TEST BANK for Nutrition Science And Applications 4th Edition by Smolin, Grosvenor

NUTRITION SCIENCE AND APPLICATIONS 4TH EDITION SMOLIN TEST BANK Chapter 1.Nutrition: Food for Health MULTIPLE CHOICE 1. Examples of informal education include a .

attending a workshop on coronary artery disease sponsored by the American Heart Association.

b .

watching a television show about diabetes.

c .

learning about food safety techniques in a high school economics course.

d .

joining a support group to help overcome an eating disorder.

ANS: B Watching a television show about diabetes is an example of informal education because it is an experience that occurs through a daily activity. Attending a workshop or joining a support group would be considered nonformal education; a high school course would be considered formal education.

DIF:Cognitive Level: ApplyingREFage 6 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 2. A college student exercises regularly and generally eats a healthy variety of foods, is taking a course in general nutrition, buys locally produced food whenever possible, is an active member of an on-campus faith-based organization, and keeps a journal to help process her emotions.

What else could be important for her to include in her life in order to develop her overall wellness? a .

Growing some of her own food

b .

Keeping a food record to help evaluate what she eats

c .

Eating meals with friends throughout the week

d .

Meeting with a registered dietitian to review her food choices

ANS: C Wellness enhances a persons level of health through development of each of the six dimensions

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of health: physical health, intellectual health, emotional health, social health, spiritual health, and environmental health. Exercise and eating a health variety of foods help develop physical health; taking a course in general nutrition helps develop intellectual health; buying locally produced food helps develop environmental health; being part of a faith-based organization helps develop spiritual health; and keeping a journal helps develop emotional health. The missing dimension in this example is development of social health; eating meals with friends throughout the week would add this dimension. Growing her own food would be another example of environmental health; keeping a food record would be another contributor to physical health; and meeting with a registered dietitian may contribute to physical, intellectual, and emotional health.

DIF:Cognitive Level: AnalyzingREFages 1-3 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. For a client who is missing meals because of poor planning or is too busy to eat, emotional health can be affected by , which can cause confusion or anxiety. a.

low blood sugar levels

b.

high blood sugar levels

c.

high blood pressure

d.

extremely low blood pressure

ANS: D Poor eating habits affect emotional health. Missing meals may cause blood sugar levels to decrease, which can cause anxiety or confusion or make it difficult to control emotions. Late night binges on snack food are likely to result in excessive energy intake but would have a less direct effect on emotional health. Eating small meals throughout the day is likely to maintain more constant blood sugar levels, which would actually have a positive effect on emotional health. Excessive caffeine consumption may contribute to anxiety, but 2 cups of caffeinated coffee is not considered excessive.

DIF:Cognitive Level: AnalyzingREFage 2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 4. The best example of the type of concern that is likely to be addressed by the U.S. Department of Health and Human Services when target goals for Healthy People 2030 are updated is a .

preference for vegetarian eating patterns among white women.

b .

low intake of fruits and vegetables by African American children.

c .

widespread use of bottled water in higher socioeconomic groups.

d .

common use of protein and vitamin supplements in athletes.

ANS: B Healthy People is used to set targets for health promotion to improve the health of all

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individuals. It addresses environmental and social issues that affect health outcomes. Low intake of fruits and vegetables by African American children is likely to have an adverse effect on their health and so may be addressed when target goals are set. Vegetarian eating patterns, use of bottled water, and use of protein and vitamin supplements do not necessarily have an adverse effect on nutritional health and so are less likely to be addressed.

DIF: Cognitive Level: Applying REF: Pages 4-6 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. An example of community support for health promotion is a .

teaching a young mother skills in safe food preparation.

b .

watching a television documentary about industry errors in food processing.

c .

labeling fresh poultry packages with information about proper food storage.

d .

being aware that Salmonella can be transmitted because of inadequate food preparation.

ANS: C Food labeling information is an example of community support because it is a regulatory measure that supports new health-promoting behaviors within a social context. Teaching, watching television and awareness may increase knowledge, but they do not alter the social context by regulation or environmental change.

DIF:Cognitive Level: ApplyingREFage 4 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 6. An example of a technique for health promotion is a .

exercising five times a week.

b .

local supermarkets expanding the availability of fresh fruits and vegetables.

c .

teaching a teenager how to choose healthier foods at fast-food restaurants.

d .

information about the relationship of dietary intake and diet-related disorders.

ANS: C Health promotion consists of strategies that are designed improve the health of individuals, families, groups, and communities, such as teaching a teenager how to choose healthier fast foods. Exercising regularly contributes to wellness, but it is not bringing about a change in health unless this is a change in behavior. Stocking a wider availability of fresh produce does not promote health, unless the supermarket uses specific strategies to encourage consumption.

Information about the relationship between nutrients and disease is simply information unless it

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is used to promote behavior change.

DIF:Cognitive Level: ApplyingREFage 4 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 7. For the efficient functioning and maintenance of the body, a person needs to consume sufficient amounts of a.

fiber.

b.

nutrients.

c.

minerals.

d.

supplements.

ANS: B The body needs sufficient amounts of all nutrients for efficient functioning and maintenance.

Both fiber and minerals are needed, but each represents only one type of nutrient. Supplements are not always necessary because sufficient nutrients can often be obtained from food.

DIF:Cognitive Level: UnderstandingREFages 8-10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. A nurse has just been assigned to a community health program for older adults. She should check the document Healthy People 2020 to become familiar with a.

nutrition priorities and goals for older American adults.

b.

dietary standards for Americans older than 50 years.

c.

dietary guidelines recommended for older adults.

d.

MyPlate recommendations for older adults.

ANS: A Healthy People 2020 focuses on targets and goals for improving the health of the nation. The nurse would check the Dietary Reference Intakes for information about dietary standards. The Dietary Guidelines for Americans and MyPlate are separate documents from Healthy People 2020 and focus on specific advice and guidelines for healthy eating.

DIF:Cognitive Level: ApplyingREFages 4-5 | Page 10 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. A healthy female middle-aged client asks what she can do to prevent the development of type 2 diabetes. Weight control and nutrition strategies discussed are considered a.

primary treatment.

b.

primary prevention.

c.

secondary prevention.

d.

tertiary prevention.

ANS: B Action to prevent the development of type 2 diabetes is considered primary prevention.

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Secondary prevention involves early detection to halt and minimize the effects of the disease, and tertiary prevention minimizes complications and helps restore health after the disorder has developed. Primary treatment is not a recognized term.

DIF: Cognitive Level: Applying REF: Pages 5-6 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 10. As a home health care nurse, you are visiting a 70-year-old client who has just returned home from the hospital after being treated for coronary artery disease. The medical nutrition therapy developed for him by the hospital dietitian is considered a.

palliative care.

b.

primary prevention.

c.

secondary prevention.

d.

tertiary prevention.

ANS: D This is an example of tertiary prevention, which entails minimizing complications and helping restore health after heart disease has developed. Primary prevention would occur before the disease developed, and secondary prevention would involve early detection to minimize the effects of the disease. Palliative care is intended only to minimize symptoms.

DIF: Cognitive Level: Applying REF: Pages 5-6 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 11. A nutrient that can be made by the body is called a.

essential.

b.

complete.

c.

incomplete.

d.

nonessential.

ANS: D Nonessential nutrients can be made by the body. Essential nutrients cannot be made by the body and must be consumed. The terms complete and incomplete refer to proteins. Complete proteins contain all the essential amino acids; incomplete proteins are lacking one or more essential amino acids.

DIF:Cognitive Level: RememberingREFages 8-9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. A client exercises regularly and wants to make sure he has sufficient energy for his workouts.

The type of nutrient that will be most helpful in providing the energy he needs is a.

carbohydrates.

b.

water.

c.

minerals.

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d. protein.

ANS: A Carbohydrates are the best source of fuel to provide energy for the body. Protein can also provide fuel for energy, but its primary purpose is important structural and functional roles.

Water and minerals are important for health but do not provide fuel for energy.

DIF: Cognitive Level: Applying REF: Pages 8-10 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 13. A 45-year-old man tells you that he drinks 3 oz of Scotch whiskey most evenings. His alcohol intake is considered a.

insignificant.

b.

moderate.

c.

higher than is recommended.

d.

dangerously high.

ANS: B Moderate alcohol intake is two servings or fewer per day for men. One serving of spirits, such as whiskey, is 1.5 ounces. Therefore, 3 oz of whiskey per day is considered moderate alcohol intake.

DIF:Cognitive Level: AnalyzingREFage 9 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 14. A dessert contains 4 g of protein, 30 g of carbohydrate, 15 g of fat, and 5 g of alcohol. The nutrient that provides the most kilocalories in the dessert is a.

protein.

b.

carbohydrate.

c.

fat.

d.

alcohol.

ANS: C Fat provides the highest number of kilocalories: At 9 kcal per gram, 15 g of fat provides 135 kcal. At 4 kcal per gram, 4 g of protein provides 16 kcals. At 4 kcal per gram, 30 g of carbohydrate provides 120 kcal. At 7 kcal per gram, 5 g of alcohol provides 35 kcal.

DIF:Cognitive Level: ApplyingREFage 9 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 15. A cup of frozen yogurt contains 24 g of carbohydrate, 2 g of fat, and 4 g of protein. The total number of kilocalories in the frozen yogurt is a.

110.

b.

130.

c.

140.

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d.

162.

ANS: B At 4 kcal per gram, 24 g of carbohydrate provides 96 kcal. At 9 kcal per gram, 2 g of fat provides 18 kcal. At 4 kcal per gram, 4 g of protein provides 16 kcal. Therefore, the total kilocalories in the frozen yogurt is 130 kcal (96 + 18 + 16).

DIF:Cognitive Level: ApplyingREFages 8-9 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 16. Combinations of amino acids link together to form a.

protein.

b.

carbohydrates.

c.

dietary fiber.

d.

lipids.

ANS: A Proteins are made up of various combinations of amino acids, linked together. Carbohydrates are made up of one or more units of simple sugars. Dietary fiber consists mostly of carbohydrate that cannot be digested. Lipids are made up of glycerol and triglycerides or sterols.

DIF:Cognitive Level: RememberingREFages 8-9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. A bodybuilder tells you that all of his meals and snacks include high-protein foods such as eggs, canned tuna, chicken, milk, and cheese. Most of the extra protein is probably used by his body to form a.

strong bones and joints.

b.

body fat stores.

c.

healthy brain tissue.

d.

increased muscle mass.

ANS: B Excess protein is broken down to amino acids and then used for energy or stored as body fat.

This mans body will use some of this protein to increase muscle mass, but increasing protein intake beyond the amount needed does not increase muscle formation. Excess protein intake does not improve bone, joint, or brain health.

DIF:Cognitive Level: ApplyingREFage 9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. When clients have a strong family history of both heart disease and cancer, the nurse should encourage them to reduce their intake of a.

dietary fiber.

b.

protein.

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c.

monounsaturated fat.

d. saturated fat.

ANS: D Saturated fat intake is related to risk of heart disease and certain types of cancer.

Monounsaturated fat intake has less effect on risk of these diseases. Dietary fiber intake should be increased to help reduce risk of cardiovascular disease and cancer. The effects of protein intake on risk of these diseases are much less significant.

DIF: Cognitive Level: Applying REF: Page 9 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 19. The National Health and Nutrition Examination Survey (NHANES) is able to assess the overall nutritional and health status of Americans because a .

the populations surveyed are representative of the total population.

b .

it focuses on ethnic and socioeconomic groups at greatest risk.

c .

it collects large volumes of survey data from all over the nation.

d .

survey methods and standards are consistent from year to year.

ANS: A Data from NHANES represent America overall because the survey populations are carefully selected to represent the total population. Their data therefore provide a better indication of the nations overall health than do large amounts of data from all over the country. It does not focus specifically on populations at high risk for disease. Standardization over time provides useful data on trends and changes but does not reveal the overall health of the nation.

DIF:Cognitive Level: ApplyingREFages 4-5 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 20. In working with a ethnic minority population, a helpful way to increase health literacy could be to a .

invite members of the community to help identify needs and teaching strategies.

b .

encourage acculturation and adoption of healthful American eating patterns.

c .

set up a feeding program to provide healthy food for members of the community.

d .

use visual aids rather than written materials during health education encounters.

ANS: A

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Members of an ethnic minority population can be very helpful in identifying needs and effective teaching strategies for people in their community and in encouraging people in the community to accept advice from nurses or other health professionals. They do not necessarily need to adopt American eating patterns; often these are less healthful than their traditional eating patterns.

Setting up feeding programs does not promote positive self-efficacy. Visual aids may be helpful, but their use is not necessarily the best educational strategy.

DIF: Cognitive Level: Applying REF: Pages 6-7 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 21. A client has heard that nutrients can be converted to other nutrients in the body. He takes high-dose vitamin C supplements because he believes this will supply his bodys need for other vitamins. What would you tell him? a .

He should switch to a multivitamin supplement instead of just vitamin C.

b .

Each vitamin has a specific function and needs to be supplied through a variety of foods.

c .

Vitamin C can provide only water-soluble vitamins, and he still needs to consume fat-soluble vitamins.

d .

Vitamin C supplements should be taken only when he has symptoms of a cold or influenza.

ANS: B Vitamins cannot be converted into other vitamins; each has a specific function, and the best way to consume adequate amounts of each vitamin is to eat a variety of foods. Vitamin C is water soluble, but it cannot be converted to other water-soluble vitamins. Vitamin C is needed by the body at all times, not just when someone is ill. A multivitamin supplement would provide a better range of vitamins than just vitamin C, but it is still better to consume vitamins from food, rather than from supplements.

DIF:Cognitive Level: ApplyingREFages 9-10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. For a mother with two children who works in health care management 60 to 70 hours a week, the biggest barrier to healthy eating is likely to be a.

lack of concern for her own or her childrens health.

b.

inadequate income to purchase healthy foods.

c.

insufficient time to plan and prepare healthful meals.

d.

lack of knowledge about healthy eating.

ANS: C For busy professionals and families, the biggest barrier to healthy eating is usually hectic schedules and lack of time to plan and prepare healthy meals. Most mothers, especially those who work in a health care field, are concerned about their familys health. Many professional women have at least some understanding of healthy eating. With a professional job, lack of

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income is not very likely to be a barrier to healthy eating.

Chapter 2. Nutrition Guidelines: Applying the Science of Nutrition MULTIPLE CHOICE 1. A client tells you that he cannot eat most green vegetables because they taste too bitter. What is the most likely explanation? a .

He has certain genetic taste markers that make him a super taster.

b .

He associates eating green vegetables with unpleasant childhood memories.

c .

He needs to train himself to enjoy the acquired taste of bitter vegetables.

d .

He is making an excuse to avoid making healthful changes in his eating habits.

ANS: A Some people have variations in genetic taste markers that make them super tasters. These people often experience the taste of certain vegetables as being bitter. Environmental factors such as childhood memories may also influence food choices but are not usually associated with tasting vegetables as bitter. Tastes can be acquired and sometimes people make excuses to avoid making changes, but these are less likely explanations for this particular problem DIF:Cognitive Level: ApplyingREFage 18 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 2. A teenaged client is hungry and goes to the refrigerator for a snack. A holiday has just been celebrated at her home, and many of her favorite foods are available. She selects some slices of roast turkey and a cup of her aunts special fruit salad. This is an example of a.

bingeing.

b.

abundance.

c.

food choice.

d.

food preference.

ANS: D This teenager is able to select foods according to her preferences. Food choices are restricted by convenience, but many of her favorite foods are available, and so her choices are not limited.

The food is abundant, and she may choose to binge and overeat, but her selections are made according to her food preference.

DIF:Cognitive Level: AnalyzingREFage 18 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 3. A mother tells you that she does not allow her young children to eat while they watch television, even though her husband often eats high-fat, sugary foods while they watch television as a family. The most important thing to discuss with her is the

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a .

genetic factor of preference for sweet and salty tastes.

b .

influence of ethnicity on preference for sour tastes.

c .

childrens weights when they were born and their weights now.

d environmental effects of parental food choices and television watching. .

ANS: D Because young children spend so much time with their families, their parents food choices have a major effect on their own future food choices. Preventing young children from eating while watching television will have only a short-term effect, and they are likely to imitate their father in eating high-fat, high-sugar snacks. The fathers food preferences are probably influenced by genetics and ethnicity, and it may be interesting to find out whether the childrens current weights are healthy for their heights (although their birth weight is probably not relevant), but this information has less immediate effect on the nutritional health of this family.

DIF:Cognitive Level: ApplyingREFage 18 | Page 35 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial integrity 4. If a middle-aged couple with two teenage children has insufficient income to purchase food, the most helpful program for them would be the a .

MyPlate food guidance system.

b .

National School Lunch and School Breakfast Programs.

c .

federal governments Supplemental Nutrition Assistance Program (SNAP).

d .

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

ANS: C SNAP provides financial assistance to buy nutritious foods for individuals and families with incomes below certain levels. WIC provides assistance only to women who are pregnant or breastfeeding and to infants and children up to the age of 5 who are at nutritional risk. School meal programs would benefit the children but not the adults. MyPlate would help the family make healthy food choices but would not help with their financial problems.

DIF:Cognitive Level: ApplyingREFages 18-19 | Page 21 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. For most Americans, the most significant nutrition concerns are

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a .

lack of interest in making healthy food choices.

b .

poor availability of fruits and vegetables in many areas.

c .

excessive intake of saturated fats, cholesterol, sodium, and sugars.

d inadequate intake of key vitamins, minerals, and phytochemicals. .

ANS: C Most Americans have high intake of saturated fats, cholesterol, sodium, and sugars, which is associated with increased prevalence of chronic disease. Many people have inadequate intake of micronutrients, but this has a lesser overall effect than excessive intakes of fats, sodium, and sugars. Some areas of the country have poor availability of fruits and vegetables, but this is not a widespread problem in the country as a whole. Many Americans express at least some concern about making healthy food choices.

DIF:Cognitive Level: UnderstandingREFages 18-20 | Page 30 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 6. Excessive intake of high-sodium, high-fat foods can lead to diet-related illnesses such as a.

genetic disorders, hypertension, and diabetes.

b.

hypertension and sickle cell anemia.

c.

viral infections that necessitate antibiotics.

d.

coronary artery disease and hypertension.

ANS: D Coronary artery disease and hypertension are more common in individuals who consume highsodium, high-fat diets. The risk for genetic disorders, sickle cell anemia, and viral infections is not affected by dietary fat and sodium intake.

DIF:Cognitive Level: ApplyingREFage 19 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. Of the following, the most important overall dietary modification to help reduce the risk of chronic disease is a.

eating fewer foods that contain preservatives.

b.

buying mostly locally grown foods.

c.

eating more plant-based foods.

d.

eating more animal-based foods.

ANS: C Scientific evidence from the nutrition literature shows that shifting to a more plant-based diet is one of four significant modifications to dietary intake patterns that will improve the overall

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health of Americans. Preservatives per se have not been associated with health status (although foods that contain preservatives may be more highly processed and may have higher levels of fat, sugar, and sodium and lower levels of nutrients than do foods without preservatives). Buying locally grown foods may be a good agricultural and economic practice, but it does not affect health status. Eating more animal-based foods would be the opposite of what is recommended.

DIF: Cognitive Level: Applying REF: Page 20 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 8. One way to help clients follow the Dietary Guidelines for Americans is to encourage them to use a.

Healthy People 2020.

b.

the MyPlate food guidance system.

c.

the Supplemental Nutrition Assistance Program (SNAP).

d.

the Exchange Lists for Meal Planning.

ANS: B MyPlate is designed to help clients implement the recommendations of the Dietary Guidelines for Americans. Healthy People 2020 sets national targets for health promotion. SNAP provides funds for individuals and families with low incomes to buy nutritious foods. The Exchange Lists for Meal Planning is intended primarily for patients with diabetes and those who need to lose weight; the system helps patients choose appropriate portion sizes to control their intake of fat, protein, carbohydrate, and energy.

DIF: Cognitive Level: Understanding REF: Pages 18-23 | Pages 27-28 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. For a client who follows a vegan diet, the most helpful meal planning tool would be a .

the Healthy Eating Plate, produced by the Harvard School of Public Health.

b .

the Mediterranean Diet Pyramid, from Oldways Preservation and Exchange Trust.

c .

the Power Plate, created by the Physicians Committee for Responsible Medicine.

d .

Exchange Lists for Meal Planning, from the American Diabetes Association and the American Dietetic Association

ANS: C The Power Plate is a vegan food planning guide that eliminates all sources of animal foods. The Healthy Eating Plate and Mediterranean Diet Pyramid could be adapted for a vegan diet, but they include meat and dairy options. The Exchange Lists for Meal Planning is intended to help design eating patterns for clients who need to monitor their intake of energy and specific macronutrients, such as clients with diabetes.

DIF: Cognitive Level: Applying REF: Pages 22-25 | Pages 27-28 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

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10. An indirect benefit of the Fruits & VeggiesMore Matters program is a .

better understanding of fruit and vegetable preparation techniques.

b .

increased availability of fruits and vegetables in food deserts.

c .

eating more fresh produce in season.

d .

decreasing dietary fat intake.

ANS: D Fruits & VeggiesMore Matters is designed to increase intake of fruits and vegetables. Fruits and vegetables are naturally low in fat; they would replace higher fat foods in the diet and thus would indirectly decrease dietary fat intake. The program does not address fruit and vegetable preparation techniques, does not target availability of produce in food desert areas, and does not address eating fruits and vegetables in season versus out of season.

DIF: Cognitive Level: Applying REF: Page 23 | Page 26 | Page 30 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 11. A meal planning guide that would be helpful for a patient who needs to closely monitor their intake of calories, carbohydrates, protein, and fat is the a.

National Fruit and Vegetable Program.

b.

MyPlate food guidance system.

c.

Dietary Guidelines for Americans.

d.

Exchange Lists for Meal Planning.

ANS: D In the Exchange Lists for Meal Planning, foods are grouped according to their kilocalorie, carbohydrate, protein, and fat content, and serving sizes that contain specific amounts of each of these are listed. Therefore, this guide can help clients monitor their intake. The National Fruit and Vegetable Program simply encourages increased intake of fruits and vegetables. The Dietary Guidelines for Americans gives general advice but does not translate this into specific amounts of foods. MyPlate would help patients achieve healthy intake of kilocalories, carbohydrate, protein, and fat, but it would not be specific enough for them to monitor their intake closely.

DIF: Cognitive Level: Applying REF: Pages 19-23 | Pages 26-28 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 12. One reason that increasing fruit and vegetable consumption helps decrease dietary fat intake is that fruits and vegetables a.

are natural appetite suppressants.

b.

replace high-fat foods in the diet.

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c.

are rich in antioxidants and phytochemicals.

d. decrease absorption of fat from foods.

ANS: B Fruits and vegetables replace high-fat foods in the diet because they are high in fiber and water; they cause satiety so that clients have less desire for high-fat foods. Fruits and vegetables are not, and do not contain, natural appetite suppressants and do not hinder absorption of fat from foods.

They are rich in antioxidants and phytochemicals, but increased intake of these substances does not affect fat intake.

DIF:Cognitive Level: UnderstandingREFage 23 | Pages 26-27 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. Why are health professionals concerned about the trend toward eating more food away from home? a .

Larger portion sizes often contribute to excessive caloric intake.

b .

Eating away from home means less social interaction.

c .

Eating out tends to decrease the variety of foods eaten.

d .

Restaurant meals are associated with more sedentary lifestyles.

ANS: A Restaurants and fast food outlets often serve large portions that increase caloric intake. Eating away from home does not necessarily decrease social interaction, inasmuch as families or friends may eat away from home in groups. Eating out does not necessarily decrease the variety of foods eaten, depending on individual food choices. Eating out has not been related to physical activity levels.

DIF:Cognitive Level: UnderstandingREFage 21 | Page 29 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 14. If clients want to use the food label to check the number of kilocalories in a product, they should also check the a.

calories from fat.

b.

servings per container.

c.

Percent Daily Value.

d.

ingredient list.

ANS: B The number of calories in a product is stated for a standard serving size of that food. Clients need to multiply the calories per serving by the number of servings in the container to know how many calories are in the container. The calories from fat are not related to the total number of

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calories in the food. The Percent Daily Value refers to the nutrient content of the food rather than its caloric value. The ingredient list does not give any information about calories.

DIF:Cognitive Level: AnalyzingREFage 32 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 15. The most useful part of the food label for clients who want to make sure they choose foods high in nutrients is the a.

Percent Daily Value.

b.

health claims.

c.

organic seal.

d.

amount of nutrients per serving.

ANS: A The Percent Daily Value shows how a food fits into the overall daily diet and would therefore show whether it makes a high or low contribution to nutrient intake. Health claims may indicate that a food has high or low amounts of specific nutrient related to that particular health claim, but they would not indicate overall nutrient content of the food. The organic seal, if present, indicates the farming methods used to grow the food but does not give any information about nutrient content. The amount of nutrients per serving is listed for only some nutrients; the listing would not give any information about vitamins and minerals in the food because these are listed only as Percent Daily Values.

Chapter 3. Digestion, Absorption, and Metabolism MULTIPLE CHOICE 1. Peristalsis is necessary to make it possible for people to a.

chew

b.

digest

c.

swallow

d.

smell and taste

food.

ANS: C Peristalsis makes swallowing possible as involuntary movements of circular and longitudinal muscles move food along the esophagus from the mouth to the stomach. Chewing is accomplished by jaw muscles and is not related to peristalsis. Peristalsis helps move food along the gastrointestinal tract to the places where digestion of each nutrient takes place, but it does not make digestion itself possible. Smell and taste are not related to peristalsis.

DIF:Cognitive Level: ApplyingREFage 42 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. Examples of mechanical digestion include

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a .

activity of salivary amylase in the mouth.

b .

churning and mixing of food in the stomach.

c .

action of bile breaking fats into smaller droplets.

d effects of secretin in stimulating the pancreas to release bicarbonate. .

ANS: B Churning and mixing of food in the stomach is an example of mechanical digestion because it causes physical breakdown of the food. Salivary amylase is an enzyme that causes chemical breakdown of food; bile causes emulsification of fats. Secretin is a hormone that stimulates release of bicarbonate from the pancreas; this buffers stomach acid so that intestinal enzymes can work.

DIF:Cognitive Level: UnderstandingREFages 42-43 | Page 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. An example of a problem caused by a sphincter muscle not operating properly is a.

constipation.

b.

gallbladder disease.

c.

heartburn.

d.

peptic ulcer.

ANS: C Heartburn is caused by reflux of acidic stomach contents into the esophagus when the sphincter muscle between these two parts of the digestive tract does not operate properly. Constipation is usually caused by slow peristalsis, often in relation to inadequate intake of dietary fiber and fluid. Gallbladder disease is unrelated to gastrointestinal sphincters. Peptic ulcer is usually caused by Helicobacter pylori infection.

DIF: Cognitive Level: Applying REF: Pages 42-43 | Page 46 | Pages 49-50 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. The best description of an enzyme is a(n) a.

chemical messenger.

b.

acid and alkali buffer.

c.

emulsifier.

d.

organic catalyst.

ANS: D Enzymes are organic catalysts that work on specific classes of nutrients to change them from one form to a simpler form. The description chemical messenger applies to hormones. The emulsifier

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in the intestines is bile. The pancreas secretes alkaline bicarbonate to buffer stomach acid so that intestinal enzymes can work properly.

DIF:Cognitive Level: RememberingREFage 40 | Pages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Chemicals that act as messengers are called a.

proteins.

b.

hormones.

c.

enzymes.

d.

nerve impulses.

ANS: B Hormones act as messengers between organs to cause release of needed secretions. Some, but not all, hormones are proteins. Enzymes work locally on specific classes of nutrients to change them from one form to a simpler form. Nerve impulses send messages in the body but via electrical impulses rather than via chemicals.

DIF:Cognitive Level: RememberingREFages 43-44 | Page 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. The action of salivary amylase in the mouth is an example of a.

chemical digestion.

b.

chewing.

c.

mechanical digestion.

d.

peristalsis and segmentation.

ANS: A Salivary amylase is an enzyme that chemically digests starch in the mouth. It does not contribute to mechanical digestion. Chewing is an example of mechanical digestion. Peristalsis and segmentation help propel food along the gastrointestinal tract and mix food with intestinal secretions.

DIF: Cognitive Level: Understanding REF: Page 40 | Page 42 | Page 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. Most mechanical breakdown of food occurs in the a.

large intestine.

b.

liver and pancreas.

c.

mouth and stomach.

d.

esophagus and mouth.

ANS: C Mechanical breakdown of food occurs in the mouth during chewing and in the stomach as the food is mixed by muscular action. By the time food reaches the large intestine, it is already

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broken down, and most of the nutrients have been absorbed. The liver and pancreas produce secretions that help with chemical but not mechanical breakdown of food. Food passes through the esophagus largely unchanged, and so the esophagus is not involved in breakdown.

DIF:Cognitive Level: UnderstandingREFage 40 | Pages 42-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. The body process over which people have most conscious control is a.

ingestion.

b.

digestion.

c.

metabolism.

d.

excretion.

ANS: A People can choose the foods and fluids they ingest. Digestion, metabolism, and excretion are largely automatic processes. A persons actions may affect those processes indirectly (e.g., exercise affects metabolism, stress may affect digestion), but people have less control over them than over ingestion.

DIF: Cognitive Level: Applying REF: Page 48 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 9. When someone walks by a bakery and smells the fresh bread, his or her mouth starts to water.

As the person thinks about eating the fresh bread, another digestive function that starts to occur is a.

peristalsis in the small intestine.

b.

stimulation of pancreatic secretions.

c.

increased blood flow to the gut and liver.

d.

release of the hormone gastrin in the stomach.

ANS: D Release of the hormone gastrin from the stomach may be caused by the cephalic phase of gastric secretions when someone thinks about eating food. Thinking about food does not stimulate peristalsis, pancreatic secretions, or blood flow to the gut and liver.

DIF:Cognitive Level: ApplyingREFage 43 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. The most important functions of the small intestine are a.

digestion and denaturation.

b.

segmentation and excretion.

c.

digestion and absorption.

d.

peristalsis and mechanical digestion.

ANS: C

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Most digestion and absorption occurs in the small intestine. Denaturation is not part of the digestive process. Segmentation occurs in the small intestine, but excretion does not. Peristalsis occurs throughout the digestive tract, and mechanical digestion occurs in the mouth and stomach.

DIF:Cognitive Level: ApplyingREFages 43-45 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. The most important function of the villi of the small intestine is to a.

increase the secretion of enzymes for digestion.

b.

increase the surface area for absorption of nutrients.

c.

excrete waste into the intestines.

d.

secrete hormones in response to nutrients in the gut.

ANS: B Villi increase the surface area of the small intestine, which makes it possible for it to absorb more nutrients. Digestion occurs in the small intestine but is not a function of the villi. Excretion does not occur in the small intestine. The villi do not secrete hormones.

DIF:Cognitive Level: RememberingREFage 43 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. The layer of the gastrointestinal tract that contributes most to mechanical digestion of food is the a.

mucosa.

b.

submucosa.

c.

muscularis.

d.

serosa.

ANS: C The muscularis is a layer of muscle tissue that causes churning, peristalsis, and segmentation of food, which contribute to mechanical digestion. The mucosa is the inside layer that releases enzymes and digestive juices. The submucosa is a layer of connective tissue that contains blood vessels and nerves that regulate digestion. The serosa is the outermost layer of the gastrointestinal wall and connects to the peritoneum lining.

DIF:Cognitive Level: UnderstandingREFage 42 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 13. If pancreatic secretions were absent, a .

there would be no bicarbonate to buffer the acid in chyme entering the duodenum.

b .

mechanical digestion in the stomach would be inhibited.

c .

the hormone secretin would not be secreted by the small intestine.

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d the gallbladder would not contract to release bile into the small intestine. .

ANS: A Pancreatic secretions contain bicarbonate, which is important in buffering the acidity of chyme from the stomach. Pancreatic secretions enter the small intestine, below the stomach, and so have no effect on the stomachs mechanical digestion. The hormone secretin causes release of pancreatic secretions; pancreatic secretions do not affect its release. Bile release is initiated by the hormone cholecystokinin (CCK), not by pancreatic secretions.

DIF:Cognitive Level: ApplyingREFages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. Release of digestive secretions into the small intestine is caused by that are released when . a.

enzymes; food enters the stomach

b.

enzymes; food enters the small intestine

c.

hormones; food enters the stomach

d.

hormones; enters the small intestine

ANS: D Hormones that are released when chyme enters the small intestine cause the release of digestive secretions into the small intestine. The causative agents are hormones, not enzymes. The digestive secretions contain enzymes; enzymes do not trigger their release. If hormones were released when food entered the stomach, digestive secretions would be released into the small intestine too early and could cause damage.

DIF:Cognitive Level: UnderstandingREFages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. If the large intestine did not carry out its main function, feces would be a.

alkaline.

b.

acidic.

c.

liquid.

d.

very dry.

ANS: C A major function of the large intestine is absorption of water, and so if the large intestine were dysfunctional, feces would be liquid. Feces would not be dry if the large intestine did not remove water. The large intestine does not have a significant effect on the acidity or alkalinity of feces.

DIF:Cognitive Level: ApplyingREFage 44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. If the speed of peristalsis were to increase, the result would be a.

heartburn.

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b.

vomiting.

c.

diarrhea.

d. constipation.

ANS: C If peristalsis were to speed up, food would move quickly through the gastrointestinal tract, and time for absorption of nutrients and water would be insufficient, which would result in diarrhea.

Constipation can be related to decreased peristalsis. Heartburn is caused by reflux of stomach contents in the esophagus and is not related to peristalsis. Vomiting is caused by a reverse in the direction of peristalsis.

DIF:Cognitive Level: ApplyingREFages 42-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. The part of the digestive system that is easiest to live without is the a.

taste buds.

b.

gallbladder.

c.

large intestine.

d.

appendix.

ANS: D The least vital part of the intestine is the appendix; it does not have any known function in humans. The taste buds are important for the enjoyment of food and to stimulate food intake. The gall bladder is not essential, but it allows for storage of bile to be released as needed for optimal digestion. The large intestine is important for absorption of water and a few other nutrients; it is possible to live without it, but intake must be adapted to compensate for unabsorbed fluid, electrolytes, and other substances.

DIF:Cognitive Level: ApplyingREFage 40 | Pages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. What is the main difference between passive diffusion and active transport? a .

In active transport, the villi membrane surrounds the substance.

b .

Active transport requires energy; passive diffusion does not.

c .

Passive diffusion is involuntary; active transport is voluntary.

d .

Active transport requires enzymes; passive diffusion does not.

ANS: B Active transport requires energy to absorb nutrients against a concentration gradient; passive diffusion does not require energy because nutrients travel with the concentration gradient. The absorptive process by which the villi membrane surrounds the substance is pinocytosis. Neither

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passive diffusion nor active transport is under voluntary control, and neither process involves enzymes.

DIF:Cognitive Level: ApplyingREFage 45 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. Nutrients are considered to have become part of the body only once they have a.

been placed inside the mouth.

b.

been swallowed.

c.

passed through the microvilli cells.

d.

been stored throughout the body.

ANS: C Nutrients are considered to be truly inside the body once they have been absorbed from the intestines through the microvilli cells. When food is in the mouth or swallowed, it is still outside the body in that the nutrients are not available for metabolism and storage. Stored nutrients are inside the body, but that is not the point at which they are first considered to be inside.

DIF:Cognitive Level: RememberingREFage 45 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. People tend to feel full for longer after eating a high-fat meal rather than a low-fat meal because a .

ingestion of fat causes release of hormones that signal a feeling of fullness to the brain.

b .

food stays in the stomach for longer to allow emulsification by bile and digestion by gastric enzymes.

c .

fat in the duodenum causes release of gastric inhibitory polypeptide, which decreases peristalsis of the stomach.

d .

metabolism of the products of fat metabolism by the liver takes longer than metabolism of other nutrients.

ANS: C As fat inters the duodenum after a high-fat meal, it causes release of gastric inhibitory polypeptide, which decreases peristalsis in the stomach. Food stays in the stomach longer, and so the person feels full longer. People feel full after a high-fat meal is because the stomach is full for longer, not because the brain is told by hormone messengers that it is full. Emulsification of fat by bile and digestion of fat by enzymes occurs in the small intestine, not in the stomach.

Metabolism of nutrients is not related to a feeling of fullness.

DIF:Cognitive Level: ApplyingREFage 43 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. The bloodstream carries nutrients to the liver soon after absorption because the liver

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a .

produces hormones that regulate blood glucose level.

b .

is an important site of metabolism and production of vital substances.

c .

is able to determine which substances should be stored and eliminated.

d has functions similar to those of the stomach in relation to the digestive process. .

ANS: B After absorption, the bloodstream carries nutrients to the liver because it has so many important metabolic functions in the body, and so its nutrient needs take priority. Hormones that regulate blood glucose level are produced by the islets of Langerhans in the pancreas. The liver stores some substances and eliminates others, but this is not the primary reason that blood travels there directly from the intestines. The functions of the liver are very different from those of the stomach.

DIF:Cognitive Level: RememberingREFage 46 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. An example of catabolism is the a.

building of new muscle tissue during growth.

b.

breakdown of glucose to provide energy.

c.

synthesis of protein from amino acids.

d.

use of enzymes to digest protein and release amino acids.

ANS: B Catabolism is the breakdown of absorbed and stored nutrients into small particles, which causes the release of energy as heat and chemical energy. An example of this is the breakdown of glucose to provide energy. Building new muscle tissue during growth and synthesis of protein from amino acids are examples of anabolism. Use of enzymes to digest protein is a function of digestion, not related to anabolism and catabolism, which are metabolic functions.

DIF:Cognitive Level: UnderstandingREFage 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 23. Healing of a broken bone is an example of a.

anabolism.

b.

catabolism.

c.

absorption.

d.

metabolism.

ANS: A Healing of a broken bone is an anabolic process because it involves use of nutrients and

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substrates to form new body tissue. Catabolism is the breakdown of body tissues to release energy or release nutrients for other body processes. Metabolism comprises both anabolism and catabolism. Absorption is the process by which nutrients are taken into the body from the gut.

DIF:Cognitive Level: ApplyingREFage 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. A busy and stressed person who eats very few fruits and vegetables and does not take time to exercise is likely to experience a.

vomiting.

b.

diarrhea.

c.

constipation.

d.

lactose intolerance.

ANS: C Busy lifestyles, stress that causes muscle tension, lack of exercise to maintain tone in gastrointestinal muscles, and lack of dietary fiber (from fruits, vegetables, and whole grains) are likely to result in constipation. Diarrhea may be caused by stress, not by lack of fruits and vegetables or lack of exercise. Vomiting is caused by motion sickness or by ingestion of a virus or toxin. Lactose intolerance is caused by an inability to digest lactose, the sugar in milk.

DIF: Cognitive Level: Applying REF: Page 39 | Page 46 | Pages 48-49 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. Dehydration may occur after a.

vomiting and diarrhea.

b.

constipation and heartburn.

c.

esophagitis and anemia.

d.

gastroesophageal reflux and hiatal hernia.

ANS: A Both vomiting and diarrhea cause abnormal loss of fluid, which can lead to dehydration.

Constipation, heartburn, esophagitis, anemia, gastroesophageal reflux, and hiatal hernia do not affect hydration status.

DIF:Cognitive Level: ApplyingREFage 44 | Page 48 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 26. A person who complains of problems with gas, bloating, and diarrhea if he or she eats breakfast cereal with milk, but not if he or she eats pancakes or waffles, may have a.

milk allergy.

b.

gluten intolerance.

c.

irritable bowel syndrome.

d.

lactose intolerance.

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ANS: D These symptoms are likely to be caused by lactose intolerance. Patients with lactose intolerance cannot digest lactose, the sugar in milk, and so it ferments in the intestines, causing gas, bloating, and diarrhea. Milk allergy may also cause diarrhea, but it would probably also cause skin rash, asthma, or both. Gluten intolerance would not be affected by milk intake. Symptoms of irritable bowel syndrome would probably not be related to eating foods with milk.

Chapter 4. Carbohydrates: Sugars, Starches, and Fiber MULTIPLE CHOICE 1. The primary function of carbohydrates in the body is to provide a.

sweetness.

b.

satiety.

c.

energy.

d.

dietary fiber.

ANS: C The most important function of carbohydrates in the body is to provide energy. Unrefined sources of carbohydrate do provide dietary fiber, but refined carbohydrates do not. Similarly, unrefined carbohydrates may add to satiety, but refined carbohydrates contribute less to satiety than do protein and fat. Simple carbohydrates provide sweetness; this is pleasant but not essential to the body.

DIF: Cognitive Level: Remembering REF: Page 51 | Page 54 | Pages 58-59 | Pages 64-66 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 2. Fructose, galactose, and glucose are examples of a.

disaccharides.

b.

polysaccharides.

c.

monosaccharides.

d.

complex carbohydrates.

ANS: C Fructose, galactose, and glucose each consist of a single unit of carbohydrate and are therefore monosaccharides. Disaccharides consist of two carbohydrate units; polysaccharides and complex carbohydrates consist of several carbohydrate units.

DIF:Cognitive Level: RememberingREFages 53-54 | Page 58 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. The sweetness in a banana comes mostly from a.

fructose and sucrose.

b.

fructose and glucose.

c.

glucose and maltose.

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d. maltose and sucrose.

ANS: A The most common sugars found naturally in fruits such as a banana are fructose and sucrose. It may also contain some glucose, but this contributes less to the sweetness. Fructose is the sweetest of the sugars, and so it contributes most to the sweetness. Maltose is found only in germinating grains or as a product of partial starch digestion in the gut.

DIF: Cognitive Level: Applying REF: Pages 53-54 | Pages 58-59 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 4. A blood glucose level of 60 mg/dL is considered to be a.

inconclusive.

b.

representative of hypoglycemia.

c.

representative of normoglycemia.

d.

representative of hyperglycemia.

ANS: B The normal range for blood glucose level is 70 to 100 mg/dL. Therefore, 60 mg/dL is considered to represent hypoglycemia.

DIF:Cognitive Level: ApplyingREFage 57 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. In comparison with table sugar (sucrose), honey tastes because it contains . a.

sweeter; fructose

b.

sweeter; maltose

c.

less sweet; fructose

d.

less sweet; maltose

ANS: A Honey is sweeter than table sugar because it contains fructose, the sweetest of all the sugars.

Maltose is less sweet than table sugar and is not found in honey; it is found only in germinating grains and as a product of partial starch digestion.

DIF:Cognitive Level: ApplyingREFages 54-56 | Page 58 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 6. Someone who follows a strict vegetarian (vegan) diet and eats very few refined foods is likely to have intake of carbohydrates and dietary fiber. a.

low; complex

b.

high; complex

c.

low; simple

d.

high; simple

ANS: B

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Strict vegetarian diets contain only plant foods that have high levels of carbohydrates. Refined foods contain more simple sugars and some starch. Unrefined foods contain mostly complex carbohydrates and fiber. Therefore, someone who follows a strict vegetarian diet and eats very few refined foods is likely to have a high intake of complex carbohydrates and dietary fiber.

DIF: Cognitive Level: Applying REF: Pages 52-53 | Page 62 | Pages 64-65 | Page 68 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. A person would be most likely to produce excessive ketones if his or her food intake that day consisted only of a.

green salad with oil and vinegar dressing.

b.

refried pinto beans and rice.

c.

cheeseburgers and French fries.

d.

fried eggs with bacon and hash brown potatoes.

ANS: A Ketones are produced when insufficient carbohydrate is available and the body has to metabolize fat for energy. A green salad with oil and vinegar dressing provides energy from fat but minimal amounts of carbohydrate. In the other meals, carbohydrate is provided by beans, rice, the bun for the burger, and the potatoes used to make the fries and hash browns.

DIF: Cognitive Level: Applying REF: Page 54 | Page 57 | Page 63 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. Since the 1970s, consumption of refined white sugar has decreased, mostly because a.

health-conscious consumers are using less of it.

b.

use of high-fructose corn syrup has increased.

c.

use of artificial sweeteners has increased.

d.

use of honey and other natural sweeteners has increased.

ANS: B Use of refined white sugar has decreased because use of high-fructose corn syrup has increased.

High-fructose corn syrup is used because it is cheaper to produce and sweeter than white table sugar. Unfortunately, consumers are not using less sugar; in fact, they are consuming more sugar overall. Use of artificial sweeteners, honey, and other natural sweeteners has increased, but this is not the main contributor to decreased refined white sugar consumption.

DIF: Cognitive Level: Remembering REF: Page 59 TOP: Nursing Process: Evaluation MSC: Client Needs: Health promotion and maintenance 9. The person who is most likely to develop dental caries is one who a.

eats dessert after each meal.

b.

drinks two or three regular soft drinks every day.

c.

snacks on candy bars between meals.

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d. chews gum throughout the day.

ANS: C Dental caries is mostly likely to be caused by snacking on sweet, sticky foods (like candy bars) between meals. When desserts are eaten with meals, the teeth are exposed to carbohydrates for less time each day, so bacteria have less time to ferment the carbohydrate and cause caries. Soft drinks do not stick to the teeth like more sticky sweet foods and so are less likely to contribute to caries. Chewing gum may stimulate saliva production, which washes the teeth, and so it does not usually contribute to dental caries.

DIF:Cognitive Level: UnderstandingREFages 59-61 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 10. The most significant effect of bacteria in the mouth is fermentation of a .

dietary fiber, which promotes formation of beneficial short-chain fatty acids.

b .

dietary fiber, which increases intestinal gas production.

c .

simple carbohydrates, which promotes production of sugar alcohols and causes halitosis.

d .

simple carbohydrates, which promotes formation of plaque and tooth decay.

ANS: D Bacteria cause fermentation of sugars in the mouth and promote formation of plaque, which causes tooth decay. Bacteria are not capable of producing sugar alcohols, although their action on food may contribute to halitosis. Fermentation of dietary fiber occurs in the large intestine, not in the mouth.

DIF: Cognitive Level: Remembering REF: Page 59 | Page 61 | Page 65 | Page 67 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 11. The primary reason for chewing sugar-free gum instead of sugar-sweetened gum is that sugar-free gum a .

is calorie-free and helps with weight control.

b .

contains sugar alcohols that do not promote dental caries.

c .

contains gums that provide soluble dietary fiber.

d .

is sweeter than sugar-sweetened gum because it contains artificial sweeteners.

ANS: B Sugar-free gum is usually made with sugar alcohols, which are not fermented by bacteria in the mouth and so do not promote dental caries. Sugar alcohols contain fewer kilocalories than other

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sugars but nonetheless contain 2 to 3 kcal per gram, and so they are not calorie-free. Chewing gum is not usually swallowed and so would not contribute to dietary fiber; in addition, this is not different with sugar-sweetened versus sugar-free gum. Sugar-free gum is usually sweetened with sugar alcohols, which are actually less sweet than other sugars.

DIF: Cognitive Level: Remembering REF: Pages 60-62 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 12. Aspartame should not be consumed by a.

infants and school-aged children.

b.

individuals who suffer from arthritis.

c.

individuals who have phenylketonuria (PKU).

d.

anyone who is underweight or trying to gain weight.

ANS: C Aspartame contains phenylalanine, and so it should not be consumed by individuals who have phenylketonuria. There is no evidence that moderate intake of aspartame is harmful for infants and school-aged children, although there may be no reason for them to consume it. Claims that aspartame causes arthritis have not be verified. Food sweetened with aspartame rather than sugar will provide fewer kilocalories and so will not help individuals gain weight, but this does not mean that underweight people should avoid aspartame.

DIF: Cognitive Level: Remembering REF: Pages 60-62 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 13. John wants to increase his dietary fiber intake. The best breakfast choice to help him achieve this goal would be a.

pancakes and orange juice.

b.

oatmeal with raisins.

c.

scrambled egg and toast.

d.

blueberry muffin and jam.

ANS: B The best sources of dietary fiber are whole grains, fruits, and vegetables. Therefore, the breakfast with the highest amount of dietary fiber would be oatmeal with raisins. Pancakes, toast, and the muffin could contribute dietary fiber if they are made with whole wheat flour, but this was not specified. Orange juice is basically oranges with the fiber removed. Jam made with whole fruit may be high in fiber, but relatively small amounts are eaten. Animal foods such as eggs do not contain dietary fiber.

DIF: Cognitive Level: Applying REF: Pages 64-66 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 14. Colon cancer runs in Janes family. She may be able to decrease her risk of developing this cancer if she increases her intake of

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a.

fish and bran.

b.

apples, strawberries and citrus fruit.

c.

oatmeal, barley and legumes.

d. whole grains and vegetables.

ANS: D High intake of insoluble fiber helps decrease risk of colon cancer because it is fermented to produce short-chain fatty acids that decrease risk of tumor formation. The best sources of insoluble fiber are whole grains and vegetables. Oatmeal, barley, legumes, apples, strawberries, and citrus fruit contain more soluble than insoluble fiber. Bran has high amounts of insoluble fiber, but fish does not contain dietary fiber.

DIF: Cognitive Level: Applying REF: Pages 64-66 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 15. Eating a bowl of oatmeal for breakfast every day may help prevent a.

heart disease because it contains soluble fiber.

b.

high blood pressure because it contains potassium.

c.

hypoglycemia because it contains complex carbohydrate.

d.

osteoporosis because it contains calcium and vitamin D.

ANS: A Oatmeal helps prevent heart disease because it contains soluble fiber, which helps decrease blood cholesterol levels. It is not a significant source of potassium and is unlikely to affect blood pressure, except by displacing other foods with high levels of sodium. Hypoglycemia is prevented by consuming foods that contain protein and carbohydrate throughout the day, rather than eating a specific food at one meal. Oatmeal would contain a significant amount of calcium and vitamin D only if it is made or eaten with milk, and so it would not necessarily help prevent osteoporosis.

DIF: Cognitive Level: Applying REF: Pages 57-58 | Pages 65-67 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 16. Athletes use physical training and dietary manipulation to increase their body stores of energy in the form of a.

glucose.

b.

glycogen.

c.

amino acids.

d.

short-chain fatty acids.

ANS: B Athletes use these methods to increase their body stores of energy in the form of glycogen.

Glycogen is the form of carbohydrate stored in the liver and muscles. Glucose and amino acids are not stored in the body. Also, the primary function of amino acids is tissue building, not

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energy production. Short-chain fatty acids are produced when bacteria cause fermentation of dietary fiber in the colon. They are used as an energy source only by epithelial cells in the colon.

DIF:Cognitive Level: UnderstandingREFages 56-57 | Page 65 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 17. After a high-carbohydrate meal, the dominant process would be a.

glycogenesis.

b.

glycogenolysis.

c.

gluconeogenesis.

d.

glucagon production.

ANS: A After a high-carbohydrate meal, the carbohydrate is digested and absorbed as glucose. Excess glucose is converted to glycogen; this process is called glycogenesis. The other three processes occur a long time after a meal, after a fast, or after exercise, when glucose stores are low. In glycogenolysis, glycogen is converted back to glucose. Gluconeogenesis is conversion of fat and protein to glucose. Production of the hormone glucagon increases blood glucose levels by stimulating glycogenolysis and gluconeogenesis.

DIF: Cognitive Level: Applying REF: Pages 56-57 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. A dietary fiber intake of 18 g daily is considered a.

the minimum recommended.

b.

below the optimal range of intake.

c.

within the optimal range of intake.

d.

above the optimal range of intake.

ANS: B A fiber intake of 18 g is below the optimal range of daily intake for dietary fiber. The recommended range is 25 to 38 g/day.

DIF:Cognitive Level: RememberingREFages 67-69 TOP:Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 19. A beneficial effect of bacterial fermentation of dietary fiber in the colon is a.

production of intestinal gas.

b.

providing monosaccharides for energy.

c.

production of short-chain fatty acids.

d.

production of long-chain fatty acids.

ANS: C Bacteria cause fermentation of dietary fiber in the colon to produce short-chain fatty acids, which

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provide energy for mucosal cells and inhibit tumor formation.

DIF:Cognitive Level: RememberingREFages 64-67 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. Increased consumption of fruits and vegetables would be most beneficial to someone with a.

arthritis.

b.

diarrhea.

c.

constipation.

d.

osteoporosis.

ANS: C Foods with high amounts of dietary fiber, such as fruits and vegetables, can help relieve constipation by increasing fecal bulk. Arthritis is not related to intake of fruits and vegetables.

High intake of fruits and vegetables may exacerbate diarrhea. Osteoporosis is related to intake of calcium and vitamin D; fruits and vegetables are not good sources of these nutrients.

DIF: Cognitive Level: Applying REF: Pages 66-67 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 21. Peter has been very ill and has not eaten for 3 days. In order to provide carbohydrate for his brain and other cells, his body will break down a.

body fat.

b.

liver glycogen.

c.

blood glucose.

d.

muscle protein.

ANS: D The body needs a minimum of about 100 g carbohydrate daily, so after 3 days Peters body will have used up his bodys glucose and glycogen stores (about 150 g in muscles and about 90 g in liver). Body fat cannot be converted to glucose, and so his body must break down muscle protein to produce glucose by gluconeogenesis.

DIF:Cognitive Level: AnalyzingREFages 56-57 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. An example of a food with a low glycemic index is a.

lentil soup.

b.

a bagel.

c.

a sports drink.

d.

cornflakes cereal.

ANS: A Lentil soup has a low glycemic index. Foods with a low glycemic index produce a relatively small increase in blood glucose level. Lentils have high amounts of fiber, which tends to

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decrease glycemic index. Bagels, sports drinks, and cornflakes have relatively low amounts of fiber.

DIF: Cognitive Level: Applying REF: Pages 57-58 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 23. If someones stomach is removed, his or her ability to digest carbohydrate would be a.

limited to only disaccharides and monosaccharides.

b.

limited to only polysaccharides.

c.

largely unaffected.

d.

lost completely.

ANS: C Most carbohydrate digestion occurs in the small intestine. Salivary amylase begins some carbohydrate digestion in the mouth, but this stops in the acid environment of the stomach. The stomach is the main site of protein digestion. Therefore, removal of the stomach has little effect on carbohydrate digestion.

DIF:Cognitive Level: ApplyingREFages 55-56 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. If someone chewed a piece of bread for a long time, its taste would become a.

unchanged.

b.

salty.

c.

sweeter.

d.

bitter.

ANS: C Saliva in the mouth contains salivary amylase, or ptyalin, which begins starch digestion. If a starchy food such as bread stays in the mouth long enough, the amylase will break down the starch to produce monosaccharides and disaccharides, which taste sweet.

Chapter 5. Lipids: Triglycerides, Phospholipids, and Cholesterol MULTIPLE CHOICE 1. Of the following, the food that would provide the most energy per ounce is a.

butter.

b.

tuna.

c.

pasta.

d.

hard candy.

ANS: A Butter would provide the most energy per ounce because fat is the densest energy source. Fat provides 9 kcal/g; protein and carbohydrate each provide 4 kcal/g. Tuna is mostly protein with

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just a small amount of fat, pasta is mostly carbohydrate, and hard candy is only carbohydrate, and so all of these would provide fewer calories per ounce than would butter.

DIF:Cognitive Level: ApplyingREFage 74 | Page 81 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 2. The most beneficial function of cholesterol in the body is a.

formation of sex hormones, bile, and vitamin D.

b.

depositing plaques in arteries.

c.

being part of cell membrane structure.

d.

solubility in both water and fat.

ANS: A The body uses sterols such as cholesterol to make sex hormones, bile, and vitamin D. Cholesterol does contribute to deposition of arterial plaques, but this is not beneficial to the body. Cell membrane structure and solubility in both water and fat are functions of phospholipids; cholesterol is a sterol, not a phospholipid.

DIF:Cognitive Level: ApplyingREFages 77-78 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. If a patient receiving parenteral nutrition develops eczema, the patient probably has a.

vitamin C deficiency.

b.

essential fatty acid deficiency.

c.

protein-energy malnutrition.

d.

phospholipid and sterol deficiency.

ANS: B In a patient receiving fat-free parenteral nutrition, eczema may be a sign of essential fatty acid deficiency. Eczema is not caused by vitamin C deficiency; symptoms of vitamin C deficiency include bleeding gums and breakdown of scar tissue. Eczema is not a sign of protein-energy malnutrition. The body makes phospholipids and sterol, and so deficiency does not occur.

DIF: Cognitive Level: Applying REF: Page 74 TOP: Nursing Process: Diagnosis MSC:Client Needs: Physiological integrity 4. If a food that is usually made with hydrogenated oil is made with vegetable oil instead, one potential concern is that the a.

flavor will be significantly different.

b.

food will feel oily to the touch.

c.

food will contribute more to cardiovascular risk.

d.

food will have a shorter shelf life.

ANS: D Hydrogenation of vegetable oils increases their shelf life because the double bonds are removed,

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which renders the fatty acids less vulnerable to oxidation; therefore, a food made with vegetable oil may have a shorter shelf life. Use of vegetable oil does not necessarily result in a different flavor from use of hydrogenated fat and does not make the food feel more oily. Foods made with vegetable oils are less likely to contribute to cardiovascular disease than those made with hydrogenated fats, which contain saturated and trans fatty acids.

DIF:Cognitive Level: UnderstandingREFage 82 | Page 84 TOP:Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care environment 5. A triglyceride is a compound composed of a.

glycerol with two fatty acids attached.

b.

glycerol with three amino acids attached.

c.

glycerol with three fatty acids attached.

d.

organic molecules formed in triangular chains.

ANS: C Triglycerides are compounds made up of glycerol and three fatty acids. The compound of glycerol plus two fatty acids is a diglyceride. Glycerol does not combine with amino acids.

Triglycerides do not form in triangular chains.

DIF:Cognitive Level: RememberingREFage 75 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. To decrease intake of saturated fatty acids and increase intake of polyunsaturated fatty acid, one dietary change would be from using to using oil. a.

shortening; coconut

b.

margarine; olive

c.

soybean oil; canola

d.

butter; sunflower

ANS: D Sunflower oil is rich in polyunsaturated fatty acids, and butter is rich in saturated fatty acids; therefore, this switch would have the best effect. Shortening actually has higher amounts of polyunsaturated fatty acids and lower amounts of saturated fatty acids than does coconut oil.

Olive oil contains lower amounts of saturated fatty acids than does margarine, but it is rich in monounsaturated fatty acids, not polyunsaturated fatty acids. Both canola oil and soybean oil have relatively low amounts of saturated fatty acids; canola oil contains mostly monounsaturated fatty acids, whereas soybean oil is rich in polyunsaturated fatty acids.

DIF: Cognitive Level: Applying REF: Page 76 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 7. If a client wants to lose 1 lb of body fat each week, he or she would need to make sure that the daily calorie intake was lower than the daily energy needs by kcal/day.

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a.

350

b.

500

c.

900

d.

3500 ANS: B One pound of body fat contains 3500 kcal. To create a weekly deficit of 3500 kcal, daily energy intake would need to be less than daily energy expenditure by 500 kcal (3500 7).

DIF: Cognitive Level: Applying REF: Page 74 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 8. Of the following fats, the one that is most likely to be liquid is a.

milk fat.

b.

beef drippings.

c.

coconut oil.

d.

peanut oil.

ANS: D In general, plant oils are more liquid and animal fats tend to be solid. Both milk fat (butter) and beef drippings (lard) have high amounts of saturated fatty acids and tend to be solid fats.

Coconut oil is a plant oil, but it has high amounts of saturated fatty acids, and so it is usually solid. Peanut oil has high amounts of unsaturated fatty acids and is a liquid oil.

DIF: Cognitive Level: Understanding REF: Pages 75-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. The number of double bonds present in the fatty acid chain determines the a .

number of fatty acids attached to the glycerol molecule.

b .

number of glycerol molecules attached to a fatty acid.

c .

degree of saturation or unsaturation of a fatty acid.

d .

degree of saturation or unsaturation of the glycerol molecule.

ANS: C The number of double bonds in a fatty acid chain determines the degree of saturation or unsaturation of a fatty acid. The number of fatty acids attached to the glycerol molecule determines whether it is a monoglyceride (one fatty acid), a diglyceride (two fatty acids), or a triglyceride (three fatty acids). There is never more than one glycerol molecule attached to a fatty acid, and glycerol molecules do not vary in the degree of saturation or unsaturation.

DIF:Cognitive Level: UnderstandingREFages 75-77

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TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 10. A client who wishes to avoid blood clots may benefit from regular intake of a.

fish oil capsules.

b.

salmon.

c.

lecithin.

d.

olives and olive oil.

ANS: B Omega-3 fatty acids help decrease risk of blood clots. The best source of omega-3 fatty acids is fatty fish, such as salmon; fish oil capsules are not recommended because large doses may decrease immunity. Lecithin and the monounsaturated fatty acids found in olive oil do not decrease risk of blood clotting.

DIF: Cognitive Level: Applying REF: Pages 75-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 11. Overall energy intake can be greatly affected by relatively small changes in intake of a.

protein.

b.

carbohydrate.

c.

fat.

d.

alcohol.

ANS: C Fat contains more energy per gram than any other nutrient (9 kcal/g versus 4 kcal/g for protein and carbohydrate and 9 kcal/g for alcohol). Therefore, relative small increases or decreases in fat intake can result in significant increases or decreases in energy intake.

DIF: Cognitive Level: Understanding REF: Page 74 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 12. The number of kilocalories provided by 23 g of fat is a.

92.

b.

161.

c.

207.

d.

230.

ANS: C Fat contains 9 kcal/g. Therefore, 23 g fat contain 207 kcals (23 9).

DIF:Cognitive Level: ApplyingREFage 74 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. If dietary analysis shows that fat provides 31% of an individuals energy intake, their fat intake would be

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a.

considered below the recommended range.

b.

considered within the recommended range.

c.

considered above the recommended range.

d. generally recognized as safe.

ANS: B The Acceptable Macronutrient Distribution Range for fat is 20% to 35% of kilocalories; therefore, 31% is within the recommended range. Generally recognized as safe is a term used for food additives.

DIF:Cognitive Level: ApplyingREFage 80 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 14. Sources of invisible fat include a.

pastries and pies.

b.

bacon and chicken with skin.

c.

butter and sour cream.

d.

oil and vinegar salad dressing.

ANS: A In baked goods such as pastries and pies, the fat cannot be seen; it is absorbed into the flour, which makes it invisible. Bacon has visible strips of white fat, chicken skin is visibly fatty, butter and sour cream can be seen unless they are melted into toast or potatoes, and oil can be seen floating on top of the vinegar in salad dressing.

DIF:Cognitive Level: ApplyingREFages 81-83 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 15. An example of emulsification is a.

chewing of food in the mouth.

b.

use of egg yolk to make mayonnaise.

c.

commercial hydrogenation of liquid oils.

d.

digestion of fat in the small intestine.

ANS: B The lecithin in egg yolk acts as an emulsifier in the making of mayonnaise. Chewing of food is mastication. Hydrogenation of liquid oils does not emulsify them. In the small intestine, bile emulsifies fat to increase the surface area for digestion, but the fat is not actually digested there.

DIF:Cognitive Level: ApplyingREFage 78 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 16. For someone with coronary heart disease, what would be the most helpful piece of information on a food label? a.

Total calories per serving

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b.

Milligrams of cholesterol per serving

c.

Grams of saturated fat per serving

d.

Grams of total fat per serving ANS: C Saturated fat intake has the greatest influence on blood cholesterol levels and coronary heart disease. Intakes of total fat and total energy are important, but not as important as saturated fat.

Intake of cholesterol is less important because most cholesterol is made by the body, and dietary sources contribute relatively little.

DIF: Cognitive Level: Applying REF: Page 82 | Pages 84-86 | Page 88 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 17. If a salad dressing is made with olive oil, it would contain mostly fatty acids. a.

trans

b.

saturated

c.

polyunsaturated

d.

monounsaturated

ANS: D Olive oil is rich in monounsaturated fatty acids. Trans fatty acids are found in hydrogenated fats.

Polyunsaturated fatty acids are found mostly in other liquid vegetable oils. Saturated fatty acids are found in dairy, meat fats, and coconut and palm oil.

DIF: Cognitive Level: Applying REF: Page 76 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. The best description of a fat with high amounts of trans fatty acids is that it is a.

liquid at room temperature.

b.

found naturally in tropical oils.

c.

easily transformed from one state to another.

d.

produced by hydrogenation of plant oils.

ANS: D Trans fatty acids are formed when liquid plant oils are hydrogenated to form a hard fat, such as margarine or shortening. Trans fatty acids are not naturally present in any fats or oils, and fats with high amounts of trans fatty acids tend to form solid, rather than liquid, fats at room temperature. Trans fatty acids are shelf stable and so are not easily transformed.

DIF:Cognitive Level: RememberingREFage 82 | Page 84 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 19. An alternative to hydrogenation to increase the shelf life of polyunsaturated fat is the addition of a.

vitamin E.

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b.

vitamin D.

c.

hydrogen.

d. zinc.

ANS: A Antioxidants provide a way to preserve unsaturated fats without hydrogenation. Vitamin E is an example of an antioxidant that may be added to unsaturated fats. Vitamin D and zinc do not have antioxidant properties. Hydrogen is added during hydrogenation.

DIF:Cognitive Level: ApplyingREFages 84-85 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 20. The most important property of phospholipids that makes them valuable both in foods and in the body is that they a.

carry fat-soluble vitamins.

b.

are useful as low-energy fat substitutes.

c.

are soluble in water and fat at the same time.

d.

function as natural antioxidants.

ANS: C Phospholipids are valuable in foods and in the body because they are soluble in water and fat at the same time. This makes them useful emulsifiers and important components of cell membranes. Phospholipids have no particular role in carrying fat-soluble vitamins. They are not used as fat substitutes. They do not function as antioxidants.

DIF: Cognitive Level: Understanding REF: Pages 77-78 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 21. Most fat enters the lymphatic system after a.

absorption.

b.

circulation.

c.

metabolism.

d.

hydrogenation.

ANS: A Most fat is absorbed into the lymphatic system from the small intestine. It then passes into the circulation. Therefore, circulation and metabolism occur after, not before, fat enters the lymphatic system. Hydrogenation occurs during food production and is not connected to processing of fat in the body.

DIF:Cognitive Level: ApplyingREFage 78 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. Jacob usually eats a sandwich with salami, mayonnaise, lettuce, and tomato on wheat bread for lunch. What change would be most helpful in decreasing his risk of cardiovascular disease?

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a.

Add sprouts instead of tomato.

b.

Switch to whole-wheat bread.

c.

Omit the mayonnaise.

d.

Replace the salami with turkey.

ANS: D Replacing the salami with turkey would be most beneficial because salami has high amounts of saturated fatty acids, which tend to increase blood cholesterol levels. Turkey also contains saturated fatty acids but has low amounts of fat overall. Switching the whole-wheat bread would increase dietary fiber intake, which would also help decrease blood cholesterol level, but the effect would not be as great as a decrease in saturated fat. Omitting the mayonnaise would help decrease overall fat intake, but the fat in mayonnaise is mostly unsaturated and so it would be less beneficial than using a lower fat meat. Both sprouts and tomatoes add vitamin C and other nutrients, and so this change would make very little difference nutritionally.

DIF:Cognitive Level: ApplyingREFage 76 | Pages 80-83 TOP:Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 23. High levels of low-density lipoprotein cholesterol (LDLc) are associated with an increased risk of a.

diabetes mellitus.

b.

high levels of high-density lipoprotein cholesterol (HDLc).

c.

coronary artery disease.

d.

high blood pressure and stroke.

ANS: C High levels of low-density lipoprotein cholesterol are associated with increased risk of coronary artery disease. They do not have a direct effect on risk for diabetes mellitus or high blood pressure and stroke. LDLc and HDLc levels are not necessarily related.

DIF:Cognitive Level: RememberingREFage 82 | Pages 84-85 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 24. A client who is trying to follow a low-fat eating pattern tells you that he or she has experienced diarrhea. You may want to find out whether he or she has a.

eaten foods made with the fat substitute carrageenan.

b.

eaten foods made with the fat substitute olestra.

c.

greatly increased intake of fish and seafood.

d.

developed essential fatty acid deficiency.

ANS: B Olestra is a fat substitute that is not digested or absorbed and may cause diarrhea if eaten in large quantities. Carrageenan is a carbohydrate that is digested and does not cause diarrhea. Fish and

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seafood consumption and essential fatty acid deficiency are not associated with diarrhea.

DIF: Cognitive Level: Applying REF: Page 74 | Page 77 | Page 86 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 25. The client most likely to benefit from use of medium-chain triglycerides is one who a .

has essential fatty acid deficiency.

b .

has malabsorption because of removal of part of the small intestine.

c .

needs to gain weight after surgery and chemotherapy to treat bowel cancer.

d .

has high levels of both serum total cholesterol and low-density lipoprotein cholesterol.

ANS: B Medium-chain triglycerides are beneficial for patients with malabsorption because they are relatively easily absorbed. They do not contain essential fatty acids. They contain the same amount of energy as other fatty acids, and so they would not be especially beneficial for a client who needs to gain weight. They do not influence serum cholesterol levels.

DIF: Cognitive Level: Applying REF: Page 74 | Page 78 | Pages 85-86 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 26. A good lunch choice for someone who wants to increase intake of omega-3 fatty acids would be a.

peanut butter and jelly sandwich.

b.

lentil soup.

c.

salad with olive oil dressing.

d.

grilled tuna sandwich.

ANS: D Fatty fish, such as tuna, are an excellent source of omega-3 fatty acids, and so the grilled tuna sandwich would be the best choice. Peanut butter and olive oil have high amounts of monounsaturated fatty acids but are not good sources of omega-3 fatty acids. Lentil soup is likely to have low amounts of fat.

DIF: Cognitive Level: Applying REF: Pages 76-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 27. If a person did not produce bile, a.

fats would pass through the intestines undigested.

b.

fats would be digested and absorbed too quickly.

c.

fat digestion may occur more slowly.

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d. digestion of fat would be unaffected.

ANS: C Bile emulsifies dietary fats to increase their surface area for action of digestive enzymes.

Therefore, without bile, digestion of fat would occur more slowly. Because of mixing and churning of chyle with digestive secretions and enzymes in the small intestine through peristalsis and segmentation, digestion would still occur, but more slowly.

DIF:Cognitive Level: ApplyingREFages 78-79 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 28. A client who is a bodybuilder eats large quantities of tuna, chicken, and lean meats every day. Any extra energy from these foods that the clients body does not need will be stored as a.

adipose tissue.

b.

essential body fat.

c.

muscle tissue.

d.

glycogen.

ANS: A Extra energy from any source is stored as fat in adipose tissue. Muscle is developed in response to exercise; it requires some protein, but extra protein cannot be stored as muscle tissue.

Glycogen stores in the body are limited. Essential body fat is the fat that protects organs and nerve cells; its amount does not increase with dietary excess.

Chapter 6. Proteins and Amino Acids MULTIPLE CHOICE 1. If a person were to eat a diet that provided carbohydrate, fat, and micronutrients, but very little protein, for example if he or she ate only whole-wheat pita bread with olive oil, a .

the body would manufacture amino acids to make essential proteins from fatty acids and glycogen.

b .

body metabolism would decrease to conserve amino acids until protein intake was resumed.

c .

the liver would recirculate amino acids instead of breaking them down and excreting urea.

d .

the body would break down muscle tissue to provide amino acids to make essential proteins.

ANS: D The body needs regular dietary protein to provide amino acids. If no protein is eaten in the diet, the body uses muscle tissue to provide amino acids to make essential body proteins. The liver cannot recirculate amino acids; some are always broken down, and the nitrogen portion is excreted as urea. Body metabolism may decrease slightly, but it would not be sufficient to conserve amino acids for any length of time. The body cannot manufacture amino acids from fatty acids and glycogen.

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DIF:Cognitive Level: ApplyingREFages 90-92 | Page 94 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. If a man weighs 190 lb and eats 150 g protein per day, his protein intake is Recommended Dietary Allowance (RDA). a.

less than 100%

b.

between 100% and 150%

c.

between 150% and 200%

d.

greater than 200%

of the

ANS: D The RDA for protein is 0.8 g per kilogram of body weight. This mans weight is 190 lb, or 86 kg; 86 kg 0.8 = 69.1 g protein per day. Thus, an intake of 150 g is more than twice his RDA of 69.1 g of protein per day.

DIF:Cognitive Level: ApplyingREFage 97 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. Some proteins contain an alpha helix, which is part of their structure. a.

primary

b.

secondary

c.

tertiary

d.

quaternary

ANS: B The alpha helix structure is an example of the secondary structure of proteins. The primary structure is the amino acid sequence. The tertiary structure comprises bonds that form within chains in loops or folds. Quaternary structure is formed by combinations of more than one polypeptide.

DIF:Cognitive Level: UnderstandingREFage 92 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 4. The most accurate statement about amino acids is that a .

most amino acids contain sulfur.

b .

they are stored in the liver for use when needed.

c .

essential amino acids cannot be manufactured by body cells.

d .

nonessential amino acids cannot be manufactured body cells.

ANS: C

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Body cells cannot manufacture essential amino acids. Cells can make nonessential amino acids from essential amino acids. The liver is not able to store significant amounts of amino acids.

Some but not most amino acids contain sulfur.

DIF:Cognitive Level: ApplyingREFage 90 | Page 96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Nonessential amino acids can be made by the liver from a.

glucose and urea.

b.

other amino acids.

c.

fatty acids and glycerol.

d.

enzymes and hormones.

ANS: B The body can make nonessential amino acids from other amino acids. Once the amino group has been removed from an amino acid and has been formed into urea, the body cannot turn it back into an amino acid. Fatty acids and glycerol cannot be used to make amino acids. Enzymes and hormones may help control the manufacture of nonessential amino acids but are not themselves used to make them.

DIF:Cognitive Level: UnderstandingREFages 90-91 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. If a person usually ate 2 ounces of lean meat at lunchtime and decided to substitute cooked lentils instead, how much of the lentils would the person need to eat? a.

2 tablespoons

b.

cup

c.

cup

d.

1 cup

ANS: B Each ounce of meat is equivalent to cup cooked dry peas or lentils. Therefore, 2 oz of meat would be equivalent to cup.

DIF:Cognitive Level: ApplyingREFage 91 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. Body proteins may become denatured in the presence of a a.

drug overdose.

b.

very high fever.

c.

vitamin deficiency.

d.

high stress level.

ANS: B Very high fever may denature body proteins because the extreme heat changes the shape of the

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protein. Drug overdoses, vitamin deficiencies, and high stress levels do not cause proteins to become denatured.

DIF:Cognitive Level: ApplyingREFage 92 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. The most important function of hydrochloric acid in the stomach is to a.

convert pepsinogen to its active enzyme form, pepsin.

b.

denature dietary proteins to allow digestion.

c.

kill bacteria in food and prevent foodborne illness.

d.

stop the action of salivary amylase.

ANS: A Hydrochloric acid is essential in the stomach for activating pepsinogen to pepsin in order to begin protein digestion. The acid does denature some proteins, but this is not essential to digestion. Stomach acid may play a role in killing pathogenic bacteria and does stop the action of salivary amylase, but these effects are less important.

DIF:Cognitive Level: RememberingREFage 93 | Page 95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. A patient fell off a bicycle and broke one arm and one leg. Immediately after the accident, the patients body will be in a state of a.

anabolism.

b.

catabolism.

c.

deamination.

d.

hypermetabolism.

ANS: B Immediately after a serious accident, the physical stress, immobility, and need to break down damaged tissues cause loss of tissue through catabolism. Anabolism occurs when new protein is being formed during growth or healing. Deamination is one part of catabolism; it involves removal of the amino group when amino acids are broken down. Hypermetabolism is a term that describes an increased state of metabolism in general.

DIF:Cognitive Level: ApplyingREFages 94-95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. Without vitamin B6, the body would be unable to a.

absorb amino acids.

b.

digest proteins.

c.

convert ammonia to urea.

d.

regulate acid-base balance.

ANS: A

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Vitamin B6 (pyridoxine) is needed as a carrier for absorption of amino acids. It has several roles in protein metabolism, but it is not needed for protein digestion or for conversion of ammonia from protein breakdown to urea in the liver. Pyridoxine is not involved in regulation of acid-base balance.

DIF:Cognitive Level: UnderstandingREFage 94 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. An example of a situation in which nitrogen balance is positive is a.

aging.

b.

infection.

c.

starvation.

d.

pregnancy.

ANS: D Positive nitrogen balance means that more nitrogen is retained in the body than is excreted. This would be the situation in pregnancy, when new tissue is being formed in the mother and fetus.

Aging, infection, and starvation are all times when the nitrogen balance would be negative.

DIF:Cognitive Level: ApplyingREFages 94-95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. If a patient has a torn ligament, then during healing and recovery, the patients body would need to manufacture a.

fibrin.

b.

albumin.

c.

collagen.

d.

hemoglobin.

ANS: C Collagen is the main structural protein found in ligaments and other connective tissues, bone, and teeth. Fibrin is an important protein in blood clots. Albumin is an important blood plasma protein. Hemoglobin is the main protein that carries oxygen in the blood.

DIF:Cognitive Level: ApplyingREFage 95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 13. During acute bacterial infections, patients need extra protein to manufacture a.

hormones.

b.

antibodies.

c.

antibiotics.

d.

enzymes.

ANS: B During bouts of infection, the immune system uses protein to produce antibodies. Hormones are

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chemical messengers in the body that are sometimes proteins but are not directly involved in fighting infection. Antibiotics help recover from bacterial infections but are administered to the patient and are not produced by the body. Enzymes are protein catalysts in the body and are also not involved in fighting infection.

DIF:Cognitive Level: ApplyingREFages 95-96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. The property of protein that is most important to its buffering properties is a .

its ability to create osmotic pressure in intravascular, intracellular, and interstitial fluids.

b .

the fact that amino acids include both an acid carboxyl group and an amine base group.

c .

its ability to pump nutrients and other vital substances across cell membranes.

d .

its communication (hormones) and catalytic (enzyme) functions that help regulate body functions.

ANS: B All of these statements are true of proteins, but the condition that allows it to act as a buffer is the composition of amino acids that includes both an acid carboxyl group and an amine base group.

DIF:Cognitive Level: RememberingREFage 95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. The protein found in muscles whose function is similar to that of hemoglobin in blood is a.

collagen.

b.

oxyglobin.

c.

myoglobin.

d.

myosin.

ANS: C Hemoglobin carries oxygen in blood; the protein that carries oxygen in muscles is myoglobin.

Myosin is a contractile protein found in muscles, and collagen is a structural protein found in ligaments and tendons. Oxyglobin does not exist.

DIF:Cognitive Level: RememberingREFages 95-96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. For clients with phenylketonuria the most important part of treatment is to a .

not eat any foods that contain phenylalanine.

b .

limit their phenylalanine intake to the amount their bodies need.

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c .

take enzyme supplements to help digest phenylalanine.

d take penicillin to prevent complications. .

ANS: B People with phenylketonuria do need some phenylalanine to make essential proteins, but they should not take in more than they need because they will be unable to break down the excess.

Phenylalanine is an amino acid, the smallest product of protein digestion, and so it is not digested by enzymes. Penicillin is used to prevent secondary infections in people with sickle cell anemia but is not used to treat phenylketonuria.

DIF:Cognitive Level: UnderstandingREFage 96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. An example of a food that contains complete protein is a.

oatmeal.

b.

lentil soup.

c.

peanut butter.

d.

hard-boiled egg.

ANS: D Eggs and most other animal foods contain complete protein. Grains, legumes, and nuts contain incomplete proteins.

DIF:Cognitive Level: ApplyingREFages 96-98 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. High levels of glucocorticoid hormones are likely to be produced by someone who a.

participates in a weight-training program.

b.

consumes excessive amounts of protein.

c.

is pregnant.

d.

has a large infected wound.

ANS: D Glucocorticoid hormones are produced by the adrenal cortex and have a major role in protein catabolism. For an infected wound, catabolism is necessary to break down damaged tissue.

Weight training and pregnancy are anabolic conditions. Consuming excessive amounts of protein places a burden on the kidneys for excretion of nitrogenous waste but does not affect glucocorticoid hormone levels.

DIF:Cognitive Level: ApplyingREFage 94 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 19. An example of a meal that contains complementary proteins is

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a.

pasta and tomato sauce.

b.

split pea soup with crackers.

c.

oatmeal and buttered toast.

d. fruit yogurt with strawberries.

ANS: B Split pea soup with crackers contains complementary proteins: The incomplete legume protein in the split pea soup complements the incomplete grain protein in the crackers. Vegetables such as tomato sauce and fruit such as strawberries do not contain sufficient protein to complement another incomplete protein in a meal. Both oatmeal and toast are grains, and so their incomplete proteins are not complementary. Fruit yogurt contains complete protein and does not need to be combined with an incomplete protein.

DIF:Cognitive Level: ApplyingREFages 96-98 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 20. High urinary urea excretion may be caused by a.

high protein intake.

b.

phenylketonuria.

c.

kidney failure.

d.

administration of growth hormone.

ANS: A High levels of urinary urea excretion may be caused by protein intake in excess of the bodys need; excess protein is deaminated and used to provide energy; and the ammonia is converted to urea by the liver and excreted by the kidneys. Kidney failure causes high blood levels of urea because the kidneys are unable to excrete it; urinary urea levels would be low. Phenylketonuria is an inability to break down excess phenylalanine and would have very little effect on urea excretion. Administration of growth hormone would cause anabolism, which would result in greater use of amino acids and less urea excretion.

DIF:Cognitive Level: ApplyingREFage 94 | Page 96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. The sports coaches at a university are designing training diets for their teams. Why do they need to provide more protein for the mens rowing team than for the womens rowing team? a .

The mens team is more active than is the womens team.

b .

The mens team has more lean body mass than does the womens team.

c .

The mens team has a higher metabolic rate than does the womens team.

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d The mens team uses dietary protein less efficiently than does the womens team. .

ANS: B Men generally require more protein than do women because they have more lean body mass than do women; lean body mass requires more protein to maintain. Men are not necessarily more active than women when they compete in the same sport. They do have a higher metabolic rate, but this is because they have more lean body mass; their higher metabolic rate affects their energy needs, not their protein needs. Men do not use protein less efficiently than do women.

DIF:Cognitive Level: ApplyingREFage 97 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 22. Most physically active adults in America do not need to eat more protein than inactive adults because a .

exercise does not increase protein needs as long as energy needs are met.

b .

exercise increases the efficiency of recycling amino acids so that extra needs are met endogenously.

c .

most people have high enough protein intake to provide the extra protein needed for active muscles.

d .

most Americans are not sufficiently active to cause an increase in protein requirements.

ANS: C Athletes have higher protein needs than nonathletes (1.2 to 1.7 g/kg versus 0.8 g/kg, respectively). However, most Americans consume the amount of protein recommended for athletes, and so most American athletes do not need to increase their protein intake. Exercise does not increase the efficiency of protein turnover.

DIF: Cognitive Level: Applying REF: Page 97 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 23. The RDA of protein for a healthy adult who weighs 60 kg is g/day. a.

36

b.

48

c.

60

d.

72

ANS: B The RDA of protein for a healthy adult is 0.8 g/kg per day. Therefore, the RDA for an adult who weighs 60 kg is 48 g/day (0.8 60).

DIF:Cognitive Level: ApplyingREFage 97 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity

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24. Janet eats beans, grains, fruits, and vegetables, and milk. Her diet is considered a.

lactovegetarian.

b.

ovolactovegetarian.

c.

flexitarian.

d.

vegan.

ANS: A Diets than contain plant foods plus milk are lactovegetarian diets; ovolactovegetarian diets include milk and eggs. Vegan diets contain only plant foods. Diets that contain plant foods plus dairy, eggs, and occasional meat, fowl, or fish are flexitarian.

DIF:Cognitive Level: ApplyingREFages 98-99 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 25. Eric follows a vegetarian eating pattern, and he wants to know whether he needs to take any vitamin and mineral supplements. What would be most important to find out? a .

Whether he includes complementary vegetable proteins

b .

Whether he follows a vegan eating pattern or eats some animal foods

c .

Whether his skin has regular exposure to sunlight

d .

Whether he relies on mostly natural or mostly processed foods

ANS: B It would be important to find out whether Eric follows a vegan diet; strict vegan diets do not contain any vitamin B12 (found only in animal products) and vitamin D (obtained mostly from fortified milk). Including complementary vegetable proteins would improve the overall quality of his protein intake but would not affect his vitamin and mineral intake. Regular skin exposure to sunlight would help manufacture some vitamin D, but would not help with vitamin B12 status, and so the question of sun exposure is less important. Processed food may contain fewer micronutrients that natural foods, but this is less critical than whether he includes any animal foods in his diet.

DIF:Cognitive Level: AnalyzingREFages 98-99 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 26. A person who follows a strict kosher diet would not eat a.

macaroni and cheese.

b.

a cheeseburger and fries.

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c.

a bean-and-cheese burrito.

d. roast beef with mashed potatoes.

ANS: B A strict kosher diet would not include a cheeseburger because meat and dairy may not be eaten together. Both macaroni with cheese and a bean-and-cheese burrito contain only dairy. Roast beef with mashed potatoes is acceptable as long as the beef has been slaughtered appropriately.

DIF:Cognitive Level: ApplyingREFage 100 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC:Client Needs: Psychosocial integrity 27. An appropriate size serving of meat, poultry, or fish is about the size of a.

your fist.

b.

a dollar bill.

c.

the palm of your hand.

d.

one fourth of a dinner plate.

ANS: C An appropriate size serving of meat, poultry, or fish is about the size of the palm of your hand.

This represents about 3 ounces. A serving the size of a fist or one fourth of most dinner plates would be too large. A dollar bill is flat and therefore does not indicate a three-dimensional serving size.

DIF:Cognitive Level: RememberingREFages 99-100 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 28. A small child has normal weight, but his arms and legs are thin, whereas his belly and face appear swollen. His mother tells you that the only food they have had in the house for the past 3 weeks is noodles and some bread. The child probably has a.

malabsorption syndrome.

b.

acute infection.

c.

marasmus.

d.

kwashiorkor.

ANS: D The child probably has kwashiorkor caused by inadequate protein intake with adequate energy intake (noodles and bread provide carbohydrate but little protein). Marasmus is caused by inadequate intakes of both energy and protein and is characterized by extreme wasting in the entire body. Acute infection or malabsorption syndromes may exacerbate malnutrition but are not the primary cause.

Chapter 7. Energy Balance and Weight Management MULTIPLE CHOICE

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1. A good example of living in an obesogenic environment is a .

working for an employer who gives employees free membership at a health club.

b .

being a former high school athlete who now works in a sedentary job.

c .

living in an apartment complex where it is unsafe for children to play outside unsupervised.

d .

a physicians recommendation not to exercise during recovery from surgery.

ANS: C Obesogenic environments limit peoples ability to stay active while surrounding them with inexpensive high-energy foods. Living in an apartment complex in an unsafe area would be considered obesogenic because it limits the ability to be active. Being given a free health club membership is antiobesogenic because it encourages physical activity. A high school athlete who becomes sedentary is not necessarily prohibited from engaging in active leisure-time activities.

Needing to remain inactive during recovery from surgery is only temporary and so has less effect on long-term weight.

DIF:Cognitive Level: ApplyingREFage 159 | Page 171 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. The total amount of energy in a bowl of soup that contains 5 g of protein, 2 g of fat, and 20 g of carbohydrate is kcal. a.

27

b.

108

c.

118

d.

133

ANS: C Protein provides 4 kcal/g; fat provides 9 kcal/g; carbohydrate provides 4 kcal/g. Therefore, the soup contains 118 kcal ([5 4] + [2 9] + [20 4] = 20 + 18 + 80).

DIF:Cognitive Level: ApplyingREFage 160 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 3. The fuel for all body processes that traps energy released from food is a.

electrons.

b.

acetyl coenzyme A.

c.

glucose-6-phosphate.

d.

adenosine triphosphate.

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ANS: D The body catabolizes nutrients, and their energy is trapped in adenosine triphosphate (ATP), the fuel for all processes that require energy in the body. Electrons do not store energy. Acetyl coenzyme A is a substance that is produced in the sequence of reactions as nutrients are metabolized in the mitochondria. Glucose-6-phosphate is a substance that is produced in the sequence of reactions in the metabolism of carbohydrate.

DIF:Cognitive Level: UnderstandingREFages 160-161 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. If a person hears a friend calling for help and goes running to find out what the friend needs, the person would be getting his or her energy from a.

fatty acids via adrenaline release.

b.

glucose and amino acids via aerobic pathways.

c.

glycogen via anaerobic glycolysis.

d.

fatty acids and glycerol via oxidative phosphorylation.

ANS: C Anaerobic pathways metabolize mostly glycogen for short-term, high-intensity activities.

Adrenaline release may or may not stimulate this metabolism. Aerobic pathways are used for longer-term, moderate-intensity activities. Oxidation of fatty acids occurs mostly in long-term, moderate-intensity activities.

DIF:Cognitive Level: ApplyingREFages 160-161 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 5. If someone goes on a long hike, after 4 hours most of his or her energy will be obtained from a.

glucose.

b.

glycogen.

c.

fatty acids.

d.

amino acids.

ANS: C In long-term, moderate-intensity exercise, the muscles use more fatty acids and less glucose and glycogen. Amino acids may used to provide glucose for the brain when glucose and glycogen stores are depleted, but they would not be the major source of energy for working muscles.

DIF:Cognitive Level: ApplyingREFages 161-162 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. Athletes who exercise regularly are able to exercise for longer, partly because their body is able to use more energy from a.

Fat.

b.

Protein.

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c.

Amino acids.

d.

Carbohydrates.

ANS: A Regular exercise increases the bodys ability to use energy from fat. This spares glycogen stores, and exercise can continue for longer. Protein and amino acids are used only when glycogen and glucose (carbohydrate) stores are exhausted; this would take longer in athletes who exercise regularly.

DIF:Cognitive Level: UnderstandingREFage 162 | Page 181 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 7. Of the following, the person who would be expected to have the highest energy expenditure is a a .

man who cycles to work every day and plays on sports teams on the weekend.

b .

man who works 60 hours a week at a high-stress job.

c .

woman who works as a personal trainer at a health club.

d .

woman who works as a nurse in a clinic.

ANS: A An active man would have the highest energy expenditure. In general, men have higher energy expenditures than do women, and active people have higher energy expenditures than do sedentary people.

DIF:Cognitive Level: AnalyzingREFages 162-163 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 8. The most effective way to increase energy expenditure is to a .

eat foods that require more energy for digestion, absorption, metabolism, and storage.

b .

use thyroid hormones to increase basal metabolic rate.

c .

increase the duration and intensity of daily activities.

d .

lift weights to increase lean body mass and thereby increase basal metabolism.

ANS: C The most effective way to increase energy expenditure is to exercise more. Lifting weights will provide a smaller increase in energy expenditure. Eating foods that stimulate the thermic effect

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of food will produce a relatively insignificant increase in energy expenditure. Use of thyroid hormones can have adverse effects unless levels are below normal and need to be restored.

DIF:Cognitive Level: ApplyingREFages 163-165 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 9. The behavior change that would do most to help preserve lean body mass is a.

avoiding weight loss.

b.

exercising regularly.

c.

decreasing dietary fat intake.

d.

ensuring adequate protein intake.

ANS: B Exercise helps maintain lean body mass (muscle). Weight loss causes some loss of lean body mass, and adequate protein intake will help maintain lean body mass, but these effects are less significant than that of exercise. Decreasing dietary fat intake does not affect lean body mass.

DIF:Cognitive Level: AnalyzingREFage 164 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC:Client Needs: Physiological integrity 10. The duration of physical activity needed to maintain physical fitness depends on the a.

time of day.

b.

ambient temperature.

c.

intensity of the activity.

d.

flexibility of the individual.

ANS: C The amount of physical activity needed to maintain physical fitness depends on the intensity of the activity. The more intense the activity, the shorter the amount of time needed to maintain fitness. Time of day, ambient temperature, and flexibility of the individual do not affect the amount of physical activity needed to maintain physical fitness.

DIF:Cognitive Level: UnderstandingREFages 164-165 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 11. The most accurate way to measure body fat levels is to use a.

body mass index (BMI).

b.

triceps skinfold thickness.

c.

underwater weighing (densitometry).

d.

bioelectric impedance analysis (BIA).

ANS: C

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Underwater weighing is considered the gold standard for measuring body fat levels. However, body mass index, triceps skinfold thickness, and bioelectric impedance analysis are often used to estimate body fat levels because those measurements are easier to perform.

DIF:Cognitive Level: UnderstandingREFage 166 TOP:Nursing Process: Assessment| Nursing Process: Evaluation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 12. For a man, a total body fat level of 18% is considered a.

too low.

b.

healthy.

c.

too high.

d.

obese.

ANS: B The recommended range for total body fat in men is 15% to 20%. Therefore, 18% is considered a healthy amount of total body fat.

DIF:Cognitive Level: ApplyingREFages 166-167 TOP:Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 13. If a health practitioner wants to assess whether an underweight womans body fat is too low, he or she may ask her whether a.

she has lost weight recently.

b.

other family members are underweight.

c.

she has a normal appetite.

d.

she menstruates regularly.

ANS: D Failure to menstruate indicates that body fat levels are too low. Recent weight loss, appetite, and family weight status may help understand why the woman is thin, but they would not indicate whether her weight is below a healthy range.

DIF:Cognitive Level: ApplyingREFage 167 TOP:Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 14. If a womans waist measurement is 34 inches and her hip measurement is 40 inches, her waist-to-hip ratio would be considered to be risk for chronic disease. a.

associated with a high

b.

unrelated to

c.

associated with a low

d.

associated with a high

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ANS: A This womans waist-to-hip ratio is 0.85 (34 40). A healthy waist-to-hip ratio for women is less than 0.8. Therefore, this womans waist-to-hip ratio is considered to be associated with a high risk for chronic disease.

DIF:Cognitive Level: ApplyingREFage 168 TOP:Nursing Process: Assessment| Nursing Process: Evaluation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 15. Frank and Gina are trying to lose weight. They walk 2 miles every evening after dinner, are eating smaller portions, and have stopped eating snacks between meals. Frank has lost twice as much weight as Gina. What is the most likely explanation? a .

Gina is not following the food plan as carefully as Frank is.

b .

Gina has a gynoid shape, and Frank has an android shape.

c .

Frank is exercising more than Gina at other times during the day.

d .

Frank had a higher level of fitness than Gina before they started to make changes.

ANS: B Most women have a gynoid shape, so that they store more subcutaneous fat, which is harder to lose than the visceral fat stored by men, most of whom have an android body shape. This is a more likely explanation than Ginas failure to follow the plan or Franks additional exercise.

Baseline fitness level would have little effect on weight loss.

DIF:Cognitive Level: ApplyingREFages 167-168 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. It would be especially beneficial for someone to avoid becoming obese if they have a family history of a.

osteoporosis and sarcopenia (muscle wasting).

b.

alcoholism and liver cancer.

c.

sleep apnea and osteoarthritis.

d.

multiple sclerosis and celiac disease.

ANS: C Obesity increases risk for sleep apnea and osteoarthritis. Risk of osteoporosis is actually inversely related to obesity. Alcoholism, liver cancer, and sarcopenia are not related to obesity.

Multiple sclerosis and celiac disease are autoimmune diseases and are not related to obesity.

DIF:Cognitive Level: ApplyingREFage 169 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 17. To lose a pound of body fat in a week, daily energy expenditure would have to increase by

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approximately

kcal.

a.

350

b.

500

c.

700

d.

3500

ANS: B One pound of fat represents 3500 kcal. To lose 1 lb of fat in a week, daily energy expenditure would need to increase by 500 kcal (3500 7).

DIF:Cognitive Level: ApplyingREFage 169 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 18. If someone goes to a seafood buffet and eats large portions of shrimp, crab, and baked fish, being careful to avoid fried seafood and high-fat sauces, the extra protein consumed will be stored as a.

amino acids in the liver.

b.

protein in muscles.

c.

glycogen in muscles.

d.

triglycerides in adipocytes.

ANS: D Excess energy intake from any source (carbohydrate, fat, or protein) is stored as triglycerides in special cells called adipocytes. The liver cannot store extra amino acids, muscles cannot store extra protein, and storage of glycogen is very limited.

DIF: Cognitive Level: Applying REF: Pages 160-162 | Pages 180-181 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 19. According to set point theory, if weight or fatness falls below the level perceived to be appropriate by the body, the individual will a .

experience a greater desire for high-fat foods.

b .

develop a new, lower set point for body weight.

c .

experience an overall increase in hunger drive.

d .

decrease his or her physical activity level until weight is regained.

ANS: C Set point theory suggests that the human body defends a set level of body fatness. Therefore, if

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weight or fatness falls below this level, an individual is likely to experience increased hunger until he or she regains the weight. Unfortunately, it is not easy to develop a new, lower set point for body weight. Appetite for high-fat foods does not necessarily increase. Physical activity level is not affected by body weight in relation to set point.

DIF:Cognitive Level: UnderstandingREFages 170-172 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. The most important factor in setting behavioral goals is a.

the clients willingness to exercise.

b.

individual habits and preferences.

c.

the amount of weight loss desired.

d.

the skill of the health care practitioner.

ANS: B Behavioral goals must be tailored to each clients habits and preferences. Their willingness to exercise is only one of many factors to consider. The amount of weight loss desired is not the focus of behavioral change. The skill of the health care practitioner may help or hinder the process of determining behavioral goals, but it is not the focus of the process.

Chapter 8. The Water-Soluble Vitamins MULTIPLE CHOICE 1. If a woman who drinks a cup of decaffeinated coffee in the morning, a cup of fruit juice with lunch, 6 cups of water throughout the day and a cup of tea at bedtime, her fluid intake would be considered a.

dangerously low.

b.

below optimal.

c.

optimal.

d.

too high.

ANS: C This womans total fluid intake for the day is 9 cups, the recommended amount for women.

Minimum fluid intake for health is around 4 cups; intake below this would be considered dangerously low. Fluid intake can be too high, but the specific amount that causes water intoxication is unknown.

DIF:Cognitive Level: ApplyingREFage 130 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 2. Having only softened tap water at home would be of most concern to a(n) a.

pregnant woman.

b.

full-time student who also works part-time.

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c.

elderly woman with osteoporosis.

d. retired man with hypertension.

ANS: D Softened water has relatively high levels of sodium, which exacerbates hypertension in saltsensitive individuals. It is not ideal for anyone to drink softened water on a regular basis, but it is of special concern for someone with hypertension. Someone who is retired is more likely to drink beverages made with tap water at home. An elderly woman with osteoporosis would benefit from the calcium in hard water, but this is less of a concern. A student who is gone at work or school most of the day would not consume much of the softened tap water. Sodium intake is not a specific concern in pregnancy.

DIF:Cognitive Level: ApplyingREFage 130 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. Interstitial fluid is the body fluid a.

within the cells.

b.

outside the cells.

c.

between the cells.

d.

in the bloodstream.

ANS: C Interstitial fluid is the body fluid between the cells. The fluid within the cells is intracellular fluid; the fluid outside the cells is extracellular fluid; the fluid in the bloodstream is blood plasma.

DIF:Cognitive Level: RememberingREFage 131 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. Dehydration is most likely to have a negative effect on a.

digestion of food.

b.

storage of excess energy.

c.

nerve impulse conduction.

d.

body temperature regulation.

ANS: D Within the body, water helps to regulate body temperature by absorbing and distributing heat throughout the body and through perspiration. Digestion of food requires secretion of digestive fluids, but this is less immediately affected by dehydration. Water is not needed to store excess energy in adipose tissue. Water is not important for this conduction of nerve impulses.

DIF:Cognitive Level: ApplyingREFages 131-132 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. It would be most difficult for the body to maintain homeostasis if over several days someone had an inadequate intake of

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a.

calcium.

b.

sodium.

c.

iron.

d. fluoride.

ANS: B Homeostasis is maintenance of physiologic equilibrium within the body. All of these minerals help maintain homeostasis, but inadequate intake of sodium over just a few days would have the most effect. Sodium is an electrolyte and is important for maintaining fluid balance in the body.

If calcium intake is inadequate, the body can draw on reserves in bone; if iron intake is inadequate, the body has some reserves in the spleen, and so body homeostasis would not be affected unless the deficiency continued long term. Fluoride deficiency may cause dental caries and may affect bone density, but this is also a long-term effect and would not affect the body over a few days.

DIF:Cognitive Level: Applying REFage 133 | Page 138 | Page 142 | Page 147 | Page 151 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. If an athlete ran a marathon, sweated profusely, and drank only water with some sugar to replace fluids and carbohydrate, his or her body would increase secretion of a.

adrenaline.

b.

aldosterone.

c.

alanine.

d.

antidiuretic hormone (ADH).

ANS: B The body would respond to loss of sodium in sweat by releasing the hormone aldosterone; this would prompt the kidney to decrease sodium excretion. During a marathon, the body may produce adrenaline in response to stress, but this would not address the problem of fluid and energy replacement without sodium replacement. Alanine is an amino acid and has no effect on sodium balance. ADH causes the kidneys to decrease water excretion but does not affect sodium excretion.

DIF:Cognitive Level: AnalyzingREFage 133 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. If a patient complained of muscle weakness, confusion, decreased appetite, and irregular heartbeat, it would be important to check blood levels of a.

sodium.

b.

calcium.

c.

potassium.

d.

magnesium.

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ANS: C These symptoms are typical of a possible blood potassium level that is either too low or too high; both conditions can be very dangerous. Low sodium levels cause headache, muscle cramps, weakness, reduced ability to concentrate, and loss of memory and appetite; high sodium levels may cause edema and hypertension. High calcium levels cause weakness, lack of energy, poor appetite, nausea and vomiting, constipation, or bone pain; low blood calcium levels cause muscle cramps, spasms, and twitching and tingling in the fingers and around the mouth. Symptoms of magnesium deficiency include twitching of muscles, muscle weakness, and convulsions; symptoms of magnesium overload are long-term diarrhea and dehydration.

DIF: Cognitive Level: Applying REF: Page 143 | Pages 145-146 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. In an older adult who is usually very alert, disorientation may be a sign of a.

iron deficiency.

b.

malnutrition.

c.

edema.

d.

dehydration.

ANS: D Disorientation may be a sign of dehydration, which is common in older adults, partly because their thirst mechanism is diminished. Iron deficiency anemia causes fatigue but not disorientation. Severe malnutrition may affect mental acuity but is less likely than dehydration to cause acute disorientation. Edema causes swelling but does not usually affect orientation.

DIF: Cognitive Level: Applying REF: Pages 133-134 | Pages 148-149 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. If an elderly client who lives alone and has a limited income has edema, it would be important to evaluate his or her dietary intake of sodium and a.

protein.

b.

calcium.

c.

chloride.

d.

potassium.

ANS: A Edema may be caused by high intake of sodium or inadequate intake of protein if protein levels in the body become so low that cellular fluid levels become imbalanced. Edema is not related to dietary intake of calcium, chloride, or potassium.

DIF:Cognitive Level: ApplyingREFage 144 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. The term bioavailability means the

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a .

total amount of a mineral in a food.

b .

ratio of free mineral to bound mineral in a food.

c .

amount of a mineral that is excreted by the body.

d amount of a mineral that can be absorbed by the body from a food. .

ANS: D Bioavailability is the amount of a mineral that can be absorbed by the body from a food. It is generally lower than the total amount of the mineral in a food. It may be related to the ratio of free mineral to bound mineral in a food, but that is only one of many factors affecting bioavailability. It is not related to the amount excreted by the body.

Chapter 9. The Fat-Soluble Vitamins MULTIPLE CHOICE 1. For a compound to be classified as a vitamin, it must a. be synthesized by the body. b. be required in large quantities. c. perform a vital function. d. be water soluble.

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 97 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. Spinach, carrots, and sweet potatoes are good sources of a. beta-carotene. b. vitamin A. c. vitamin D. d. vitamin E. ANS: A Carotene is a group name of three red and yellow pigments (alpha-, beta-, and gamma-carotene) found in dark green and yellow vegetables and some fruits. The body converts beta-carotene to vitamin A. DIF: Cognitive Level: Application REF: 98-99 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Liver is a rich source of a. vitamin A (retinol). b. vitamin C. c. vitamin D. d. vitamin E. ANS: A Liver is a rich source of preformed, natural vitamin A. Other sources include fish liver oils, egg yolk, butter, and cream.

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

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

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

ANS: D Night blindness results from a deficiency of vitamin A. Vitamin A helps form the visual pigment rhodopsin in the eye. Retinol, the name given to vitamin A, is an essential part of rhodopsin,

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commonly known as visual purple. This light-sensitive substance enables the eye to adjust to the different amounts of available light.

DIF: Cognitive Level: Knowledge REF: 97 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. Fish liver oils are a good source of a. vitamin D. b. vitamin E. c. protein. d. iron.

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

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

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

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

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

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

ANS: A

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

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 101 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. Recommended intakes for vitamin D are difficult to establish because a. exposure to sunlight varies. b. it is present in so many foods.

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c. the body stores such large amounts. d. the amount in food varies with the season.

ANS: A Recommended intakes for vitamin D are difficult to establish because of its unique hormone-like nature, difference in exposure to sun (affected by time spent outside and climate), and limited food sources.

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

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

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

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

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

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

ANS: C Vitamin E protects membranes by acting as natures most potent fat-soluble antioxidant. The polyunsaturated fatty acids in lipid membranes are easy for oxygen to break down, and vitamin E

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can interrupt this oxidation and protect the fatty acids of the cell membrane from damage.

DIF: Cognitive Level: Knowledge REF: 102 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. The fat-soluble vitamin responsible for the synthesis of blood-clotting factors by the liver is vitamin a. A. b. D. c. E. d. K. ANS: D The basic function of vitamin K is in the blood-clotting process. The most known vitamin Kdependent blood factor is prothrombin.

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 100 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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24. There is a metabolic partnership between vitamin E and a. zinc. b. chromium. c. selenium. d. iron.

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

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

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

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

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

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

The cells of smooth muscle and secretory glands must have energy to perform their work, and

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thiamin is a necessary agent for producing that energy.

DIF: Cognitive Level: Knowledge REF: 108 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. The vitamin that is destroyed by light is a. vitamin C. b. niacin. c. riboflavin. d. biotin.

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

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

ANS: A Milk is the major source of riboflavin.

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

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

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

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

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

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b. phenylalanine. c. tryptophan. d. valine.

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

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

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

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

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

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

DIF: Cognitive Level: Application REF: 124 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Wellness 36. The person most at risk for vitamin D deficiency is a a. 12-year-old girl who plays soccer at the local playground twice a week. b. 28-year-old mother who breastfeeds her 5-month-old infant and takes a daily stroll in the

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neighborhood. c. 62-year-old woman who lives in a cold climate and rarely goes outdoors. d. 42-year-old man who plays golf once a week.

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 107 TOP: Nursing Process: Diagnosis

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MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 41. A 62-year-old woman who smokes one pack of cigarettes a day and whose food intake records reveal a minimal intake of vitamin C foods may be at risk for a. easy bruising and pinpoint hemorrhages. b. cracked and bleeding lips. c. fevers and infections. d. neurologic disorders.

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Application REF: 120 TOP: Nursing Process: Planning

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MSC: NCLEX: Physiological Integrity: Physiological Adaptation 45. A young woman who is interested in becoming pregnant should be counseled on healthy eating choices, especially regarding folate-containing foods, which may help prevent a. neural tube defects. b. osteomalacia. c. pernicious anemia. d. aplastic anemia.

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

Chapter 10. Water and the Electrolytes 1. Long-term dietary calcium intake has the greatest effect on a.

body temperature.

b.

muscular strength.

c.

bone calcium levels.

d.

blood calcium levels.

ANS: C Long-term dietary calcium intake affects bone calcium levels. Calcium does not affect body temperature. The body maintains steady levels of calcium in the blood and muscles, using calcium from bone if dietary intake is insufficient.

DIF:Cognitive Level: UnderstandingREFages 138-142 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. If people want to maximize their absorption of calcium, they should avoid drinking a.

tea.

b.

milk.

c.

orange juice.

d.

bottled water.

ANS: A Tea contains oxalic acid and tannins, both of which decrease absorption of calcium. Milk contains lactose and vitamin D, which increase calcium absorption. Orange juice and bottled water do not have a significant positive or negative effect on calcium absorption.

DIF:Cognitive Level: ApplyingREFages 140-142 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 3. Lifestyle changes that may help prevent development of osteoporosis include a .

reducing intake of animal protein.

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b .

eating a piece of fruit with lunch every day.

c .

taking a daily multivitamin supplement with adequate amounts of calcium and vitamin D.

d taking a 30-minute walk most days. .

ANS: D Taking a 30-minute walk most days may help prevent development of osteoporosis because regular exercise stimulates an increase in bone density. Eating vegetable versus animal protein, increasing intake of fruit, and use of multivitamin supplements with adequate amounts of calcium and vitamin D are unlikely to prevent osteoporosis (although they may have other health benefits).

DIF:Cognitive Level: ApplyingREFages 140-142 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 4. An example of a food with high levels of phosphorus is a.

rice.

b.

carrots.

c.

cheese.

d.

bananas.

ANS: C Foods high in phosphorus include dairy foods (such as cheese). Many processed convenience foods and soft drinks also contain phosphorus as additives. Fruits, vegetables, and rice are not good sources of phosphorus.

DIF: Cognitive Level: Applying REF: Pages 142-143 | Page 147 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. A good source of calcium for someone who follows a strict vegetarian (i.e., vegan) diet would be a.

coconut milk.

b.

a bean burrito.

c.

skim milk.

d.

pasta salad.

ANS: B A good vegan source of calcium is a bean burrito because legumes contain calcium. Coconut milk and pasta salad are not good sources of calcium. Skim milk is not included in a vegan diet.

DIF: Cognitive Level: Applying REF: Pages 138-142 | Page 147 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance

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6. Secondary magnesium deficiency is most likely to occur in a.

areas where access to fresh fruits and vegetables is limited.

b.

clients with type 1 diabetes mellitus.

c.

association with excessive vomiting and diarrhea.

d.

association with dehydration attributable to heat exposure.

ANS: C Secondary magnesium deficiency may occur with excessive vomiting and diarrhea. Primary magnesium deficiency is rare; deficiency is not usually related to poor intake, and fruits and vegetables are not the only good sources of magnesium. Type 1 diabetes and dehydration due to heat exposure do not cause magnesium deficiency.

DIF: Cognitive Level: Applying REF: Pages 133-134 | Page 143 | Page 147 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. Of the following, the food choice that contains the least sodium is a.

cornbread.

b.

corn tortilla.

c.

corn on the cob.

d.

buttered popcorn.

ANS: C The food choice that contains the least sodium is corn on the cob. Of all these forms of corn, this is the least processed. Food processing usually involves addition of sodium.

DIF:Cognitive Level: ApplyingREFages 144-145 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 8. A sodium intake of 2100 mg daily by a healthy adult would be considered a.

below the adequate intake (AI).

b.

within the recommended range.

c.

below the maximum recommended level.

d.

above the maximum recommended level.

ANS: C A sodium intake of 2100 mg daily is below the maximum level recommended by the National Research Council (2400 mg/day) and the American Heart Association (2300 mg/day). The AI is 1500 mg. There is no recommended range for sodium intake, just the AI and upper limits.

DIF:Cognitive Level: ApplyingREFages 144-145 TOP:Nursing Process: Assessment| Nursing Process: Evaluation MSC: Client Needs: Health promotion and maintenance 9. A family with three young children has limited income, relies on public transportation, and has

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just moved into a very old apartment complex with old plumbing and lead pipes. The best recommendation to minimize lead exposure would be to a .

use only bottled water.

b .

run the tap water for 2 minutes before using it.

c .

boil the tap water for 2 minutes before using it.

d .

use only hot water for drinking, cooking, and preparing food.

ANS: B The best recommendation would be to run the tap water for 2 minutes before using it, so that any water sitting in the pipes that may have absorbed lead would not be used. Using bottled water is not practical for a family with limited income who uses public transportation. Boiling the water would not remove the lead and would actually concentrate it. Hot water would dissolve more lead; in fact, only cold water should be used.

DIF:Cognitive Level: AnalyzingREFage 130 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 10. If someone took a 6-hour car ride in an air-conditioned vehicle without making any bathroom stops, they weigh less at the end of the trip than at the beginning because a.

of insensible fluid losses from the skin and lungs.

b.

body fat stores would be metabolized for energy.

c.

muscle mass would be lost.

d.

fluid would be lost through sweating.

ANS: A Even in an air-conditioned vehicle, the body still loses fluid through the skin and lungs. The person would not lose significant amounts of sweat in an air-conditioned vehicle. A small but fairly insignificant amount of body fat would be metabolized. Muscle mass would be lost only if the driver were inactive or had low protein or carbohydrate intake over several days.

DIF:Cognitive Level: ApplyingREFage 132 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 1. The main reason that young women require more dietary iron than young men is a.

that they absorb iron less efficiently.

b.

to compensate for their lower muscle mass.

c.

to replace blood losses during menstruation.

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d. that they recycle hemoglobin more rapidly.

ANS: C Young women require more dietary iron than young men to replace blood losses during menstruation. There is no difference between iron absorption or hemoglobin recycling in young men versus young women. Higher iron intake does not compensate for lower muscle mass in women.

DIF:Cognitive Level: UnderstandingREFages 148-149 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 2. The most easily absorbed form of iron is found in a.

a grilled pork chop.

b.

tomatoes cooked in an iron skillet.

c.

collard greens cooked with bacon.

d.

spinach salad with strawberries.

ANS: A Heme iron is absorbed most easily; it is found in animal foods, such as pork. Cooking an acidic food such as tomatoes in an iron skillet would increase the iron content, but the iron would be nonheme, which is less well absorbed than heme iron. Similarly, the vitamin C in the strawberries would increase the absorption of the iron in the spinach, but it is still the nonheme form that is less well absorbed. Bacon may contribute a very small amount of heme iron to the collard greens, but it would be much less than the pork chop.

DIF:Cognitive Level: ApplyingREFage 148 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 3. The first signal that the body needs fluid is a.

dark, concentrated urine.

b.

the sensation of hunger.

c.

the sensation of thirst.

d.

headache.

ANS: C The body signals its need for fluid via the sensation of thirst, a dryness in the mouth. Dark, concentrated urine also indicates a need for fluid, and headache may also be caused by dehydration, but these symptoms occur later than thirst, at a time when the bodys need for fluid is much greater. Hunger is a signal that the body needs food, not fluid.

DIF:Cognitive Level: ApplyingREFage 133 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 4. Hemosiderosis, storage of too much iron in the body, is most likely to occur in a(n)

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a .

man who drinks five or more alcoholic beverages every night.

b .

adolescent who drinks four or more soft drinks daily.

c .

toddler who prefers drinking milk to eating meals.

d pregnant woman who takes iron supplements. .

ANS: A Hemosiderosis is most likely to occur in a man with high alcohol intake. Adolescents who have high intake of soft drinks are likely to have high intake of phosphorus. Toddlers who prefer to drink milk rather than eating meals may develop iron deficiency. Pregnant women who take iron supplements are unlikely to store too much iron because iron needs are very high during pregnancy.

DIF: Cognitive Level: Applying REF: Page 143 | Pages 148-150 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. In countries where the staple food source is unleavened bread made from whole grains, zinc deficiency may be prevented by eating a.

refined grains.

b.

breads with yeast.

c.

fortified grains.

d.

bread in which the grains were soaked before being baked.

ANS: B Zinc deficiency may be prevented by making breads with yeast; the yeast breaks the bond between the zinc and phytic acid, which prevents zinc from being absorbed. Eating refined grains would result in even lower zinc intake; fortification of grains does not include adding zinc; and soaking grains before making bread does not release the zinc from the phytic acid.

DIF:Cognitive Level: ApplyingREFage 150 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 6. The most reliable source of iodine in the United States is a.

seafood.

b.

dairy products.

c.

fortified table salt.

d.

residues of cleaning products.

ANS: C The main source of iodine in the United States is fortified table salt. Seafood is a good source,

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but most Americans do not eat it often enough for it to be their main source of iodine. Dairy products may contain some iodine, depending on the animal that produced them, but they are not reliable sources. Residues of cleaning products may provide some dietary iodine, but the amount is not usually enough to be significant.

DIF:Cognitive Level: ApplyingREFages 150-151 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 7. A client feels constantly tired even though she is getting 8 hours of sleep each night, and she is gaining about 2 lbs a month even though she has not changed her eating habits. You discover that she eats only organic and natural foods and avoids anything that is fortified. She may have a deficiency of a.

iron.

b.

zinc.

c.

potassium.

d.

iodine.

ANS: D Deficiency of iodine causes lethargy and weight gain; the most reliable source of iodine is iodized salt, but if the client avoids fortified foods, she may be avoiding this valuable source.

Iron deficiency would cause anemia and tiredness, but not weight gain. Deficiency of zinc impairs growth, reduces appetite, and causes immunologic disorders. Deficiency of potassium causes muscle weakness, confusion, decreased appetite, and, in severe cases, cardiac dysrhythmias. Foods are not usually fortified with iron, zinc, and potassium, and so avoiding fortified foods would not necessarily affect intake of these nutrients.

DIF: Cognitive Level: Analyzing REF: Page 146 | Pages 148-150 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. Dietary fluoride is important for a.

decreasing staining of teeth.

b.

decreasing sensitivity of teeth.

c.

stimulating production of saliva.

d.

increasing the strength of tooth enamel.

ANS: D Dietary fluoride is important for the strength of tooth enamel. It does not decrease staining or sensitivity of teeth or stimulate production of saliva.

DIF:Cognitive Level: RememberingREFage 173 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 9. Measuring the amount of a mineral in a plant food may not necessarily indicate whether it is a valuable dietary source of that mineral because

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a .

plant foods contain phytates, oxalates, and binders that reduce bioavailability.

b .

plant foods require cooking or processing to make minerals bioavailable.

c .

plants often contain inactive forms of minerals.

d the amount of minerals in plants varies widely, depending on growing . conditions.

ANS: A Plant foods contain phytates, oxalates, and binders that may limit the amount of a mineral that is available to the body, even if it is present in the food. Minerals may become more bioavailable with cooking or processing, but this is not necessarily true. Most minerals do not exist in different forms; they are generally either present or absent. The amount of minerals in plants may vary somewhat depending on the growing conditions, but this is less of a factor than bioavailability.

DIF: Cognitive Level: Applying REF: Page 136 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 10. Wilsons disease is an inherited disorder that causes excessive accumulation of a.

iron.

b.

zinc.

c.

copper.

d.

chromium.

ANS: C Wilsons disease causes excessive accumulation of copper. Excessive accumulation of iron is called hemosiderosis. Excessive accumulations of zinc and chromium do not have specific names.

Chapter 11. Major Minerals and Bone Health & Chapter 12. The Trace Minerals MULTIPLE CHOICE 1. The mineral present in the body in the greatest amount is a. sodium. b. calcium. c. iron. d. chloride.

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

DIF: Cognitive Level: Knowledge REF: 128 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The factors most responsible for regulating calcium absorption from food are

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a. activity and diet. b. dietary intake and vitamin D hormone. c. metabolic rate and cardiovascular function. d. vitamin D hormone, calcitonin, and parathyroid hormone.

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

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

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

DIF: Cognitive Level: Knowledge REF: 132-133 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The person most at risk for developing osteoporosis is a a. 25-year-old woman who plays tennis 3 times a week. b. 35-year-old woman who has sustained multiple trauma and is bedridden. c. 55-year-old woman who exercises 3 times a week and consumes adequate milk and dairy products at least 3 times a day. d. 14-year-old girl who runs track and drink 4 glasses of milk daily.

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

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

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

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

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

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

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

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

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

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

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

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

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c. water inside cells. d. cerebrospinal fluid.

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 137 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. Of the foods below, the one providing the best source of potassium is a. spinach. b. lemonade. c. processed cheese crackers. d. french fries.

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

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Application REF: 146 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. The main dietary source of iodine is a. seafood.

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b. legumes. c. iodized table salt. d. fortified foods.

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

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

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

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

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

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

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

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

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

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

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

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

ANS: B Minerals are chemical elements.

DIF: Cognitive Level: Knowledge REF: 128 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. An example of a lunch high in potassium is a a. hamburger on a bun with sliced tomatoes. b. grilled cheese sandwich and pretzels. c. pasta salad and hard roll. d. bagel with cream cheese and dill pickle.

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

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

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

DIF: Cognitive Level: Application REF: 137

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

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

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

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

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

Chapter 13. Nutrition and Physical Activity MULTIPLE CHOICE 1. The bodys carbohydrate energy reserve consists of a. glucose and fructose. b. sugar and starch. c. glucose and glycogen. d. glycogen and fatty acids.

ANS: C Glucose circulating in the blood and glycogen stores in the muscle cells and liver provide the bodys carbohydrate energy reserve.

DIF: Cognitive Level: Knowledge REF: 319 TOP: Nursing Process: Planning

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MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The most common ergogenic supplement is a. creatine. b. caffeine. c. iron. d. carnitine.

ANS: A Creatine is the most commonly used ergogenic supplement and is considered safe in moderate doses.

DIF: Cognitive Level: Knowledge REF: 326 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. If an athlete exercises for a prolonged period of time, the muscles will become a. atrophied. b. fatigued. c. cramped. d. limp.

ANS: B With prolonged exercise the muscles become fatigued. The nutrient reserves become depleted during continuous exercise; the body burns its fuel stores to meet increasing energy demands and requires replenishing. With prolonged exercise, nutrient levels fall too low to sustain the bodys continued demands. Fatigue follows, and exhaustion may result.

DIF: Cognitive Level: Application REF: 319-320 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The fuel source for short-term energy needs is a. glycogen. b. fatty acids. c. fructose. d. amino acids.

ANS: A The source for short-term energy needs is glycogen stored in muscle cells and the liver.

DIF: Cognitive Level: Knowledge REF: 319 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The most appropriate pregame meal would be a. pasta with cream sauce and apple juice. b. cheese and fruit. c. cereal with skim milk and orange juice. d. a bagel with cream cheese and water.

ANS: C A pregame meal consisting of a bowl of cereal with skim milk and a small glass of orange juice would provide high complex carbohydrates, low little fat, moderate protein, moderate fiber, and approximately 300 kcal.

DIF: Cognitive Level: Application REF: 324 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. Long-term energy needs are provided by

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a. glucose and fatty acids. b. glycogen and fatty acids. c. ascorbic acid and fatty acids. d. glycogen and amino acids.

ANS: A Long-term energy needs are provided by glucose and fatty acids. Fatty acids serve as a fuel source from stored fat tissue. Some glucose is always needed as a fuel source.

DIF: Cognitive Level: Knowledge REF: 320-321 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. For the body to maintain a high level of steady exercise a. there must be ample fat stores. b. there must be sufficient oxygen available to the cells. c. it must revert to an aerobic phase of metabolism. d. energy expenditure must decrease.

ANS: B Sufficient oxygen must be available to cells to maintain a high level of steady exercise. The aerobic capacity depends on two basic factors: (1) the fitness of the lungs, heart, and blood vessels; and (2) body composition.

DIF: Cognitive Level: Knowledge REF: 319 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. To prepare for an athletic event of high endurance, the proper glycogen-loading process is a. intensive workouts and very high intake of complex carbohydrates. b. intensive workouts 2 to 3 times a day and high intake of simple carbohydrates. c. gradual tapering of workouts and increasing carbohydrate intake. d. gradual tapering of workouts and decreasing carbohydrate intake.

ANS: C The current practice of glycogen loading or carbohydrate. It involves a moderate, gradual tapering of exercise while total carbohydrate intake in the diet is increased.

DIF: Cognitive Level: Application REF: 323-325 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. Dehydration is not affected by a. surrounding temperature. b. body fat content. c. level of fitness. d. the pregame or pre-exercise state of hydration.

ANS: B Fluid needs depend on the intensity and duration of exercise, surrounding temperature, altitude, humidity, level of fitness, and the pregame state of hydration. It is not affected by body fat content.

DIF: Cognitive Level: Knowledge REF: 319 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The effect of exercise on blood lipoprotein levels is to a. decrease low-density lipoproteins (LDLs) and decrease high-density lipoproteins (HDLs). b. increase LDLs and increase HDLs. c. increase LDLs and decrease HDLs.

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d. decrease LDLs and increase HDLs. ANS: D Exercise raises blood levels of HDLs because HDL carries surplus cholesterol from the tissues to the liver for breakdown and removal from the body. At the same time as surplus is removed, LDL levels decrease.

DIF: Cognitive Level: Knowledge REF: 314 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. Aerobic capacity is related to a. fitness of the heart and lungs. b. hydration status. c. hormone levels. d. environmental temperature and humidity.

ANS: A Aerobic capacity depends on the fitness of the lungs, heart, and blood vessels as well as body composition.

DIF: Cognitive Level: Knowledge REF: 314|318-319 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The maximal attainable heart rate for a 30-year-old is beats/min. a. 145 b. 165 c. 180 d. 190 ANS: D Rationale: The maximal attainable heart rate is calculated as 220 Age. In this case 220 30 = 190.

DIF: Cognitive Level: Application REF: 318 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. Aerobic capacity is expressed in terms of amount of of body weight per minute. a. water absorbed per kilogram b. oxygen consumed per kilogram c. oxygen consumed per pound d. carbon dioxide produced per kilogram ANS: B Aerobic capacity is expressed in terms of the amount of oxygen consumed per kilogram of body weight per minute. It depends on the fitness of the lungs, heart, and blood vessels as well as body composition.

DIF: Cognitive Level: Knowledge REF: 319 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. A lower proportion of lean body mass to fat is associated with fitness level. a. lower b. greater c. no effect on d. a gradual decline in ANS: A Lower fitness level is associated with a lower proportion of lean body mass to fat. Body tissues

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that are metabolically active comprise the lean body mass, which is mainly muscle mass.

DIF: Cognitive Level: Comprehension REF: 319 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The calories supplied by fat for a person requiring 2200 kcal should not exceed kcal. a. 300 b. 450 c. 770 d. 840 ANS: C The percentage of total daily calories supplied from fat should not be less than 20% or greater than 35%. Thus, 2200 kcal 0.35 = 770 kcal.

DIF: Cognitive Level: Application REF: 322 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 16. A food that would provide significant energy for exercise is a. lean beef. b. ice cream. c. oatmeal. d. spinach.

ANS: C A major nutrient for energy support in exercise is carbohydrate, and oatmeal is a good source of carbohydrate.

DIF: Cognitive Level: Application REF: 320-322 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 17. For an athlete consuming a 3000 kcal diet, the recommended amount of calories from carbohydrate would be a. 800 1050 kcal. b. 950 1250 kcal. c. 1300 1550 kcal. d. 1350 1950 kcal.

ANS: D The percentage of total daily calories from carbohydrate should be approximately 45% to 65%.

3000 kcal x 45% = 1350 kcal. 3000 kcal x 65% = 1950 kcal.

DIF: Cognitive Level: Application REF: 322 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 18. Vitamins and minerals are important in energy production because a. they supply a necessary energy source. b. they speed up energy production. c. more are needed during exercise. d. they are needed as cofactors in enzyme reactions.

ANS: D Vitamins and minerals are important in energy production as cofactors in enzyme reactions.

Increased exercise does not require increased vitamin and minerals.

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DIF: Cognitive Level: Comprehension REF: 321 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 19. A meal that can be beneficial if eaten before athletic competition is a. a cheeseburger with french fries. b. grilled chicken, french fries, and cola. c. whole grain pasta with tomatoes and spinach. d. fried chicken breast, onion rings, and lemonade.

ANS: C A meal before athletic competition should be low fat, low protein, and high complex carbohydrate and consist of approximately 300 kcal. The whole grain pasta with tomatoes and spinach would provide this type of meal.

DIF: Cognitive Level: Application REF: 324 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. The most beneficial rehydration fluid for most types of exercise lasting 1 hour or less is a. water with 1/4 cup sugar and 1 crushed vitamin. b. water with 1 tablespoon salt and lemon flavoring. c. a prepared or commercial solution with electrolytes. d. water with nothing added.

ANS: D Water is the most beneficial fluid for rehydration for most types of exercise.

DIF: Cognitive Level: Application REF: 325 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. For older adults, it is important that a. all adults perform 150 minutes of high-intensity exercise every week. b. adults between the ages of 65-75 be active at least 3 times per week. c. adults be as physically active as condition and ability allows during the week. d. all adults perform aerobic exercise 60 minutes each day of the week.

ANS: C Older adult guidelines follow Healthy People 2020 physical activity unless they cannot perform 150 minutes of moderate-intensity aerobic activity every week. If they cannot exercise at this intensity or for this amount of time, they should be as physically active as abilities and condition allow.

DIF: Cognitive Level: Knowledge REF: 312 TOP: Nursing Process: Intervention MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. Of the following, an activity that would be the most beneficial for a person with diabetes would be a. playing video games 2 hours a day. b. a walking regimen as approved by his or her physician. c. eating fast foods only 3 times per week. d. swimming 10 miles 7 days a week.

ANS: B

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An approved moderate exercise plan can increase the number of insulin receptor sites on cell membranes and is therefore beneficial for persons with diabetes.

DIF: Cognitive Level: Application REF: 316-318 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 23. The feeling of well-being after a vigorous workout may be from the production of a. heat. b. muscle. c. endorphins. d. hormones.

ANS: C Exercise stimulates the production of brain opiates, substances called endorphins. These natural chemicals decrease pain and improve mood, which may include an exhilarating kind of high.

DIF: Cognitive Level: Knowledge REF: 316 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance, Psychosocial Integrity 24. An athlete consumes a light meal of pasta with vegetables, fruit, and yogurt. Before beginning a competitive event, the athlete should wait a. 30 to 60 minutes. b. 1 to 2 hours. c. 2 to 3 hours. d. 3 to 4 hours.

ANS: D An athlete should consume a light meal 3 to 4 hours before a competitive event. This schedule gives the body time to digest, absorb, and transform the meal and to store glycogen.

DIF: Cognitive Level: Application REF: 324 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 25. Some fat in the diet is required to provide a. essential fatty acids. b. sufficient energy for all activities. c. cholesterol for hormone production. d. adequate body fat stores.

ANS: A Some fat in the diet is needed to provide essential fatty acids for the body to function properly.

DIF: Cognitive Level: Knowledge REF: 322 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. A food that may be a good source of iron for female and adolescent athletes is a. ice cream. b. whole milk. c. dried apricots d. apple.

ANS: C Dried fruits such as apricots are a good source of iron. Iron is the mineral that female and

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adolescent athletes may require in increased amounts to meet requirements.

DIF: Cognitive Level: Application REF: 321-322 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 27. Before running 3 miles, an athlete should a. take a 5-minute shower to prevent fatigue. b. perform 25 pushups for muscle strength. c. eat a high protein, high fat meal for energy. d. perform stretching exercises to prevent injury.

ANS: D Stretching is important to prevent stress or injury to the body. Time to cool down afterwards also is necessary.

DIF: Cognitive Level: Application REF: 318 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential 28. An appropriate amount of exercise for a 12-year-old would be a. no more than 15 minutes of stretching per day. b. at least 20 minutes of physical activity per week. c. at least 60 minutes of physical activity per day. d. no more than 30 minutes of physical activity every other day.

ANS: C Children and adolescents should do 60 minutes (1 hour) or more of physical activity per day.

Chapter 14. Nutrition During Pregnancy and Lactation MULTIPLE CHOICE 1. Nutritional needs during pregnancy are affected by a. the mothers age. b. the sex of the infant. c. the mothers food cravings. d. whether the mother works.

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

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

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

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the average adult requirement.

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

DIF: Cognitive Level: Knowledge REF: 174 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 4. The amount of extra protein required by pregnant women compared with nonpregnant women is approximately g/day. a. 10 b. 15 c. 25 d. 30 ANS: C Protein intake should increase 25 g/day during pregnancy on top of nonpregnancy needs. This increase is approximately 50% more than the average adult requirements.

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

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

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

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d. baked beans.

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

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

DIF: Cognitive Level: Knowledge REF: 175-176 TOP: Nursing Process: Application MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 8. Iron needs increase during pregnancy because of a. maternal constipation. b. increased maternal blood volume. c. increased maternal metabolic rate. d. poor iron absorption during pregnancy.

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

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

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

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

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c. the vitamins are excreted in greater quantities. d. metabolic activities increase.

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

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

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

DIF: Cognitive Level: Knowledge REF: 176-177 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. Drinking 3 to 4 cups of milk a day during pregnancy is recommended because it is a good source of a. folate. b. iron. c. vitamin D. d. vitamin C. ANS: C Milk is a good source of vitamin D along with calcium, phosphorus, and magnesium for fetal development of bones and teeth as well as for the mothers own bodily needs.

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

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

DIF: Cognitive Level: Application REF: 179-180 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

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14. A condition of severe, prolonged, and persistent vomiting during pregnancy is called a. hyperemesis gravidarum. b. placenta previa. c. gestational diabetes. d. preeclampsia.

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

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

ANS: D Helpful remedies for constipation include high-fiber foods such as whole grains, vegetables, dried fruits, and other fruits and juices.

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

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

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

DIF: Cognitive Level: Knowledge REF: 177-178 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

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Maintenance 18. A pregnancy is considered high risk if the mother a. is 16 years old. b. is vegetarian. c. works full time. d. exercises 4 or 5 times per week.

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

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

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

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

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

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

ANS: C

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

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

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

DIF: Cognitive Level: Knowledge REF: 175-176 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Of the following, the best source of folate would be a. fruit juices. b. green leafy vegetables. c. whole grains. d. citrus fruits.

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

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

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

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

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c. alcoholism. d. gestational diabetes.

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

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 190-191 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 29. During pregnancy, intake of caffeine for a 132-lb woman should be

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a. avoided. b. limited to 100 mg of coffee per day. c. limited to 300 mg of coffee per day. d. unlimited in quantity.

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

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

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

Chapter 15. Nutrition from Infancy to Adolescence MULTIPLE CHOICE 1. At birth, the reflexes an infant has are a. rooting, biting, and swallowing. b. sucking, munching, and swallowing. c. rooting, sucking, and swallowing. d. grasping, sucking, and gagging.

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

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

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

DIF: Cognitive Level: Knowledge REF: 206 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

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3. The phase that shows the most erratic growth is a. infancy. b. childhood. c. adolescence. d. adulthood.

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

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

ANS: D Growth charts are an assessment tool for measuring normal growth patterns in infants, children, and adolescents. These charts are based on large numbers of well-nourished children representing the national population.

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

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

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

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

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

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

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

DIF: Cognitive Level: Application REF: 198 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 8. An 8-month-old infant who receives approximately 0.4 L of fluid per day is meeting a. 200% of fluid needs per day. b. 100% of fluid needs per day. c. 75% of fluid needs per day. d. 50% of fluid needs per day.

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

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

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

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

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

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with bone and tooth development.

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

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

DIF: Cognitive Level: Application REF: 201 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. Hypervitaminosis of vitamins A or D is most likely to occur because of a. excessive milk intake. b. overexposure to the sun. c. overuse of vitamin supplements. d. inadequate intake of vegetables and fruits.

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

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

The feeding process influences positive growth.

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

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d. 3500 grams.

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

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

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

DIF: Cognitive Level: Application REF: 205 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 16. The ideal first food for newborns is a. infant formula. b. cows milk. c. breast milk. d. rice cereal.

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

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

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

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

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d. 12 ANS: B The recommended practice is to introduce solid foods at approximately 6 months of age.

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

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

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

DIF: Cognitive Level: Knowledge REF: 204 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 20. A type of feeding not recommended for infants during the early months is a. breast milk. b. amino acid-based formula. c. soy-based formula. d. cows milk.

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

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

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

Children can ask for seconds if they are still hungry.

DIF: Cognitive Level: Application REF: 208-209 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 22. Failure to thrive may be caused by a. early sitting and crawling.

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b. sleeping with a bottle. c. overuse of vitamin supplements. d. overdilution of formula.

ANS: D Diluting formula provides fluid without adequate nutrients.

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

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

DIF: Cognitive Level: Knowledge REF: 206 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 24. During the school-age years, the rate of growth a. increases rapidly. b. is slow and irregular. c. increases slowly. d. is similar to that during the preschool years.

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

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

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

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

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d. they tend to be overzealous in following low-fat eating patterns.

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

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 206 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. Effective strategies for weight management in children include a. regular physical activity.

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b. counting calorie intake. c. eliminating snacks. d. eliminating fried foods.

Ans A. Chapter 16 Nutrition and Aging: The Adult Years MULTIPLE CHOICE 1. John is a 34-year-old who is active in his community coaching football. He was also recently promoted to a director level position at this job. John is in adulthood. a. young b. young and middle c. middle d. older ANS: A Young adulthood is between the ages of 20 and 44 years. Physical maturity and independence are apparent with the ability to form new relationships, adopt new roles, and make many more choices regarding lifestyle.

DIF: Cognitive Level: Application REF: 220 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 2. A 42-year-old who makes independent decisions regarding who to marry and what type of family is desired is considered to be making what type of choices? a. independent b. dependent c. wealthy d. introspective ANS: A Young adults between the ages of 20 and 44 years are independent in making choices regarding relationships, careers, jobs, marriage, and family.

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

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

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a. childhood. b. early adulthood. c. middle adulthood. d. older adulthood.

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

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

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

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

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

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

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

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

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

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d. 5% to 8%.

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

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

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

DIF: Cognitive Level: Application REF: 226-227 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. A 65-year-old patients ideal body weight is 115 lbs and on the yearly physical for the past 2 years reveals a recorded weight of 121 lbs. The assessment for this patient would be which of the following? a. slightly underweight b. close to ideal body weight c. slightly overweight d. maintained constant weight ANS: B The assessment is close to ideal body weight. Ongoing review of body mass index indicates that weight ranges in the older adult associated with longer life are not necessarily the desirable weights given, but weights 10% to 25% greater. Thus thin older adults, rather than those of moderate weight, have a reduced life expectancy.

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

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

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

DIF: Cognitive Level: Application REF: 222 TOP: Nursing Process: Assessment|Nursing Process: Planning

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MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 12. The older adults diet should include adequate carbohydrates to a. provide a substrate for vitamins and minerals. b. support normal brain function. c. provide building material for muscle mass. d. maintain blood glucose level.

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

DIF: Cognitive Level: Knowledge REF: 222 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 13. It may be advisable for an older adult to take a vitamin or mineral supplement a. daily. b. weekly. c. if he or she has been ill. d. if he or she is under stress.

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

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

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

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

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

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 229 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

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Maintenance 20. The congregate meal for seniors is a. breakfast. b. the noon meal. c. the evening meal. d. decided by the center.

ANS: B Congregate meals provide the noon meal.

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

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

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

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

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

DIF: Cognitive Level: Comprehension REF: 226 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. Factors that influence the nutrition needs of young adults include

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a. growth. b. climate. c. personality type. d. physical activity.

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

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

ANS: A Feeding older adults with sensitivity helps them achieve adequate intake. Giving sufficient time to chew and swallow is important while feeding adults with sensitivity.

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 226 TOP: Nursing Process: Assessment|Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and

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Maintenance 28. Examples of foods high in nutrients that help prevent osteoporosis are a. cottage cheese and oranges. b. yogurt and canned salmon. c. oatmeal and green leafy vegetables. d. broccoli and liver.

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

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

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

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

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

Chapter 17. Food Safety MULTIPLE CHOICE 1. Promoting a health care service that improves diabetes management for the elderly in a community would assist in which of the following? a. supporting the National Health Goals-Healthy People 2020 b. reducing world hunger in the United States and Asia c. improving Medicare reimbursement claims d. providing access to child care services for children ANS: A Healthy People 2020 has a wide influence and is the focus of the nations main objective to promote health and prevent disease.

DIF: Cognitive Level: Application REF: 3-Feb TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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2. A patient requires a nutrition assessment. The most appropriate professional to perform the assessment is a a. physician. b. nurse. c. public health nutritionist. d. registered dietitian.

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

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

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

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

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

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

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

DIF: Cognitive Level: Comprehension REF: 4

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

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

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

DIF: Cognitive Level: Knowledge REF: 4 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The number of kilocalories provided by one slice of bread that contains 30 g carbohydrate, 3 g protein, and 1 g fat is kcal. a. 34 b. 136 c. 141 d. 306 ANS: C Calculate as follows: Carbohydrate provides 4 kcal/g, protein provides 4 kcal/g, and fat provides 9 kcal/g. Therefore: 30 g carbohydrate 4 kcal/g = 120 kcal 3 g protein 4 kcal/g = 12 kcal 1 g fat 9 kcal/g = 9 kcal = 141 total kcal (120 kcal + 12 kcal + 9 kcal) DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The number of kilocalories from fat in a sandwich that contains 22 g fat is kcal. a. 88 b. 132 c. 154 d. 198

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ANS: C Fat provides 9 kcal/g. Thus, 22 g fat 9 kcal/g = 198 kcal.

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

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 5 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. Mr. Katz, who is 48 years old, is admitted to the hospital with a fracture to his left hip. He weighs 248 lb (54 lb above his desired weight). He is considered to be in a state of overnutrition.

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

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Knowledge REF: 7-Jun TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. When not enough scientific evidence is available to establish a Recommended Dietary Allowance (RDA), the value used to guide intake is called the

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a. Dietary Reference Intake (DRI). b. tolerable upper intake level (UL). c. estimated average requirement (EAR). d. adequate intake (AI).

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

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

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

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

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

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

ANS: A

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

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

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

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

DIF: Cognitive Level: Application REF: 4 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance: Physiological Integrity, Physiological Adaptation 27. A patient is placed on a 2300-kcal diet. The health care provider is asked to calculate the grams of carbohydrates he is receiving from the diet. The number of grams of carbohydrates is a. 50 g. b. 35 g. c. 250 g. d. impossible to calculate from this data.

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

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

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

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

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

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

DIF: Cognitive Level: Application REF: 6-May TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. C.G. is a 45-year-old man who has a history of diabetes, and the dietary history reveals that he enjoys a good breakfast with whole grain cereal and fruit. For lunch he usually eats soup or an entre consisting of a salad and meat along with 2% milk and a sugared soda. He usually has an afternoon snack of chips and sugared soda and dinner is eaten at a restaurant most days of the week where he chooses steaks, hamburgers, and fries or onion rings along with a salad and a beer or other high- calorie beverage. One of the most important recommendations for C.G. would be a. not to eat at restaurants on a regular basis unless he chooses salads only along with water.

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b. to continue with whole grains, lean proteins, and vegetables and replace sugary sodas with sugar-free beverages. c. to drink skim milk and eliminate soups, replacing them with fatty fish five meals a week. d. to enjoy his diet as is but encourage adequate amounts of exercise throughout the week.

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

Chapter 18. World Hunger and Malnutrition MULTIPLE CHOICE 1. One of the most common deficiencies in the world is deficiency. a. zinc b. biotin c. iron d. ascorbic acid ANS: C Iron-deficiency, protein-energy malnutrition, vitamin A deficiency, and iodine deficiency are the most common deficiencies in the world today.

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

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

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

ANS: C Organic farming methods use natural means of pest control and meet the standards set by the

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U.S. Department of Agriculture National Organic Program. Organic foods are grown without the use of synthetic pesticides or fertilizers, sewage sludge, or ionizing radiation.

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

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

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

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

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

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

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

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

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

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

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

DIF: Cognitive Level: Comprehension REF: 245 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 11. Hazard Analysis and Critical Control Point (HACCP) food safety systems a. include testing to ensure that food will not cause food-borne illness. b. allow food safety inspectors to critique food production without visiting the site. c. can be used only in restaurants and food-service facilities. d. help prevent food-borne illness by controlling specific aspects of food production.

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

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

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

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

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

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

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

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

ANS: A

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

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

ANS: C Thorough cooking kills parasites in meats.

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

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

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

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

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

ANS: D

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

DIF: Cognitive Level: Knowledge REF: 259-260 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 20. Nutrition programs established by the government for the elderly include a. Share a Meal. b. Drive-Through Meals. c. Congregate Meals Program. d. Nutrition Supplements Program.

ANS: C Congregate meals are provided by the Nutrition Services Incentive Program.

DIF: Cognitive Level: Knowledge REF: 260 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 21. To increase shelf life, which of the following may be treated by irradiation? a. apples b. yogurt c. hotdogs d. milk ANS: A Fresh produce such as apples may be irradiated to increase shelf life. Irradiation can kill bacteria and parasites on food after harvest.

DIF: Cognitive Level: Application REF: 245 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 22. Standard information on the Nutrition Facts panel on a food label includes a. serving size. b. cooking instructions. c. whether the product is kosher. d. total calories per container.

ANS: A Food labels contain a Nutrition Facts panel that lists the amount of nutrients in a standard serving of food along with kilocalories from fat, percentage of daily values, number of kilocalories per gram of fat, carbohydrates, and protein.

DIF: Cognitive Level: Application REF: 239-241 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 23. If a food has a label description of low cholesterol, it must also be low in a. sodium. b. calories. c. saturated fat. d. total fat.

ANS: C

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Foods described as low cholesterol must also be low in saturated fat.

DIF: Cognitive Level: Application REF: 241 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 24. A microorganism that can live and grow without oxygen is called a. aerobic. b. anaerobic. c. antioxidant. d. antibiotic.

ANS: B Anaerobic means that a microorganism can live and grow in an oxygen-free environment.

DIF: Cognitive Level: Knowledge REF: 252 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 25. Someone who has flu-like symptoms (severe diarrhea, fever, and headache) 3 days after attending a catered event probably has a. influenza. b. a food-borne infection. c. bacterial food poisoning. d. heavy metal poisoning.

ANS: B A food-borne infection presents with flu-like symptoms and is caused by the ingestion of food that is heavily contaminated with bacteria.

DIF: Cognitive Level: Application REF: 250 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. Most food-related hazards to consumers are caused by a. food-borne illness. b. overuse of additives. c. contamination of foods with pesticides. d. eating fish from contaminated water.

ANS: A Most food-related hazards to consumers are caused by food-borne illness, which causes a high incidence of illness and death.

DIF: Cognitive Level: Application REF: 245|247 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 27. A food item that is a particularly effective carrier of Staphylococcal food poisoning is a. potato salad. b. an apple. c. sweet potato. d. a soda cracker.

ANS: A Staphylococcal food poisoning often is caused by food handlers with infected cuts. Therefore foods that require handling during preparation, such as chopping potatoes, are more likely to be contaminated. Foods that are particularly effective carriers for staphylococci and their toxins

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include custard or cream-filled bakery goods, processed meats, ham, tongue, cheese, ice cream, potato salad, sauces, chicken and ham salads, and combination dishes.

DIF: Cognitive Level: Application REF: 251-252 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 28. A food item that contains lecithin is a. baking soda. b. ice cream. c. baked potato. d. whole wheat bread.

ANS: B Lecithin is a food additive that acts as an emulsifier in dairy products.

DIF: Cognitive Level: Application REF: 246 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 29. A health claim allowed by the Food and Drug Administration would be a. low sodium and the prevention of hypertension. b. a low-carbohydrate diet and the prevention of obesity. c. supplemental vitamin A and the prevention of osteoporosis. d. high protein intake and an increased risk of cancer.

ANS: A The Food and Drug Administration guidelines indicate that any health claim on a label must be supported by substantial scientific evidence. Low sodium and the prevention of hypertension is supported by established evidence.

DIF: Cognitive Level: Knowledge REF: 240-241 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance 30. An example of a food covered by a Women, Infants, and Children (WIC) voucher would be a. lemonade. b. fortified cereal. c. popsicles. d. chocolate chip cookies.

ANS: B Foods covered with issued vouchers include milk, eggs, cheese, juice, fortified cereals, fruits, vegetables, and infant formulas.

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