type of formula is beneficial for clients who have impaired digestion due to conditions such as inflammatory bowel disease. o Polymeric formula contains complex nutrient molecules and is not indicated for clients who have impaired digestion. o Milk based supplemental formulas contain lactose and are poorly tolerated by clients who have inflammatory bowel disease. o Modular formulas are intended to increase the intake of a specific nutrient without increasing volume; they are not intended for clients who have impaired digestion. o Vitamin A enables the eyes to adapt to dim lighting more rapidly at night, which improves night vision. o Calcium facilities never transmission and cell membrane permeability, but its not a micronutrient that improves night vision. o Vitamin b6 assists in the formation of heme in hemoglobin and the synthase of neurotransmitters, but it is not a micronutrient that improves night vision. o Phosphorus assists in the formation of bones and teeth, and the regulation of hormone activity but it is not a micronutrient that improves night vision. o o o o 56. 57. Adding vitamin D to calcium supplements increases calcium absorption. The client should take calcium with milk to promote absorption. Calcium is best absorbed when 500 mg or less is taken at a time. Vitamin B12 does not affect the absorption of calcium. o A client who is experiencing dehydration should receive a continues infusion to prevent receiving a high carb load with each feeding. o A child formula has nothing to do with dehydration. It can cause abdominal distention and cramping. The nurse should warm the formula to room temp prior to administration. o A client who is experiencing dehydration should receive additional water, but diluting the formula will also reduce the amount of nutrients the client receives. o A client experiencing dehydration should receive low protein formula. o A client who is experiencing distention and bloating should receive a low fat formula. o A client who has ESKD has impaired kidney function and is unable to eliminate potassium. As urine output declines, hyperkalemia develops, which can cause cardiac dysrhythmias. 58. o The clients risk for dysthymias’ does not increase due to a diet low in fat. A diet that is high in fat can lead to CAD, which can increase risk for dysrhythmias. o The clients risk for dysrhythmias does not increase du to a diet rich in protein. However, as uremia occurs from the build up waste products from the breakdown of protein, a client who hs ESKD should not consume a diet rich in protein. o A diet deficient in iron can lead to anemia, but the clients risk for dysrhythmias does not increase due to low intake of iron. o o o o 59. 60. The nurse should recognize confusion as a manifestation of hypoglycemia. Polydipsia is manifestation of hyperglycemia. Vomiting is hyperglycemia. Ketonuria is hyperglycemia. o The nurse should recommend the client consume the supplement with beverages containing vitamin c, such as tomato juice, orange juice, because it will enhance the absorption of iron supplement. o Green tea contains caffeine, which impairs iron absorption when the items are consumed together. o Milk contains calcium, which impairs absorption. o Protein shake contains calcium which impairs iron absorption. o A client who has celiac disease can consume tapioca because this grain does not contain gluten. o A client who has celiac disease should avoid processed foods, including canned coups, they contain gluten. o Whole wheat bread avoid= gluten. o Celiac disease dietary restriction should be followed through lifetime.