CH 45 TEST Q - Test banks practice PDF

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Chapter 45. Nutrition MULTIPLE CHOICE 1. While doing a nutritional assessment of a low-income family, the community health nurse determines the familys diet is inadequate in protein content. The nurse suggests which of the following foods to increase protein content with little increase in the food budget? 1 2 3 4

Oranges and potatoes Potatoes and rice Rice and macaroni Peas and beans

ANS: 4 For families on limited budgets, substitutes can be used. For example, bean or cheese dishes can often replace meat in a meal. Peas and lentils are also inexpensive food sources of protein. Oranges and potatoes are not high in protein content. Potatoes and rice are sources of carbohydrates, not protein. Rice and macaroni are carbohydrates and are not high in protein. 2. A client is suspected of having a fat-soluble vitamin deficiency. To assist the client with this deficiency, the nurse informs the client that: 1 More exposure to sunlight and drinking milk could solve your nutritional problem 2 Eating more pork, fish, eggs, and poultry will increase your vitamin B complex intake 3 Increasing your protein intake will increase your negative nitrogen imbalance 4 Decreasing your triglyceride levels by eating less saturated fats would be a good health intervention for you ANS: 1 The fat-soluble vitamins are A, D, E, and K. With the exception of vitamin D, which can be obtained through exposure to sunlight, these vitamins are provided through dietary intake, including fortified milk. The B vitamins are not fat-soluble; they are water-soluble vitamins. Increasing protein intake will improve (decrease) a negative nitrogen imbalance, not increase it. Furthermore, increasing protein intake does not address the problem of a fat-soluble vitamin deficiency. 3. The client is diagnosed with malabsorption syndrome (celiac disease). In teaching about the gluten-free diet, the nurse informs the client to avoid: 1 2 3 4

Citrus fruits Vegetables Red meats Wheat products

ANS: 4 The treatment of malabsorption syndromes, such as celiac disease, includes a gluten-free diet. Gluten is present in wheat, rye, barley, and oats. Citrus fruits, vegetables, and red meat do not contain gluten.

4. The school nurse suspects that a junior high student may have anorexia nervosa. This eating disorder is characterized by: 1 2 3 4

A lack of control over eating patterns Self-imposed starvation Binge-purge cycles Excessive exercise

ANS: 2 Anorexia nervosa is characterized by self-imposed starvation. Bulimia nervosa is characterized by a lack of control over eating patterns and binge-purge cycles. Clients with bulimia may exercise excessively to prevent weight gain. 5.

A client is pregnant for the third time. In regard to her nutritional status, she should:

1 2 3 4

Limit her weight gain to a maximum of about 25 pounds Approximately double her protein intake Increase her vitamin A and milk product consumption Increase her intake of folic acid

ANS: 4 Folic acid intake is particularly important for DNA synthesis and the growth of red blood cells. Inadequate intake may lead to fetal neural tube defects, anencephaly, or maternal megaloblastic anemia. It is now recommended that women planning future pregnancies discuss preconception folic acid supplements. The recommended weight gain for pregnancy is 25 to 35 pounds for the woman of average weight. There is no need for the client to limit her weight gain to a maximum of 25 pounds on the basis of this being her third pregnancy. The client needs to increase her protein intake to 60 g during pregnancy; she does not need to double it. (This is an increase of approximately 20 g of protein.) Prenatal care usually includes vitamin and mineral supplementation to ensure daily intakes. The recommended intake of vitamin A does not increase over the nonpregnant state. Calcium intake increases from 800 mg to 1200 mg during pregnancy. 6.

The nurse should offer a client who has had throat surgery which of the following?

1 2 3 4

Chicken noodle soup Ginger ale Oatmeal Hot tea with lemon

ANS: 2 The client who has had throat surgery should first be offered clear liquids. If the client tolerates clear liquids, then he or she may be advanced to a full liquid diet, and then to a mechanical soft diet. Because the client had throat surgery, excoriating liquids such as citrus juices should be avoided. Also, to be able to assess for bleeding, red or dark liquids should be avoided (e.g., apple juice or ginger ale is recommended rather than grape or cranberry juice). The client should begin oral intake with clear liquids. Neither chicken noodle soup nor oatmeal is included on a clear liquid diet. Hot tea with lemon

would not be recommended. Liquids should not be hot or contain citrus, which could cause pain or excoriation and possible bleeding at the surgical site. 7. The nurse is discussing dietary intake with a client who is human immunodeficiency virus (HIV) positive. The nurse informs the client that the diet will include a: 1 2 3 4

Restriction of potassium, phosphate, and sodium Reduction in carbohydrate intake Decreased protein and increased folic acid intake Reduction in fat with smaller, more frequent meals

ANS: 4 HIV-infected clients typically experience body wasting and severe weight loss. Restorative care for these clients focuses upon maximizing kilocalories and nutrients. Low-fat diets and small, frequent, nutrientdense meals may be better tolerated. There is no need to restrict potassium, phosphate, and sodium in the client with HIV infection. The client with HIV infection does not need to reduce carbohydrate or protein or increase folic acid intake. 8. Which of the following should the nurse do first when introducing a feeding to a client with an indwelling gavage tube? 1 2 3 4

Irrigate the tube with normal saline solution. Check to see that the tube is properly placed. Place the client in a supine position. Introduce some water before giving the liquid nourishment.

ANS: 2 Before introducing a feeding through an indwelling gavage tube for enteral nutrition, it is essential that the nurse check to see that the tube is properly placed. It is not necessary to irrigate the tube with normal saline. The clients head should be elevated 30 to 45 degrees to help prevent the chance of aspiration. The tube may be flushed with 30 mL of water before initiating the feeding. However, the nurse should first verify correct tube placement. 9. The nurse is caring for a client who is receiving parenteral nutrition (PN). Which of the following is an appropriate nursing intervention when administering parenteral nutrition to a client? 1 2 3 4

Begin the infusion rates at 100 to 150 mL/hour. Maintain a consistent infusion rate. Change the infusion tubing once a week. Monitor protein levels daily.

ANS: 2 The infusion should be maintained at a consistent rate. If an infusion falls behind schedule, the nurse should not increase the rate in an attempt to catch up, because this could lead to osmotic diuresis and dehydration. An infusion should not be discontinued abruptly, because it may cause hypoglycemia. An initial rate of 40 to 60 mL/hr is recommended. To avoid infection, the infusion tubing should be

changed every 24 hours with lipids and every 48 hours when lipids are not infused. Protein levels do not need to be monitored daily. The client should be weighed daily until maximum administration rate is reached and maintained for 24 hours; then weigh the client 3 times per week. 10. Before inserting a small-bore nasogastric tube for enteral nutrition, the nurse correctly tells the client: 1 The tube will feel uncomfortable and may make you gag at times when I am inserting it 2 We will mark this tube from the end of your nose to your umbilicus to obtain the right length for insertion 3 Please hold your breath when I insert this small tube through your nose down into your stomach 4 Please tilt your head back after the tube passes the nasopharynx. ANS: 1 The procedure should be explained to the client, including how to communicate during intubation by raising his or her index finger to indicate gagging or discomfort. This will help reduce anxiety and help the client to assist in insertion. The length of the tube to be inserted is measured from the tip of the nose, to the earlobe, to the xiphoid process of the sternum. The client should be told to mouth-breathe and swallow during the procedure. The client should not hold his or her breath. The nurse should instruct the client to flex the head toward the chest after the tube has passed the nasopharynx. 11. A client is seen in the outpatient clinic for follow-up of a nutritional deficiency. In planning for the clients dietary intake, the nurse includes a complete protein, such as: 1 2 3 4

Eggs Oats Lentils Peanuts

ANS: 1 A complete protein contains all essential amino acids in sufficient quantity to support growth and maintain nitrogen balance. Eggs and meats are examples of complete proteins. Incomplete proteins lack one or more of the nine essential amino acids and include oats (cereals) and legumes (lentils and peanuts). 12. as:

According to the food guide pyramid, vegetables should be included in the average adults diet

1 2 3 4

1 to 3 servings per day 2 to 4 servings per day 3 to 5 servings per day 6 to 11 servings per day

ANS: 3

According to the food guide pyramid, the average adults diet should include 3 to 5 servings of vegetables per day. According to the food guide pyramid, the average adults diet should include 2 to 4 servings per day of fruit and 2 to 4 servings per day of grains. 13. When providing nutritional guidance, the nurse shares with the mother of an 8-year-old client that children of this age need to: 1 2 3 4

Increase their intake of B vitamins Significantly increase iron intake Maintain a sufficient intake of protein and vitamins A and C Increase carbohydrates to meet increased energy needs

ANS: 3 School-age childrens diets should be carefully assessed for adequate protein and vitamins A and C. School-age children frequently fail to eat a proper breakfast and have unsupervised intake at school. An increase in B complex vitamins is needed to support heightened metabolic activity of the adolescent, and the pregnant woman has a need to significantly increase iron intake. Increased energy needs are expected in the adolescent period. 14. When assisting the client who practices Islam or Judaism with meal planning, the nurse knows that both religions share an avoidance of: 1 2 3 4

Alcohol Shellfish Caffeine Pork products

ANS: 4 Clients who practice Islam or Judaism share an avoidance of pork in their diet. Clients who practice Islam avoid alcohol and caffeine but will eat shellfish. Clients who practice Judaism do not restrict alcohol or caffeine intake and only eat fish with scales. Seventh-Day Adventists also avoid shellfish. Mormons also avoid caffeine. 15.

Which of the following would the nurse expect to see offered on a full liquid diet?

1 2 3 4

Custard Pureed meats Soft fresh fruit Canned soup

ANS: 1 Custard is included in a full liquid diet. Pureed meats are allowed in a pureed diet, not a full liquid diet. Soft fresh fruit is not included in a full liquid diet. Fresh fruit is often part of a high- fiber diet. Cooked or canned fruits are allowed on a mechanical soft diet. Canned soup is not part of full liquid diet because it may contain noodles or rice or vegetables. Soups are allowed on a mechanical soft diet.

16. During an enteral tube feeding, the client complains of abdominal cramping and nausea. The nurse should: 1 2 3 4

Cool the formula Remove the tube Use a more concentrated formula Decrease the administration rate

ANS: 4 If the client begins to experience abdominal cramping and nausea during an enteral tube feeding, the nurse should decrease the administration rate to increase tolerance. Administration of cold formula may cause abdominal cramping and nausea. The formula is best tolerated at room temperature. The nurse should not remove the tube if the client complains of abdominal cramping and nausea. The formula may need to be diluted if the client is complaining of abdominal cramping and nausea. 17. A client is diagnosed with a peptic ulcer and has come to the primary health care provider for a follow-up visit. The client asks the nurse what foods are safe to add to his diet. An appropriate response by the nurse is to inform the client that which of the following may be added to the diet? 1 2 3 4

Citrus juices Green vegetables Frequent glasses of milk Unlimited decaffeinated coffee

ANS: 2 The client diagnosed with a peptic ulcer may be allowed to add green vegetables to his diet. The client with a peptic ulcer should avoid foods that increase stomach acidity, such as caffeine, decaffeinated coffee, frequent milk intake, citric acid juices, and certain seasonings (hot chili peppers, chili powder, black pepper). Smoking, alcohol, and aspirin are also discouraged. 18. When teaching the parents of a toddler about safe finger foods, the nurse suggests trying which of the following? 1 2 3 4

Nuts Popcorn Cheerios Hot dogs

ANS: 3 Cheerios are an appropriate finger food for a toddler or preschool child. Nuts, popcorn, and hot dogs have been implicated in choking deaths and should be avoided. If hot dogs are given to this age child, they should be cut up into irregularly shaped pieces, such as long strips.

19. Which of the following is accurate nutritional information that the nurse should share with the parents of an adolescent child? 1 2 3 4

Girls require less protein. Boys require additional iron. Vitamin B needs are decreased. Energy and caloric needs are decreased.

ANS: 2 Adolescent boys require additional iron for muscle development. Daily requirements of protein increase for both adolescent boys and adolescent girls. B complex vitamins are needed to support heightened metabolic activity. Energy and caloric needs are increased to meet greater metabolic demands of growth during the adolescent period. 20. The client is assessed by the nurse as having a high risk for aspiration. The nursing diagnosis identified for the client is feeding self-care deficit related to unilateral weakness. An appropriate technique for the nurse to use when assisting the client with feeding is to: 1 2 3 4

Place food in the unaffected side of the mouth Place the client in semi-Fowlers position Have the client use a straw Use thinner liquids

ANS: 1 If the client has unilateral weakness, the nurse should place food in the stronger side of the mouth. The client should be positioned in an upright, seated position to prevent aspiration.Clients with unilateral weakness often have difficulty using a straw. Thickened liquids are often tolerated better and will help prevent aspiration, because clients with impaired swallowing often choke more with thin liquids. 21. A nasogastric tube is inserted in order for the client to receive intermittent tube feedings. An initial chest x-ray examination is done to confirm placement of the tube in the stomach. After the x-ray confirmation, the most reliable method of checking for tube placement is for the nurse to: 1 2 3 4

Place the end of the tube in water and observing for bubbling Auscultate while introducing air into the tube Measure the pH of the secretions aspirated Ask the client to speak

ANS: 3 After the x-ray confirmation, the next best method involves testing the pH of the feeding tube aspirate and observing the appearance of the aspirate. A properly obtained pH of 0 to 4 is a good indication of gastric placement. Placing the end of the tube in water and observing for bubbling is not an accurate method of checking for tube placement. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inadvertently placed in the lungs, pharynx, or esophagus can transmit a sound similar to that of air entering the stomach.

Asking the client to speak as a method of checking for tube placement has a high degree of inaccuracy. There have been cases reported in which clients have been able to speak despite placement of feeding tubes in the lung. 22. For the client who is receiving parenteral nutrition via a central venous catheter, the nurse recognizes that a priority is to: 1 2 3 4

Use sterile technique during the administration of the feedings Maintain the initial infusion rate at no more than 40 to 60 mL/ hr Complete the administration of the feeding within 12 hours Have radiographic confirmation of the placement of the catheter

ANS: 4 After catheter placement, the catheter is flushed with saline or heparin until the position is radiographically confirmed. Aseptic technique, not sterile technique, is used during the administration of feedings. An initial rate of 40 to 60 mL/hr is recommended, and the rate is gradually increased. The rate of administration is not the priority. The nurse must first confirm correct placement of the catheter. A single container of PN should hang no longer than 24 hours; lipids no more than 12 hours. The nurse must first confirm correct placement of the catheter before any infusion is begun. 23. A client has been receiving tube feedings and is tolerating them very well. The health care provider determines that the rate of the intermittent tube feedings may be advanced. The nurse prepares to: 1 2 3 4

Increase the feedings by 50 mL/day Start an isotonic formula at half strength Infuse a bolus feeding over 5 to 10 minutes Begin feedings with 250 to 500 mL at each interval

ANS: 1 When a client is tolerating tube feedings well, the nurse should expect the health care provider to order the feedings to be increased by 50 mL/day to achieve needed volume and calories in six to eight feedings. Formula is started at full strength for isotonic formulas. Intermittent feedings are allowed to infuse over at least 20 to 30 minutes. Feedings should be begun with no more than 150 to 250 mL at one time. 24. The nurse is aware that there are medications that are taken that alter the clients taste and may influence the dietary intake. In reviewing the medications taken by the clients on the unit, the nurse will consult with the nutritionist to develop a palatable meal plan for the client taking: 1 2 3 4

Ampicillin Morphine Furosemide Acetaminophen

ANS: 1 Ampicillin may cause an alteration in taste. Opiates, such as morphine, cause decreased peristalsis and may result in constipation. Decreased drug absorption may occur when diuretics, such as furosemide, are administered with food. Decreased acetaminophen absorption may occur if administered with food. Overdose of acetaminophen is associated with liver failure. Morphine, furosemide, and acetaminophen do not affect the clients sense of taste. 25. Food safety is a concern of a group of adults attending the community health clinic. The participants identify to the nurse that they have seen a lot of reports on television about Escherichia coli and how dangerous it can be. When asked where the bacteria comes from, the nurse responds that a potential source of E. coli is: 1 2 3 4

Sausage Soft cheeses Milk products Ground beef

ANS: 4 E. coli may be contracted from undercooked meat, such as ground beef. Sausage is a potential source of botulism. Soft cheeses are a potential source of listeriosis, and milk products are a potential source of shigellosis. 26. A nurse is discussing high-nutrient-density food selections with a client recovering from extensive partial-thickness burns. Which of the following statements by the client reflects the best understanding of this dietary concept? 1 2 3 4

Ill snack on things like sugar-free pudding and Jello. Fried chicken and pot...