Nutritional Foundations And Clinical Applications 7th Edition By Michele Grodner, Sylvia Escott-Stum

TEST BANK FOR Nutritional Foundations and Clinical Applications: A Nursing Approach 7th Edition Author: Michele Grodner, Sylvia Escott-Stump, Suzanne Dorner

Table of Content Chapter 01: Wellness Nutrition Chapter 02: Personal and Community Nutrition Chapter 03: Digestion, Absorption, and Metabolism Chapter 04: Carbohydrates Chapter 05: Fats Chapter 06: Protein Chapter 07: Vitamins Chapter 08: Water and Minerals Chapter 09: Energy, Weight, and Fitness Chapter 10: Nutrition Across the Life Span Chapter 11: Nutrition Assessment and Patient Care Chapter 12: Food-Related Issues Chapter 13: Nutrition for Disorders of the Gastrointestinal Tract Chapter 14: Nutrition for Disorders of the Liver, Gallbladder, and Pancreas Chapter 15: Nutrition for Diabetes Mellitus Chapter 16: Nutrition in Metabolic Stress: Burns, Trauma, and Surgery Chapter 17: Nutrition for Cardiopulmonary Diseases Chapter 18: Nutrition for Diseases of the Kidneys Chapter 19: Nutrition for Neuro-Psychiatric Disorders Chapter 20: Nutrition in Cancer and HIV/AIDS

Chapter 01: Wellness Nutrition Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition 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.

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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 person’s level of health through development of each of the six dimensions of health: physical health, intellectual health, emotional health, social health, spiritual health, and environmental health. Exercise and eating a healthy 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: Analyzing

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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: A Poor eating habits affect emotional health. Missing meals may cause blood sugar levels to decrease, which can cause anxiety or confusion or make 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: Analyzing

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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 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.

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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.

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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 to 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 is used to promote behavior change.

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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: Understanding REF: Page 5 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.

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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.

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.

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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.

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11. A nutrient that can be made by the body is called a. essential. b. complete.

TOP: Nursing Process: Planning

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: Remembering

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12. A client exercises regularly and wants to make sure that 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. 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 to play important structural and functional roles. Water and minerals are important for health but do not provide fuel for energy.

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13. A 45-year-old man tells you that he drinks 3 ounce 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 ounce of whiskey per day is considered moderate alcohol intake.

DIF: Cognitive Level: Analyzing

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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/g, 15 g of fat provides 135 kcal. At 4 kcal/g, 4 g of protein provides 16 kcals. At 4 kcal/g, 30 g of carbohydrate provides 120 kcal. At 7 kcal/g, 5 g of alcohol provides 35 kcal.

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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. d. 162.

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

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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: Remembering

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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 man’s 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.

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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. 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.

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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 nation’s 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.

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20. In working with an 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 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.

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21. A client has heard that nutrients can be converted to other nutrients in the body. He takes highdose vitamin C supplements because he believes this will supply his body’s 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 are compounds that indirectly assist other nutrients through the complete processes of digestion, absorption, metabolism, and excretion. 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.

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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 children’s 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 family’s health. Many professional women have at least some understanding of healthy eating. With a professional job, lack of income is not very likely to be a barrier to healthy eating.

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23. A class of nutrients that is important in body structure and influences the function of muscles and the central nervous system is a. proteins. b. minerals. c. vitamins. d. carbohydrates.

ANS: B Minerals are important in body structures and influence the function of muscles and the central nervous system. Proteins are structural components and form part of muscles but are less influential in the central nervous system. Vitamins and carbohydrates do not have structural functions.

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24. If mine workers were trapped in a mine and it took several days for a rescue team to reach them, the nutrient that they would need most in order to survive is a. protein. b. carbohydrates. c. water. d. vitamins.

ANS: C The body can survive only a few days without water. The body may not function optimally without other nutrients, but it can survive many days and even weeks without them.

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25. The client who would benefit most from an increase in dietary fiber intake is one with a. fatigue. b. constipation. c. dehydration. d. coronary heart disease.

ANS: B Adequate dietary fiber and fluid intake can help alleviate constipation. It has a small but less significant effect in helping reduce risk of coronary heart disease. Dietary fiber intake does not affect fatigue or hydration status.

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26. To provide adequate amounts of vitamins and minerals, the best course of action is to

a. lose weight to achieve ideal body weight. b. eat a variety of foods from each food group. c. follow the same general food pattern each day. d. consume foods high in fiber and low in saturated fat.

ANS: B Including a variety of foods from each food group increases the likelihood of obtaining adequate amounts of vitamins and minerals. Achieving ideal body weight does not guarantee adequate nutrient intake. Following the same general food pattern each day could actually limit vitamin and mineral intake because the assortment of foods is likely to be limited. Choosing foods high in fiber and low in saturated fat diet does not necessarily result in intake of adequate levels of vitamins and minerals.

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MSC: Client Needs: Health Promotion and Maintenance 27. If a nurse wants to evaluate whether a client’s vitamin or mineral supplement contains too much of a specific nutrient, the nurse should a. check the manufacturer’s recommendations about intake for that nutrient. b. request blood and urine tests to determine the client’s body stores of that nutrient. c. compare the amount in the supplement to the tolerable upper intake level (UL) for that nutrient. d. compare the amount in the supplement to the Recommended Dietary Allowance (RDA) for that nutrient.

ANS: C

The UL is the maximum intake that should not be exceeded to prevent adverse health risks; this should be compared to the amount in the supplement. The Recommended Dietary Allowance is the amount that meets the needs of most health individuals in a life-stage and gender group, but it is not the upper level for safety. Manufacturers do not necessarily provide reliable information about safety of supplements they are marketing. Blood and urine tests may or may not show whether the body is accumulating unsafe levels of a nutrient, depending on the nutrient and how long the supplement has been taken.

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28. Why is it difficult to specify the number of grams of protein that he or she should eat each day? a. More research studies are needed to help determine ideal levels of protein intake for various age and gender groups. b. Health care professionals should not give specific advice to clients, to avoid lawsuits. c. It is unrealistic to expect clients to meet precise levels of protein intake. d. Recommended protein intakes are expressed as a range and are based on a percentage of energy intake, which varies between individuals.

ANS: D Protein intake does not need to be precise and can be within an acceptable range, expressed as a percentage of energy intake. Health care professionals should not give unnecessarily precise advice, but they can give scientifically based advice without concern for lawsuits. A reasonable amount of research has been conducted to be able to give at least general advice about protein intake. The likelihood that clients will achieve a specific protein intake is not related to the difficulty in identifying what their intake level should be.

DIF: Cognitive Level: Analyzing

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29. If a college student is eating only one small meal per day in an attempt to lose weight and is taking high doses of vitamin and mineral supplements to try to make up for the lack of food, the student would be described as having a. malnutrition. b. disordered nutrition. c. overnutrition. d. undernutrition.

ANS: A An imbalance of intake of nutrients, energy, or both (in this case, high intake of some nutrients and low intake of energy) is called malnutrition. Overnutrition refers only to excessive intake, excessive nutrients, or excessive energy. Undernutrition refers only to inadequate intakes of nutrients, energy, or both. ―Disordered nutrition‖ is not a recognized term.

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30. An overweight client has been trying to lose weight for years. She tells you that she believes she is genetically designed to be overweight and that the foods available in supermarkets today make weight loss impossible. The client’s attitude shows a. positive self-efficacy. b. negative self-efficacy. c. poor environmental health. d. poor emotional health.

ANS: B

The client’s attitude demonstrates negative self-efficacy. She does not perceive that she has power over her life and behaviors. A belief that she could change her personal behaviors would reflect positive self-efficacy. She is able to express her feelings, and so she does not necessarily have poor emotional health. Her belief about healthy food choices in her environment is not necessarily accurate.

DIF: Cognitive Level: Applying

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Chapter 02: Personal and Community Nutrition Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

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.

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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 aunt’s 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.

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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 a. genetic factor of preference for sweet and salty tastes. b. influence of ethnicity on preference for sour tastes. c. children’s 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 father’s food preferences are probably influenced by genetics and ethnicity, and it may be interesting to find out whether the children’s 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.

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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 government’s 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.

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5. For most Americans, the most significant nutrition concerns are 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: Understanding REF: Pages 18-20 | Page 30 TOP: Nursing Process: Assessment

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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.

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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 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.

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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.

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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.

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10. An indirect benefit of the ―Fruits & Veggies—More 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 & Veggies—More 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.

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11. A meal planning guide that would be helpful for patients who need 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.

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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. 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: Understanding REF: Page 23 | Page 26 | Page 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: Understanding REF: Page 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 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: Analyzing

REF: Page 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.

DIF: Cognitive Level: Applying

REF: Pages 31-35

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

16. If a client is trying to increase intake of dietary fiber, a useful symbol to look for on the food label would be the a. MyPlate food guidance graphic. b. U.S. Department of Agriculture (USDA) 100% Organic seal. c. ―Fruits & Veggies—More Matters‖ logo. d. 100% Whole Grain stamp.

ANS: D Whole grains are an important source of dietary fiber, and so the 100% Whole Grain stamp would help a client select high-fiber foods. Fruits and vegetables also contain high amounts of dietary fiber, but the ―Fruits & Veggies—More Matters‖ logo is not used in labeling individual foods. MyPlate is also not used on food labels. The organic status of a food does not reveal any information about its dietary fiber content.

DIF: Cognitive Level: Understanding REF: Pages 21-23 | Page 27 | Page 33 | Page 34 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

17. The Nutrition Facts panel on a food label is useful for a. determining the ingredients in a product. b. determining the ease of preparing a product. c. comparing the price value of two or more products. d. comparing the nutritional value of two or more products.

ANS: D The Nutrition Facts panel on a food label lists the quantities of specific key nutrients in the food and can therefore be used to compare the nutritional value of two or more products. The ingredients are listed elsewhere on the package, rather than in the Nutrition Facts panel. The Nutrition Facts panel does not indicate how easy the food is to prepare and does not include any information about cost or price.

DIF: Cognitive Level: Understanding REF: Page 32 | Page 33 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

18. A pregnant woman may look for a health claim on food labels that links a. sodium intake and risk of stroke. b. calcium intake and risk of osteoporosis. c. folic acid intake and risk of neural tube defects. d. fruit and vegetable intake and risk of heart disease.

ANS: C

The U.S. Food and Drug Administration has approved use of a health claim stating the relationship between folic acid intake during pregnancy and decreased risk of neural tube defects in infants. It has also approved use of a health claim stating the relationships between (1) calcium intake and (2) decreased risk of osteoporosis, between (1) a diet rich in fiber-containing grain products, fruits, and vegetables and (2) reduced risk of coronary heart disease, and between (1) a diet low in sodium and (2) reduced risk of high blood pressure (not specifically stroke); however, this information is not directly relevant to a pregnant women.

DIF: Cognitive Level: Applying

REF: Page 35

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

19. An eating behavior that is most likely to have a negative long-term effect on health is a. a monthly meal out at an expensive restaurant. b. eating French fries with lunch once a week. c. avoiding a specific fruit or vegetable. d. drinking one can of sugar-sweetened beverage every day.

ANS: D Small daily practices have a cumulative effect on nutritional health. Eating a rich meal once a month or even ordering French fries once a week will have less overall effect on health than daily habits. It is possible to avoid a specific fruit or vegetable and still make healthy food choices by including other fruits and vegetables.

DIF: Cognitive Level: Applying

REF: Page 18 | Page 21

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

20. The most helpful general recommendation for making healthy food choices would be to a. focus on organic and natural foods. b. learn to use the Nutrition Facts Panel on food labels. c. eat more food from plant sources and less food from animal sources.

d. replace refined grain products with whole grain foods.

ANS: C The most helpful overall recommendation would be a shift to a more plant-based diet, which automatically decreases intake of saturated fat and cholesterol. Replacing refined grains with whole grains is a good choice, but it is only one aspect of healthy eating. Organic and natural foods do not necessarily improve nutrient intake. Learning to use the Nutrition Facts Panel is helpful, but not all foods have these labels (fruits, vegetables, and meats do not have to carry these labels).

DIF: Cognitive Level: Analyzing

REF: Page 20 | Pages 32-34

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

21. A client works at a fast food restaurant and usually orders a cheeseburger and regular soda at lunchtime. What would be the most simple recommendation to make this a healthier choice? a. Eat the meat patty and cheese without the bun, and drink juice. b. Do not add ketchup or mustard, and drink cappuccino. c. Skip this meal and fast until dinner. d. Omit the cheese from the burger, and drink skim milk.

ANS: D Omitting the cheese from the hamburger would decrease intake of saturated fat and calories; replacing the soda with skim milk would replace the calcium without added fat and sodium.

Removing the bun would decrease calories but would not decrease the fat content; drinking juice would provide some nutrients but also an amount of sugar similar to that of regular soda.

Ketchup and mustard add sodium and a relatively small number of calories, but their impact is less significant than the cheese; fast-food cappuccino is high in sugar and fat. Missing meals does not usually help improve overall dietary intake; regular intake of nutrients throughout the day helps body metabolism function well.

DIF: Cognitive Level: Analyzing

REF: Pages 19-21 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

22. A male client is 38 years old. He is married with two children, aged 7 and 9 years. Both he and his wife work full time. What other information would be important to know when showing him how to use MyPlate to develop a personalized food plan? a. His wife enjoys cooking home-made meals. b. He is currently training to run a marathon. c. Both his father and mother both have type 2 diabetes. d. He has an allergy to nuts.

ANS: B MyPlate recommendations are based on age, sex, and activity level. Therefore, the most important information would be that he is training for a marathon. MyPlate gives recommendations for numbers of servings from each food group each day; it does not recommend specific foods, and so allergy information is not important because other foods within the food group could be selected. His parents’ health problems may help motivate him to make healthy food choices, but this information is not needed to use MyPlate. The number of foods from each food group is not affected by whether foods are home cooked or preprepared.

DIF: Cognitive Level: Applying

REF: Page 21

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

23. For a busy client who works 50 hours a week, a helpful strategy for making healthy food choices is a. eating several small meals throughout the day. b. planning meals and snacks in advance. c. buying fruits and vegetables in season. d. using the Dietary Guidelines for Americans as a guide.

ANS: B Planning ahead for meals and snacks can be very helpful for busy clients so that they do not rely on impulsive food choices. It allows them to make decisions ahead of time instead of waiting until they are tired and hungry. Eating several small meals throughout the day may help maintain energy in a long workday but does not help make healthier food choices. Buying fruits and vegetables in season helps to save money on groceries but is not necessarily related to making healthy food choices. The Dietary Guidelines for Americans provides general advice but does not help with specific food choices.

DIF: Cognitive Level: Applying

REF: Page 31 | Page 35

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

24. A single mother has epilepsy and does not drive. She works full time from home, and her three children take the bus to school. She generally rides her bike or walks wherever she needs to go.

What would be your greatest concern related to the family’s nutritional well-being? a. It is not safe for someone with epilepsy to prepare food with sharp knives and a hot stove. b. She is unlikely to be able to afford healthy food for three children as a single mother. c. Because she does not drive, she may not have access to affordable and high-quality food. d. Working full time would not leave her enough time to prepare nutritious food for her family.

ANS: C

The greatest concern is that because she does not drive, she may not have access to affordable and quality food. Depending on her job, she may have sufficient income to purchase nutritious food, and many women are able to work full time and make time to prepare food for their families. She may need to be careful in the kitchen and perhaps cook only when other family members are home in case she has a seizure, but if her epilepsy is well controlled, there is no reason why she should not cook.

DIF: Cognitive Level: Analyzing

REF: Pages 29-31

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

25. For someone who is able to shop for food only once a month, the most nutritious fruits and vegetables would be _____ fruits and vegetables. a. fresh seasonal b. frozen c. canned d. dried

ANS: B When they have to be stored for longer than a few days, the most nutritious type of fruits and vegetables would be frozen. Many fresh fruits and vegetables lose some vitamins and may start to rot after a few days. Canned and dried fruits and vegetables are better than none at all, but they contain lower levels of vitamins and may contain added salt or sugar.

DIF: Cognitive Level: Applying

REF: Page 30 | Page 31

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

26. In choosing between two types of canned soup with regard to the best source of calcium, what information would you look for? a. Dairy products in the ingredient list

b. The Percent Daily Value for calcium c. Health claims related to calcium content d. A ―Good source of calcium‖ description

ANS: B The most helpful comparison would be the Percent Daily Value for calcium in the two products.

The presence of dairy products in the ingredient list does not indicate the amount of calcium in the product. Similarly, health claims and ―Good source of calcium‖ descriptions would not help you compare the two products.

DIF: Cognitive Level: Applying

REF: Page 32 | Page 33

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

27. In a comparison of food products, the description that means the lowest fat content per serving is a. ―lean.‖ b. ―very lean.‖ c. ―light.‖ d. ―low fat.‖

ANS: D ―Low fat‖ means no more than 3 g of fat per serving. ―Lean‖ means no more than 10 g of fat per serving. ―Extra lean‖ means no more than 5 g of fat per serving. ―Light‖ means that the food contains one third fewer calories, or half the fat, of the original, which does not give any specific information about the fat content.

DIF: Cognitive Level: Analyzing

REF: Page 33

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

28. The main reason for choosing organic foods is

a. to support the local economy. b. concern for the environment. c. to improve nutrient intake. d. better taste and quality.

ANS: B The main reason for choosing organic foods is concern for the environment. Many organic foods are grown and sold locally, but this is not a primary concern. Organic foods are not necessarily better in terms of nutritional value, taste, and quality.

DIF: Cognitive Level: Applying

REF: Page 33 | Page 34

TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

29. An individual would be described as having an external locus of control if he or she a. writes out a shopping list each week and generally buys only foods on the list. b. tries to eat mostly foods produced through organic and sustainable farming practices. c. has decided to eat a turkey sandwich but ends up ordering pizza with friends. d. tries to influence friends and family to help them make healthier food choices.

ANS: C Individuals with an external locus of control do not feel they are able to control outside forces that have power over their experiences, so they may be easily influenced to eat pizza instead of a sandwich. Individuals who write and buy foods from a shopping list would be described as having an internal locus of control because they have an inner sense of their ability to guide life events. Use of organic foods and a desire to influence other people’s food choices are not related to locus of control.

DIF: Cognitive Level: Applying

REF: Page 43

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

30. In a research study, subjects in one group decrease their intake of saturated fat and cholesterol, and those in a control group maintain their current level of intake for 2 years, with regular monitoring of risk factors for cardiovascular disease. This type of research study is called a(n) a. case study. b. epidemiologic study. c. monitoring study. d. experimental study.

ANS: D In experimental studies, researchers compare health outcomes of subjects who receive treatment or intervention with those of subjects in a control group, who receive no treatment or intervention. In epidemiologic studies, researchers track the occurrence of health or disease processes among populations to determine possible causative factors. In case studies, researchers examine individual cases of disease or health problems. ―Monitoring studies‖ is not a recognized research term.

DIF: Cognitive Level: Remembering

REF: Page 29

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

Chapter 03: Digestion, Absorption, and Metabolism Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. Peristalsis is necessary to make it possible for people to _____ food. a. chew b. digest

c. swallow d. smell and taste

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: Applying

REF: Page 42

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

2. Examples of mechanical digestion include 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: Understanding REF: Page 42 | Page 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: Page 42 | Page 43 | Page 46 | Page 49 | Page 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 in the intestines is bile. The pancreas secretes alkaline bicarbonate to buffer stomach acid so that intestinal enzymes can work properly.

DIF: Cognitive Level: Remembering

REF: Page 40 | Page 43 | Page 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: Remembering

REF: Page 43 | Page 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 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: Understanding REF: Page 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 person’s 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: Applying

REF: Page 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 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: Applying

REF: Pages 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: Remembering

REF: Page 41

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: Understanding REF: Page 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. 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 stomach’s 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: Applying

REF: Page 43 | Page 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: Understanding REF: Page 43 | Page 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: Applying

REF: Page 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. 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: Applying

REF: Pages 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: Applying

REF: Page 40 | Page 43 | Page 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 passive diffusion nor active transport is under voluntary control, and neither process involves enzymes.

DIF: Cognitive Level: Applying

REF: Page 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: Remembering

REF: Page 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 occur in the small intestine, not in the stomach.

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

DIF: Cognitive Level: Applying

REF: Page 43

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

21. The bloodstream carries nutrients to the liver soon after absorption because the liver 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: Remembering

REF: Page 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: Understanding REF: Page 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 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: Applying

REF: Page 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 | Page 48 | Page 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: Applying

REF: Page 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.

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.

DIF: Cognitive Level: Applying

REF: Page 46

TOP: Nursing Process: Diagnosis

MSC: Client Needs: Physiological Integrity

27. The adjectives mechanical and chemical describe two a. actions needed to cook food. b. ways to move substances in the body. c. types of action that result in digestion. d. ways in which molecules are transported into and out of cells.

ANS: C Mechanical and chemical describe two types of action that take place in digestion. These adjectives describe processes that may be used to cook food, but they are not needed for this description. Substances are moved in the body and into and out of cells by mechanical and chemical means, but these adjectives are not generally used for these processes.

DIF: Cognitive Level: Applying

REF: Page 40 | Pages 42-44

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

28. If a meal is eaten at noon, by 8 PM that evening, the food would probably be in the a. stomach. b. small intestine. c. large intestine. d. colon.

ANS: B Food stays in the stomach for 2 to 6 hours. It then takes about 5 hours to pass through the small intestine and another 9 to 16 hours to pass through the large intestine, which includes the colon.

Therefore, 8 hours after a meal, the food would be in the small intestine.

DIF: Cognitive Level: Applying

REF: Page 43 | Page 44 | Page 46

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

29. If the small intestine did not release secretin, the result would be that a. the stomach would not release gastric juices to moisten and begin digestion of swallowed food. b. the gallbladder would not release bile to help the process of fat breakdown. c. peristalsis would slow down, and food would move very slowly through the intestines. d. the chyme entering the small intestine would be too acidic for digestive enzymes to work.

ANS: D Secretin causes the pancreas to release bicarbonate into the small intestine to reduce the acidity of the chyme being released by the stomach; this ensures the correct pH for the digestive enzymes in the small intestine to digest the food. Release of bile by the gallbladder and peristalsis are affected by the hormone cholecystokinin (CCK), rather than by secretin. Secretion of gastric juices is controlled by gastrin.

DIF: Cognitive Level: Applying

REF: Page 43 | Page 44

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

30. If peristalsis were to reverse direction, the result would be a. vomiting. b. diarrhea. c. constipation. d. intestinal failure.

ANS: A Reverse peristalsis causes vomiting; instead of food moving from the mouth to the stomach and then the small intestine, it flows backwards and is regurgitated out of the mouth. Diarrhea may be caused by increased peristalsis, so that waste is eliminated before the water can be reabsorbed.

Constipation may be caused by slow peristalsis, so that food moves to the rectum very slowly.

Reverse peristalsis does not cause intestinal failure, although ongoing vomiting prevents ingestion, digestion, and absorption of food.

DIF: Cognitive Level: Applying

REF: Page 42 | Page 43 | Page 48

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

Chapter 04: Carbohydrates Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

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 | Page 58 | Page 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: Remembering

REF: Page 53 | Page 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. 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: Page 53 | Page 54 | Page 58 | Page 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: Applying

REF: Page 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: Applying

REF: Pages 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 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: Page 52 | Page 53 | Page 62 | Page 64 | Page 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. 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: Understanding REF: Pages 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 promote production of sugar alcohols and causes halitosis. d. simple carbohydrates, which promote 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 sugarfree 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 sugars but nonetheless contain 2 to 3 kcal/g, 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 been 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 Jane’s family. She may be able to decrease her risk of developing this cancer if she increases her intake of 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: Page 57 | Page 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 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: Understanding REF: Page 56 | Page 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: Page 56 | Page 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: Remembering

REF: Pages 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 provide energy for mucosal cells and inhibit tumor formation.

DIF: Cognitive Level: Remembering

REF: Pages 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: Page 66 | Page 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 Peter’s body will have used up his body’s 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: Analyzing

REF: Page 56 | Page 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 decrease glycemic index. Bagels, sports drinks, and cornflakes have relatively low amounts of fiber.

DIF: Cognitive Level: Applying

REF: Page 57 | Page 58

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

23. If someone’s 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: Applying

REF: Page 55 | Page 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.

DIF: Cognitive Level: Applying

REF: Page 55

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

25. If a healthy person’s blood glucose level is 120 mg/dL, his or her body would respond by releasing a. glucagon. b. somatostatin. c. insulin. d. epinephrine.

ANS: C The normal range for blood glucose level is 70 to 100 mg/dL. Therefore, a blood glucose level of 120 mg/dL is high, and the body would release insulin to promote storage of blood glucose to remove the excess from the blood. Glucagon, somatostatin, and epinephrine all increase blood glucose levels, and so they would have the opposite of the desired effect.

DIF: Cognitive Level: Applying

REF: Page 57

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

26. The main concern with increasing intake of high-fructose corn syrup is that it a. provides mostly fructose, which is poorly metabolized. b. provides energy but no nutrients. c. promotes storage of body fat. d. cultivates an increased desire for sweet foods and beverages.

ANS: B The main concern with high intake of high-fructose corn syrup in processed foods and beverages is that it provides energy but no nutrients. Fructose is easily metabolized by the body and converted to glucose, which may be used for energy or stored as body fat. It does not promote storage of body fat more than any other excess energy. A taste for sweet foods is largely innate, and even though a desire for sweet foods may be cultivated, it is not necessarily related to intake of this specific sweetener.

DIF: Cognitive Level: Understanding REF: Page 59 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

27. The best way to ensure adequate nutrient intake is to eat plenty of a. refined grains. b. enriched grains. c. whole grains.

d. fiber supplements.

ANS: C Whole grains supply the most nutrients. When grains are refined, the bran and germ are removed, and many nutrients and fiber are lost. Enrichment replaces some, but not all, of the nutrients that are removed when grains are refined. Fiber supplements contain dietary fiber but do not contain all the other vitamins and minerals found in whole grains.

DIF: Cognitive Level: Applying

REF: Page 68 | Page 69

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

28. For someone with diabetes mellitus, high blood glucose levels may be caused by high intakes of a. refined carbohydrates. b. any type of food. c. any type of sugar. d. any type of carbohydrate.

ANS: D Any type of carbohydrate can cause an increase in blood glucose level in people with diabetes.

Refined carbohydrates and sugars tend to increase blood glucose level more quickly, but high intake of any carbohydrate causes blood glucose level to rise. Fats and proteins have less effect on blood glucose level than do foods that contain carbohydrate.

DIF: Cognitive Level: Understanding REF: Page 57 | Page 58 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

29. A client experiences bloating, gas, and diarrhea after eating ice cream or drinking milk. These symptoms are probably related to a. hypoglycemia.

b. lactose intolerance. c. inadequate fiber intake. d. diverticulitis.

ANS: B Some adults develop lactose intolerance because they lose the ability to produce lactase, the enzyme that digests lactose, the disaccharide in milk. Undigested lactose is fermented in the colon, which causes bloating, gas, and diarrhea. Hypoglycemia is a low level of blood glucose and is unrelated to intake of dairy products. Inadequate fiber intake is likely to cause constipation, not diarrhea. Diverticulitis is also often related to low fiber intake and is unrelated to intake of dairy products.

DIF: Cognitive Level: Applying

REF: Page 54 | Page 55

TOP: Nursing Process: Diagnosis

MSC: Client Needs: Physiological Integrity

30. The end product of starch digestion in the body is a. sucrose. b. maltose. c. glycogen. d. glucose.

ANS: D Starch is ultimately broken down to individual monosaccharide glucose units. Starch consists of chains of only glucose and so contains no fructose. Sucrose is a disaccharide that contains glucose and fructose and so cannot be formed from starch. Glycogen may be formed from glucose in the body but is not formed during digestion.

DIF: Cognitive Level: Remembering TOP: Nursing Process: Assessment

REF: Pages 54-56 | Page 58

MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance Chapter 05: Fats Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

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 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: Applying

REF: Page 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: Applying

REF: Page 77 | Page 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, 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: Understanding REF: Page 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: Remembering

REF: Page 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. 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: Understanding REF: Pages 75-77 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 vs. 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

DIF: Cognitive Level: Applying

REF: Page 74

TOP: Nursing Process: Assessment

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13. If dietary analysis shows that fat provides 31% of an individual’s energy intake, their fat intake would be 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: Applying

REF: Page 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: Applying

REF: Pages 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: Applying

REF: Page 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 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: Remembering

REF: Page 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. 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: Applying

REF: Page 84 | Page 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: Page 77 | Page 78 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

21. Most fat enters the lymphatic system after a. absorption. b. digestion. 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: Applying

REF: Page 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? 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: Applying

REF: Page 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: Remembering

REF: Page 82 | Page 84 | Page 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 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 | Page 85 | Page 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: Page 76 | Page 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. 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: Applying

REF: Page 78 | Page 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 client’s 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.

DIF: Cognitive Level: Applying

REF: Page 75 | Page 76 | Page 79 | Page 80

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

29. A healthy daily fat intake for someone who eats 3000 kcal per day is _____ g. a. 100 b. 33 to 83 c. 67 to 117 d. 600 to 1050

ANS: C The Acceptable Macronutrient Distribution Range for fat is 20% to 35% of energy intake. Of 3000 kcal, 20% to 35% is 600 to 1050 kcal. Fat contains 9 kcal/g, and so this represents approximately 67 to 117 g (600/9 to 1050/9 g) of fat daily.

DIF: Cognitive Level: Applying

REF: Page 80

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance | Client Needs: Physiological Integrity

30. A client grew up on a farm and learned to prepare foods with butter and lard produced by the farm animals. She is now in her 60s and has just learned that she has coronary artery disease. To best meet her physical needs, as well as psychological needs, the health practitioner should a. suggest that she adopt a low-fat vegetarian dietary pattern. b. ask how she usually prepares foods and suggest ways to reduce the use of animal fat. c. advise her to eat more fruits and vegetables and to replace some of the animal fat

with palm and coconut oil. d. advise her to avoid adding fat to foods and eat only very lean poultry and fish.

ANS: B The health practitioner should start with the ways the client usually prepares food and suggest ways in which she can use less animal fat and more heart-healthy unsaturated fats without making dramatic or arbitrary changes. A low-fat vegetarian dietary pattern is not necessary and may be unacceptable to the client. Eating more fruits and vegetables may be beneficial, but palm and coconut oil are high in saturated fat, which would not be helpful. It is probably not necessary for her to avoid adding any fat to foods and to eat only very lean poultry and fish; such drastic changes might not be maintained by the client.

DIF: Cognitive Level: Analyzing

REF: Page 76 | Pages 81-84 | Page 87 | Page 88

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance Chapter 06: Protein Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

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.

DIF: Cognitive Level: Applying

REF: Pages 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 _____ of the Recommended Dietary Allowance (RDA). a. less than 100% b. between 100% and 150% c. between 150% and 200% d. greater than 200%

ANS: D The RDA for protein is 0.8 g per kilogram of body weight. This man’s weight is 190 lb, or 86 of 69.1 g of protein per day.

DIF: Cognitive Level: Applying

REF: Page 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: Understanding REF: Page 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 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: Applying

REF: Page 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: Understanding REF: Page 90 | Page 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 meat would be equivalent to

cup cooked dry peas or lentils. Therefore, 2 ounce of

cup.

DIF: Cognitive Level: Applying

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

DIF: Cognitive Level: Applying

REF: Page 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: Remembering

REF: Page 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 patient’s 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: Applying

REF: Page 94 | Page 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 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: Understanding REF: Page 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: Applying

REF: Page 94 | Page 95

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

12. If a patient has a torn ligament, then during healing and recovery, the patient’s 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: Applying

REF: Page 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 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: Applying

REF: Page 95 | Page 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: Remembering

REF: Page 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: Remembering

REF: Page 95 | Page 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. 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: Understanding REF: Page 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: Applying

REF: Pages 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: Applying

REF: Page 94

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

19. An example of a meal that contains complementary proteins is 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: Applying

REF: Pages 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 body’s 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: Applying

REF: Page 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 men’s rowing team than for the women’s rowing team? a. The men’s team is more active than is the women’s team. b. The men’s team has more lean body mass than does the women’s team. c. The men’s team has a higher metabolic rate than does the women’s team. d. The men’s team uses dietary protein less efficiently than does the women’s 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: Applying

REF: Page 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 vs. 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

DIF: Cognitive Level: Applying

REF: Page 97

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

24. Janet eats beans, grains, fruits, and vegetables, and milk. Her diet is considered a. lacto vegetarian. b. ovo-lacto vegetarian. c. flexitarian. d. vegan.

ANS: A Diets than contain plant foods plus milk are lacto vegetarian diets; ovo-lacto vegetarian 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: Applying

REF: Page 98 | Page 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: Analyzing

REF: Page 98 | Page 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. 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: Applying

REF: Page 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: Remembering

REF: Page 99 | Page 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.

DIF: Cognitive Level: Applying

REF: Page 101 | Page 102

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

29. Examples of individuals who may have an increased risk for malnutrition include a. inactive middle-aged men. b. sleep-deprived adolescents. c. children with chronic infections. d. breastfed infants.

ANS: C Chronic infection at any age and especially in childhood increases the risk of malnutrition because nutrient needs may be higher and nutrients may not be so well absorbed. Also, appetite may be lower. Inactivity in middle-aged men is likely to lead to overnutrition, not undernutrition.

Sleep deprivation in adolescents is not associated with malnutrition. Breast-fed infants are usually well nourished and are not at high risk for malnutrition.

DIF: Cognitive Level: Applying

REF: Page 101 | Page 102

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance 30. An example of the lifestyle habit of ―chaining‖ is a. gradually reducing intake of sugar-sweetened beverages. b. eating a piece of fruit with breakfast every day. c. keeping a record of all food and beverages eaten.

d. involving all family members in choosing healthy foods.

ANS: B Eating a piece of fruit with breakfast every day is an example of ―chaining.‖ Chaining involves linking two behaviors; soon the individual will always want to eat a piece of fruit whenever he or she eats breakfast. Gradually reducing intake of sugar-sweetened beverages, keeping a record of all food and beverages eaten, and involving all family members in choosing healthy foods are other good strategies to help improve eating habits.

DIF: Cognitive Level: Applying

REF: Page 102 | Page 104

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity Chapter 07: Vitamins Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. A patient is admitted to the hospital with confusion, memory loss, and ataxia. What other information would lead you to suspect that his symptoms may be caused by secondary thiamin deficiency? a. The patient has very limited funds and has been eating mainly rice and beans. b. The patient admits that he struggles with alcoholism. c. The patient is recovering from a minor stroke. d. The patient has a family history of Alzheimer’s disease.

ANS: B

Alcoholism may be associated with a secondary thiamin deficiency because the liver needs increased amounts of thiamin to detoxify alcohol. Limited food intake may cause primary deficiency (although legumes are a good source of thiamin, and so primary deficiency is unlikely). Strokes and Alzheimer’s disease may cause confusion, memory loss, and ataxia, but not in relation to a secondary vitamin deficiency.

DIF: Cognitive Level: Analyzing

REF: Page 107 | Page 111 | Page 112 | Page 119

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

2. An example of someone who has a relatively high risk for vitamin deficiencies is a(n) a. 45-year-old half marathon runner. b. 85-year-old man living independently. c. college-age woman living with roommates. d. breastfed newborn.

ANS: B Subgroups of the population at risk for vitamin deficiencies include older adults because of decreased vitamin absorption and limited physical and economic resources to purchase and prepare food. Active middle-aged adults and college students usually consume enough food to ensure adequate vitamin intake. Vitamin deficiencies are rare among breastfed newborns.

DIF: Cognitive Level: Applying

REF: Page 106 | Page 124

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

3. Deficiencies are likely to develop most rapidly with low intake of vitamin a. A. b. C. c. D. d. E.

ANS: B Vitamin C is water soluble; vitamins A, D, and E are fat soluble. Deficiencies of water-soluble vitamins develop more rapidly because they are not stored in the body.

DIF: Cognitive Level: Applying

REF: Page 108 | Page 109

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

4. The best way to ensure intake of a variety of phytochemicals is to a. take a daily multivitamin supplement that includes phytochemicals. b. increase intake of soy-based foods, such as soy milk, tofu, and soy flour. c. choose whole grains and include at least five servings of fruits and vegetables daily. d. include at least three servings of dairy products daily and use a variety of herbs and spices.

ANS: C The best way to ensure intake of a variety of phytochemicals is to eat a variety of plant-based foods, including whole grains, fruits, and vegetables. Multivitamin supplements do not necessarily contain phytochemicals. Soy-based foods contain only a limited selection of phytochemicals. Dairy products do not contain phytochemicals; herbs and spices may provide some but are used in small quantities and so would not provide significant amounts.

DIF: Cognitive Level: Applying

REF: Page 109 | Page 111

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

5. The person who would have the highest need for thiamin is a. someone who lifts weights to maintain health. b. a pregnant woman. c. a professional cyclist.

d. an older adult who walks 2 miles daily.

ANS: C Thiamine needs are related to metabolic rate (i.e., energy expenditure) because thiamine is a coenzyme in energy metabolism. Therefore, the professional cyclist needs the most thiamin because he or she has the greatest energy needs. Pregnancy, walking, and weightlifting all increase energy needs, but less so than professional athletic training.

DIF: Cognitive Level: Analyzing

REF: Page 111

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

6. A homeless man is brought into the emergency room with muscle weakness, loss of coordination, and tachycardia. He has alcohol on his breath. He may be suffering from a deficiency of a. thiamin. b. riboflavin. c. niacin. d. folate.

ANS: A Symptoms of thiamine deficiency include muscle weakness, loss of coordination, and tachycardia. Alcoholism increases the body’s need for thiamin and may contribute to a secondary thiamin deficiency. Symptoms of riboflavin deficiency include cheilosis, glossitis, and dermatitis. Niacin deficiency causes pellagra, characterized by dermatitis, dementia, and diarrhea. Symptoms of folate deficiency include megaloblastic anemia, glossitis, diarrhea, irritability, absent-mindedness, depression, and anxiety.

DIF: Cognitive Level: Applying

REF: Pages 111-116

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

7. If whole milk is stored in a clear bottle in a refrigerator with a glass front, a. the milk fat may separate and rise to the top of the bottle. b. some of the protein in the milk may become denatured. c. the ultraviolet light exposure may destroy the vitamin D. d. the ultraviolet light exposure may destroy the riboflavin.

ANS: D Riboflavin is destroyed by ultraviolet light, and so storage of milk in a clear bottle and a glassfront refrigerator may cause loss of riboflavin. Vitamin D is not affected by ultraviolet light.

Ultraviolet light does not cause milk fat to separate out and does not denature protein.

DIF: Cognitive Level: Remembering

REF: Page 92 | Page 112 | Page 121

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

8. A good way to increase intake of riboflavin would be to a. eat cereal with skim milk for breakfast instead of toast and juice. b. replace romaine lettuce salad with spinach salad. c. drink orange juice instead of apple juice. d. make sandwiches with whole grain bread instead of white bread.

ANS: A The most significant source of riboflavin in the United States is milk, and so switching to cereal with milk for breakfast would increase riboflavin intake. Replacing romaine lettuce with spinach would increase intake of folate. Replacing apple juice with orange juice would increase vitamin C intake. Eggs, meats, and whole grains are all good but lesser sources of riboflavin. Using whole grains would increase intake of several vitamins and would increase riboflavin intake slightly, but less than by drinking extra milk.

DIF: Cognitive Level: Applying REF: Page 112 | Page 113 | Page 115 | Page 118 | Page 119 TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

9. In a very poor country where the subsistence crop is corn and intake of animal protein is very limited, the population has a high risk for developing a. scurvy. b. pellagra. c. spina bifida. d. pernicious anemia.

ANS: B Corn has low levels of niacin, and low intake of animal protein would mean that relatively little tryptophan would be available to be converted to niacin; therefore, the population would be at risk for developing pellagra, the niacin deficiency disorder. Scurvy is caused by deficiency of vitamin C. Lack of folate during early pregnancy can lead to spina bifida. Pernicious anemia is caused by lack of intrinsic factor in the stomach to facilitate absorption of vitamin B12.

DIF: Cognitive Level: Applying

REF: Pages 113-117

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

10. Niacin can be manufactured by the body from the amino acid a. alanine. b. arginine. c. tryptophan. d. phenylalanine.

ANS: C

Niacin can be manufactured by the body from tryptophan, but not from alanine, arginine, or phenylalanine.

DIF: Cognitive Level: Remembering

REF: Page 129

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

11. A young woman recently married tells you that she is excited to have children. She should be especially careful to consume adequate amounts of a. folic acid. b. vitamin B12. c. pyridoxine. d. vitamin E.

ANS: A Women who may become pregnant need to ensure adequate intake of folic acid to prevent neural tube defects. The neural tube forms before many women know they are pregnant, and so it is important to ensure adequate intake of folic acid before pregnancy. Vitamin B12, pyridoxine, and vitamin E are all important vitamins, but the need for them is not especially associated with pregnancy.

DIF: Cognitive Level: Understanding REF: Pages 114-116 | Page 119 | Page 123 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

12. An example of a high-folate meal is a. fish, French fries, and coleslaw. b. spinach salad with orange segments. c. oatmeal with brown sugar and raisins. d. pork chops with applesauce.

ANS: B Good sources of folate include leafy green vegetables (including spinach), legumes, ready-to-eat cereals, and some fruits and juices (including orange). Fish, oatmeal, raisins, pork, and applesauce are not good sources of folate.

DIF: Cognitive Level: Applying

REF: Page 115 | Page 119

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

13. The type of anemia associated with folate deficiency is _____ anemia. a. microcytic b. pernicious c. megaloblastic d. iron deficiency

ANS: C The type of anemia associated with folate deficiency is megaloblastic anemia. Microcytic anemia is associated with iron deficiency. Pernicious anemia is associated with vitamin B12 deficiency.

Iron-deficiency anemia is (as its name suggests) associated with deficiency of iron, not of folate.

DIF: Cognitive Level: Remembering

REF: Pages 114-116

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

14. If an older adult develops delusions and hallucinations, it is important to check his or her blood levels of a. vitamin B12. b. intrinsic factor. c. folic acid.

d. thiamin.

ANS: A Delusions and hallucinations may be signs of vitamin B12 deficiency, even before development of anemia. Intrinsic factor is produced by the stomach and is vital for absorption of vitamin B12; it is not found in the blood. Loss of intrinsic factor in older adults contributes to vitamin B12 deficiency. Folic acid deficiency may cause irritability, absent-mindedness, depression, and anxiety, and thiamin deficiency causes memory loss and confusion, but neither of these is associated with delusions and hallucinations.

DIF: Cognitive Level: Applying

REF: Page 112 | Page 116

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

15. If a patient needs regular injections of vitamin B12, the most likely explanation is that a. he or she follows a vegan eating pattern. b. he or she struggles with alcoholism. c. he or she has a malabsorption syndrome. d. his or her stomach does not produce intrinsic factor.

ANS: D Vitamin B12 injections are necessary for patients who do not produce intrinsic factor, which is essential for absorption of vitamin B12 from the gut. Patients who follow a vegan eating pattern need vitamin B12 supplements because this vitamin is found only in animal foods. However, they can use oral supplements because they are still able to absorb the vitamin; they do not need injections. Alcoholism does not affect absorption of vitamin B12. Malabsorption syndromes may decrease absorption of vitamin B12, but with adequate dietary intake and supplements, affected patients may still be able to absorb sufficient amounts from the gut.

DIF: Cognitive Level: Applying

REF: Page 116

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

16. An example of a meal with high levels of biotin is a a. cheese-and-tomato sandwich. b. roast beef and mustard sandwich. c. peanut butter and jelly sandwich. d. vegetarian sandwich with avocado and alfalfa sprouts.

ANS: C The richest sources of biotin include liver, kidney, peanut butter, egg yolks, and yeast.

DIF: Cognitive Level: Applying

REF: Page 117 | Page 119

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

17. Some choline can be synthesized by the body from a. glycerol. b. cholesterol. c. tryptophan. d. methionine.

ANS: D The body can synthesize some choline from methionine, but not enough to meet the needs of the body. The body cannot synthesize choline from glycerol, cholesterol, or tryptophan.

DIF: Cognitive Level: Remembering

REF: Page 117

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

18. Scurvy would be most likely to occur in someone who lives in a a. remote village in northern Minnesota.

b. farming community in Florida. c. city in central California. d. fishing community on the coast of Maine.

ANS: A Scurvy is caused by vitamin C deficiency. Both Florida and California produce abundant citrus fruit, other fruits, and vegetables, which are excellent sources of vitamin C. A community on the coast of Maine does not necessarily produce good sources of vitamin C locally, but it is connected to commercial transportation, and so a variety of foods are probably available. A remote village in northern Minnesota may not have good access to fresh fruits and vegetables during the winter months, and so scurvy could potentially develop.

DIF: Cognitive Level: Applying

REF: Pages 117-119

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

19. If a registered dietitian is concerned about the adequacy of a client’s vitamin C intake, he or she would want to find out whether the client a. drinks milk. b. follows a vegan diet. c. has regular exposure to sunlight. d. smokes cigarettes.

ANS: D The dietitian would need to know whether the client smokes cigarettes because smokers require more vitamin C than nonsmokers. A vegan diet raises concerns about intake of vitamin B12 (found only in animal foods) but does not necessarily affect vitamin C intake. Regular exposure to sunlight and milk intake affect vitamin D status but not vitamin C status.

DIF: Cognitive Level: Applying

REF: Pages 116-119 | Pages 121-123

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

20. Vegetables are likely to be highest in vitamin C if they are a. boiled. b. canned. c. stir-fried. d. oven roasted.

ANS: C Vegetables are likely to be highest in vitamin C if they are stir-fried. Heat destroys vitamin C, and so cooking for the minimum amount of time preserves vitamin C. Oven roasting is a slow cooking method, and so more vitamin C is lost. Vitamin C is also water soluble, and so cooking methods that use water, such as boiling and canning, cause loss of vitamin C into the cooking liquid. In stir-frying, vegetables are cooked quickly without water.

DIF: Cognitive Level: Understanding REF: Page 118 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

21. Foods that are good sources of preformed vitamin A include a. sweet potatoes. b. egg yolk. c. tomatoes. d. carrots.

ANS: B

Preformed vitamin A is found only in the fat of animal foods; egg yolk is a good source. Sweet potatoes, tomatoes, and carrots are all good sources of carotenoids, which can be converted to retinoids (vitamin A) in the body.

DIF: Cognitive Level: Applying

REF: Page 120

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

22. The best description of blindness caused by vitamin A deficiency in developing countries is that it is a. temporary and treatable. b. infectious and often fatal. c. limited to night blindness. d. permanent but preventable.

ANS: D The blindness caused by vitamin A deficiency is permanent once it occurs, but it can be prevented by administration of periodic supplements. Vitamin deficiencies may be exacerbated by infections that increase nutrient needs, but the deficiencies themselves are not infectious.

Blindness may cause early death but is itself not fatal. Vitamin A deficiency may cause both night blindness and complete blindness.

DIF: Cognitive Level: Understanding REF: Page 120 TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

23. Foods rich in antioxidant vitamins include a. oranges and vegetable oils. b. apples and butter. c. carrots and olive oil.

d. mushrooms and milk.

ANS: A The two vitamins that function as antioxidants in the body are vitamins C and E. Citrus fruits such as oranges are excellent sources of vitamin C; vegetable oils are excellent sources of vitamin E.

DIF: Cognitive Level: Understanding REF: Page 117 | Page 118 | Page 123 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

24. The main reason that the adequate intake (AI) for vitamin D increases in older adults is that a. their ability to absorb dietary vitamin D is diminished. b. conversion of vitamin D to its active forms is less efficient. c. their skin is less efficient in synthesizing vitamin D during sun exposure. d. they require more vitamin D than do younger adults to maintain bone health.

ANS: C Older adults need more dietary vitamin D because their skin is less efficient in synthesizing vitamin D during sun exposure. Their ability to absorb vitamin D and convert vitamin D to its active form has less effect on vitamin D needs. They do not necessarily require more total vitamin D than do younger adults for bone health; they need more from foods because their skin manufactures less.

DIF: Cognitive Level: Understanding REF: Page 121 | Page 122 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

25. Rickets would be most likely to develop in a(n)

a. elderly frail adult who lives alone. b. Asian college student who does not drink milk. c. white toddler who has been weaned from breast milk. d. 9-month-old breastfed African American baby.

ANS: D Rickets is caused by vitamin D deficiency in infants and toddlers; those who are breast-fed and have dark skin are at higher risk because breast milk is low in vitamin D and dark skin is less efficient at forming vitamin D when exposed to sun. In response to low intake of vitamin D and calcium, elderly adults may develop osteoporosis and younger adults may develop osteomalacia.

DIF: Cognitive Level: Applying

REF: Page 122

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity | Client Needs: Safe and Effective Care Environment

26. The most likely cause of vitamin toxicity is a. high intake of fortified foods. b. increased absorption as a result of medications. c. long-term use of megadose supplements. d. high intake of nutrient-dense foods.

ANS: C Vitamin toxicity is usually caused by use of high-dose supplements over a long period of time.

Levels of vitamins in fortified foods are unlikely to be toxic, and very few foods contain high enough levels to cause toxicity. Medications do not cause significant increases in vitamin absorption.

DIF: Cognitive Level: Understanding REF: Page 106 MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Planning

27. An example of a meal with high levels of vitamin K is a. grilled shrimp with rice and green beans. b. eggs, bacon, and hash browns. c. stir-fried beef with broccoli. d. bacon, lettuce, and tomato sandwich.

ANS: C The best source of vitamin K is green leafy vegetables, such as broccoli. Dairy products, meats, cereals, and fruits provide smaller amounts.

DIF: Cognitive Level: Applying

REF: Page 124

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

28. Vitamin K deficiency could be a problem in someone who a. does not produce intrinsic factor. b. uses antibiotics for several months. c. struggles with alcoholism. d. has limited skin exposure to sunlight.

ANS: B Antibiotics kill gut bacteria that synthesize vitamin K, and so long-term use of antibiotics may cause vitamin K deficiency. Intrinsic factor is required for absorption of vitamin B12, not vitamin K. Alcoholism is associated with secondary deficiencies of several B vitamins. Skin exposure to sunlight stimulates production of vitamin D.

DIF: Cognitive Level: Applying

REF: Page 124

TOP: Nursing Process: Assessment | Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

29. The first step to ensure adequate intake of vitamins is to a. use a daily multivitamin supplement. b. increase fortification of key foods in the food supply. c. target specific supplements for specific subgroups of the population. d. ensure that the diet includes a variety of foods from all of the food groups.

ANS: D The best way to ensure adequate intake of vitamins is to start with a diet that includes a variety of foods from all the food groups. Reliance on supplements and food fortification do not result in an overall optimal diet. Use of supplements by specific subgroups of the population may be a second step in ensuring dietary adequacy, but it would not be the first step.

DIF: Cognitive Level: Applying

REF: Page 106 | Page 124 | Page 125

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

30. The primary reason that many Americans use vitamin supplements on a regular basis is that a. supplements taste better than food. b. this practice is necessary for good health. c. it is cheaper than consuming an adequate diet. d. it is easier than making dietary and behavioral modifications.

ANS: D It is often easier to take vitamin supplements than to make dietary and behavioral modifications to ensure that the diet provides adequate nutrients. Supplements do not necessarily taste good, and supplements are not necessary for good health for most people. Supplements are also not necessarily cheaper than foods containing a variety of nutrients.

DIF: Cognitive Level: Applying

REF: Page 124

TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity Chapter 08: Water and Minerals Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

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 woman’s 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: Applying

REF: Page 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.

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: Applying

REF: Page 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: Remembering

REF: Page 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: Applying

REF: Page 131 | Page 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 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 REF: Page 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: Analyzing

REF: Page 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.

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 | Page 145 | Page 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: Page 133 | Page 134 | Page 148 | Page 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: Applying

REF: Page 144

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

10. The term bioavailability means the 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.

DIF: Cognitive Level: Understanding REF: Page 136

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

11. 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: Understanding REF: Pages 138-142 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

12. 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: Applying

REF: Pages 140-142

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

13. Lifestyle changes that may help prevent development of osteoporosis include a. reducing intake of animal protein. b. eating a piece of fruit with lunch every day. c. reducing intake of whole grains. 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 reducing whole grain intake are unlikely to prevent osteoporosis.

DIF: Cognitive Level: Applying

REF: Pages 140-142

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

14. 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: Page 142 | Page 143 | Page 147

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

15. 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

16. 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: Page 133 | Page 134 | Page 143 | Page 147

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

17. 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: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

18. A sodium intake of 2100 mg daily by a healthy 42-year-old adult would be considered a. below the adequate intake (AI) for adults. b. above the adequate intake (AI) for adults. c. within the adequate intake (AI) for adults. d. within the accepted range for older adults.

ANS: C

A sodium intake of 2100 mg daily is above the AI of 1500 mg per day for adults and above the AI of 1300 mg daily for adults 51 to 70 years of age. This dietary recommendation is based on the known adequate intake required for good health.

DIF: Cognitive Level: Applying

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19. A family with three young children has limited income, relies on public transportation, and has 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: Analyzing

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20. 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: Applying

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21. 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. 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 and hemoglobin recycling in young men versus young women. Higher iron intake does not compensate for lower muscle mass in women.

DIF: Cognitive Level: Understanding REF: Page 148 | Page 149 TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

22. 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: Applying

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23. 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 body’s need for fluid is much greater. Hunger is a signal that the body needs food, not fluid.

DIF: Cognitive Level: Applying

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MSC: Client Needs: Health Promotion and Maintenance

24. Hemosiderosis, storage of too much iron in the body, is most likely to occur in a(n) 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

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TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

25. 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: Applying

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26. 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, 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: Applying

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27. A client feels constantly tired even though she is getting 8 hours of sleep each night, and she is gaining about 2 lb 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

28. 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: Remembering

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29. 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 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.

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MSC: Client Needs: Physiological Integrity 30. Wilson’s disease is an inherited disorder that causes excessive accumulation of a. iron. b. zinc. c. copper. d. chromium.

ANS: C

Wilson’s disease causes excessive accumulation of copper. Excessive accumulation of iron is called hemosiderosis. Excessive accumulations of zinc and chromium do not have specific names.

DIF: Cognitive Level: Remembering

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31. A good dietary source of chromium is a. pasta. b. grapes. c. oatmeal. d. cauliflower.

ANS: C Oatmeal is a good dietary source of chromium because it is a whole grain. Good sources do not include refined grains (such as pasta), fruits, and vegetables.

DIF: Cognitive Level: Applying

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32. Apart from lowering dietary sodium intake, a dietary change that is most likely to help decrease high blood pressure levels is a. decreasing intake of dairy products. b. increasing intake of vegetable protein. c. increasing intake of calcium and potassium. d. replacing saturated fats with polyunsaturated fats.

ANS: C

Dietary changes that may help decrease high blood pressure include increasing intake of calcium and potassium. This could be accomplished by increasing, rather than decreasing, intake of dairy products. Intake of vegetable versus animal protein and replacing saturated fats with polyunsaturated fats do not decrease blood pressure, although these changes may have other health benefits.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance 33. A wife who blames her high blood pressure on her husband’s preference for salty foods is an example of a. denial. b. chaining. c. reframing. d. projection.

ANS: D A wife who blames her high blood pressure on her husband’s preference for salty foods is an example of projection. She is projecting her unhealthy behaviors on her husband instead of taking responsibility for her own health. Denial would be ignoring the problem. Chaining would be associating one behavior with another. Reframing would be replacing negative expectations and associations with positive ones.

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Chapter 09: Energy, Weight, and Fitness Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

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 physician’s recommendation not to exercise during recovery from surgery.

ANS: C Obesogenic environments limit people’s 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.

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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

DIF: Cognitive Level: Applying

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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.

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: Understanding REF: Page 160 | Page 161 TOP: Nursing Process: Assessment

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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: Applying

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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 be 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: Applying

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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. c. amino acids.

d. carbohydrates.

ANS: A Regular exercise increases the body’s 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: Understanding REF: Page 162 | Page 181 TOP: Nursing Process: Planning

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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: Analyzing

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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 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: Applying

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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: Analyzing

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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: Understanding REF: Page 164 | Page 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 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: Understanding REF: Page 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.

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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 woman’s 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: Applying

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TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance 14. If a woman’s waist measurement is 38 inches and her hip measurement is 40 inches, her waistto-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

ANS: A This woman’s waist-to-hip ratio is 0.95 (38 ÷ 40). A healthy waist-to-hip ratio for women is less than 0.8. Therefore, this woman’s waist-to-hip ratio is considered to be associated with a high risk for chronic disease.

DIF: Cognitive Level: Applying

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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 Gina’s failure to follow the plan or Frank’s additional exercise.

Baseline fitness level would have little effect on weight loss.

DIF: Cognitive Level: Applying

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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.

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17. To lose a pound of body fat in a week, daily energy expenditure would have to increase by 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: Applying

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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 | Page 180 | Page 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 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: Understanding REF: Pages 170-172 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

20. The most important factor in setting behavioral goals is a. the client’s 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 client’s 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.

DIF: Cognitive Level: Applying

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21. If a client wants to relearn to pay attention to hunger and satiety cues, he or she may find it helpful to a. keep a journal of perceived emotions. b. establish a regular pattern of meals. c. eat all food at home. d. avoid eating until he or she is very hungry.

ANS: A A journal of perceived emotions (especially if it also includes foods eaten) may help a client to relearn how to pay attention to hunger and satiety cues. Establishing a regular pattern of meals may help a client develop healthful eating habits but would not help identify hunger and satiety.

Eating all food at home is probably not realistic for most clients and is not related to hunger cues.

Avoiding eating until very hungry is likely to result in erratic food intake and overeating.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 22. An athlete’s kilocalorie intake is most likely to be appropriate if he or she a. maintains a low percentage of body fat. b. consumes at least 1800 kcal per day. c. maintains a competitive and healthy weight. d. does not experience hunger between workouts.

ANS: C The best index of appropriate energy intake is maintenance of a competitive and healthy weight.

Different percentages of body fat may be appropriate for different types of athletes and different individuals. Specific kilocalorie needs of individuals vary greatly. Hunger is subjective and does not necessarily indicate whether energy intake is appropriate.

DIF: Cognitive Level: Understanding REF: Page 178 TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

23. If an athlete weighed 150 lb at the beginning of an athletic event and weighed 146 lb at the end of the event because of water lost in sweat, their athletic performance toward the end of the event would be a. improved. b. unaffected. c. impaired. d. unpredictable.

ANS: C Loss of 4 lb by a 150-lb athlete represents loss of 2.7% of body weight. Loss of 2% to 3% of body weight impairs performance, causing an increase in body temperature, confusion, and loss of coordination.

DIF: Cognitive Level: Analyzing

REF: Page 178 | Page 179

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MSC: Client Needs: Physiological Integrity

24. The best way for someone to measure fluid loss during a workout is a. the amount needed to satisfy thirst. b. volume of urine production. c. change in body temperature. d. loss of body weight.

ANS: D

Loss of body weight is the best indicator of fluid loss during a workout. Thirst is unreliable.

Urine volume may help indicate hydration status but is not definitive. Body temperature is generally unaffected unless fluid loss is extreme.

DIF: Cognitive Level: Remembering

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25. Sports drinks may be more beneficial than water for an athlete who a. is exercising in cold weather. b. runs for at least 2 hours, 4 days a week. c. experiences hunger during workouts. d. takes a 1-hour aerobics class 5 days a week.

ANS: B For athletes who exercise for longer than 90 minutes, sports drinks may be beneficial because they provide some carbohydrates and electrolytes. Otherwise, fluid replacement is the main priority, and water is just as beneficial as sports drinks. With shorter bouts of exercise, normal food intake replaces nutrient losses. Exercising in cold weather would reduce sweat losses and so would make a sports drink less beneficial.

DIF: Cognitive Level: Applying

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26. An example of a good food for replacing glycogen stores is a. raw carrots. b. string cheese. c. breakfast cereal. d. scrambled eggs.

ANS: C Foods with high levels of carbohydrate, such as breakfast cereal, help replace glycogen stores.

Raw carrots provide low amounts of energy; string cheese and scrambled eggs provide mostly protein and fat.

DIF: Cognitive Level: Applying

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27. The person who is mostly likely to need to be concerned about the adequacy of his or her protein intake is a a. male bodybuilder. b. woman who walks 30 minutes per day. c. man who plays basketball twice a week. d. female vegetarian runner with a low kilocalorie intake.

ANS: D Female athletes often do not consume sufficient kilocalories, and so some protein may be used for energy, which increases requirements. Also, vegetarians may need more protein to provide sufficient essential amino acids. Most bodybuilders and moderately active men and women are likely to consume enough protein in their regular diet.

DIF: Cognitive Level: Applying

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28. The factor that is most effective in increasing muscle mass is a. exercise.

b. low fat intake. c. high protein intake. d. amino acid supplements.

ANS: A Exercise is essential for increasing muscle mass. Adequate intake of protein helps provide the building materials for muscles to grow in response to exercise, but most diets provide sufficient protein without needing a high protein intake or amino acid supplements. Fat intake per se is not related to increasing muscle mass.

DIF: Cognitive Level: Understanding REF: Page 178 | Page 180 | Page 181 TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

29. An example of an athlete who is most likely to benefit from a multivitamin or mineral supplement that provides 100% of the Daily Recommended Intake (DRI) is a a. gymnast. b. swimmer. c. bodybuilder. d. football player.

ANS: A Athletes with thin builds, such as gymnasts, may limit their food intake to control their energy intake and may therefore benefit from a multivitamin or mineral supplement. Most athletes consume plenty of food and therefore plenty of vitamins and minerals. For these athletes, adding supplements could result in intake of toxic levels of some nutrients.

DIF: Cognitive Level: Analyzing

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30. An example of a beverage that may have a demonstrated ergogenic effect is a. milk. b. beer. c. coffee. d. ginseng tea.

ANS: C Coffee contains caffeine, which helps increase fatty acid oxidation and spares glycogen. Milk contains protein, but amino acids have not been proven to have ergogenic benefits. Beer contains alcohol, which is not an ergogenic acid. Ginseng has not been shown to have any ergogenic value.

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TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance Chapter 10: Nutrition Across the Life Span Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. A pregnant client complains of constipation during pregnancy. This is probably caused by a. inadequate intakes of dietary fiber and fluids. b. reduced activity levels as body size increases. c. increased levels of the hormone estrogen. d. increased levels of the hormone progesterone.

ANS: D During pregnancy, increased progesterone levels cause relaxation of smooth muscle, which slows intestinal transit and may cause constipation. Estrogen levels also increase but do not cause constipation. Increases in fiber and fluid intake may help relieve constipation, but low intake is not the primary cause during pregnancy. Similarly, reduced levels of physical activity may exacerbate constipation but are not the primary cause.

DIF: Cognitive Level: Applying

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MSC: Client Needs: Physiological Integrity

2. In order to prevent hypertensive disorders of pregnancy, a pregnant woman should a. restrict her sodium intake. b. continue her regular sodium intake. c. restrict her protein intake. d. take iron and calcium supplements.

ANS: B It is dangerous to restrict sodium intake during pregnancy; sodium restriction can reduce plasma volume and cardiac output. She should follow a well-balanced diet, including plenty of protein to replace urinary losses, and receive adequate vitamins and minerals. She should not restrict protein intake, and iron and calcium supplements are not generally recommended.

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REF: Page 189 | Page 195 | Page 196

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

3. For a woman with a healthy prepregnancy weight, gaining a total of 31 pounds throughout pregnancy would be considered a. too low for a healthy pregnancy. b. too high for a healthy pregnancy. c. within the current recommended range for weight gain.

d. within the current recommended range for weight gain for a woman experiencing gestational diabetes.

ANS: C The recommended range of weight gain by a woman with a healthy weight before pregnancy is 25 to 35 pounds. Weight gain recommendations for women with gestational diabetes are the same as those for women without this condition and are based on prepregnancy weight.

DIF: Cognitive Level: Applying

REF: Page 189 | Page 190

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

4. If an obese woman is 6 months pregnant and has gained about 8 lb so far, her health care provider should recommend that she should a. try to maintain her current weight throughout the rest of her pregnancy. b. continue to gain weight at about the same rate throughout the pregnancy. c. increase her weight gain to achieve weight gain in the recommended range. d. plan food choices carefully and gradually lose weight during pregnancy.

ANS: B For an obese woman, the recommended amount of total weight gain is 11 to 20 lb. When 6 months pregnant, the woman is at the end of the second trimester and so should have gained about half of this amount, 5.5 to 10 lb. Her 8-lb weight gain is within this range, and so she should continue to gain weight at about the same rate throughout her pregnancy. It is unsafe to attempt to lose weight during pregnancy, and even maintaining her current weight may indicate that she is ingesting insufficient nutrients to support a healthy pregnancy.

DIF: Cognitive Level: Applying

REF: Pages 189-192

TOP: Nursing Process: Assessment | Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

5. The nutrient that pregnant women are most likely to need to take in the form of a supplement is a. iron. b. calcium. c. protein. d. vitamin C.

ANS: A Pregnant women need almost twice as much iron as nonpregnant women because of the expansion in maternal red blood cell volume and to supply the needs of the developing fetus.

This amount is hard to achieve without use of a supplement; it cannot easily be achieved simply with a well-balanced diet. Pregnant women absorb more of their dietary calcium, and so the amount they need to ingest does not increase. Increased protein needs are easily met by typical diets. Vitamin C needs increase slightly, but the higher amount can be obtained easily from a well-balanced diet.

DIF: Cognitive Level: Applying

REF: Page 190 | Page 193

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

6. The health care provider would be most concerned if a pregnant woman told him or her that she a. has to taste wines to pair with foods for catering events. b. has cravings for salty snacks throughout the day. c. follows a vegan pattern of eating. d. lost 40 lb during the year before she became pregnant.

ANS: A

There is no safe level of alcohol consumption during pregnancy; therefore, a job that requires tasting alcoholic beverages would be a major concern. The client could be encouraged to taste wines but spit them out instead of swallowing them. Excessive salt intake is not wise, but moderate sodium intake is not a problem during pregnancy, and salt restriction can be dangerous.

Well-planned vegan diets can support a healthy pregnancy; vegan mothers need supplemental vitamin B12, iron, and possibly other nutrients. Weight loss before the pregnancy is likely to have a positive effect on health outcomes, as long as nutrient intake is adequate.

DIF: Cognitive Level: Analyzing

REF: Pages 188-190 | Page 194

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

7. If a woman in her last trimester of pregnancy has marked edema, what else should be evaluated? a. Body temperature and hematocrit b. Blood and urinary glucose levels c. Blood pressure and urine protein levels d. Sodium intake and urinary sodium excretion

ANS: C Edema in late of pregnancy may be a sign of preeclampsia; hypertension and proteinuria would confirm this diagnosis. Sodium intake and excretion, blood and urinary glucose levels, body temperature, and hematocrit are not usually related to edema in pregnancy.

DIF: Cognitive Level: Applying

REF: Page 195 | Page 196

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

8. Recommendations for treatment of gestational diabetes include a. weight loss. b. dietary control. c. avoidance of sugar.

d. oral diabetes medication.

ANS: B Gestational diabetes is generally treated through dietary control and moderate exercise. These measures help regulate weight gain; weight loss is not recommended during pregnancy. Dietary control may include limiting sugar intake, but sugar need not be avoided completely. If gestational diabetes cannot be controlled through diet and exercise, insulin may be used, but oral diabetes mediations are not used during pregnancy.

DIF: Cognitive Level: Understanding REF: Page 196 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

9. The best way for a nursing mother to increase her milk supply is to a. nurse her infant more often and for longer periods of time. b. provide supplemental formula to allow milk reserves to build. c. drink lactogenic herbal teas that stimulate milk production. d. drink extra milk and add extra servings of dairy products.

ANS: A Nursing the infant more often and for longer periods of time stimulates milk production.

Providing supplemental formula will actually decrease milk production. Lactogenic herbal teas may increase milk production slightly, but it is important to check their safety with a physician.

Extra milk and dairy products do not increase milk supply.

DIF: Cognitive Level: Understanding REF: Page 199 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

10. The most potentially harmful situation for an infant is

a. breastfeeding during the day and bottle-feeding at night. b. running out of infant formula and using whole milk for a few days instead. c. breastfeeding by a mother who is being treated with antibiotics. d. breastfeeding by a mother who gained less weight than is recommended during pregnancy.

ANS: B Whole milk used instead of infant formula is harmful to infants. The protein and sodium levels are too high, and the increased renal solute load may cause dehydration. Levels of several other nutrients are also inadequate. A routine of breastfeeding during the day and bottle-feeding at night is less ideal than exclusive breastfeeding, but it is acceptable. Antibiotic use is not necessarily a contraindication to breastfeeding; mothers should check with the pharmacist to make sure the particular antibiotic they are using is safe. Gaining too little weight during pregnancy may affect a mother’s ability to produce milk, but adequate lactation may still be possible if dietary intake is adequate.

DIF: Cognitive Level: Analyzing

REF: Pages 200-202

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

11. A meal that a family should not share with their 10-month-old infant is a. meatloaf and mashed potatoes. b. refried beans and cheese. c. peanut butter and honey sandwich. d. baked fish and butternut squash.

ANS: C

Ten-month-old infants can eat most soft foods but should not be given pieces of a peanut butter and honey sandwich because honey may cause infantile botulism and peanut butter can be a choking hazard.

DIF: Cognitive Level: Applying

REF: Page 202 | Page 203

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

12. To prevent baby bottle tooth decay in infants who need a bottle at bedtime, the bottle should not contain a. fruit juice. b. beverages sweetened with sugar. c. any liquid other than water. d. iron-fortified infant formula.

ANS: C Baby bottle tooth decay is caused when infants go to sleep with bottles containing any liquids that contain sugar or other nutrients, including formula, breast milk, fruit juice, or other sweetened beverages. If they are put to bed with a bottle, it should contain only water.

DIF: Cognitive Level: Applying

REF: Page 204

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

13. The best way to encourage children to consume adequate nutrients with less than 30% of kilocalories from fat is to a. avoid fast food and fried foods. b. follow a vegan eating pattern. c. provide low-fat foods and a vitamin or mineral supplement. d. include plenty of fruits, vegetables, and whole grains.

ANS: D Children should be provided with a diet that includes plenty of fruits, vegetables, and whole grains to help them consume adequate nutrients with less than 30% of kilocalories from fat. It is not necessary to avoid fast food and fried foods completely, although they should be eaten in moderation. A vegan eating pattern may not provide adequate amounts of iron, zinc, vitamin B12, and other important nutrients found in lean meats and low-fat dairy products. Low-fat processed food products can help limit fat intake, but a vitamin or mineral supplement does not compensate for omitting fruits, vegetables, and whole grains.

DIF: Cognitive Level: Applying

REF: Page 207 | Page 210

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

14. If a 2-year-old is drinking four 8-ounce cups of milk daily, he or she is probably drinking a. too little milk to provide sufficient calcium for the growing skeleton. b. approximately the right amount of milk to meet nutrient needs. c. approximately the right amount of milk, if the child is at a healthy weight. d. too much milk, which may displace other important foods from the diet.

ANS: D Children aged 1 to 3 years should drink two to three 8-ounce cups of milk per day. Therefore, four cups of milk is probably too much and may displace other important foods from their diet.

DIF: Cognitive Level: Applying

REF: Page 208

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

15. A mother of a toddler tells you that her child drinks several cups of fruit juice each day. How would you respond?

a. It is important to decrease juice intake because high potassium intake can be dangerous for young children. b. Even though fruit juice contains some micronutrients, intake should be limited because it also has high levels of natural sugar. c. As long as the juice is 100% real fruit juice, this is a good way to increase intake of fruits and micronutrients. d. Drinking juice is healthful as long as the child has adequate intake of foods from all the food groups.

ANS: B Excessive juice intake may displace more nutrient-dense foods from the diet because it provides kilocalories with few nutrients. Even 100% real fruit juice has high levels of natural sugar. If intake of foods from other food groups is adequate, the child’s energy intake may be too high.

The amount of potassium in juice is not harmful.

DIF: Cognitive Level: Applying

REF: Page 208

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

16. If a child does not like a food when he or she tries it for the first time, the a. child’s preference should be respected, and the child should not be encouraged to try it again. b. child should be offered a reward if he or she eats a reasonable amount of the food. c. child should be encouraged to eat at least five bites to see whether his or her taste buds adjust. d. child should be offered the food at least 8 to 10 times at other meals before he or she decides whether he or she likes it.

ANS: D

Children often need to be exposed to new food 8 to 10 times before they will accept them.

Rewarding children for eating foods and forcing them to eat specific amounts do not usually encourage acceptance. They should be offered the food again because one time is not sufficient to determine food preferences.

DIF: Cognitive Level: Remembering

REF: Page 206 | Page 208

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

17. The child most likely to develop type 2 diabetes is the one who a. is obese. b. is malnourished. c. has multiple food allergies. d. lives in a low-income household.

ANS: A Type 2 diabetes is strongly associated with obesity. Malnutrition, food allergies, and poverty do not generally contribute to type 2 diabetes.

DIF: Cognitive Level: Applying

REF: Page 215

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

18. An example of a breakfast that would meet the School Breakfast Program requirements would be a. scrambled egg, bacon, toast, and orange juice. b. cold breakfast cereal with milk, toast with honey. c. toast with peanut butter, banana, and milk. d. turkey sausage, hash browns, ketchup, and milk.

ANS: C

School Breakfast Program requirements indicate that a breakfast must include a serving of milk, a serving of fruit, and two servings consisting of meat or bread and cereal. A meal of toast (bread serving), peanut butter (meat serving), banana (fruit serving), and milk (milk serving) meets this requirement. A meal of scrambled egg (meat serving), bacon (meat serving), toast (bread serving), and orange juice (fruit serving) is missing milk. A meal of cold breakfast cereal (bread serving), milk (milk serving), and toast with honey (bread serving) is missing fruit. A meal of turkey sausage (meat serving), hash browns with ketchup (vegetable serving), and milk (milk serving) is missing a serving of meat or bread.

DIF: Cognitive Level: Applying

REF: Page 211

TOP: Nursing Process: Planning | Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

19. The person who is most likely to have an inadequate calcium intake is a(n) a. school-age child who receives free school breakfast and lunch. b. toddler who prefers to drink milk rather than eat meals. c. adolescent boy who plays varsity football. d. adolescent girl who is a competitive gymnast.

ANS: D Calcium intake is a concern for teenage girls because their intake of calcium-rich foods is often inadequate; this is especially true of girls engaged in sports such as gymnastics, who may try to limit their food intake to maintain a competitive weight. Adolescent girls and boys have the same calcium needs, but adolescent boys are more likely to have adequate intake because they eat more food; this is especially true for boys involved in sports such as football, who tend to eat large amounts of food. A toddler who drinks milk rather than eating food would have a good calcium intake but may have an inadequate iron intake. A school-aged child who receives free school breakfast and lunch would receive milk with both meals and so would be less likely to have an inadequate intake of calcium.

DIF: Cognitive Level: Analyzing

REF: Page 208 | Pages 210-212

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

20. The best way to reduce the risk of asphyxiation (choking) in toddlers is to make sure that they a. drink plenty of fluids with meals. b. avoid conversation during meals. c. sit down while eating and chew foods well. d. eat with utensils rather than with their fingers.

ANS: C Toddlers may choke if they are too active while they are eating or if they do not chew foods properly. Therefore, sitting down while eating and chewing foods well can help prevent choking.

Drinking plenty of fluids with meals will not necessarily prevent choking. Conversation should be encouraged during meals to help create a relaxed family atmosphere and to slow the pace of eating. Eating with utensils rather than fingers is not related to a risk of choking.

DIF: Cognitive Level: Remembering

REF: Page 213 | Page 214

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

21. Lead poisoning may be diagnosed at the same time as a. food allergies. b. anorexia nervosa. c. iron-deficiency anemia. d. vitamin D and calcium deficiencies.

ANS: C

Lead poisoning is associated with iron-deficiency anemia, and the two may be diagnosed at the same time. Lead poisoning is not related to food allergies, anorexia nervosa, or vitamin D deficiencies. Lead poisoning may be related to calcium deficiency, but this is less obvious than iron deficiency.

DIF: Cognitive Level: Understanding REF: Page 213 | Page 216 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

22. The lifestyle factor that would contribute most to a child’s becoming overweight is a. attending after-school daycare. b. trading foods at lunchtime with friends. c. being raised by one or more grandparents. d. being home alone after school every day.

ANS: D Many factors contribute to overweight in children. Being home alone after school every day is associated with using food as comfort and sedentary activities. After-school daycare programs are likely to provide appropriate snacks and opportunities to be active. Being raised by grandparents is not necessarily related to obesity, and trading foods at lunchtime with friends would not necessarily increase energy intake.

DIF: Cognitive Level: Applying

REF: Page 213 | Page 215

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity | Client Needs: Physiological Integrity

23. Interventions for obese children should focus on a. gradual weight loss. b. low-fat food choices. c. healthy lifestyle behaviors. d. increased physical activity.

ANS: C Interventions for obese children should focus on healthy lifestyle behaviors, including eating habits and activity patterns. These may include low-fat food choices and increasing physical activity, but factors contributing to obesity must be evaluated and addressed for the specific child. Gradual weight loss is not the goal. As lifestyle habits improve, a child may lose weight or maintain a fairly constant weight as height increases until he or she reaches a healthy weight for height.

DIF: Cognitive Level: Understanding REF: Page 215

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

24. An example of a child who is at high risk for iron-deficiency anemia is the child a. who has allergies to milk and nuts. b. who lives in an African American low-income family. c. whose parents work full time. d. who eats most food away from home.

ANS: B Iron-deficiency anemia is associated with poverty and malnutrition and is most common in African American, Hispanic American, and Native American families. A child with allergies to milk and nuts may have low intake of calcium but would probably not have low intake of iron.

Working parents and eating food away from home are not known to be related to iron-deficiency anemia.

DIF: Cognitive Level: Applying

REF: Page 216

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity | Client Needs: Psychosocial Integrity

25. As adults age, they are likely to want to add _____ to their food. a. less salt b. more salt c. fewer salt substitutes d. more salt substitutes

ANS: B As adults age, they are likely to want to add more salt to their food. This is to compensate for their diminished sense of taste as a result of loss of taste buds. Some older adults may choose to use salt substitutes to avoid using excess sodium; however, the use of such substitutes is not widespread.

DIF: Cognitive Level: Applying

REF: Page 216

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

26. Protein needs continue to increase until about age 24 years because a. height continues to increase. b. lean body mass continues to increase. c. protein metabolism becomes less efficient. d. higher protein intake prevents conversion of muscle to body fat.

ANS: B Protein needs continue to increase until about age 24 years because lean body mass continues to increase in both men and women. This increase in lean body mass is not necessarily accompanied by an increase in height. Efficiency of protein metabolism is not diminished at this age. Exercise, rather than higher protein intake, prevents conversion of muscle to body fat.

DIF: Cognitive Level: Applying

REF: Page 217

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

27. One way a 50-year-old individual can help maintain lean body mass and minimize increases in body fat is to a. engage in regular exercise, including strength training. b. use stress-reduction strategies, such as massage therapy. c. ensure that the diet includes adequate amounts of high-quality protein. d. decrease energy intake to prevent weight gain.

ANS: A Middle-aged adults can help maintain their lean body mass and minimize increases in body fat by exercising regularly and including strength training. Stress reduction may help with other aspects of health, but not with maintaining lean body mass and controlling body fat. Adequate amounts of high-quality protein will not maintain lean body mass without regular exercise.

Decreasing energy intake will help prevent increases in body fat but will not help maintain lean body mass.

DIF: Cognitive Level: Understanding REF: Page 217 | Page 218 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

28. In comparison with the iron needs of younger women, those of older women a. decrease because of slower turnover of red blood cells. b. decrease because of menopause. c. increase because iron absorption becomes less efficient. d. increase because oxygen use is less efficient.

ANS: B

Older women require less dietary iron than do younger women because they do not lose iron with menstrual blood losses after menopause. Red blood cell turnover does not change with age.

The oxygen-carrying ability of hemoglobin and myoglobin does not change with age. Iron absorption may decrease slightly with age, but iron needs are still lower for older women.

DIF: Cognitive Level: Applying

REF: Page 218

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

29. If an older adult is confused, he or she may have a deficiency of a. iron. b. zinc. c. water. d. protein.

ANS: C Confusion in older adults is often caused by dehydration (i.e., deficiency of water). Deficiency of iron may cause anemia and tiredness, deficiency of zinc may cause poor wound healing and changes in taste acuity, and deficiency of protein may cause weakness and loss of lean body mass.

DIF: Cognitive Level: Applying

REF: Page 218 | Page 220

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

30. An older adult’s nutritional status may decline if he or she has arthritis because a. arthritis is associated with loss of appetite. b. the ability to prepare food may be impaired. c. taste changes may cause food to be unappetizing. d. arthritis causes an increase in protein and nutrient requirements.

ANS: B Arthritis causes joint stiffness and pain that may make it difficult for older adults to prepare food.

Arthritis does not affect appetite, sense of taste, or protein and nutrient requirements.

DIF: Cognitive Level: Applying

REF: Page 218

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

31. The best way for older adults who live in cold climates to meet their increased need for vitamin D is to a. increase their skin exposure to sunlight. b. increase their intake of vitamin D–fortified dairy products. c. take vitamin D supplements. d. increase their intake of fatty fish.

ANS: C Older adults living in cold climates usually need supplements of vitamin D. In cold climates, increasing skin exposure to sunlight is not realistic. Increasing intake of vitamin D–fortified dairy products and fatty fish would increase vitamin D intake somewhat but would be unlikely to result in intake that meet the DRI.

DIF: Cognitive Level: Applying

REF: Page 220

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

32. If an older adult has lost several teeth and complains that foods are bitter or tasteless, he or she may have a deficiency of a. zinc. b. iron. c. vitamin C. d. vitamin B12.

ANS: A Inadequate zinc intake decreases sensitivity of taste receptors. This is especially likely to occur in someone who has lost teeth because he or she may find it difficult to chew meat and other foods that are good sources of zinc. Inadequate intake of iron and vitamin B12 is associated with anemia. Inadequate intake of vitamin C causes poor wound healing.

DIF: Cognitive Level: Applying

REF: Page 220

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

33. An example of someone who is at high risk for malnutrition and weight loss is a(n) a. 21-year-old student who works part time. b. 36-year-old single mother with three children. c. 57-year-old man who is unemployed. d. 88-year-old widow who lives alone.

ANS: D Elderly adults, especially those who live alone, are at high risk for malnutrition and weight loss because of low income, physical difficulties with shopping and preparing food, and lack of social interaction at meal times. Students, single mothers, and unemployed men could have some risk factors for malnutrition if they are busy, depressed, or lacking income, but malnutrition is less common in these groups than among older adults.

DIF: Cognitive Level: Applying

REF: Pages 217-221

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

34. In adults older than 80, the greatest dietary concern is a. preventing weight gain. b. increasing lean body mass.

c. maintaining adequate nutritional status. d. preventing coronary heart disease and cancer.

ANS: C The greatest dietary concern for adults older than 80 is maintaining adequate nutritional status to promote optimal health and quality of life. At this age, weight gain is rarely a problem. It is possible but unlikely for them to increase their lean body mass. Preventing coronary heart disease and cancer is less of a concern at this age; in fact, too much concern about healthy eating can result in inadequate dietary intake.

DIF: Cognitive Level: Applying

REF: Pages 220-222

TOP: Nursing Process: Assessment | Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

35. An appropriate way to maintain a healthy body weight includes a. eating only at set mealtimes. b. learning to respond to actual hunger cues. c. counting calories to restrict energy intake. d. avoiding foods that have high levels of fat and added sugar.

ANS: B An important strategy for maintaining a healthy body weight is learning to respond to actual hunger cues, eating when hungry, and stopping when full. It is not necessary to restrict meals to set times. Counting calories may be successful but is not a realistic long-term strategy. Limiting foods that have high levels of fat and added sugar may help decrease kilocalorie intake, but it is not necessary to avoid them altogether.

DIF: Cognitive Level: Applying

REF: Page 221

TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity | Client Needs: Health Promotion and Maintenance

36. The person most likely to be eligible for the Supplemental Nutrition Assistance Program (SNAP) is a a. 55-year-old single man who earns minimum wage. b. college student who works part time. c. single mother with three children who works part time. d. pregnant woman with gestational diabetes.

ANS: C SNAP provides coupons that people with low incomes can use to buy food. Eligibility is based on income, economic resources, and family size. A single mother with three children who works part time is most likely to be eligible. Complications of pregnancy do not affect eligibility. A single man who earns minimum wage and a college student who works part time are less likely to have incomes below the required percentage of the poverty level.

DIF: Cognitive Level: Applying

REF: Page 221 | Page 222

TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

37. The program that would be most helpful for a lonely 75-year-old widow who has been gradually losing weight since her husband’s death is the _____ Program. a. Senior Nutrition b. Emergency Food Assistance c. Supplemental Nutrition Assistance d. Child and Adult Care Food

ANS: A

The Senior Nutrition Program provides inexpensive meals, education, and socialization for all adults aged 60 and older. It does not specifically target disabled, low-income, or socially isolated adults. The Emergency Food Assistance Program supplements the dietary intake of low-income households through the distribution of basic commodities. The Supplemental Nutrition Assistance Program provides coupons to boost the food-purchasing power of low-income families. The Child and Adult Care Food Program provides meals and snacks to senior citizens who participate in qualified daycare programs.

DIF: Cognitive Level: Applying

REF: Page 221 | Page 222

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

38. After going through menopause, a woman may need to pay extra attention to her food and activity habits because she is now at increased risk for a. osteoporosis. b. type 2 diabetes. c. bronchial asthma. d. iron-deficiency anemia.

ANS: A After menopause, decreased estrogen levels cause loss of bone density, which leads to osteoporosis. Risk of type 2 diabetes increases with age, especially if weight increases, but is not specifically related to menopause. Asthma is not related to menopause. Iron-deficiency anemia decreases after menopause because blood is no longer lost in menstruation.

DIF: Cognitive Level: Applying

REF: Page 216 | Page 217 | Page 221

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

39. Alcohol abuse is associated with poor nutritional status because a. alcohol intake increases basal metabolic rate.

b. alcoholic beverages displace healthful foods from the diet. c. alcohol increases the desire for foods with high levels of fat and sugar. d. people with alcoholism often eat in bars that serve a limited number of foods.

ANS: B Alcohol provides kilocalories but no nutrients, and it depresses appetite, which reduces intake of healthful foods. Alcohol affects nutrient absorption, metabolism, and excretion, but not basal metabolic rate. It does not increase the desire for foods with high levels of fat and sugar. Many people with alcoholism drink at home and so are not limited to foods served in bars.

DIF: Cognitive Level: Applying

REF: Page 216 | Page 218 | Page 219

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

40. An example of rationalizing is a. restricting food intake by rationing food. b. coping with stress by using biofeedback techniques. c. identifying emotional triggers for eating. d. using a busy schedule to justify poor food choices.

ANS: D Rationalizing applies reasonable explanations to behaviors: for example, using a busy schedule to justify poor food choices. Rationing food is an example of restrained eating. Coping with stress using biofeedback techniques and identifying emotional triggers for eating are useful behavioral techniques that can help promote health.

DIF: Cognitive Level: Applying

REF: Page 222 | Page 223

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

Chapter 11: Nutrition Assessment and Patient Care Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th

Edition

MULTIPLE CHOICE

1. The situation in which it would be most important for the nurse to contact the registered dietitian (RD) is if a a. patient complains of constipation during his or her hospital stay. b. patient’s family complains about the quality of the food in the hospital. c. patient reports losing 10 lb in the past year without trying. d. patient has been receiving intravenous glucose and saline but no oral intake for 36 hours.

ANS: D It would be most important for the nurse to contact the RD to conduct a nutrition assessment if the patient has received only intravenous fluids with no nutrient intake for more than 24 hours.

Constipation may warrant a nutrition assessment if it is ongoing, but in the short term, it is probably related to surgery, medical procedures, inactivity, or medications. Loss of 10 lb in a year is not considered severe and would warrant nutrition assessment only if other nutrition risk factors are present. Family complaints should be treated with respect but would warrant nutrition assessment only if the patient’s oral intake is significantly compromised; stressed family members often complain about food because it is unfamiliar and they believe it is the one thing in the hospital that should be familiar.

DIF: Cognitive Level: Applying

REF: Page 228 | Page 229 | Page 234

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

2. An example of a common cause of iatrogenic malnutrition is a. scheduling of frequent daily tests that prevents the patient from eating meals. b. food from home brought in by family members and friends of a patient. c. small portion sizes of hospital food and absence of snacks.

d. errors in ordering and delivery of meals for hospitalized patients.

ANS: A A common cause of iatrogenic malnutrition is the scheduling of frequent tests that require patients to fast beforehand, possibly through the next meal time. It is not uncommon for patients to miss breakfast because they need to fast, to miss lunch because they are having a test, and to be too tired to eat very much at dinner. Bringing food from home may help prevent malnutrition.

Hospital portion sizes are usually appropriate, and extra food and snacks can be ordered if needed. Errors in ordering and delivering patient meals are rare.

DIF: Cognitive Level: Applying

REF: Page 228

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

3. If a patient is 6 feet tall and his or her waist measures 42 inches, the patient would be considered to have _____ fat levels consistent with _____ risk for chronic disease. a. essential; low b. essential; high c. abdominal; low d. abdominal; high

ANS: D Waist-to-height ratio (WHtR) indicates abdominal fat levels, which can be predictive of risk for diabetes, hypertension, and cardiovascular disease. This patient has a WHtR ratio of 42:72, or 0.58. A WHtR ratio exceeding 0.5 is consistent with high risk for chronic disease.

DIF: Cognitive Level: Applying

REF: Page 167 | Page 235

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

4. The best way to estimate height for a patient with both legs amputated below the knee is to use

a. demi-span (distance from the sternal notch to the middle finger). b. knee height (with the use of calipers to measure heel-to-thigh distance). c. recumbent bed height measured while the patient is lying down. d. the patient’s stated pre-amputation height.

ANS: A The most reliable method for a double leg amputee would be to use a formula based on measured demi-span. Knee height and recumbent bed height would not be measurable with lower limbs missing. Stated height is not necessarily accurate.

DIF: Cognitive Level: Applying

REF: Page 233

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

5. If a male patient weighs 140 pounds when he is admitted to a long-term care facility and weighs 147 pounds 2 months later, his percent weight change during his hospital stay is a. 3.5%. b. 5%. c. 7%. d. 14%.

ANS: B Percent weight change = [(147 –

DIF: Cognitive Level: Applying

REF: Page 234

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

6. If a patient weighed 150 lb 1 month ago and now weighs 140 lb, the weight loss would be considered a. insignificant.

b. mild. c. moderate. d. severe.

ANS: D Percent weight loss = [(150 – 5% of body weight in 1 month is considered severe.

DIF: Cognitive Level: Applying

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7. An elderly patient who has been living alone and has gradually been losing weight has had a stroke and is transferred to a long-term care facility. It is unlikely that he will be able to achieve adequate oral intake during recovery, and so a percutaneous endoscopic gastrostomy (PEG) tube is inserted to begin tube feedings into his stomach. If the patient gains 8 lb in the first week of tube feeding, it is likely that a. he is retaining fluid weight. b. the tube feeding is well tolerated. c. he is constipated. d. the feedings are replenishing muscle and fat stores.

ANS: A Weight gains exceeding 1 pound in a day are probably caused by excess fluid. The body cannot accumulate lean body mass or body fat this quickly, and accumulation of this amount of feces is highly unlikely.

DIF: Cognitive Level: Applying

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MSC: Client Needs: Physiological Integrity

8. Body mass index (BMI) would be most useful for evaluating the weight status of a(n) a. middle-aged, moderately active woman. b. elderly, mostly sedentary man. c. high-school football player. d. young woman undergoing chemotherapy.

ANS: A BMI measurement would be most useful for a healthy, moderately active woman. It may yield an underestimate of body fat in older adults, an overestimate of body fat in muscular individuals such as football players, and invalid results in patients who are acutely ill or who have lost muscle mass, as may be the case for a patient undergoing chemotherapy.

DIF: Cognitive Level: Applying

REF: Page 235

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MSC: Client Needs: Health Promotion and Maintenance

9. An example of a patient considered to be at high nutrition risk is a(n) a. 72-year-old man who has been vomiting for 2 hours. b. 38-year-old overweight man who has had a heart attack. c. 18-month-old child with weight in the third percentile for height. d. woman with a broken leg and a serum albumin level of 3.8 g/dL.

ANS: C A child with weight below the fifth percentile for height has high nutrition risk. A man between 65 and 75 years of age has moderate nutrition risk; vomiting for 2 hours does not necessarily increase nutrition risk. An overweight man who has had a heart attack may benefit from longterm interventions to decrease weight and saturated fat intake, but he is not at immediate nutrition risk. Broken bones may represent moderate nutrition risk, but a serum albumin level greater than 3.5 is not of immediate concern.

DIF: Cognitive Level: Applying

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10. Measurement of serum albumin level would be most useful for predicting visceral protein status in a(n) a. patient with congestive heart failure who has very little appetite. b. elderly patient who has been living alone and is scheduled for nonemergency surgery. c. patient with liver failure related to chronic alcohol abuse. d. patient who was in a serious car accident and is recovering from multiple fractures.

ANS: B Serum albumin level is a good index of visceral protein status for patients who are otherwise healthy, such as an older adult scheduling nonemergency surgery. Congestive heart failure, hepatic insufficiency, and trauma may cause abnormally low values.

DIF: Cognitive Level: Applying

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11. If a patient complains of fatigue and has spoon-shaped nails, a test that may be ordered is _____ measurement. a. total bilirubin b. blood hemoglobin c. plasma glucose d. blood urea nitrogen (BUN)

ANS: B

Fatigue and spoon-shaped nails may indicate iron-deficiency anemia, and so assessment of hemoglobin level would be appropriate. Bilirubin level reflects liver function, and BUN level reflects renal function; problems with either may cause fatigue, but not spoon-shaped nails.

Plasma glucose level may be used to monitor diabetes control.

DIF: Cognitive Level: Applying

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12. If a hospitalized patient is not recovering well and seems to have a poor appetite, it would be appropriate to request a a. tube feeding. b. calorie count. c. food record. d. menu analysis.

ANS: B If staff are concerned about the adequacy of a patient’s diet in an acute-care or long-term care facility, they may conduct a calorie count to determine what the patient is actually eating. Food records are usually kept by patients themselves when they are not in a hospital setting. Menu analysis shows what is available to the patient but does not measure what the patient actually ate.

A tube feeding is not appropriate unless the patient is incapable of achieving adequate oral intake.

DIF: Cognitive Level: Applying

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13. If nutrition screening identifies a patient as being at high nutrition risk, the next step in their care would be nutrition a. intervention by a registered dietitian. b. assessment by a registered dietitian.

c. diagnosis by the physician. d. monitoring and evaluation by the nurse.

ANS: B Someone identified as being at high nutrition risk should first receive a comprehensive nutrition assessment, preferably by a RD. This would be followed by nutrition diagnosis by the RD, nutrition intervention by the RD and nursing staff, and nutrition monitoring and evaluation by the RD, nurse, and physician.

DIF: Cognitive Level: Analyzing

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14. If a patient is immobilized for several days and cannot get out of bed, the most important thing for the nurse to do is to a. compare fluid intake and output every 2 hours and check for edema. b. change the patient’s position or turn the patient several times a day. c. conduct a calorie count to make sure the patient’s food intake is adequate. d. change sheets and blankets during each shift.

ANS: B It is especially important for nurses to turn and reposition immobilized patients frequently to reduce their risk of skin breakdown and shifts in body fluids. Changing the sheets every shift is not necessary and may be too disruptive. Encouraging the patient to maintain adequate oral intake would be helpful, but a calorie count is not needed unless there are specific concerns about inadequate intake. Checking for edema is helpful, but keeping track of fluid intake and output every 2 hours is unnecessary unless specific problems with fluid balance are identified.

DIF: Cognitive Level: Applying

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15. The best way to evaluate the weight of a hospitalized patient is a. at the same time as assessing the patient’s vital signs. b. no more than once a week, to avoid measuring fluid shifts rather than true weight. c. by using a bed scale. d. while the patient is wearing a hospital gown, at the same time each day, and after voiding.

ANS: D For consistent and comparable results, patients’ weights should be measured daily, at the same time each day, after voiding, and while the patient is wearing a hospital gown. It is helpful to measure weight daily rather than just weekly because it may be important to measure fluid gains or losses. Measuring weight at the same time as assessing vital signs would be too frequent. A bed scale is necessary only for patients who are unable to stand; most patients can stand on a regular beam or electronic scale.

DIF: Cognitive Level: Analyzing

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16. When a nurse is recording food intake for a calorie count, the best way to describe food intake is to a. list the percentage of each food served that was actually eaten. b. describe intake in qualitative terms, such as ―fair,‖ ―adequate,‖ and ―good.‖ c. weigh each food before and after the patient eats and list the weight of food eaten. d. visit the patient each day and obtain a 24-hour diet recall.

ANS: A

It is important to provide objective measurements of food intake for calorie counts such as percentage of food served that is actually eaten or amount eaten in terms of household measurements. Weighing food is impractical in a hospital setting. A 24-hour diet recall is unlikely to be accurate because it relies on the patient’s memory and is not quantitative.

Qualitative descriptions of the amount of food eaten cannot be accurately translated into calorie and protein intake.

DIF: Cognitive Level: Understanding REF: Page 241 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

17. If a patient reports feeling lethargic and having a headache, and you notice that his or her hair is thin and the skin is dry, it would be important to ask the patient whether he or she a. has access to and is able to afford enough food. b. follows a vegan eating pattern or restricts intake of animal foods. c. uses any herbal or botanical remedies on a regular basis. d. takes high-dose vitamin supplements that contain vitamin A.

ANS: D Lethargy, headache, dry skin, and hair loss are all symptoms of vitamin A excess, which is usually caused by use of high-dose supplements rather than food. Asking about food security is appropriate if the patient has general symptoms of malnutrition. Herbal or botanical remedies are not necessarily associated with these specific symptoms. A vegan eating pattern may cause vitamin B12 deficiency, which may manifest as confusion, depression, ataxia, weakness, and paresthesias.

DIF: Cognitive Level: Applying

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18. A patient with diabetes is recovering at home after foot surgery. He takes antidepressant and antihypertensive medications, as well as an oral hypoglycemia agent. When the nurse visits at noon to change his dressing, his or her greatest concern would be a. the open bottle of vodka on the table next to his recliner. b. the fact that he has not yet eaten lunch. c. his reliance mainly on canned and prepackaged food in the house. d. his complaints that his family does not come and help him.

ANS: A For a patient taking several medications, especially including one for depression, the open bottle of vodka may signify alcohol dependency and may cause serious interactions with his medications. It is not uncommon for patients to each lunch after noon. Convenience food is higher in sodium than fresh food, but it is less of a concern than potentially high alcohol intake.

His complaints about his lack of help may or not be a concern, depending on other help that is available to him.

DIF: Cognitive Level: Analyzing

REF: Page 245 | Pages 251-253

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19. A situation that may be associated with moderate nutrition risk is a. use of analgesic medications to manage a patient’s pain. b. being tube fed for several weeks and transitioning to oral intake. c. food brought in by family members for a hospitalized patient. d. following a low-fat, high-fiber, low-sodium diet.

ANS: B

Transitioning from tube feeding to oral intake is associated with moderate nutrition risk because oral intake may not be adequate initially. Managing a patient’s pain may decrease nutritional risk because pain-free patients usually have a better appetite. Food brought in by family members for a patient may also improve food intake and nutritional status, if they do not need to follow a restrictive or modified diet. Following a low-fat, high-fiber, low-sodium diet is likely to improve nutritional health.

DIF: Cognitive Level: Applying

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20. Overall, the greatest concern in screening patients for risk of malnutrition is a. edema. b. muscle wasting. c. unintended weight gain. d. unintended weight loss.

ANS: D Unintended weight loss is the greatest predictor of nutritional risk. Muscle wasting may indicate loss of somatic protein, and edema may indicate loss of visceral protein, but these conditions are more likely to be caused by non–nutrition-related factors. Unintended weight gain is associated with risk of chronic disease, but not with nutrition risk.

DIF: Cognitive Level: Understanding REF: Page 239 | Page 244 TOP: Nursing Process: Assessment

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21. Rapid weight gain (>1 pound in a day) is probably caused by accumulation of a. fluid. b. feces. c. body fat. d. lean body mass.

ANS: A Weight gains exceeding 1 pound in a day are probably caused by excess fluid. The body cannot accumulate lean body mass or body fat this quickly, and accumulation of this amount of feces is highly unlikely.

DIF: Cognitive Level: Remembering

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22. A BMI of 18 would reflect a. underweight. b. normal weight. c. overweight. d. severe overweight.

ANS: A A BMI less than 18.5 is classified as underweight. A BMI between 18.5 and 24.9 is considered normal weight, 25 to 29.9 is considered overweight, and 30 or greater is considered obese.

DIF: Cognitive Level: Applying

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23. An elderly patient falls at home and lies on the floor for 24 hours without anything to eat or drink for 24 hours before being found and admitted to the hospital. What would be an important thing for the nurse to do before collecting blood to evaluate nutritional status? a. Weigh the patient. b. Assess food and beverage intake before the fall. c. Rehydrate the patient. d. Manage the patient’s pain.

ANS: C It is important to rehydrate patients who have not had any fluids for some time. If they are not rehydrated before blood is collected, test results will be falsely elevated. Weighing the patient will be useful only after the patient is rehydrated. Managing the patient’s pain is important, but is not directly related to evaluation of nutritional status. Assessing food and beverage intake before the fall may be part of a complete nutrition assessment, but it is not necessary before collection of blood samples.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

24. A patient who is scheduled for knee surgery mentions not having eaten much in the past few weeks because it has been difficult to shop and prepare food. To evaluate the patient’s immune function, the physician may decide to test the patient’s serum _____ levels. a. iron b. vitamin D c. prealbumin d. creatinine

ANS: B Low serum vitamin D levels are related to poor immune function. Low serum iron levels may be associated with anemia. Serum prealbumin levels are positively related to visceral protein status.

High serum creatinine levels indicate renal function and loss of muscle tissue.

DIF: Cognitive Level: Applying

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25. A meal rich in nutrients that promote wound healing is a. a bean burrito with salsa and guacamole. b. a roast beef sandwich on whole grain bread with strawberries. c. a grilled cheese sandwich and carrot sticks. d. tuna salad on a bed of lettuce with crackers.

ANS: B Nutrients that promote wound healing include protein, zinc, and vitamin C. Roast beef is an excellent source of protein and zinc, the whole grain bread is also a good source of zinc, and strawberries are an excellent source of vitamin C. The beans in the burrito provide some protein, but the meal has relatively low amounts of zinc and vitamin C. Cheese also provides protein, but carrot sticks provide more vitamin A than vitamin C and, unless the bread is whole grain, the zinc content is low. Tuna salad also provides protein but relatively little zinc; lettuce provides relatively little vitamin C.

DIF: Cognitive Level: Applying

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26. If a patient is taking a monoamine oxidase inhibitor (MAOI) for depression, a meal that may result in unpleasant side effects and dangerous hypertension is a. salad with bacon and blue cheese. b. peanut butter sandwich and grapefruit juice. c. fresh fruit salad with nuts and honey. d. cream of mushroom soup with crackers.

ANS: A MAOIs inhibit the enzyme monoamine oxidase, which inactivates tyramine found in foods such as Chianti wine, aged cheese (such as blue cheese), and some fermented foods. Grapefruit juice should be avoided by people taking certain other drugs, but not MAOIs.

DIF: Cognitive Level: Applying

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27. A patient may be at high nutritional risk if he or she a. is receiving a soft diet. b. has a serum albumin level of 2.5 g/dL. c. has been receiving a tube feeding for 1 week. d. has gained 5 pounds during the previous month.

ANS: B Serum albumin levels of 3 g/dL or lower indicate high nutritional risk; serum albumin levels between 2.4 and 2.9 mg/dL indicate moderate malnutrition. Soft diets are altered in texture but are still nutritionally adequate. Tube feedings are also nutritionally adequate if administered correctly. Gradual weight gain does not necessarily indicate nutritional risk.

DIF: Cognitive Level: Analyzing

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28. If a patient is prescribed long-term treatment with steroids, he or she will need to be advised to a. avoid foods that contain tyramine. b. avoid grapefruit juice. c. try to eat more than they want, to avoid weight loss. d. limit intake of high-calorie foods, to avoid weight gain.

ANS: D Steroids are appetite stimulants, so it would be helpful to counsel patients to limit food intake to avoid weight gain. Grapefruit juice and tyramine do not affect the action of steroids.

DIF: Cognitive Level: Applying

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29. If a hospitalized patient is taking warfarin (Coumadin) to reduce risk of blood clots, you would be concerned if a family member brought them lunch consisting of a. a fruit smoothie containing grapefruit juice. b. a peanut butter sandwich and chocolate milk. c. spicy rice and beans with tomatoes. d. spinach salad with chopped egg and nuts.

ANS: D Foods high in vitamin K, such as spinach, may reduce the efficacy of warfarin. Grapefruit juice affects the action of several drugs, but not warfarin. Dairy products may affect the action of some antibiotics.

DIF: Cognitive Level: Applying

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30. If a patient who received four prescription medications is going to begin enteral tube feedings, the best thing for the nurse to do is to a. use liquid medications and flush the tube before and after administration. b. crush each medication and dissolve it in water before administration. c. crush the medications and mix them with the tube feeding. d. contact the pharmacy to determine the best route of administration.

ANS: D

The nurse should contact the pharmacy to determine the best route of administration for each drug. Some drugs are available in liquid form and can be administered via the feeding tube.

Some medications can be crushed and dissolved in water in order to administer them.

Medications should never be mixed with enteral formulas because they may alter the consistency of the feeding and cause the tube to become clogged.

DIF: Cognitive Level: Understanding REF: Pages 253-255 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Safe and Effective Care Environment Chapter 12: Food-Related Issues Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. A clear liquid diet would be most appropriate for a. someone who has had several teeth removed and is unable to chew. b. a pregnant woman with persistent nausea. c. someone who has had a stroke and has difficulty swallowing. d. a patient who has had major surgery within the past 18 hours.

ANS: D Clear liquid diets are appropriate for patients who have just undergone surgery. Patients who are unable to chew can be given mechanically altered diets but can still eat foods that do not need to be chewed. Clear liquid diets do not necessarily help with nausea and would not provide the nutrients needed to support a healthy pregnancy. Patients who have difficulty swallowing often have the most trouble swallowing liquids, and so a clear liquid diet could be unsafe.

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2. One advantage of a full liquid diet is that it a. has low levels of saturated fat and high levels of fiber. b. is suitable for patients with lactose intolerance. c. is likely to be tolerated by patients with dysphagia. d. can provide an adequate diet if very carefully planned.

ANS: D With careful planning, a full liquid diet can provide adequate nutrition. However, full liquid diets tend to have high levels of saturated fat (from dairy products) and low levels of fiber (because whole foods are not eaten). It is not suitable for patients with lactose intolerance unless it is highly modified because it includes considerable amounts of dairy products. It is not well tolerated by patients with dysphagia, who often have difficulty swallowing liquids.

DIF: Cognitive Level: Understanding REF: Page 266 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

3. If a patient is receiving radiation to the mouth and neck area and has a sore mouth, the most appropriate type of diet while he or she is in hospital would be a _____ diet. a. regular b. mechanical soft c. full liquid d. clear liquid

ANS: B For someone with a sore mouth, a mechanical soft diet would be easier to eat without pain than would a regular diet. The patient can probably tolerate soft foods; a full or clear liquid diet would be overly restrictive and more likely to result in inadequate nutrient intake.

DIF: Cognitive Level: Applying

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4. If a patient drools, takes a long time to eat, and often gags during meals, he or she may have a. dementia. b. esophageal cancer. c. regurgitation. d. dysphagia.

ANS: D Drooling, taking a long time to eat, and frequent gagging are signs of dysphagia, or difficulty swallowing. Esophageal cancer may or may not cause dysphagia. Dementia and regurgitation are not necessarily associated with these symptoms.

DIF: Cognitive Level: Applying

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5. If a physician orders a ―diet as tolerated‖ for a patient, the nurse should a. make food selections for the patient in accordance with the patient’s symptoms. b. determine the appropriate type of diet for the patient in accordance with the patient’s condition. c. consult the registered dietitian to determine when the diet should be advanced. d. encourage the patient to normalize the diet as his or her appetite and symptoms allow.

ANS: D

A ―diet as tolerated‖ order allows patients to select foods according to their appetite and symptoms; the nurse should encourage gradual progression to normal eating as they are able.

The registered dietitian does not need to be consulted to advance the diet. The nurse should work with such patients and allow them to make food selections themselves to encourage adequate nutrient intake; the nurse should not make food selections for patients.

DIF: Cognitive Level: Applying

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6. If an individual has back pain and seeks treatment with acupuncture, as well as a physician at a traditional spine clinic, this would be an example of using _____ medicine. a. traditional b. integrative c. alternative d. complementary

ANS: D This is an example of complementary medicine: combining a non-Western healing approach (acupuncture) at the same time as conventional medicine (spine clinic). Traditional medicine would mean using only the spine clinic and perhaps physical therapy. Integrative medicine merges conventional medicine with complementary and alternative therapies for which efficacy and safety have been established through scientific methods. Alternative medicine replaces traditional Western methods with non-Western healing approaches.

DIF: Cognitive Level: Understanding REF: Page 269 | Page 272 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

7. If a patient starts vomiting immediately after eating seafood and states that the one other time he or she ate seafood, he or she had a similar reaction, the patient probably has a. food poisoning. b. celiac disease. c. an allergy to seafood d. a viral infection.

ANS: C A food allergy may cause vomiting immediately after the offending food is eaten; because the same thing happened when the patient ate seafood before, an allergy is even more likely. A viral infection or food poisoning would not occur every time the patient ate seafood. Celiac disease is caused by an immunologic reaction to gluten, which is not found in seafood.

DIF: Cognitive Level: Applying

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8. A one-a-day multivitamin or multimineral supplement at 100% or less of the Dietary Reference Intake (DRI) is probably most beneficial for a(n) a. young adult who lifts weights before work every morning. b. older adult living at home alone. c. business executive with a high-stress job. d. newly retired, socially active woman.

ANS: B A multivitamin or multimineral supplement that contains 100% or less of the DRIs for most micronutrients may help provide a nutritional ―safety net‖ for groups at high risk for nutritional insufficiency, including older adults who live alone. Young adults who are physically active and socially active new retirees are likely to meet their nutritional needs through food. Psychological and emotional stress does not significantly alter nutrient needs.

DIF: Cognitive Level: Applying

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MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

9. According to the Dietary Supplement Health and Education Act (DSHEA) of 1994, dietary supplements are considered a. foods. b. drugs. c. nutrients. d. food additives.

ANS: A DSHEA considers dietary supplements to be foods, not drugs, nutrients, or food additives.

DIF: Cognitive Level: Remembering

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10. Using a margarine fortified with plant sterol and stanol esters to help decrease blood cholesterol levels is an example of using a a. probiotic. b. functional food. c. dietary supplement. d. complementary food.

ANS: B

Margarine fortified with physiologically active food components, such as plant sterol and stanol esters, is considered a functional food. Probiotics contain live microorganisms thought to be beneficial to the body. Dietary supplements contain natural or synthetic nutrients in an isolated form. Complementary is a term used to describe nontraditional therapies used alongside conventional treatments, rather than to describe foods.

DIF: Cognitive Level: Applying

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11. For patients who are taking prescription or over-the-counter drugs, herbal preparations a. should all be avoided. b. can be considered safe. c. should be taken separately from drugs. d. may cause dangerous herb–drug interactions.

ANS: D For patients who take prescription or over-the-counter drugs, herbal preparations can cause dangerous herb–drug interactions. They cannot be considered safe simply because they are ―natural.‖ They do not necessarily need to be avoided, but their use should be discussed with a physician or pharmacist. Taking the herbal preparation separately from drugs may not help, depending on how long each drug and each herb remain active in the body.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning

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12. Registered dietitians may encourage patients to use specific herbal supplements a. that are less expensive than conventional medications. b. that they have used themselves and found to be helpful. c. that are approved by the U.S. Department of Agriculture (USDA). d. for which efficacy and safety have been scientifically studied and documented.

ANS: D Registered dietitians may encourage patients to use specific herbal supplements for which efficacy and safety have been scientifically studied and documented. They would probably also want to make sure that the supplements are safe to use in combination with any other medications the patient uses. Herbal supplements are not necessarily less expensive than conventional medications. Health practitioners should not rely on their own anecdotal experience when making recommendations to patients. Herbal supplements are regulated by the U.S. Food and Drug Administration (FDA), not by the USDA.

DIF: Cognitive Level: Applying

REF: Pages 269-271

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

13. The most important thing a nurse can do to prevent the spread of foodborne illness among hospitalized patients is to a. discard any food that is uneaten within 30 minutes of being served. b. wear a mask when serving food or helping feed patients. c. wash hands thoroughly before serving food and after using the bathroom. d. discourage friends and family members from bringing in food for the patient.

ANS: C Thorough and frequent hand washing is most important to prevent the spread of foodborne disease. Wearing a mask may be helpful for immunocompromised patients but is less important than hand washing. Uneaten food should be refrigerated and, if it is not eaten within 24 hours, discarded. Bringing in favorite foods can help improve nutrient intake and is not necessarily dangerous if the food is eaten immediately or refrigerated and kept for no more than 24 hours.

DIF: Cognitive Level: Applying

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14. A patient should be discouraged from using echinacea to help reduce the duration of colds if he or she is using a. anticoagulant drugs to prevent formation of blood clots. b. immunosuppressant drugs after organ transplantation. c. oral contraceptives or hormone replacement therapy. d. oral hypoglycemic agents for treatment of diabetes.

ANS: B Patients should not use echinacea if they are taking immunosuppressant drugs because Echinacea may decrease the immunosuppressant effect. Echinacea is not known to interfere with anticoagulant effects, hormone treatments, or oral hypoglycemic agents.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment

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15. If a patient with depression takes a selective serotonin reuptake inhibitor (SSRI), the nurse may want to ask about use of herbal products because of potential interactions if the patient is using a. ginseng. b. ginkgo biloba. c. St. John’s wort. d. evening primrose oil.

ANS: C St. John’s wort may be used to treat depression and may interact with SSRIs to cause serotonin syndrome (sweating, agitation, and tremor). Ginseng, ginkgo biloba, and evening primrose oil are not known to interact with SSRIs.

DIF: Cognitive Level: Applying

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16. Nurses should ask patients about their use of over-the-counter medications because a. those medications may cause drug–drug or nutrient–drug interactions. b. the medical staff has a legal responsibility to know what patients are using. c. they may be able to advise patients about cheaper generic forms of drugs. d. patients should not take prescription and over-the-counter drugs at the same time.

ANS: A Over-the-counter medications are just as likely as prescription medications to cause drug–drug or nutrient–drug interactions. It is important to ask patients, but medical staff are not legally required to know what patients are using, especially if patients do not offer this information. It would be more appropriate for a pharmacist to advise patients about generic forms of drugs.

Prescription and over-the-counter drugs may be taken at the same time, but it is important for the medical staff to know what patients are taking to avoid harmful interactions.

DIF: Cognitive Level: Applying

REF: Pages 269-273 | Page 285

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

17. A patient who is an orthodox Jew would not eat a. chicken in cream sauce. b. a hamburger and fries. c. a grilled cheese and tomato sandwich. d. scrambled eggs and hash browns.

ANS: A

Kosher food laws prohibit consumption of meat and dairy products at the same meal, so chicken (meat) in cream sauce (dairy) would not be allowed. A hamburger and fries contain meat, but not dairy (as long as the burger is not a cheeseburger); a grilled cheese sandwich contains dairy but no meat. Scrambled eggs and hash browns contain neither dairy nor meat.

DIF: Cognitive Level: Applying

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18. A food restriction shared by both Muslims and Jews is a. not combining meat and dairy at the same meal. b. not eating pork or any food products from pigs. c. avoiding coffee, tea, and alcohol. d. eating fish with fins and scales but not shellfish.

ANS: B Neither observant Muslims nor observant Jews eat pork or foods from pigs. Observant Jews do not combine meat and dairy at the same meal and do not eat shellfish. Observant Muslims avoid coffee, tea, and alcohol.

DIF: Cognitive Level: Remembering

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19. During a home visit to a patient receiving home enteral nutrition, the greatest source of concern would be if the a. patient was receiving enteral feedings only during the night. b. patient has gained 1 pound during the past month. c. family complains that they miss being able to eat meals together. d. family is blending family meals to make their own formula.

ANS: D Home-blended tube feedings would be a concern because their nutrient composition, osmolality, and consistency are inconsistent; because they can easily become contaminated and cause foodborne illness; and because they may clog feeding tubes. Receiving enteral feedings at night can provide adequate nutrition without the inconvenience of being attached to a feeding tube during the day. If the family misses eating meals together, they can be encouraged to play board games and enjoy other activities together instead. Gaining 1 pound in a month is not a concern. If weight gain continues, the amount of formula can be adjusted slightly.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Safe and Effective Care Environment

20. If a patient has had a stroke and needs enteral feedings because he or she cannot chew or swallow but has no other medical problems, he or she can be fed with a(n) _____ formula. a. isotonic b. modular c. elemental d. polymeric

ANS: D A patient whose digestive system works normally and who has no other medical problems besides an inability to chew and swallow can receive enteral feedings with a standard polymeric formula. Such formulas are not necessarily isotonic; isotonic formulas may be used if a patient develops diarrhea. Modular formulas are used for specific medical conditions necessitating more or less of one or more macronutrients. Elemental formulas are used if the patient has difficulties digesting the formula or if the formula is administered into the jejunum rather than the stomach.

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TOP: Nursing Process: Planning

21. If a patient with cystic fibrosis and pancreatic insufficiency requires enteral feedings, he or she should be fed a(n) a. elemental formula. b. modular formula. c. formula specially formulated for critically ill patients. d. lactose-free formula.

ANS: A Patients with pancreatic insufficiency are unable to properly digest nutrients, and so they should be fed an elemental formula, in which the nutrients are predigested or hydrolyzed. A modular formula contains intact nutrients; separate formulas contain carbohydrate, protein, and fat, but they all still must be digested. Specialty formulas for critically ill patients are intended for patients with burns or acute physical stress. A lactose-free formula still contains intact nutrients and would require digestion.

DIF: Cognitive Level: Applying

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22. Feeding tubes should be placed into the small intestine rather than the stomach if a. the patient is comatose. b. a regular polymeric formula is being used. c. the patient prefers not to have a tube passing through his or her nose. d. the patient is expected to resume oral feedings within 1 to 2 weeks.

ANS: A

Feeding tubes should be placed into the small intestine rather than the stomach if the patient is not alert and does not have an intact gag reflex; such patients include comatose patients. Regular polymeric formulas can be administered into the stomach or duodenum, but not the jejunum.

Feeding tubes can be passed through the nose or through a stoma into the stomach or into the small intestine; the nose is usually used only if the feeding tube will be needed for less than 1 or 2 weeks. The time frame within which the patient is expected to resume oral feedings affects whether the nose or surgical placement is used, but it does not affect whether feedings are administered into the stomach or small intestine.

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23. If a patient is to receive enteral feedings for several weeks because of esophageal surgery but is otherwise generally healthy, he or she may be fed through a _____ tube. a. nasogastric b. nasoduodenal c. percutaneous endoscopic gastrostomy (PEG) d. jejunostomy

ANS: C The patient would probably be fed through a PEG tube; more permanent placement is appropriate for feedings over several weeks; the patient should be at low risk for aspiration, and so the gastric feedings are appropriate. A feeding tube would not be passed through the nose and down the throat if the patient is having esophageal surgery. A jejunostomy tube would be needed only if the patient had a higher risk of aspiration.

DIF: Cognitive Level: Applying

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24. If a patient starts to experience diarrhea 12 hours after starting enteral feedings, the first course of action the medical staff would try is a. switching to a lactose-free formula. b. decreasing the rate of the formula feeding. c. switching to an elemental formula. d. stopping the feeding until the diarrhea resolves.

ANS: B For patients who experience diarrhea when they begin a tube feeding, the first course of action should be to decrease the rate of the formula feeding. If this does not work, a lactose-free formula may be helpful. An elemental formula would be used only if the patient’s ability to digest food is compromised. The feeding should not be stopped unless absolutely necessary because it is important for the patient to have a supply of nutrients. It is possible that the diarrhea is caused by infection, medications, or other causes other than the enteral formula.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment | Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

25. Bolus enteral feedings would be appropriate for a patient who a. has had a gastrectomy. b. has a PEG tube. c. is being fed via a nasoduodenal tube. d. has a history of aspiration-related pneumonia.

ANS: B

Bolus feedings should be administered only into the stomach because a larger volume is administered at one time and the duodenum and jejunum cannot hold this larger volume. Patients at high risk for aspiration should not receive bolus feedings because the fullness of the stomach is more likely to cause regurgitation. A patient who has had a gastrectomy does not have a stomach to receive the bolus.

DIF: Cognitive Level: Applying

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26. To determine the nutritional adequacy of a tube feeding, a. the patient’s actual formula intake and body weight should be recorded daily. b. intake and output records should be completed during each nursing shift. c. urine glucose levels, gastric residuals, and bowel movements should be recorded. d. anthropometric, biochemical, and clinical indexes should be assessed weekly.

ANS: D To determine nutritional adequacy of enteral or any other feedings, anthropometric, biochemical, and clinical indexes should be measured weekly. These indexes show how feedings are affecting the patient’s weight and nutritional status. Daily recording of weight can help assess fluid shifts and may give some indication of kilocalorie adequacy over time. Measurement of actual formula intake, use of intake and output records, assessment of urinary glucose level, measurement of gastric residuals, and records of bowel movements may help evaluate formula tolerance and ensure that the patient is receiving the prescribed amount of formula but do not demonstrate adequacy.

DIF: Cognitive Level: Applying

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27. To reduce the risk of aspiration, patients who are receiving enteral tube feedings should be positioned

a. sitting upright at least 90 degrees. b. lying on their side. c. with the head of the bed elevated 30 to 45 degrees. d. with the head of the bed elevated 45 to 60 degrees.

ANS: C Patients who are receiving enteral tube feedings should be positioned with the head of the bed elevated 30 to 45 degrees to help prevent aspiration. They do not need to sit upright. Lying on their side does not reduce the risk of aspiration.

DIF: Cognitive Level: Remembering

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TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity | Client Needs: Safe and Effective Care Environment

28. A patient has undergone several gut resections because of cancer and is unlikely to resume adequate oral intake of nutrients. The best way to feed this patient would be via a. central parenteral nutrition. b. peripheral parenteral nutrition. c. a PEG tube. d. jejunal enteral feedings.

ANS: A Long-term parenteral nutrition must be administered centrally because peripheral veins cannot handle high enough concentrations of nutrients to provide long-term nutrient needs.

Administration of enteral nutrition via a PEG tube or jejunal feedings is not appropriate because this patient does not have sufficient gut function.

DIF: Cognitive Level: Applying

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29. Intravenous lipid emulsions are used as part of parenteral nutrition to prevent fatty acid deficiency and to a. increase patient satiety. b. provide a source of fat-soluble vitamins. c. add kilocalories without increasing osmolality. d. add kilocalories with minimal expense.

ANS: C Intravenous lipid emulsions are used to add kilocalories to parenteral nutrition without increasing osmolality. Amino acids and dextrose can add kilocalories, but they are very hypertonic. Lipids may contribute to patient satiety, but this effect is limited because they do not pass through the gastrointestinal tract. Intravenous lipid emulsions do not contain vitamins; these are added separately. Lipids are not necessarily less expensive than other parenteral nutrients.

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30. If a patient receiving parenteral nutrition has a fluid restriction, he or she would need to be fed via _____ parenteral nutrition. a. peripheral b. central c. peritoneal d. cyclical

ANS: B Patients with fluid restrictions need more concentrated nutrient solutions, which are hypertonic and need to be administered via a central vein. Parenteral nutrition is not administered via the peritoneum and is not usually administered cyclically.

DIF: Cognitive Level: Applying

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31. During transitions from parenteral or enteral tube feedings to oral feedings, patients should be monitored to ensure that a. they do not develop hypoglycemia. b. total nutritional intake is adequate. c. their weight does not increase rapidly. d. they do not experience nausea and vomiting.

ANS: B When patients transition from parenteral or enteral feedings to oral feedings, it is important to ensure that they achieve adequate nutrient intakes. Hypoglycemia may develop if parenteral nutrition is discontinued too quickly, but not after enteral feedings are stopped. Most patients struggle initially to maintain adequate oral intake, so weight gain is not a concern. Nausea and vomiting are not common, especially if oral feedings are resumed gradually.

DIF: Cognitive Level: Understanding REF: Page 283

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32. The best way to maintain the integrity and function of the gut in someone who is receiving parenteral nutrition is to a. supplement parenteral nutrition with probiotics. b. encourage patients to smell foods to stimulate gastric juices. c. use enemas to keep fluids in the gut without using the oral route. d. give the patient small sips of diluted fruit juice if possible.

ANS: D

Minimal enteral intake, even small sips of diluted juice, can help maintain normal gastrointestinal tract physiology and gut mucosal immunity. Probiotics may be used in patients who are being fed enterally or orally, but not parenterally. Smelling food may stimulate production of digestive secretions, but it has not been shown to protect the gut. Enemas would reach only the rectum and lower colon and would not maintain gut function.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Safe and Effective Care Environment Chapter 13: Nutrition for Disorders of the Gastrointestinal Tract Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. If a patient with multiple sclerosis starts coughing frequently during meals and starts to eat significantly less food than normal, the patient may have a. pneumonia. b. gastroesophageal reflux disease. c. peptic ulcer. d. dysphagia.

ANS: D Patients with multiple sclerosis may develop dysphagia; coughing during meals and eating less than usual are common symptoms. Dysphagia may cause pneumonia if food enters the lungs and causes infection. Gastroesophageal reflux disease causes burning and pain but typically not coughing. Peptic ulcer causes intestinal pain but not coughing.

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2. For a patient with dysphagia, the food that would be most difficult to swallow is a. applesauce. b. mashed potatoes. c. chocolate pudding. d. chicken noodle soup.

ANS: D Patients with dysphagia often have difficulty swallowing thin liquids, such as chicken noodle soup. Thicker, pureed foods such as applesauce, mashed potatoes, and chocolate pudding are usually easier to swallow.

DIF: Cognitive Level: Applying

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3. If a patient has difficulty swallowing, the best position for eating is a. propped up in bed with a caregiver by the bedside. b. sitting upright opposite a caregiver. c. sitting at a dining table with social dining companions. d. lying on the left side, with a caregiver by the side.

ANS: B The safest eating position for someone who has trouble swallowing is sitting upright; the caregiver should sit opposite to help provide cues and reminders while the patient is eating. It is usually best for patients with dysphagia not to interact socially during mealtimes because talking may make swallowing more difficult. Sitting propped up in bed and leaning back would make it easier for food to enter the airway. Lying on one’s side while eating is very likely to cause aspiration.

DIF: Cognitive Level: Applying

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4. The most acute risk for patients with dysphagia is a. constipation. b. dehydration. c. dry mouth. d. panic attacks.

ANS: B An acute daily concern for patients with dysphagia is dehydration. Patients are not usually allowed to drink fluids without supervision, and so fluid intake must be monitored throughout the day. Constipation and dry mouth may occur with poor fluid and food intake but are less acute. Patients with dysphagia may experience feelings of panic, but this is not the most acute concern.

DIF: Cognitive Level: Applying

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5. The most helpful recommendation for a client who often experiences heartburn at night would be to a. avoid eating within 4 hours of going to bed. b. increase the fiber content of the diet. c. decrease the fiber content of the diet. d. take antacid medications before going to bed.

ANS: A

Gastroesophageal reflux disease (GERD) usually occurs 1 to 4 hours after eating; therefore, waiting at least 4 hours after eating before going to bed would help prevent heartburn at night.

Antacid medications may be helpful but should not be used on a regular basis before other strategies have been tried. Fiber content of the diet does not affect heartburn.

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6. An example of a meal that is likely to relax the lower esophageal sphincter and allow gastroesophageal reflux is a. pasta with marinara sauce and sourdough bread. b. ham with rice pilaf. c. fried chicken and pasta salad. d. chicken and spinach tortilla wrap and salsa.

ANS: C High-fat foods and beverages relax the lower esophageal sphincter (allowing stomach contents to back up). Both fried chicken and pasta salad are high in fat and would exacerbate gastroesophageal reflux. The other meals are relatively low in fat and would be much less likely to cause reflux.

DIF: Cognitive Level: Applying

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7. Peptic ulcer disease (PUD) would be most like to occur in someone who uses medication to treat a. gastroesophageal reflux disease. b. constipation. c. celiac disease.

d. joint pain or arthritis.

ANS: D Risk of PUD increases with chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), often used to treat joint pain or arthritis. Use of antacids to treat GERD would decrease risk of PUD. Laxatives and stool softeners used to treat constipation do not affect risk of PUD. Celiac disease is treated by avoiding dietary sources of gluten, not with medications.

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8. Nutrition therapy for peptic ulcers should be individualized, depending on a. type of drug treatment. b. location of the ulcer. c. patient tolerance. d. the cause of the ulcer.

ANS: C There are no specific dietary recommendations for treatment of peptic ulcer, and so foods eaten depend on the patient’s symptoms and tolerance. The type of drug treatment and location of the ulcer do not significantly affect food tolerance. Factors that contribute to formation of peptic ulcers are mostly nonnutritional (stress, skipping meals, chronic use of use of NSAIDs), and so dietary intake is not a significant factor in treatment.

DIF: Cognitive Level: Understanding REF: Page 294 | Page 295 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

9. If a patient who has undergone gastric bypass surgery for treatment of extreme obesity experiences sudden sweating, nausea, and stomach cramps after meals, the patient may have a. gastroesophageal reflux. b. pancreatitis. c. peptic ulcer disease. d. dumping syndrome.

ANS: D Patients who have undergone gastric bypass may experience dumping syndrome as a large volume of hyperosmolar food is dumped into the small intestine because the stomach reservoir is missing or too small. GERD and peptic ulcers are not necessarily more common after gastrectomy. Pancreatitis causes extreme pain and vomiting but is not related to gastric bypass.

DIF: Cognitive Level: Analyzing

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10. An appropriate meal for someone with dumping syndrome would be a. a small vanilla milkshake. b. cream of mushroom soup. c. half a turkey sandwich. d. popcorn and sugar-free soda.

ANS: C Individual tolerances vary, but the turkey half-sandwich would probably be tolerated best. Half a sandwich is probably small enough not to cause symptoms. A milkshake is high in sugar and probably too cold. Cream of mushroom soup is probably too hot, and liquids should be taken between rather than with meals. The carbonation in the soda may increase gastrointestinal distention because of gas.

DIF: Cognitive Level: Applying

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11. If a patient has esophagitis and also has worn tooth enamel, he or she may have a. a hiatal hernia. b. fluoride deficiency. c. an eating disorder. d. gastroesophageal reflux disease.

ANS: C The eating disorder bulimia nervosa causes esophagitis and eroded tooth enamel because of the effects of stomach acid being vomited back into the esophagus and mouth. A hiatal hernia and GERD may cause esophagitis, but stomach contents would enter only the esophagus, not the mouth, and so the teeth would not be worn. Fluoride deficiency may cause loss of tooth enamel but would not cause esophagitis.

DIF: Cognitive Level: Applying

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12. An example of a meal that may contain gluten is a. baked chicken breast with herbed rice. b. pork chop with sweet potatoes and butter. c. grilled steak with baked potato and sour cream. d. roast beef with mashed potatoes and gravy.

ANS: D

Gravy is often made with wheat flour, which contains gluten. Rice, potatoes, and sweet potatoes do not contain gluten. Baked chicken, pork chops, and grilled steak do not contain gluten unless they are breaded or coated with wheat flour before being cooked.

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13. A patient with lactose intolerance would be most likely to experience symptoms if he or she ate a a. cup of pudding. b. turkey sandwich with Swiss cheese. c. biscuit with butter and honey. d. cup of sherbet.

ANS: A A cup of pudding would contain a cup of milk; most individuals with lactose intolerance can only tolerate 1/2 to 3/4 cup milk at one time. Sherbet, Swiss cheese, biscuits, and butter all have low levels of lactose.

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14. Milk may be made suitable for patients with lactose intolerance by treating it with tablets that contain a. yogurt. b. lactase enzyme. c. vitamin D and calcium. d. Lactobacillus acidophilus.

ANS: B Lactase enzyme tables may be added to milk 24 hours before it is drunk to digest the lactose; this makes the milk suitable for patients with lactose intolerance. Lactobacillus acidophilus and yogurt are not necessarily better tolerated than regular milk. Vitamin D and calcium do not affect lactose intolerance, although patients with lactose intolerance may benefit from supplements of these nutrients if their intake is low because they avoid milk.

DIF: Cognitive Level: Understanding REF: Page 300 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

15. For patients with inflammatory bowel disease, nutrition therapy is a. the primary mode of treatment. b. rarely necessary. c. an important adjunct to drugs and surgery. d. highly specialized.

ANS: C Nutrition therapy is important to help maintain nutritional status of patients with inflammatory bowel disease, but is used in conjunction with drug and surgical treatments; it is not the primary mode of treatment. Nutrition therapy is often needed to maintain weight and micronutrient status.

Awareness of deficiencies that occur in these patients is important, but the RD does not need specialized knowledge to work with patients with IBD.

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16. Because patients with active Crohn’s disease have intestinal inflammation, they benefit from high intake of a. fat.

b. dietary fiber. c. simple sugars. d. protein.

ANS: D Patients with inflammatory bowel disease benefit from a diet high in protein to compensate for malabsorption. Fat intake should be moderate to provide adequate kilocalories within a healthful diet; high fat intake may cause steatorrhea. Dietary fiber may irritate the inflamed gut. Simple sugars provide a readily digested and absorbed source of energy but no other nutrients.

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17. Patients with inflammatory bowel disease may benefit from a high-fiber diet during a. acute episodes. b. times of remission. c. recovery from surgery. d. preparation for surgery.

ANS: B A high-fiber diet may help stimulate peristalsis during times of remission in patients with inflammatory bowel disease. During acute episodes, the diet should be low in fiber and should promote bowel rest. In general, the diet should be high calorie, high protein, and nutrient dense to compensate for malabsorption.

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18. Fluid loss is most likely to be a problem for a patient with a. a colostomy. b. a hiatal hernia. c. an ileostomy. d. Crohn’s disease.

ANS: C Fluid loss is most likely to be a problem for a patient with an ileostomy because food exits the intestines before water is absorbed in the colon. A colostomy may cause some fluid loss, depending on where the colostomy is located and how much of the colon the intestinal contents pass through for fluid absorption. A hiatal hernia does not cause fluid loss. Crohn’s disease may cause some fluid loss during acute periods of inflammation because of malabsorption.

DIF: Cognitive Level: Applying

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19. The most significant nutritional concern for a patient with an ileostomy is a. fat malabsorption and steatorrhea. b. dumping syndrome. c. loss of fluid and electrolytes. d. malabsorption of protein and carbohydrates.

ANS: C For a patient with an ileostomy, digestive output exits the body instead of passing through the colon, the major site of absorption of water and electrolytes. Digestion and absorption of protein, carbohydrate, and fat are not usually affected. Dumping syndrome is caused by a partial or total gastrectomy.

DIF: Cognitive Level: Analyzing

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20. For patients with ostomies, a lower amount of output occurs a. if the ostomy is closer to the rectum. b. if the ostomy is further from the rectum. c. with high fiber intake. d. with high fat intake.

ANS: A As effluent progresses through the colon, water is absorbed, and the effluent becomes more solid; therefore, an ostomy closer to the rectum would have a smaller volume. Fiber intake may increase output slightly, but less so than the site of the ostomy; fat intake does not significantly affect the amount of output.

DIF: Cognitive Level: Applying

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21. If a patient has had a large portion of their small intestine removed because of cancer and is unable to maintain a stable weight, a feeding regimen that would be most appropriate is a. enteral feedings into the stomach. b. enteral feedings into the jejunum. c. parenteral nutrition only. d. supplemental parenteral nutrition.

ANS: D

Patients who have undergone removal of large portions of the small intestine and are unable to maintain their weight should receive supplemental parenteral nutrition. Enteral feedings would not be more effective than oral feedings because these patients have a limited amount of gut to absorb the nutrients. Parenteral nutrition should not be used alone because some oral feeding helps stimulate recovery of gut function and maintain gut integrity.

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22. If a patient receiving chemotherapy is struggling with nausea and vomiting, helpful suggestions may include a. drinking acidic fruit juices to stimulate gastric juices. b. being active before and after meals to improve appetite. c. eating frequent small meals throughout the day. d. eating foods with plenty of flavor and aroma.

ANS: C Patients receiving chemotherapy who have nausea and vomiting are most likely to maintain adequate nutritional intake if they eat several small meals throughout the day. Rest before and after meals is more likely than activity to help control nausea. Acidic fruit juices may increase feelings of nausea. Bland foods are likely to be better tolerated than flavorful and aromatic foods.

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23. The best way to prevent formation of diverticula in the colon is to a. eat plenty of fruits, vegetables, and whole grains. b. avoid foods with rough hulls, such as nuts and seeds. c. use stool softeners to promote daily bowel movements. d. avoid foods that cause gas and increase pressure in the colon.

ANS: A Diverticula are caused by high pressure in the colon, often in association with straining to have a bowel movement; they can be prevented by intake of high-fiber foods, such as fruits, vegetables, and whole grains. There is no evidence that nuts, seeds, or other foods with hulls increase risk of diverticula. Using stool softeners to promote daily bowel movements may help prevent diverticula, but eating a high-fiber diet is preferable because of other nutritional benefits. Foods that cause gas are not associated with formation of diverticula.

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24. Someone who may benefit from avoiding sugar-free chewing gum is a patient with a. peptic ulcer disease. b. gastroesophageal reflux disease. c. irritable bowel syndrome. d. celiac disease.

ANS: C Sugar-free chewing gum is usually sweetened with sorbitol or mannitol, which may exacerbate irritable bowel syndrome. PUD, GERD, and celiac disease are not generally affected by chewing gum or intake of sugar alcohols.

DIF: Cognitive Level: Applying

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25. In consuming a high-fiber diet, it is important to also consume adequate amounts of a. fluid.

b. calcium and iron. c. fat-soluble vitamins. d. complex carbohydrates.

ANS: A It is important to consume adequate fluid along with a high-fiber diet to prevent fecal impaction.

High-fiber diets generally have high levels of complex carbohydrates. Slightly more calcium and iron may be needed because fiber may decrease the bioavailability of these nutrients. However, diets high in fiber tend to have higher amounts of nutrients in general. Requirements for fatsoluble vitamins are not generally affected by fiber intake.

DIF: Cognitive Level: Understanding REF: Page 305 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

26. If a client complains of excessive gas, a good question to ask is whether he or she a. drinks coffee and tea. b. has problems with constipation. c. chews gum. d. is under a lot of stress.

ANS: C Excessive gas may be caused by swallowing air while chewing gum. Drinking coffee and tea, stress, and constipation do not usually cause excess gas formation.

DIF: Cognitive Level: Applying

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27. An example of a daily change that may help decrease constipation is

a. drinking tomato juice instead of carbonated beverages with lunch. b. eating oatmeal and raisins instead of a bagel for breakfast. c. snacking on pretzels instead of potato chips. d. eating mashed potatoes instead of pasta with dinner.

ANS: B Increasing intake of dietary fiber helps prevent constipation; oatmeal and raisins have significantly higher levels of fiber than does a bagel. In fruit and vegetable juices, most of the fiber is removed during the juicing process; drinking vegetable juice would add nutrients but not fiber. Pretzels have less fat than potato chips, but both have low amounts of fiber. Mashed potatoes contain only slightly more fiber than does pasta.

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28. An example of a high-fiber food item to include with lunch is a. pasta with tomato sauce and Parmesan cheese. b. beef tacos with lettuce and tomatoes. c. an omelet with mushrooms and onions. d. black bean soup.

ANS: D Beans such as black beans have especially high amounts of fiber. Tomatoes, lettuce, mushrooms, onions, and white pasta have lower amounts of dietary fiber. Cheese, beef, and eggs contain no dietary fiber.

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29. A possible cause of acute diarrhea is a. short bowel syndrome. b. lactose intolerance. c. emotional stress. d. celiac disease.

ANS: C Acute diarrhea may be caused by enteritis, medications, dietary changes, or emotional stress.

Short bowel syndrome, lactose intolerance, and celiac disease may cause chronic diarrhea by causing various types of malabsorption.

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30. Treatment of diarrhea generally begins with a. a high-fiber, low-fat diet. b. removal of the cause of diarrhea. c. adequate fluids to hydrate the patient. d. a low-fat, low-fiber, or low-lactose diet.

ANS: C The primary concern in treatment of diarrhea is provision of adequate fluids to hydrate the patient. After taking fluids, affected patients may progress to a low-fat, low-fiber, or low-lactose diet and then to a regular diet as tolerated. If possible, the cause of diarrhea may be removed, but this is not always possible and is not the first priority. A high-fiber, low-fat diet may be beneficial once the diarrhea has resolved.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Physiological Integrity Chapter 14: Nutrition for Disorders of the Liver, Gallbladder, and Pancreas Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. If an otherwise healthy patient with normal body weight develops fatty liver disease, it would be especially important to evaluate their a. blood glucose level. b. alcohol intake. c. total fat intake. d. use of nonsteroidal anti-inflammatory drugs (NSAIDs).

ANS: B Fatty liver disease can also be associated with diabetes, and so blood glucose level may also be somewhat relevant. A high fat intake may exacerbate but would not cause fatty liver disease. Use of NSAIDs does not cause fatty liver disease.

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2. If an obese postmenopausal woman who does not drink alcohol develops fatty liver disease and wants to avoid progression to cirrhosis or liver cancer, the best recommendation is to a. decrease intake of saturated fats. b. decrease intake of carbohydrate. c. lose 3 to 4 lb per week. d. lose 1 to 2 lb per week.

ANS: D For an obese woman, gradual weight loss, 1 to 2 lb per week, probably helps reverse fatty liver disease and prevents progression. More rapid weight loss may exacerbate fatty liver disease and would result in loss of muscle tissue, as well as body fat. Decreasing intake of fructose may be helpful, but a general decrease in carbohydrate intake is not necessarily recommended other than to reduce energy intake. A decrease in total fat intake may be helpful and may help decrease energy intake, but a specific decrease in saturated fat intake is not warranted for this condition.

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3. If a client will be visiting an area where hepatitis E virus (HEV) is endemic, the best way to prevent becoming infected is to a. eat only cooked fruits and vegetables and drink only commercially bottled water. b. eat only at internationally recognized establishments. c. obtain a vaccination before entering that area. d. avoid all types of dairy products.

ANS: A HEV is transmitted via the fecal-oral route, so avoiding raw fruits, raw vegetables, and potentially contaminated water helps prevent infection. Even internationally recognized establishments may employ infected food workers. Dairy products are less common sources of HEV. A vaccination for HEV is not available.

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4. A symptom that is common to all types of hepatitis is a. jaundice.

b. headache. c. dehydration. d. muscle aches.

ANS: A All types of hepatitis cause jaundice. HEV causes flulike aches and pains, including headache.

Dehydration may occur if patients have nausea and vomiting.

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5. In treating patients with hepatitis, it is important for nurses to help patients cope with the challenge of a. difficulty sleeping. b. poor appetite. c. fat restriction. d. fluid restrictions.

ANS: B For patients with hepatitis, poor appetite makes it difficult to maintain adequate nutritional intake. Fluids are generally encouraged rather than restricted, especially to replace losses from vomiting or diarrhea. Fat intake does not need to be restricted unless not tolerated. Patients are usually very tired and would rather sleep than eat.

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6. An individual may be at risk for HEV infection if they travel to India and eat a. curried shrimp.

b. fresh fruit salad. c. Tandoori chicken. d. cooked foods from street vendors.

ANS: B HEV is transmitted via the fecal-oral route; food prepared by infected food handlers may transmit the disease. Raw fruits and vegetables (e.g., fruit salad) are common sources of infection. Foods that are cooked, such as curried shrimp and Tandoori chicken, and foods cooked by street vendors are not common sources.

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7. For patients with hepatitis, an important way to minimize loss of muscle mass is to a. participate in daily aerobic exercise. b. participate in daily strength exercise. c. maintain an adequate protein intake. d. maintain an adequate micronutrient intake.

ANS: C Adequate protein intake does not prevent loss of muscle mass but does help minimize it. Patients with hepatitis need to rest to promote recovery and healing; their bodies cannot handle the stress of exercise. Maintaining adequate intake of micronutrients is important but does not specifically help maintain muscle mass.

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8. The person at greatest risk for developing cirrhosis or liver cancer is a(n)

a. young woman who drinks a glass of wine every day. b. young man who travels extensively to tropical countries. c. middle-aged overweight man with gallstones. d. older adult infected with hepatitis C virus (HCV).

ANS: D Infection with HCV often progresses to cirrhosis or liver cancer; the progression is more rapid in older adults. For a woman, drinking less than 2 drinks a day should not cause liver damage.

Traveling to tropical countries does not necessarily increase risk for cirrhosis or liver cancer as long as appropriate precautions are taken to prevent hepatitis infection. Gallstones are not related to liver cancer or cirrhosis.

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9. If a patient with cirrhosis of the liver has a ―soft‖ diet order, he or she probably has a. lethargy. b. cholelithiasis. c. esophageal varices. d. hepatic encephalopathy.

ANS: C A low-fiber, soft diet is recommended for patients with esophageal varices because fibrous or abrasive foods could cause potentially life-threatening bleeding. Patients with cholelithiasis should follow a low-fat diet; patients with hepatic encephalopathy should restrict their protein intake. Lethargy associated with liver disorders may make a soft diet easier to eat, but this would not be the reason for the diet order.

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10. A good meal for a patient with ascites would be a. canned minestrone soup with saltine crackers. b. baked chicken with a roll and steamed green beans. c. bacon, sausage, eggs, and toast. d. tortilla chips with nacho cheese and salsa.

ANS: B Patients with ascites should restrict their intake of sodium to limit fluid retention. Baked chicken, a roll, and steamed vegetables have low levels of sodium. Canned soups, cured meats, processed cheese, and chips have high levels of sodium.

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11. If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing a. fatty liver disease. b. hepatitis D. c. secondary depression. d. hepatic encephalopathy.

ANS: D

If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing hepatic encephalopathy because the brain is influenced by compounds that have been absorbed from the intestine and have not been metabolized by the liver. Fatty liver disease develops first, before progression to cirrhosis. Any form of hepatitis can lead to cirrhosis, but cirrhosis does not cause hepatitis. Depression may cause apathy, but it does not usually cause confusion.

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12. If a patient with cirrhosis of the liver is treated with lactulose and neomycin, he or she probably has a. a secondary infection. b. ascites. c. esophageal varices. d. hepatic encephalopathy.

ANS: D Neomycin is an antibiotic used to sterilize the bowel to decrease the amount of urea that can be converted to ammonia, and lactulose is used to lower stool pH, which traps ammonia in the colon; these two drugs are used to decrease ammonia levels in hepatic encephalopathy.

Esophageal varices are not treated with medications. Ascites is treated with sodium restriction.

Secondary infections may be treated with neomycin but not with lactulose.

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13. Someone who drinks one glass of wine every night with dinner plus an occasional beer when watching a football game would be considered to be a. alcoholic.

b. an alcohol addict. c. a moderate drinker. d. a heavy drinker.

ANS: C Someone who drinks one to two drinks per day is considered a moderate drinker. A heavy drinker consumes three or more drinks daily. Alcoholism (which is the condition of being an alcohol addict) is a disabling addictive dependence on alcohol, usually characterized by intake of significantly more than one to two drinks daily.

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14. If a person has no history of liver disease but does have a strong family history of cardiovascular disease, the person may help decrease the overall risk for chronic disease by a. following a lacto-ovo vegetarian diet. b. avoiding use of NSAIDs. c. abstaining from drinking any alcoholic beverages. d. drinking one or two servings of alcoholic beverages daily.

ANS: D Moderate alcohol intake may help reduce risk of heart disease and is acceptable for people without any history of or risk factors for liver disease. Abstaining from drinking alcohol would not increase cardiovascular risk, but it also would not decrease risk. NSAIDs do not affect cardiovascular risk. Following a lacto-ovo vegetarian diet may increase cardiovascular risk if it includes large quantities of eggs and high-fat dairy products such as cheese.

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15. If a malnourished patient with cirrhosis of the liver seems to be vulnerable to development of hepatic encephalopathy, the best food to give them would be a. scrambled eggs. b. roast beef with gravy. c. a hamburger. d. a bean burrito.

ANS: D Vegetable proteins produce less ammonia than do animal proteins, and so the bean burrito would be a good source of protein for a malnourished patient at risk for hepatic encephalopathy.

Scrambled eggs, roast beef, and hamburgers all provide animal protein.

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16. If a patient with end-stage liver disease gains 5 lb in 1 week, the most likely explanation is a. development of ascites. b. restoration of muscle mass. c. high energy intake. d. edema in the extremities.

ANS: A In a patient with end-stage liver disease, sudden weight gain is usually a sign of ascites. Muscle mass would not be restored this quickly, even with plenty of exercise and good nutritional intake.

Energy intake high enough to produce this much weight gain is unlikely because patients with liver disease often have poor appetite. Edema in the extremities is more common with congestive heart failure.

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17. A patient with end-stage liver disease may lose fat stores and muscle mass, but this may not be evident from measurements of body weight because of a. dehydration. b. fat redistribution. c. ascites and edema. d. electrolyte imbalances.

ANS: C Many patients with end-stage liver disease accumulate fluid, manifested as ascites and edema.

This increases body weight, which may mask fat and muscle losses. Patients with end-stage liver disease are not usually dehydrated and do not usually have electrolyte imbalances. Fat infiltrates the liver but is not otherwise redistributed in the body.

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18. After liver transplantation, long-term nutrition recommendations most closely resemble those for patients with a. hepatitis. b. gallstones. c. peptic ulcer disease. d. metabolic syndrome.

ANS: D

Long-term nutrition management after liver transplantation needs to be tailored to help prevent excessive weight gain, hypertension, and hyperlipidemia; recommendations would be most similar to those for patients with metabolic syndrome. Patients with hepatitis usually need to be encouraged to eat more; those with gallstones need to decrease total fat intake, and peptic ulcer disease is mostly managed with drug therapy and stress reduction.

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19. An example of an individual who may be at high risk for gallstones is a(n) a. underweight woman who runs 3 miles four times a week. b. overweight man who smokes and has a sedentary job. c. overweight man who has recently begun an exercise program. d. mother with four children who has lost 25 pounds in the past 3 months.

ANS: D Rapid weight loss increases risk for gallstones, and so a mother who has lost 25 pounds in the past 3 months could easily develop gallstones. Underweight, regular exercise, smoking, and eating eggs do not increase risk for gallstones. Overweight increases risk for gallstones, but less than rapid weight loss.

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20. Cholecystitis is caused by a. blockage of the bile duct by gallstones, bacterial infection, or ischemia. b. concentration of bile in the gallbladder that favors formation of gallstones. c. failure of the gallbladder to contract and release bile into the small intestine. d. intake of excessive amounts of cholesterol and fat, in combination with bacterial infection.

ANS: A Cholecystitis occurs when gallstones block the cystic duct or as the result of stasis, bacterial infection, or ischemia of the gallbladder. Concentration of bile in the gallbladder causes cholelithiasis, or formation of gallstones. Failure of the gallbladder to contract and release bile may lead to gallstone formation; this may be caused by very low fat intake or dieting. Neither intake of excessive amounts of cholesterol and fat nor bacterial infection is associated with gallbladder disease.

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21. The most beneficial dietary change for a patient with cholelithiasis and cholecystitis would be to a. avoid fried foods and creamy sauces. b. abstain from drinking alcohol. c. refrain from eating 4 hours before bedtime. d. avoid eggs, shrimp, and high-cholesterol foods.

ANS: A A low-fat diet is used to treat painful symptoms associated with cholelithiasis and cholecystitis.

Avoiding alcohol and following a low-cholesterol diet do not alleviate symptoms. Avoiding alcohol is indicated for diseases of the liver, not the gallbladder. Even though gallstones contain cholesterol derivatives, most cholesterol is made by the body and is not dietary. Refraining from eating 4 hours before bedtime would help prevent pain caused by heartburn but not that caused by gallstones.

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22. After surgical removal of the gallbladder (cholecystectomy), the nurse should counsel patients to a. follow a low-fat, low-cholesterol diet. b. ensure high intake of protein and fluid. c. eat a well-balanced diet as tolerated. d. avoid snacking between meals.

ANS: C After cholecystectomy, long-term dietary restrictions are not needed. Some patients need to restrict fat intake for a few weeks during recovery, but not for the long term. High intake of protein and fluid is not needed. Including nutritious snacks may be helpful during recovery.

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23. If a nurse is beginning an enteral feedings for a patient with pancreatitis, the only appropriate type of formula is a. modular. b. hydrolyzed. c. intact. d. hypercaloric.

ANS: B For patients with pancreatitis, formula must be hydrolyzed or elemental so that it does not require digestion and stimulate the pancreas. It is infused after most digestion takes place in the intestines and thus needs to be ready for absorption. Modular, intact, and hypercaloric formulas would stimulate the pancreas to produce digestive enzymes and this would cause great pain in a patient with pancreatitis.

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24. At the beginning of an acute episode of pancreatitis, the nutrition priority is to provide a. a clear liquid diet. b. jejunal enteral feedings. c. parenteral nutrition. d. intravenous fluids.

ANS: D At the beginning of an acute episode of pancreatitis, the main priority is to keep patients hydrated. Depending on the length of the episode, patients may need enteral jejunal feedings.

Patients may be able to progress to a clear liquid diet, but this would not be the first step.

Parenteral feedings are not generally used because of impaired immune responses and bowel atrophy.

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25. The only appropriate diet order for a patient with pancreatitis is to begin feedings via a. nasogastric tube. b. percutaneous endoscopic gastrostomy (PEG) tube. c. nasoduodenal tube. d. percutaneous endoscopic gastrojejunostomy.

ANS: D

Enteral feedings for patients with pancreatitis should be infused into the jejunum below the ligament of Treitz to decrease pancreatic stimulation. Infusion into the stomach or duodenum would stimulate the pancreas and greatly increase pain.

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26. For patients with any kind of liver disease, the most important dietary modification is a. abstaining from alcohol. b. decreasing fat intake. c. increasing protein intake. d. avoiding dietary fructose.

ANS: A During treatment of any kind of liver disease, it is most important for patients to abstain from drinking alcoholic beverages. Increasing dietary protein may help with recovery, and decreasing fat intake may be generally beneficial as long as energy intake is adequate. Avoiding dietary fructose may be helpful to patients with fatty liver disease, but it is not the most important feature of therapy.

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27. If a patient is infected with HCV, he or she may a. have consumed contaminated food or water. b. be co-infected with hepatitis B virus (HBV). c. have had sexual contact with an infected person. d. have recently gotten a tattoo.

ANS: D HCV is associated with sharing contaminated needles or tattooing or piercing equipment.

Hepatitis D virus (HDV) is the type of hepatitis that only occurs as a co-infection with HBV. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are spread via contaminated food and water. HAV, HBV, and HDV are transmitted via sexual contact.

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28. For patients who are infected with hepatitis and have a poor appetite, the best way to increase protein and energy intake would be a. adding peanut butter to toast, soups, or smoothies. b. tossing salads and pasta with olive oil. c. mixing powdered milk into mashed potatoes and soups. d. adding sugar to coffee and tea.

ANS: A Peanut butter adds both energy and protein without adding a lot of volume. Olive oil and sugar add only energy, and powdered milk adds protein but relatively little energy.

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29. As a patient who has undergone liver transplantation heals, a necessary transition is a. increasing protein intake to replace pretransplantation losses. b. restricting fluid and sodium intakes to prevent ascites. c. generally eating less to avoid weight gain and chronic disease. d. generally eating more to maintain body weight and muscle mass.

ANS: C Patients who have undergone liver transplantation require extra energy and protein during recovery, but in the long term they should generally eat less to avoid excessive weight gain, hypertension, hyperlipidemia, and diabetes. After healing is complete, their protein needs are similar to those of other healthy adults. Sodium intake should be moderate, but fluid restriction is unnecessary; ascites is unlikely to occur as long as the new liver is functioning well.

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30. A bottle of beer that contains 13 g of carbohydrates and 16 g of alcohol provides _____ kcal. a. 116 b. 155 c. 164 d. 203

ANS: C Carbohydrate provides 4 kcal/g; alcohol provides 7 kcal/g. Therefore, this bottle of beer would

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TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance Chapter 15: Nutrition for Diabetes Mellitus Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. At a routine physical examination, a 50-year-old man has a fasting blood glucose level of 160 mg/dL. The next step in diagnosis and treatment would be a. referral to a diabetes clinic. b. prescribing an oral hypoglycemic agent. c. rechecking fasting blood glucose level. d. evaluating cardiovascular risk factors.

ANS: C Type 2 diabetes mellitus is diagnosed when the fasting blood glucose level exceeds 126 mg/dL on at least two occasions; therefore, the first step in care would be to recheck his fasting blood glucose level. If the diagnosis is confirmed, referral to a diabetes clinic, use of an oral hypoglycemic agent, and evaluation of cardiovascular risk factors may be warranted.

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2. If a patient with type 2 diabetes shows early signs of kidney disease, the first priority in nutrition management is a. restricting dietary protein intake. b. normalizing blood glucose levels. c. limiting dietary sodium intake. d. increasing fluid intake.

ANS: B If a patient with diabetes begins to develop any kind of complications, the priority in treatment is always normalizing blood glucose levels. Avoiding excessive intakes of protein and sodium and maintaining adequate protein intake may be beneficial but are not the first steps.

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3. If a patient with type 1 diabetes is unable to maintain good blood glucose control through insulin injections, the physician may recommend a. an oral hypoglycemic agent. b. using an insulin pump. c. more frequent self-monitoring of blood glucose. d. a daily exercise routine.

ANS: B An insulin pump is likely to result in better blood glucose management. Oral hypoglycemic agents cannot be used to treat type 1 diabetes. More frequent self-monitoring of blood glucose and daily exercise may be helpful but are not as beneficial as an insulin pump. A daily exercise routine has definite health benefits, especially for patients with diabetes, but it would not necessarily help normalize blood glucose level.

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4. If a 15-year-old student who runs cross-country and long-distance track events starts to lose weight and is continually thirsty and hungry, he or she may have a. type 1 diabetes. b. type 2 diabetes. c. acquired immunodeficiency syndrome (AIDS). d. hepatitis virus infection.

ANS: A

Polyphagia, polydipsia, and weight loss are hallmarks of untreated type 1 diabetes mellitus. Type 2 diabetes is associated with overweight and inactivity. AIDS and hepatitis may result in weight loss but are accompanied by loss of appetite rather than increased appetite.

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5. The cause of type 1 diabetes mellitus is a. excessive intake of simple sugars. b. destruction of pancreatic beta cells. c. inability of cells to respond to insulin in the bloodstream. d. inability of the pancreas to keep up with the body’s demands for insulin.

ANS: B Type 1 diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells. Excessive sugar intake does not cause any kind of diabetes mellitus. Type 2 diabetes is caused by inability of cells to respond to insulin in the bloodstream. In type 1 diabetes, the pancreas is not able to keep up with the body’s demands for insulin, but the cause of this is destruction of beta cells.

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6. The two strongest risk factors for type 2 diabetes are a. obesity and family history. b. recurrent viral infections and stress. c. male gender and upper body obesity. d. preference for sweet foods and sedentary lifestyle.

ANS: A

The two strongest risk factors for type 2 diabetes are obesity and family history. Upper body obesity and sedentary lifestyle may also contribute to the risk for the disease. Male gender, preference for sweet foods, recurrent viral infections, and stress are not risk factors for type 2 diabetes.

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7. If a patient with type 2 diabetes wants to lose weight, the preferred choice of medication would be a. insulin. b. sulfonylureas. c. thiazolidinediones. d. metformin.

ANS: D Metformin does not result in weight gain and may even result in weight loss because it decreases intestinal glucose absorption and improves insulin sensitivity. Insulin tends to cause weight gain because it lowers blood glucose levels by increasing storage as fat. Sulfonylureas tend to promote weight gain because they cause stimulate insulin secretion, and thiazolidinediones tend to promote weight gain because they cause improve insulin sensitivity.

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8. If members of an overweight family wants to reduce their risk for type 2 diabetes, the most helpful nutritional change they could make would be to a. increase their intake of dietary fiber. b. decrease their intake of refined sugar. c. decrease their portion sizes at meals and snacks.

d. switch to a vegetarian pattern of eating.

ANS: C The best way to prevent development of type 2 diabetes is to attain a normal body weight; decreasing portion sizes would help decrease energy intake, resulting in weight loss. Increasing intake of dietary fiber would be of some benefit in increasing satiety; high-fiber foods generally tend to be lower in fat and energy, and so increasing their intake may be of some benefit, but it is possible to increase fiber intake without decreasing energy intake. High-sugar intake does not cause type 2 diabetes, unless it causes weight gain. Switching to a vegetarian pattern of eating may not be beneficial and could even cause further weight gain if the diet includes a lot of eggs and cheese; a vegan eating pattern would probably help with weight loss and decrease risk for type 2 diabetes.

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9. In a patient with type 2 diabetes, a glycosylated hemoglobin (HgbA1c) level of 7.9% would be considered a. too low. b. normal. c. indicative of prediabetes. d. indicative of poor blood glucose control.

ANS: D For individuals with type 2 diabetes mellitus, glycosylated hemoglobin levels should be less than 7%; 7.9% indicates poor blood glucose control. Prediabetes would be diagnosed if a previously undiagnosed client had an HgbA1c level of 5.7% to 6.4%. A ―too low‖ level of HgbA1c has not been identified.

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10. The person who would be most likely to develop type 2 diabetes mellitus is a(n) a. sedentary Asian American man. b. man with alcohol-related cirrhosis of the liver. c. woman with retinal damage. d. overweight Native American woman.

ANS: D The prevalence of type 2 diabetes mellitus is high among Native Americans, and risk increases with overweight. The prevalence of type 2 diabetes among Asian Americans is relatively low, even though being sedentary contributes to risk. Retinal damage may be a complication of the disease, but it does not increase risk of developing it. Alcohol abuse and cirrhosis of the liver do not contribute to risk for type 2 diabetes.

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11. If someone using intensive insulin therapy with multiple injections daily wanted to celebrate his or her birthday and enjoy a slice of birthday cake, he or she would a. decrease food intake at other meals. b. add an extra aerobic workout afterwards. c. use an extra dose of intermediate- or long-acting insulin. d. use an extra dose of short- or rapid-acting insulin.

ANS: D

Intensive insulin therapy allows for unexpected meals and snacks by adding a dose of short- or rapid-acting insulin. Intermediate- or long-acting insulin would not act quickly enough to normalize blood glucose levels. An extra aerobic workout may help decrease blood glucose levels, but it could produce dangerous ketosis if blood glucose levels are too high. The patient may choose to slightly decrease food intake at other meals to offset the extra energy intake, but any major decrease in food intake at other meals could cause hypoglycemia, and eating the cake afterwards would cause hyperglycemia.

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12. If a patient with diabetes mellitus checks blood glucose level before going for a 2-mile run and it is 90 mg/dL, he or she should a. administer extra short- or rapid-acting insulin. b. administer extra intermediate- or long-acting insulin. c. eat carbohydrate-containing food before exercising. d. go for the run and recheck blood glucose levels afterwards.

ANS: C Patients with diabetes mellitus should exercise when their blood glucose level is between 100 and 250 mg/dL. With a blood glucose level of 90 mg/dL, the patient may experience hypoglycemia during the run, so he or she should first eat food containing carbohydrate.

Administering extra insulin of any type would lower blood glucose levels still further and cause dangerous hypoglycemia.

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13. To prevent hypoglycemia after exercise, patients with type 1 diabetes should a. decrease the insulin dose. b. omit a scheduled insulin dose. c. increase their intake of protein-based foods. d. increase their intake of carbohydrate-based foods.

ANS: D To prevent hypoglycemia after exercise, patients with type 1 diabetes should increase their intake of carbohydrate-based foods. Decreasing or omitting an insulin dose would essentially starve cells and could be dangerous. Increasing intake of protein-based foods would not prevent a decrease in blood glucose level as effectively as would carbohydrate-based foods.

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14. The best strategy for a patient with type 2 diabetes to use to maintain good metabolic control is to a. avoid all sources of simple carbohydrates. b. avoid eating during the evening or at night. c. space their meals evenly throughout the day. d. eat one large meal and two small meals each day.

ANS: C

Patients with type 2 diabetes are most likely to maintain good metabolic control if they space their meals evenly throughout the day. Avoiding all sources of simple carbohydrates does not address other dietary excesses of kilocalories, fat, and complex carbohydrate. Avoiding eating during the evening and at night may help control kilocalorie intake but would not help control blood glucose levels. Eating one large meal and two small meals each day would result in uneven metabolic control.

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15. Glycosylated hemoglobin level is used to indicate a. the effect of meals on blood glucose level. b. day-to-day variations in blood glucose level. c. iron-deficiency anemia in patients with diabetes. d. overall blood glucose control over several weeks.

ANS: D Glycosylated hemoglobin level is used to indicate overall blood glucose control throughout the previous 100 to 120 days. The effect of meals on blood glucose level is determined through selfmonitoring of blood glucose levels. Glycosylated hemoglobin level does not show day-to-day variations in blood glucose level. Iron-deficiency anemia is diagnosed through measurement of total hemoglobin level in patients with and without diabetes.

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16. A young man with type 1 diabetes runs 3 miles, falls asleep on the sofa, and forgets to eat his next meal. He is likely to experience a. nephropathy.

b. hypoglycemia. c. hyperglycemia. d. diabetic ketoacidosis.

ANS: B A young man who exercises and forgets to eat his next meal is likely to experience hypoglycemia because he used up his available blood glucose and glycogen stores while exercising but still has exogenous insulin in his bloodstream. Hyperglycemia would occur if he ate extra carbohydrate without using extra insulin. Diabetic ketoacidosis would occur if he omitted insulin doses. Nephropathy is a long-term complication of diabetes mellitus.

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17. An individual with a blood glucose level of 65 mg/dL would have a. hypoglycemia. b. a normal blood glucose level. c. hyperglycemia. d. impaired glucose tolerance.

ANS: A The normal range of blood glucose levels is 90 to 130 mg/dL. Low blood sugar is a blood glucose below 70 mg/dL and represents hypoglycemia; thus a blood glucose level of 65mg/dL would be considered low. Blood glucose levels above 180 mg/dL would represent hyperglycemia. Impaired glucose tolerance is diagnosed when fasting plasma glucose levels are 100 to 125 mg/dL.

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18. Diabetic ketoacidosis may occur in a patient with type 1 diabetes who a. gets caught in traffic and misses a meal. b. participates in an all-day sporting event. c. accidentally takes a double dose of insulin. d. goes away for the weekend and forgets to take his or her insulin.

ANS: D Diabetic ketoacidosis may occur in a patient with type 1 diabetes who goes away for the weekend and forgets to take his or her insulin. Missing a meal would cause hypoglycemia.

Participation in an all-day sporting event could cause hypoglycemia if he or she did not eat extra food. Taking a double dose of insulin would cause hypoglycemia.

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19. If a woman is brought into the emergency room with nausea, weakness, and fruity-smelling breath, the test you would perform first is a. blood glucose measurement. b. blood alcohol measurement. c. a pregnancy test. d. blood pressure measurement.

ANS: A The most important test to perform first is measurement of blood glucose level because this can and must be corrected rapidly if the patient has ketoacidosis. Blood alcohol level could be checked if blood glucose level is normal. A pregnancy test and blood pressure may be important measurements if blood glucose and blood alcohol are normal, but those would not be performed first.

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20. If someone with type 1 diabetes has nausea and vomiting, weakness, and fatigue, as well as excessive hunger and thirst, but does not have a fruity or acetone odor on his or her breath, he or she may have a. hepatic encephalopathy. b. diabetic ketoacidosis. c. hyperglycemic hyperosmolar nonketotic syndrome (HHNS). d. hypoglycemia.

ANS: C Nausea and vomiting, weakness, fatigue, polyphagia, and polydipsia can all be symptoms of both HHNS and diabetic ketoacidosis. However, with diabetic ketoacidosis, the breath smells fruity because of ketones. If this is not the case, the patient has HHNS. Hypoglycemia would be characterized by hunger, confusion, trembling, and erratic behavior. Hepatic encephalopathy is not associated with diabetes.

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21. If a young man with type 1 diabetes wants to eat cake for dessert after a meal of roast chicken, mashed potatoes, gravy, green beans, and dinner rolls, he should eat a. fewer potatoes, fewer rolls, or fewer of both. b. less chicken and gravy. c. fewer green beans. d. less of everything.

ANS: A Foods containing sucrose (such as cake or other desserts) should be substituted for other carbohydrate foods in the meal plan, and so he should eat fewer potatoes or rolls. Chicken, gravy, and green beans have low levels of carbohydrate, and so he does not need to eat less if he wants to eat dessert.

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22. Patients with type 1 diabetes should be taught to regulate the _____ in meals and snacks. a. kilocalorie content b. total amount of sugars c. total amount of dietary fiber d. total amount of carbohydrates

ANS: D Patients with type 1 diabetes should learn to regulate the total amount of carbohydrates in meals and snacks. The overall kilocalorie content and amount of dietary fiber are less important. The amount of sugar is important only as it contributes to total carbohydrate.

DIF: Cognitive Level: Applying

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23. An example of a good after-workout snack for someone with type 1 diabetes is a. skim milk. b. beef jerky. c. string cheese. d. peanuts.

ANS: A A good after-workout snack for someone with type 1 diabetes is a glass of milk. Milk provides carbohydrate in the form of lactose. Beef jerky and string cheese do not provide carbohydrate.

Peanuts provide some carbohydrate but not enough to restore blood glucose levels after a workout.

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24. If a patient with diabetes complains that he or she is experiencing diarrhea on a regular basis, the nurse should ask about a. whether the patient uses sugar-free gum. b. the patient’s intake of dietary fiber. c. the amount of sleep that the patient gets each night. d. the patient’s use of laxative medications.

ANS: A Sugar-free gum is sweetened with sugar alcohols, sorbitol, mannitol, and xylitol, which may cause diarrhea when used in large amounts. Low intake of dietary fiber may cause constipation, but high intake does not usually cause diarrhea. Amount of sleep does not usually affect bowel function significantly. The nurse may ask about use of laxative medications, but it is unlikely that a patient who complains about diarrhea is using them.

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25. Patients with diabetes are most likely to maintain good glycemic control successfully if their prescribed meal plan

a. includes some favorite foods each week. b. is based on the patient’s usual eating habits. c. is tailored to achieve individual weight-loss goals. d. includes meals and snacks eaten at the same time each day.

ANS: B To facilitate compliance, patients’ meal plans should be based on their usual eating habits.

Including some favorite foods each week may improve quality of life, achieving weight-loss goals may minimize the effects of the disease, and including meals and snacks at the same time each day may improve glycemic control, but these measures would not have much effect on compliance.

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26. If a young woman with type 1 diabetes mellitus is in a car accident and breaks several bones, she is likely to need a. less insulin than usual. b. more insulin than usual. c. a different type of insulin. d. the same amount of insulin.

ANS: B Serious injury increases insulin requirements because of increased hepatic glucose production caused by the release of epinephrine, norepinephrine, glucagon, and cortisol.

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27. If a patient with type 1 diabetes mellitus has a fever and no appetite, he or she should consume a. dry foods, such as toast or crackers. b. commercial liquid nutrition supplements. c. liquid or soft sources of carbohydrates. d. water, tea, or beverages sweetened with nonnutritive sweeteners.

ANS: C Patients with type 1 diabetes mellitus who are sick and unable to eat regular food should consume liquid or soft sources of carbohydrates to maintain their blood glucose level. Dry foods may be difficult to eat and would not help restore fluid losses caused by fever. Commercial liquid nutrition supplements are expensive and unnecessary. Noncaloric fluids would prevent dehydration but would not provide carbohydrate to maintain the blood glucose level.

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28. Eating plans for patients with diabetes mellitus and gastroparesis should include a. six small meals daily. b. three regular meals daily. c. high-protein intake. d. increased fluid intake.

ANS: A For patients with gastroparesis, six small meals daily are better tolerated than three regular meals daily. Patients with gastroparesis do not have increased needs for protein and fluid.

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29. A pregnant woman is most likely to develop gestational diabetes during her pregnancy if she a. is underweight and gains insufficient weight during pregnancy. b. is overweight and has a family history of type 2 diabetes. c. has cravings for high-sugar foods during the first trimester. d. is white, non-Hispanic, and unmarried.

ANS: B Gestational diabetes is associated with overweight and family history of type 2 diabetes.

Underweight and insufficient weight gain may cause intrauterine growth retardation. Sugar intake and food cravings do not directly affect risk of gestational diabetes. White, non-Hispanic women have a lower risk for gestational diabetes than do Native American, African American, and Hispanic and Latina American women. Marital status is not associated with risk for gestational diabetes.

DIF: Cognitive Level: Understanding REF: Page 340 TOP: Nursing Process: Assessment

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30. For women with type 1 diabetes, good metabolic control is especially important at the time of conception and during the first trimester to prevent a. macrosomia. b. fetal malformations. c. nutrient deficiencies. d. excessive weight gain.

ANS: B

In women with type 1 diabetes, good metabolic control at the time of conception and during the first trimester helps prevent fetal malformations. Macrosomia is related to hyperglycemia in the second and third trimesters. Metabolic control does not affect nutrient deficiencies. Excessive weight gain may exacerbate poor metabolic control, but poor metabolic control does not usually cause weight gain.

DIF: Cognitive Level: Remembering

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TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance Chapter 16: Nutrition in Metabolic Stress: Burns, Trauma, and Surgery Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. If a 75-year-old woman needs hip replacement surgery but reports that she has lost 15 lb since her husband died 3 months ago because she has had very little appetite, the best approach would be to a. provide enteral feedings immediately after surgery. b. delay surgery until the patient returns to usual body weight. c. recommend using a multivitamin or multimineral supplement. d. ensure at least 2 weeks of good nutritional intake before surgery.

ANS: D

Loss of 15 lb in 3 months is probably associated with significant nutritional risk; at least 2 weeks of good nutritional intake should be encouraged before surgery to minimize risk of complications and improve healing. The patient is able to eat, and so enteral feedings are not needed, and it would be better to improve nutritional status before surgery rather than afterwards. Supplements may be helpful, but it is always better to obtain nutrients from food rather than supplements.

Delaying surgery until the patient returns to usual body weight is not necessary so long as nutrient stores are replenished.

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2. If a patient is healing more slowly than expected after surgery, he or she may benefit from a. enteral feedings. b. supplemental zinc and vitamins A and C. c. supplemental iron and vitamins B12 and D. d. additional branched-chain amino acids.

ANS: B Vitamins A and C and zinc play an important role in wound healing. Iron and vitamin B12 are important for maintaining optimal immune status, and vitamin D is important for healing broken bones. Branched-chain amino acids do not play a specific role in healing. Enteral feedings are not needed unless the patient is unable to maintain adequate oral intake.

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3. Of the following, the most stressful physical traumas would be a. a single bone fracture. b. a low-grade fever c. minor surgery.

d. a large third-degree burn.

ANS: D Serious burns result in significant increases in metabolic rate. Fractures, low-grade fevers, and minor surgery also increase metabolic rate, but to a lesser degree than do burns.

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4. If someone has been fasting for 36 hours, his or her body is meeting its glucose needs by breaking down a. glycogen. b. keto acids. c. amino acids. d. fatty acids.

ANS: C Glycogen stores are depleted after 24 hours of starvation, so after 36 hours, the body would have to deaminate amino acids and produce glucose by gluconeogenesis. The body cannot make glucose from fatty acids. Keto acids are byproducts of incomplete fatty acid metabolism and also cannot be converted to glucose.

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5. If a malnourished patient has a poor appetite, the nurse’s first priority should be to recommend a. enteral feedings. b. increasing intake of fruits and vegetables. c. several small meals and snacks each day.

d. limiting between-meal snacks to promote hunger.

ANS: C The nurse should encourage malnourished patients to eat several small meals and snacks each day to promote adequate intake without fatigue. Enteral feedings may be necessary if the patient cannot achieve adequate intake, but it would not be the first strategy used. Increasing intake of fruits and vegetables would increase the volume of food eaten, which may cause satiety before the patient has ingested sufficient energy and protein. Limiting between-meal snacks is likely to decrease overall food intake.

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6. Once patients have completely recovered from gastric bypass surgery for treatment of obesity, an appropriate meal would be a. a large green salad with chopped turkey and vinaigrette dressing. b. a medium vanilla shake. c. half a small chicken breast and 1/2 cup of green beans. d. a cup of bean soup with vegetable sticks.

ANS: C After bariatric surgery, the total volume of food eaten at a meal should not exceed 1 cup, including no more than 2 oz of meat; the half chicken breast and green beans would meet these criteria. A large salad would provide low energy levels and is appropriate for weight loss but would be too great a volume of food after gastric bypass surgery. A medium vanilla shake would provide a high amount of energy and would be more than 1 cup in volume. Bean soup and vegetable sticks would be another healthy choice, but the overall volume of food would be too great.

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7. If a student group goes on hunger strike and drinks water but does not eat any food for 4 days, they are likely to a. feel colder than usual. b. have increased mental acuity. c. sleep for shorter periods of time. d. develop fluid overload.

ANS: A The body conserves energy during starvation by decreasing metabolic rate, which would make the students feel colder than usual. Mental acuity would decrease as a result of decreased glucose supply. To conserve energy, they are likely to sleep more rather than less. With gradual loss of sodium, the students are more likely to experience fluid loss than overload; long-term lack of protein intake may result in edema or ascites, but this would not develop in a few days.

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8. A major difference between starvation and stress is that metabolic rate _____ during starvation and _____ during recovery from injury. a. increases; decreases b. decreases; increases c. is unaffected; increases d. decreases; is unaffected

ANS: B

Metabolic rate decreases during starvation because the body is trying to conserve energy. It increases during stress because the body uses energy to heal the injury.

DIF: Cognitive Level: Understanding REF: Pages 349-351 TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

9. If a patient who has fallen down a flight of steps has a low body temperature, low blood pressure, and high blood glucose levels, he or she is probably a. in the initial injury (ebb) phase. b. in the recovery (flow) phase. c. developing a serious infection. d. developing multiple organ dysfunction syndrome (MODS).

ANS: A Low body temperature (hypothermia), low blood pressure, and high blood glucose levels are characteristics of the initial injury phase. In the recovery phase, patients still have high blood glucose levels, but blood pressure normalizes and body temperature increases. Serious infections would also cause high blood glucose levels with an increase in body temperature and no effect on blood pressure. In MODS, body temperature is usually elevated; this is unlikely to result simply from a fall.

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10. Four days after a major accident involving multiple broken bones, the patient would be expected to be in the _____ phase. a. critical b. stress c. ebb

d. flow

ANS: D After major stress, such as an accident causing multiple broken bones, patients are in the initial injury (ebb) phase (commonly known as shock) for 36 to 48 hours. By 4 days after the injury, they would be in the flow phase and would be highly hypermetabolic.

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11. During starvation or fasting, the body adapts so that it can obtain as much energy as possible from a. glycogen. b. glucose. c. protein. d. fat.

ANS: D During starvation, the body conserves protein and glycogen stores as much as possible, and all body tissues other than the brain, nerves, and red blood cells derive most of their energy from fat.

DIF: Cognitive Level: Understanding REF: Page 350 TOP: Nursing Process: Assessment

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12. If a man who weighs 80 kg is recovering from surgery and has an average protein intake of 105 g/day, his protein intake is a. inadequate. b. deficient.

c. appropriate. d. excessive.

ANS: C During moderate stress, such as recovery from surgery, protein intake should be 1.0 to 1.5 g/kg body weight. For an 80-kg man, the recommended intake would therefore be 80 to 120 g/day. An intake of 105 g/day is within this range and is therefore likely to be adequate.

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13. If a 40-year-old woman weighing 60 kg breaks both ankles while hiking and is hospitalized, her fluid needs would be _____ mL. a. 1800 to 2100 b. 2100 to 2400 c. 2400 to 2700 d. 2700 to 3000

ANS: B Fluid needs during hypermetabolic stress for adults younger than 55 years are 35 to 40 mL/kg.

For a 60-

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14. The amino acid that plays an important role in the gastrointestinal tract during stress is a. arginine. b. glutamine. c. methionine.

d. phenylalanine.

ANS: B During stress, glutamine is mobilized in large quantities from skeletal muscle and the lungs to be used directly as a fuel source by intestinal cells. Glutamine also plays a significant role in maintaining intestinal immune function and enhancing wound repair by supporting lymphocyte and macrophage proliferation, hepatic gluconeogenesis, and fibroblast function. Arginine has a role in maintaining immune function in the gastrointestinal tract but is not as critical in stress as glutamine. Methionine and phenylalanine do not have specific roles during stress.

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15. When refeeding a malnourished patient, it is especially important to monitor blood levels of a. phosphorus. b. iron. c. zinc. d. vitamin C.

ANS: A Overfeeding of a malnourished patient can result in dangerous hypophosphatemia as phosphorus enters the cells from the blood. Iron is important for immune function and zinc and vitamin C levels are important for healing, but these levels are not so critical during refeeding.

DIF: Cognitive Level: Understanding REF: Page 359 TOP: Nursing Process: Assessment | Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

16. During the initial injury (ebb) phase, the main nutritional priority is

a. normalizing blood glucose levels. b. normalizing fluid status. c. providing adequate protein. d. avoiding overfeeding.

ANS: B During the initial injury phase, the main priority is fluid resuscitation. At this time, the body is unable to metabolize exogenous protein and energy. Avoidance of overfeeding is important but is not the primary initial concern.

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17. The best way to determine energy needs of stressed patients is to use a. indirect calorimetry. b. the Ireton-Jones formula. c. the Dietary Reference Intakes. d. patient hunger and appetite cues.

ANS: A Energy needs of stressed patients are highly individual; the most accurate way to measure them is using indirect calorimetry. Formulas such as Ireton-Jones are used when indirect calorimetry is not available, but their results are less accurate. The Dietary Reference Intakes provide estimates of energy needs for health populations but do not account for individual differences or for stress.

Stressed patients often have very poor appetites despite high energy needs.

DIF: Cognitive Level: Understanding REF: Page 351 | Page 352 | Page 356 TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

18. If a malnourished patient undergoes an emergency appendectomy and develops pneumonia during the recovery, he or she probably a. has a history of smoking. b. used protein from the intercostal muscles for energy. c. had bronchitis before undergoing surgery. d. needs evaluation for dysphagia.

ANS: B Malnourished stressed patients may use protein from their intercostal muscles for energy; weakening of chest muscles increases the likelihood of pneumonia. It is unfair to assume a history of smoking in a patient who develops pneumonia. Pneumonia is sometimes caused by dysphagia or may develop from bronchitis, but in a stressed malnourished patient, this is not the most likely explanation.

DIF: Cognitive Level: Analyzing

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19. If a severely burned patient has been unable to eat more than a few bites each day for a week, he or she should be fed by means of a. enteral feedings into the stomach. b. enteral feedings into the jejunum. c. central parenteral nutrition. d. peripheral parenteral nutrition.

ANS: A

If a stressed patient is unable to maintain adequate oral intake for more than 5 to 10 days, he or she should be fed via an enteral feeding tube into the stomach. Jejunal feedings would be used only if the patient has a high risk for aspiration. Enteral feedings are preferred over parenteral feedings because they promote normal nutrient metabolism and maintain integrity of the gut.

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20. In a critically ill patient receiving parenteral nutrition, a blood glucose level of 145 mg/dL is considered a. too low. b. acceptable. c. slightly elevated. d. seriously elevated.

ANS: B For critically ill patients receiving parenteral nutrition, the goal is to maintain blood glucose levels between 140 and 180 mg/dL. Therefore, a blood glucose level of 150 mg/dL is acceptable.

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21. If a patient has significant fluid losses from perspiration and wound dressings that cannot be measured easily, the best way to monitor fluid balance is to a. measure serum sodium levels. b. weigh the patient daily. c. use formulas to calculate losses. d. check urine concentration.

ANS: B The best way to monitor fluid balance is to weigh the patient daily. Hormones are secreted to keep serum sodium level within a narrow range regardless of hydration status. Formulas are not available to calculate fluid losses. Urine concentration does not provide a definitive measurement of fluid status.

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22. After surgery, once bowel sounds return, the most appropriate first meal should be a. clear liquids. b. soft and low in fiber. c. chosen by the physician. d. chosen by the patient.

ANS: D Once bowel sounds return after surgery, patients may gradually introduce foods as they choose.

Patients used to be given liquids initially, but there is no reason to justify this practice. Patients are more likely to achieve adequate oral intake if they are allowed to make their own food choices.

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23. If a patient undergoes resection of 6 inches of the colon, he or she is likely to have the best outcome if he or she a. gives the bowel complete rest for 7 to 14 days. b. begins oral or enteral feedings the day after surgery. c. follows a soft, low-fiber diet. d. follows a high-fiber diet to promote laxation.

ANS: B After gastrointestinal surgery, the patient recovers best if he or she begins oral or enteral feedings the first day after surgery. Complete bowel rest is likely to result in loss of integrity of the intestinal mucosa. The amount of fiber in the diet is less important than delivery of nutrients to promote healing and maintain immune function.

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24. Presurgical nutritional status would be most important for a(n) a. middle-aged man undergoing open heart surgery to replace a heart valve. b. young woman undergoing a mastectomy for treatment of breast cancer. c. older adult undergoing cholecystectomy. d. child undergoing tonsillectomy.

ANS: A Patients with high risk for malnutrition who undergo high-risk procedures, such as open heart surgery, prostatectomy, and hip replacement, have significantly longer hospital stays and higher mortality rates than do well-nourished patients. Outcomes of mastectomy, cholecystectomy, and tonsillectomy would also be affected by nutritional status, but to a lesser degree.

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25. The factor that contributes most to development of MODS is a. blood glucose level. b. inflammatory response.

c. fever. d. malnutrition.

ANS: B MODS generally results from an uncontrolled inflammatory response. Blood glucose level may be elevated and fever is likely to be present, but these are symptoms rather than causes.

Malnutrition exacerbates but does not cause MODS.

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26. The best indicator that it is safe for a patient to begin to resume oral intake after surgery is a. presence of bowel sounds. b. return of appetite. c. ability to sit upright. d. normal blood glucose level.

ANS: A After surgery, patients may resume oral intake when they have bowel sounds because this indicates that the gastrointestinal tract is working. Appetite may not return for several days, but patients still need nutrients, and so they need to eat anyway. Patients should not eat lying down because of the risk of aspiration, but they do not need to be able to sit completely upright to eat.

Blood glucose level is not an indicator of whether the patient is ready to resume oral intake.

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27. The staff member best equipped to determine the nutrient needs of patients with severe burns is the

a. physician. b. registered nurse. c. pharmacist. d. registered dietitian.

ANS: D Registered dietitians have the training necessary to best determine the nutrient needs of patients according to their age, weight, gender, area and degree of burn, and nutritional status. The nurse makes important contributions to monitoring outcomes and identifying potential concerns, and the physician determines treatment. The pharmacist would be involved if the patient receives parenteral nutrition or if there are concerns about drug-nutrient interactions.

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28. If a patient is seriously burned and the muscle tissue is visible, the patient has a _____ burn. a. first-degree b. second-degree c. third-degree d. nonthermal

ANS: C A burn that destroys the entire epidermis, dermis, and underlying subcutaneous tissue so that muscle tissue visible is a third-degree burn. First-degree burns involve only the epidermis.

Second-degree burns involve the epidermis and dermis. Nonthermal injuries are caused by electricity, chemicals, or radiation and may be first-, second-, or third-degree burns.

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29. If a patient experiences a third-degree burn over 30% of the body surface area, the first priority would be a. provision of adequate protein. b. prevention of nausea and vomiting. c. replacement of fluids and electrolytes. d. provision of adequate energy.

ANS: C During the first 24 to 48 hours after a major burn, nutrition care focuses on replacement of fluids and electrolytes. Provision of adequate protein and energy is important over the long term, but it is not the first priority in this early treatment period. Burned patients do not usually experience nausea and vomiting.

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30. The factor that would have the greatest influence on the energy needs of a burned patient is the a. patient’s activity level. b. patient’s emotional stress level. c. percentage of total body surface area burned. d. type of burn (thermal, chemical, electrical, or radioactive).

ANS: C Energy needs of burned patients are influenced by size of the burn. Patients are not usually active after major burns, and so activity does not affect energy needs. Emotional stress does not affect energy needs. Energy needs are not affected by the cause of the burn.

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TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity Chapter 17: Nutrition for Cardiopulmonary Diseases Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. If a patient has a family history of cardiovascular disease and is concerned about his own level of risk, the most useful measurements would be a. serum sodium and glucose levels. b. blood oxygen and carbon dioxide levels. c. serum total and high-density lipoprotein (HDL) cholesterol levels. d. serum triglyceride and low-density lipoprotein (LDL) cholesterol levels.

ANS: D Serum triglyceride and LDL cholesterol levels would be the best predictors of cardiovascular risk. Blood glucose level may help identify type 2 diabetes, which often coexists with cardiovascular disease but is not necessarily predictive of it. Serum sodium levels do not demonstrate cardiovascular risk. Blood oxygen and carbon dioxide levels would reflect lung function. Serum total and HDL cholesterol levels would be somewhat related to cardiovascular risk, but less so than triglycerides and LDL cholesterol.

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2. If gangrene develops in a patient’s foot and the patient is found to have high blood lipid levels, he or she probably has a. type 2 diabetes mellitus.

b. peripheral artery disease. c. angina pectoris. d. fatty liver disease.

ANS: B Peripheral artery disease is a form of cardiovascular disease in which atherosclerosis develops in major arteries and blocks blood flow to the extremities. This may lead to ischemic necrosis of extremities and even gangrene; elevated blood lipids levels would indicate that this is the case.

Type 2 diabetes may cause nerve damage in the extremities, and gangrene could occur, but blood lipids are not necessarily elevated. Angina pectoris is caused by atherosclerosis in the coronary arteries, and fatty liver disease is caused by excess alcohol intake or obesity.

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3. If a patient has a thrombosis in a cerebral artery, he or she would experience a. a stroke. b. a migraine headache. c. a heart attack. d. angina pectoris.

ANS: A If a patient has a thrombosis in a cerebral artery, he or she would experience a stroke, or cerebrovascular accident. A migraine headache is thought to be caused by dilation of blood vessels in the brain. Heart attacks are caused by a thrombosis in a coronary artery that completely blocks the artery. Angina pectoris is caused by a thrombus in the coronary artery that causes only partial occlusion of the blood vessel.

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4. A patient who would be likely to have elevated serum triglyceride levels is a(n) a. single mother who works full time and eats only two meals a day. b. teenager taking antibiotics during recovery from a streptococcal infection. c. overweight man who drinks three alcoholic beverages a day. d. young man infected with hepatitis A virus.

ANS: C Elevations in serum triglyceride levels are associated with long-term excessive alcohol intake (more than two drinks per day for a man), overweight and obesity, physical inactivity, cigarette smoking, and very high carbohydrate intake. Serum triglyceride levels are not related to meal frequency, use of antibiotics, or hepatitis A infection.

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5. The primary goal of therapy to reduce risk of cardiovascular disease is to lower serum levels of _____ cholesterol. a. total b. LDL c. HDL d. very low-density lipoprotein (VLDL)

ANS: B The primary goal of therapy to reduce risk of cardiovascular disease focuses on lowering blood levels of LDL cholesterol. Lowering serum total cholesterol and VLDL cholesterol levels and increasing HDL cholesterol levels also decreases cardiovascular risk but are not the main focus.

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6. In a 55-year-old woman, an LDL cholesterol level of 195 mg/dL would be considered a. normal. b. borderline high. c. high. d. very high.

ANS: D A serum LDL cholesterol level in excess of 190 mg/dL is considered very high. LDL cholesterol levels of 160 to 189 mg/dL are considered high; levels of 130 to 159 mg/dL, borderline high; levels of 100 to 129 mg/dL, normal; and levels lower than 100 mg/dL, optimal.

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7. A serum triglyceride level of 175 mg/dL is considered a. normal. b. borderline high. c. high. d. very high.

ANS: B A serum triglyceride level of 175 mg/dL is considered borderline high. Serum triglyceride levels lower than 150 mg/dL are considered normal; levels of 150 to 199 mg/dL, borderline high; levels of 200 to 499 mg/dL, high; and levels in excess of 500 mg/dL, very high.

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8. For a person who is implementing therapeutic lifestyle changes (TLCs) to reduce his or her risk of coronary heart disease, the best salad choice would be a. coleslaw. b. mixed greens with olive oil vinaigrette and walnuts. c. sliced tomatoes with bacon and Greek dressing. d. fruit salad with yogurt dressing and coconut.

ANS: B TLC recommendations include focusing on sources of monounsaturated fat, such as olive oil and walnuts, and decreasing intake of saturated fat. Coleslaw contains mayonnaise, which is likely to be made with an oil high in polyunsaturated fat; the kind of oil in the Greek dressing, and bacon contains saturated fats. Yogurt dressing is not high in fat, but any fat it does contain is saturated; coconut also contains saturated fat.

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9. Of the following, the most helpful change to decrease blood LDL cholesterol levels would be to a. eat oatmeal instead of a bagel for breakfast. b. use fresh rather than canned vegetables. c. use margarine instead of butter. d. eat a salad instead of a sandwich for lunch.

ANS: A

Switching to oatmeal instead of a bagel for breakfast would increase intake of soluble fiber, which can significantly lower the serum LDL cholesterol level. Using fresh instead of canned vegetables would decrease sodium intake, which would help decrease blood pressure but would not affect serum lipid levels. Using margarine instead of butter may or may not be beneficial, depending on the type of oil the margarine is made from, the degree of hydrogenation, and whether it contains added stanols. Eating a salad instead of a sandwich could increase blood LDL cholesterol levels, depending on the amount and type of dressing and cheese.

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10. A patient with high serum LDL cholesterol levels tells you that he usually eats a granola bar and a cup of coffee on the way to work; eats a grilled cheese sandwich and chips for lunch; eats a home-cooked meal for dinner, which is usually a chicken dish with potatoes or pasta and frozen vegetables; and snacks on popcorn and pretzels. The most beneficial change for him to make to lower his LDL cholesterol levels would be to a. use fresh instead of frozen vegetables. b. drink decaffeinated instead of regular coffee. c. eat unsalted pretzels and popcorn. d. eat a turkey sandwich with 100% whole-grain bread instead of grilled cheese.

ANS: D Cheese has high levels of saturated fat, and grilled cheese sandwiches are often made with butter (which also has high levels of saturated fat) or margarine (which may have high levels of saturated fat), and so switching to a turkey sandwich would help decrease saturated fat intake and lower LDL cholesterol levels. Using fresh instead of frozen vegetables makes no difference other than taste. Drinking decaffeinated instead of regular coffee will not affect serum lipid levels.

Eating unsalted pretzels and popcorn would help decrease blood pressure but not blood lipids.

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11. A dietary change that is likely to have a significant effect on reducing the risk of coronary heart disease is a. snacking on tortilla chips instead of peanuts. b. drinking decaffeinated coffee instead of regular coffee. c. switching from cornflakes to oatmeal for breakfast. d. choosing a fast-food fish sandwich instead of a hamburger.

ANS: C Switching from cornflakes to oatmeal for breakfast is likely to have a significant effect on reducing risk of coronary heart disease because this change will increase intake of soluble fiber.

Snacking on tortilla chips instead of peanuts would increase intake of polyunsaturated fat and decrease intake of monounsaturated fat, which would probably not affect LDL cholesterol levels and may decrease HDL cholesterol levels. Drinking decaffeinated coffee instead of regular coffee is not beneficial for most people. Choosing a fast-food fish sandwich instead of a hamburger could result in increased total fat intake because the fish is fried; intake of saturated and unsaturated fats depends on the fat used for frying and any sauces added.

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12. The first step in therapy to reduce the risk for coronary heart disease is a. therapeutic lifestyle change. b. stress reduction. c. use of LDL cholesterol-lowering medications. d. use of antithrombotic medications.

ANS: A The first step in therapy to reduce the risk for coronary heart disease is therapeutic lifestyle change (TLC), including diet and physical activity. Cholesterol-lowering medications may be added later if necessary to achieve further reductions in LDL cholesterol. Antithrombotic medications are not used routinely (they are sometimes used to reduce risk of blood clots). Stress reduction can help decrease cardiac risk but is not the first step.

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13. If a patient has an initial LDL cholesterol level of 180 mg/dL and implements TLC dietary changes, and if after 6 weeks the serum LDL cholesterol level has decreased only to 165 mg/dL, the patient should a. continue TLC dietary changes for a total of 3 months. b. follow the Dietary Approaches to Stop Hypertension (DASH) diet pattern. c. begin drug therapy with a bile acid sequestrant. d. begin drug therapy with statins.

ANS: A Drug therapy should be initiated only if TLC recommendations are unsuccessful in achieving health LCL cholesterol levels after 3 months; therefore, the patient should continue to implement the dietary changes. The DASH diet pattern is intended to decrease high blood pressure, not high lipid levels.

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14. Primary or essential hypertension is caused by a. unknown factors. b. sedentary lifestyle. c. excess sodium intake. d. being overweight or obese.

ANS: A The causes of primary and essential hypertension are unknown. Sedentary lifestyle, excess sodium intake, and being overweight or obese all contribute to hypertension and are all factors that can be modified to decrease blood pressure.

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15. If a patient’s blood pressure is 152/94 mm Hg, he or she has a. normal blood pressure. b. prehypertension. c. stage 1 hypertension. d. stage 2 hypertension.

ANS: C Blood pressure of 152/94 mm Hg is considered representative of stage 1 hypertension. In stage 1 hypertension, systolic blood pressure ranges from 140 to 159 mm Hg, or diastolic blood pressure ranges from 90 to 99 mm Hg. In stage 2 hypertension, systolic blood pressure is 160 mm Hg or higher, or diastolic blood pressure is 110 mm Hg or higher. In prehypertension, systolic blood pressure ranges from 120 to 139 mm Hg, or diastolic blood pressure ranges from 80 to 89 mm Hg. Normal systolic blood pressure is less than 120 mm Hg, and normal diastolic blood pressure is less than 80 mm Hg.

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16. An example of a dietary change that may help decrease risk of hypertension is a. eating oatmeal instead of toast and honey. b. eating popcorn instead of pretzels. c. using olive oil instead of butter. d. drinking skim milk instead of soda.

ANS: D Increasing intake of foods rich in potassium, magnesium, and calcium, such as milk, can help decrease risk of hypertension. Eating oatmeal instead of toast and honey would increase intake of soluble fiber, and using olive oil instead of butter would increase intake of monounsaturated fat and decrease intake of saturated fat; both of these changes would decrease cardiovascular risk but not blood pressure. Eating popcorn instead of pretzels would increase intake of dietary fiber, which is beneficial for overall health but not for lowering blood pressure.

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17. If a middle-aged man has high blood pressure, has a sedentary lifestyle, is about 30 pounds overweight, eats mostly processed food, and drinks two alcoholic beverages most days, the most effective way for him to lower his blood pressure is to a. reduce his sodium intake. b. achieve and maintain a healthy weight. c. participate in aerobic exercise every day. d. abstain from drinking alcoholic beverages.

ANS: B The most effective way for him to lower his high blood pressure would be to achieve and maintain a healthy weight. Reducing sodium intake, participating in aerobic exercise every day, and abstaining from drinking alcoholic beverages would also help lower his blood pressure, but to a lesser extent.

DIF: Cognitive Level: Analyzing

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18. In the United States, most dietary sodium comes from a. salt added at the table. b. sodium naturally present in foods. c. salt added to foods during cooking. d. salt added to foods during processing.

ANS: D In America, most dietary sodium comes from salt added to foods during processing. Processed foods often contain more sodium than when foods are prepared from scratch at home; in addition, intake of processed foods is high. Therefore, salt added at the table and salt added to foods during cooking contribute less to overall salt intake. Most natural foods contain relatively little sodium.

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19. The main purpose of nutrition therapy for patients who have just experienced a myocardial infarction is to decrease a. blood pressure. b. the risk of blood clotting. c. LDL cholesterol levels.

d. the workload of the heart.

ANS: D Immediately after a myocardial infarction, nutrition therapy is designed to decrease the workload of the heart. Long-term nutrition therapy may focus on decreasing LDL cholesterol levels and blood pressure. Risk of blood clotting is controlled with medications rather than through diet.

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20. If a patient had a myocardial infarction on Monday, by Thursday he or she should be eating a. a clear liquid diet. b. mostly cold foods. c. small, frequent meals. d. three moderate meals a day.

ANS: C One or two days after a myocardial infarction, patients probably best tolerate small, frequent meals. A clear liquid diet is used only during the first 24 hours after a myocardial infarction.

There is no reason to eat mostly cold foods. Three moderate meals a day would place a greater oxygen demand on the heart than would smaller, more frequent meals.

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21. The patient who benefits most from a sodium restriction of 2000 mg/day is one with a. severe heart failure. b. stage 1 hypertension.

c. cystic fibrosis. d. chronic obstructive pulmonary disease.

ANS: A Patients with severe heart failure require strict restriction of dietary sodium intake to reduce extracellular fluid. Patients with hypertension also benefit from sodium restriction (<2300 mg/day), but the restriction is less critical. Patients with cystic fibrosis actually need extra sodium intake; restriction could be dangerous. Patients with chronic obstructive pulmonary disease need to focus on eating sufficient calories and protein more than on restricting sodium intake.

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22. An elderly patient with cardiac cachexia tells you that he or she is being careful to eat highprotein foods throughout the day; you would also want to encourage him or her to a. include food sources of potassium, calcium, and magnesium. b. ensure that his or her overall energy intake is adequate. c. use oils rich in essential fatty acids. d. increase the fluid intake to 3 L per day.

ANS: B It is important to make sure that patients with cardiac cachexia have adequate intakes of energy so that protein can be used to prevent further catabolism rather than being broken down for energy. Foods with high levels of potassium, calcium, and magnesium can help decrease high blood pressure but do not have a specific benefit for patients with heart failure. Oils rich in essential fatty acids are beneficial for overall health but also have no specific benefit for patients with heart failure. Fluid intake may sometimes need to be restricted for patients with heart failure to prevent fluid overload.

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23. The best time to begin to adopt heart-healthy eating habits is during a. childhood, to establish a lifelong healthy lifestyle. b. adolescence, because most teenagers have poor eating habits. c. young adulthood, once development is complete. d. middle adulthood, when coronary heart disease begins to develop.

ANS: A The best time to begin to adopt heart-healthy eating habits is during childhood, when lifelong eating habits are being established. It is beneficial to begin healthy eating habits at any age, but it is not necessary to wait until poor habits have developed or until coronary heart disease begins to develop. Severe food restrictions should be avoided in children and adolescents to ensure adequate kilocalorie and nutrient intakes for growth and development. However, children and adolescents can still learn to choose foods and develop habits that will maintain optimal heart health throughout their life.

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24. The most appropriate protein to include in a heart healthy meal is a. fried chicken thigh. b. smoked ham slice. c. grilled salmon. d. country fried steak.

ANS: C Grilled salmon would be the most appropriate protein source for a heart healthy meal. Smoked ham contains sodium and fried foods are not appropriate for a heart healthy meal plan.

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25. If a patient with chronic obstructive pulmonary disease (COPD) has lost 30 lb in a year and now weighs 132 lb (60 kg), the amount of protein he or she would need to replenish his or her protein stores is _____ g/day. a. 48 to 60 b. 72 to 114 c. 96 to 150 d. 120 to 180

ANS: C Malnourished patients with COPD need 1.6 to 2.5 g of protein per kilogram of body weight to

or 96 to 150 g/day. If patients with COPD are not malnourished, they need 1.2 to 1.9 g/kg.

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26. If a patient with COPD normally eats a sandwich for lunch and wants to decrease his or her respiratory quotient (RQ), he or she could a. add extra mayonnaise and remove some of the bread. b. remove the cheese and add lettuce and tomato. c. add extra lean meat and use mustard instead of mayonnaise. d. use whole-grain bread and add spinach.

ANS: A RQ is lower when the proportion of energy intake from fat is higher and the proportion of energy intake for carbohydrate is lower; therefore, adding mayonnaise and removing bread would increase the ratio of fat to carbohydrate. Removing cheese and using mustard instead of mayonnaise would actually decrease fat and increase RQ. Lettuce, tomatoes, and spinach contain very little energy and would have very little effect on RQ. Whole-grain bread would add dietary fiber, which does not affect RQ. Adding extra lean meat would add protein but would have little effect on the proportion of fat and carbohydrate.

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27. If a patient with cystic fibrosis has diarrhea and is losing weight, it would be most important to evaluate whether the a. pancreatic enzyme replacement therapy is adequate. b. patient has developed an eating disorder. c. patient is drinking adequate fluids to maintain good hydration. d. patient is struggling with loss of appetite.

ANS: A Patients with cystic fibrosis require individualized pancreatic enzyme replacement therapy because their pancreatic ducts often become obstructed by viscous secretions; inadequate enzyme replacements cause malabsorption, diarrhea, and weight loss. Patients with cystic fibrosis need large amounts of food to maintain weight and do not usually develop eating disorders. They do not usually struggle with maintaining hydration or with loss of appetite.

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28. Most patients with cystic fibrosis require a a. low-fat, low-energy diet and hormone replacement therapy. b. high-fiber diet, supplements of water-soluble vitamins, and diuretics. c. high-protein diet, sodium restriction, and supplements of fat-soluble vitamins. d. high-kilocalorie diet, multivitamin supplements, and enzyme replacement therapy.

ANS: D Patients with cystic fibrosis require a high-kilocalorie diet to compensate for high metabolic rate and malabsorption, multivitamin supplements to compensate for malabsorption, and enzyme replacement therapy to increase digestion and absorption of nutrients. A low-fat, low-energy diet would result in malnutrition. In cystic fibrosis, secretion of enzymes is impaired, but hormone production is normal. A high-fiber diet does not have any specific benefit for this population.

Diuretics are not needed and could be dangerous because of excessive electrolyte losses. Sodium intake should be liberal, rather than restricted. Protein intake may exceed the Dietary Reference Intake (DRI), but needs are met by increased food intake.

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29. An appropriate meal plan for a patient with TB is a. low protein, high fat. b. high calorie, high protein. c. high calorie provided mostly by fat. d. high protein, very low fat.

ANS: B While there is no special diet for TB, a high calorie, high protein, nutrient-rich meal plan is suggested with small, frequent feedings.

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30. For an infant with cystic fibrosis, the greatest concern would be if the mother wanted to a. high bottle feed her infant with formula. b. pump breast milk and bottle feed the infant. c. breastfeed without using enzyme supplements. d. employ a nanny to care for the child during the day.

ANS: C Infants with cystic fibrosis may be breastfed or fed infant formula along with enzyme replacement therapy; if the mother wanted to breastfeed exclusively and was unwilling to use enzyme replacement therapy or supplements, the infant would become severely malnourished.

Attending daycare may be a concern because of increased risk of infection, but employing a nanny should not pose a significant risk.

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31. If a ventilator-dependent patient with acute respiratory failure does not receive sufficient protein and energy from enteral feedings, the most serious consequence is that the a. chest muscles may not be strong enough for weaning from the ventilator. b. patient will lose muscle tone. c. gut will lose integrity, and bacterial translocation may occur. d. patient may develop essential fatty acid deficiency.

ANS: A

If patients with acute respiratory failure do not receive sufficient energy and protein, the protein in their chest muscles may be used for energy and they may be too weak to be weaned from the ventilator. They may lose some muscle tone, but this is less problematic. As long as they are receiving some enteral nutrition, they should be able to maintain gut integrity. Essential fatty acid deficiency is not necessarily caused by inadequate intake of protein and energy.

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32. When using parenteral nutrition support for patients with acute respiratory failure, it is important to avoid use of high glucose concentrations because a. glucose tolerance is often impaired. b. they may cause hypersecretion of insulin. c. they increase RQ. d. they may lead to development of diabetes mellitus.

ANS: C Parenteral nutrition support for patients with acute respiratory failure should not include high glucose concentrations because they result in excess carbon dioxide production, which increases RQ. Lipids should be used to provide a significant proportion of nonprotein kilocalories (1 to 2 g of lipid per kilogram of body weight). Glucose tolerance is not affected by respiratory failure.

Infusion of high concentrations of glucose does not cause hypersecretion of insulin or lead to development of diabetes mellitus.

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TOP: Nursing Process: Planning | Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity Chapter 18: Nutrition for Diseases of the Kidneys Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE 1. Kidney disease affects the body’s ability to maintain a. body temperature. b. body weight. c. bone health. d. bowel function.

ANS: C Kidney disease prevents the final step of vitamin D synthesis and disrupts calcium and phosphorus metabolism; thus it adversely affects bone health. The kidneys do not play a role in regulation of body temperature, bowel function, or body weight.

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2. If a patient is losing significant amounts of protein in urine, he or she probably has a. acute renal failure. b. chronic renal failure c. nephrotic syndrome. d. renal calculi.

ANS: C Loss of protein in the urine occurs in patients with nephritic syndrome. Acute and chronic renal failure cause, respectively, abrupt and gradual loss of renal function, but protein is not usually lost in the urine. Renal calculi, or kidney stones, do not cause loss of protein in the urine.

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3. One of the nurse’s important roles in care of patients with nephrotic syndrome is a. monitoring serum sodium level. b. monitoring fluid intake and output. c. ordering a high-protein, low-sodium diet. d. monitoring serum phosphorus level.

ANS: B It is very important for nurses to monitor fluid intake and output of patients with nephrotic syndrome because needs change as kidney function changes. Protein intake is individualized to minimize stress on the kidneys and prevent malnutrition. Sodium intake is usually restricted.

Ordering diets is the responsibility of the physician. The nurse may alter the physician’s orders if the patient’s serum sodium levels are elevated, but this is not the nurse’s primary responsibility.

Monitoring serum phosphorus levels is more important for patients with end-stage renal disease.

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4. The best way to ensure that patients with nephrotic syndrome are able to use their dietary protein to maintain lean body tissue is to a. provide 1.5 to 2.0 g protein per kilogram of body weight per day. b. encourage daily exercise. c. ensure adequate energy intake. d. provide adequate dietary potassium.

ANS: C

Adequate energy intake is important to ensure that protein can be used to maintain lean body mass rather than for energy. Protein intake is usually restricted to 0.7 to 1.0 g/kg/day to decrease the burden on the kidneys. Patients with nephrotic syndrome are usually too sick to exercise.

Increasing potassium intake does not increase retention of muscle mass.

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MSC: Client Needs: Physiological Integrity 5. An example of a source of ―hidden‖ sodium is a. mouthwash. b. saltine crackers. c. opaque salt shakers. d. raw fruits and vegetables.

ANS: A Hidden sources of sodium include mouthwash; if patients use mouthwash, they should be instructed not to swallow it. Saltine crackers are coated with visible salt. Opaque salt shakers do not hide the fact that they contain sodium. Raw fruits and vegetables have low levels of sodium.

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6. If a patient with acute renal failure gains 2 lb in 24 hours, the cause is likely to be a. urea retention. b. fluid retention. c. increased fat stores. d. increased muscle mass.

ANS: B In patients with acute renal failure, sudden increases in weight are usually caused by fluid retention. Most such patients have very little appetite, and so they are unlikely to gain fat; they are also inactive, and so they are unlikely to increase muscle mass. Also, gains in muscle mass and fat stores tend to be slow. Urea retention does not cause an increase in weight.

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7. If a patient with third-degree burns covering 40% of the body surface area suddenly exhibits high blood pressure and edema and is not producing urine, he or she has probably developed a. severe malnutrition. b. nephrotic syndrome. c. chronic renal failure. d. acute renal failure.

ANS: D In a stressed patient, loss of urine production accompanied by high blood pressure and edema is a sign of acute renal failure. Chronic renal failure develops more gradually, usually over several years. Nephrotic syndrome is characterized by loss of protein in the urine, but urine production does not usually stop. Severe malnutrition would cause edema but not hypertension and loss of urine production.

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8. It would be most challenging to design a diet for chronic renal failure for a. a patient with elevated levels of serum low-density lipoprotein (LDL) cholesterol. b. a patient with hypertension. c. someone who follows a vegan eating pattern.

d. someone who adheres to strict kosher food laws.

ANS: C It would be most difficult to design a diet for a patient who follows a vegan eating pattern because vegetable proteins are generally of lower quality, and the foods that contain them tend to have high phosphorus levels. Many patients with chronic renal failure also have high blood pressure and high LDL cholesterol levels; diets for renal disease generally restrict sodium intake and can be designed to be low in saturated fat. Kosher food laws can be accommodated within renal diets; meat and dairy cannot be eaten together, but dairy is restricted for patients with renal disease anyway.

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9. Protein needs of patients with acute renal failure who do not need dialysis are a. lower than those of patients receiving hemodialysis. b. the same as those of patients receiving hemodialysis. c. higher than those of patients receiving hemodialysis. d. dependent on the volume of urine produced.

ANS: A Patients with acute renal failure who do not need dialysis have lower protein needs than patients receiving hemodialysis because the latter lose protein during treatments. Protein is not lost in the urine, and so protein needs are not affected by the volume of urine produced.

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10. In order to calculate fluid needs for a patients in the oliguric phase of acute renal failure, it is important to know the patient’s a. body weight. b. energy intake. c. serum sodium level. d. amount of output.

ANS: D In the oliguric phase of acute renal failure, fluid needs are the amount of output (urine, vomitus, and diarrhea) plus 500 mL per day, and so it is important to know the patient’s urine output.

Fluid needs for these patients are not based on body weight, energy intake, or serum sodium level.

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11. The person who is most likely to develop chronic kidney disease is a(n) a. obese woman with elevated levels of LDL cholesterol. b. man with type 2 diabetes and hypertension. c. man who drinks two alcoholic beverages a day and smokes cigarettes. d. woman with tuberculosis and acquired immunodeficiency syndrome (AIDS).

ANS: B Chronic renal failure often results from vascular damage in patients with type 2 diabetes and hypertension. Regular alcohol intake may cause liver damage (although two drinks per day is not excessive for a man), and smoking causes lung damage and increases risk for cardiovascular disease. Elevated LDL cholesterol levels and obesity are associated with cardiovascular disease.

Tuberculosis and AIDS are not associated with chronic kidney disease.

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12. Before development of end-stage renal disease, the primary focus of nutrition therapy for patients with chronic renal failure is a. limiting intake of sodium and fluid. b. limiting foods that produce toxic metabolic byproducts. c. providing sufficient protein to prevent secondary complications. d. providing adequate energy, protein, and nutrients to promote recovery.

ANS: B Before development of end-stage renal disease, nutrition therapy for patients with chronic renal failure focuses on limiting foods that produce toxic metabolic byproducts; this reduces the burden on the kidneys. Sodium intake and fluid intake do not need to be limited at this stage.

Protein intake should be limited to the amount needed by the body because breakdown of excess protein produces toxic metabolic byproducts. Chronic kidney disease is irreversible, and so provision of adequate nutrients does not promote recovery, although it is important to maintain good nutritional status.

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13. The National Renal Diet a. provides carefully calculated menus for patients with chronic renal failure. b. provides flexible meal planning tools for patients with chronic renal failure. c. provides lists of foods that are acceptable for patients with chronic renal failure. d. allows patients with chronic renal failure to select foods without the help of a registered dietitian.

ANS: B The National Renal Diet provides flexible meal planning tools for patients with chronic renal failure. Food intake needs to be tailored to individual preferences and lifestyles, and so menus are not provided. The help of a registered dietitian is still needed to develop a personalized meal plan. There are no ―acceptable‖ and ―unacceptable‖ foods for patients with chronic renal failure, but the National Renal Diet helps patients choose appropriate portion sizes of foods with high levels of nutrients that must be limited.

DIF: Cognitive Level: Understanding REF: Pages 387-389 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

14. Of the following, the meal that would be best to include as part of a renal diet plan is a. cheese omelet with biscuits. b. baked chicken with rice and green beans. c. bean burrito with tortilla chips and salsa. d. peanut butter sandwich on whole wheat bread.

ANS: B The meal that would fit best within a renal diet plan is baked chicken with rice and green beans.

This provides high-quality protein without excessive sodium, potassium, or phosphorus. The omelet provides high-quality protein from eggs and cheese, but cheese has high levels of phosphorus and biscuits have higher levels of sodium than do other breads. The beans in the burrito provide lower quality protein and have high levels of phosphorus; also, the tortilla chips have high levels of sodium (unless they are unsalted). Peanut butter provides lower quality protein and has high levels of phosphorus; whole wheat bread also has high levels of phosphorus.

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15. A food that is restricted in patients who are receiving hemodialysis and taking phosphate binders is a. banana. b. potato. c. egg. d. milk.

ANS: D Milk is restricted in patients who are receiving hemodialysis because it has high levels of phosphorus. Bananas and potatoes have high amounts of potassium, not phosphorus. Eggs do not have high levels of phosphorus and provide a good source of high-quality protein.

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16. It is most appropriate to take medications to reduce serum phosphorus levels a. with fluids. b. with meals. c. between meals. d. one hour after meals.

ANS: B Phosphate binders, used to reduce serum phosphorus levels, should be taken with meals. This allows the medications to bind the phosphorus in the food. They are ineffective if taken with fluids only, between meals, or 1 hour after meals.

DIF: Cognitive Level: Applying

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17. Patients with chronic renal failure often need supplements that contain an active form of vitamin a. A. b. C. c. D. d. K.

ANS: C Patients with chronic renal failure often need supplements that contain an active form of vitamin D because the kidney fails to complete the final step in activating vitamin D. Supplements of fatsoluble vitamins (including A and K) are not needed; vitamin A toxicity has sometimes developed in patients undergoing hemodialysis. Supplements of vitamin C and other watersoluble vitamins may be needed but do not need to be given in an active form.

DIF: Cognitive Level: Understanding REF: Page 390 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

18. If a patient with chronic renal failure develops anemia, he or she probably needs to be given a. erythropoietin. b. vitamin B12 supplements. c. folate supplements. d. red blood cells.

ANS: A

In patients with chronic renal failure, the kidneys do not produce sufficient erythropoietin, a hormone that stimulates bone marrow to produce red blood cells. Erythropoietin is administered to prevent anemia. Vitamin B12 and folate supplements are not usually needed because anemia is not caused by deficiency of these nutrients. Administering red blood cells would provide only temporary relief, rather than replacing the hormone that makes the body produce its own red blood cells.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment

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19. The nurse would be most concerned if a family member visited a patient during hemodialysis treatment and brought the patient a. a salad with olive oil dressing and chopped egg. b. a bagel with homemade jam. c. unsalted pretzel sticks and honey. d. a chocolate milkshake.

ANS: D Patients receiving dialysis need to limit their intake of phosphorus, and both chocolate and dairy products have high levels of phosphorus. A salad with olive oil dressing has low levels of phosphorus and sodium, and the chopped egg would provide a reasonable amount of high-quality protein. A bagel and unsalted pretzel sticks have low levels of phosphorus and sodium, and jam and honey add enjoyable calories.

DIF: Cognitive Level: Applying

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20. If a patient with chronic renal failure begins peritoneal dialysis, his or her protein intake should a. be calculated on the basis of the degree of malnutrition. b. be determined by the patient’s blood urea nitrogen level.

c. decrease because the patient is not losing protein in urine. d. increase because protein is lost into the dialysate.

ANS: D Patients treated with peritoneal dialysis require additional protein to replace losses into the dialysate by diffusion. Protein is not lost in the urine in patients with chronic renal failure.

Protein intake is based on body weight, not on degree of malnutrition or blood urea nitrogen level.

DIF: Cognitive Level: Understanding REF: Page 392 TOP: Nursing Process: Assessment

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21. If a patient wishes to continue working and be active during the day, the best kind of peritoneal dialysis would be a. intermittent. b. manual. c. mechanical. d. continuous ambulatory.

ANS: D Continuous ambulatory peritoneal dialysis allows patients to continue their usual activities; they just need to take time to exchange dialysate four or five times within a 24-hour period.

Intermittent dialysis required patients to be restricted to a chair or bed during treatments. Ability to continue normal activities does not depend on whether dialysate is exchanged manually or mechanically, although manual exchanges are likely to be more convenient.

DIF: Cognitive Level: Applying

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22. In comparison with patients treated with hemodialysis, patients treated with peritoneal dialysis have _____ dietary protein needs. a. slightly higher b. slightly lower c. much higher d. much lower

ANS: A Patients treated with peritoneal dialysis have higher dietary protein needs than those treated with hemodialysis because a little more protein is lost into the dialysate. However, some protein is lost into the dialysate with both forms of dialysis, and so the difference is not great.

DIF: Cognitive Level: Analyzing

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23. In comparison with patients treated with hemodialysis, patients treated with peritoneal dialysis have a. similar energy needs. b. higher energy needs. c. lower energy needs. d. more variable energy needs, depending on activity level.

ANS: C Patients treated with peritoneal dialysis have lower energy needs than those treated with hemodialysis because dextrose is absorbed from the peritoneal dialysate. Activity level affects energy needs of patients with either form of dialysis.

DIF: Cognitive Level: Analyzing

REF: Page 388 | Page 390 | Page 392

TOP: Nursing Process: Planning

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24. For bone health, it is very important for patients with chronic renal failure—whether they are receiving hemodialysis, peritoneal dialysis, or no dialysis—to restrict their intake of a. potassium. b. oxalates. c. fluid. d. phosphorus.

ANS: D Elevated blood phosphorus levels may lead to osteodystrophy (defective bone development) in patients with chronic renal failure, regardless of treatment; it is very important for them to restrict intake of foods with high levels of phosphorus. Fluid restrictions depend on urine output and blood pressure. Potassium intake should be restricted to 2 to 3 g/day in patients receiving hemodialysis and 2 to 4 g/day in patients receiving hemodialysis; intake depends on use of diuretics in patients not receiving dialysis. Oxalates do not need to be restricted in patients with renal failure but should be restricted by patients who develop calcium oxalate renal calculi.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Planning

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25. The most significant challenge for patients with diabetes mellitus and chronic renal failure who are treated with peritoneal dialysis is that a. insulin is lost into the dialysate. b. glucose is absorbed from the dialysate. c. the combined food restrictions are complex. d. peritoneal dialysis causes taste changes and food aversions.

ANS: B

Peritoneal dialysis may cause difficulty with metabolic control for patients with diabetes mellitus because glucose is absorbed from the dialysate. Loss of insulin into the dialysate is not a problem. Combined food restrictions are somewhat complex but do not make control of blood glucose levels more difficult. All patients with renal disease experience taste changes and food aversions, but these do not necessarily affect control of diabetes.

DIF: Cognitive Level: Analyzing

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26. Two weeks after a patient has undergone renal transplantation, his or her energy needs a. are lower than normal. b. are higher than normal. c. fluctuate from day to day. d. depend on nutritional status before surgery.

ANS: B For the first 6 to 8 weeks after renal transplantation, energy needs are higher than normal because of the stress from surgery and catabolism. They do not generally fluctuate from day to day and do not depend on nutritional status before surgery.

DIF: Cognitive Level: Applying

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27. In a patient who is receiving steroids after renal transplantation, it is important to monitor _____ levels. a. hemoglobin b. blood glucose c. blood urea nitrogen d. serum phosphorus

ANS: B Steroid therapy may cause glucose intolerance, and so blood glucose levels should be monitored.

Steroids do not usually cause anemia. Serum phosphorus and blood urea nitrogen levels should be normal after successful renal transplantation and are not affected by steroid use.

DIF: Cognitive Level: Analyzing

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28. A patient who has calcium oxalate kidney stones should a. limit foods with high levels of calcium. b. avoid calcium supplements. c. limit foods with high levels of oxalate. d. avoid lower quality vegetable proteins.

ANS: C For patients with calcium oxalate kidney stones, it is most effective to limit foods with high levels of oxalate. Patients do not need to restrict dietary calcium; in fact, adequate calcium intake from food and supplements is encouraged. Restricting animal protein sources is recommended; restriction of vegetable proteins is not recommended.

DIF: Cognitive Level: Remembering

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29. The most important advice for preventing kidney stones is to a. restrict dietary calcium intake. b. increase dietary protein intake. c. drink at least 10 to 12 cups of fluid daily. d. achieve and maintain a healthy body weight.

ANS: C The most important advice for preventing kidney stones is to drink at least 10 to 12 cups of fluid daily. Restricting dietary calcium intake is not necessary and may actually increase stone formation. Increasing dietary protein intake may increase stone formation. Body weight does not appear to be related to formation of kidney stones.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

30. An example of a food that may increase urinary oxalate levels is a. a ginger cookie. b. a cinnamon roll. c. a blueberry muffin. d. spinach casserole.

ANS: D Spinach are among the foods that cause significant increases in urinary oxalate excretion; therefore, spinach casserole may increase urinary oxalate levels. Ginger cookies, cinnamon rolls, and blueberry muffins would not increase urinary oxalate levels.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance Chapter 19: Nutrition for Neuro-Psychiatric Disorders Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. The best place for a patient with Alzheimer’s disease to eat would be a. in front of the television. b. at a table with a caregiver. c. at a table with several dining companions. d. alone in a quiet room.

ANS: B Eating at a table with a caregiver is most likely to encourage adequate nutritional intake. Other dining companions or television may distract the patient and decrease food intake. A patient with Alzheimer’s disease may become confused or forget to eat if he or she is alone.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 2. An example of a meal that may be beneficial for cognitive function in patients with Alzheimer’s disease is a. baked salmon and spinach salad. b. scrambled eggs and whole-grain toast. c. cottage cheese and applesauce. d. calves’ liver and onions.

ANS: A Foods with high levels of antioxidants (e.g., spinach) and omega-3 fatty acids (e.g., salmon) may help improve cognitive function in patients with Alzheimer’s disease. Patients do not need to be restricted to soft foods. Calves’ liver is a good source of iron but has no specific benefit for Alzheimer’s disease.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity | Client Needs: Health Promotion and Maintenance

3. If a patient with amyotrophic lateral sclerosis (ALS) is having difficulty speaking and is losing weight, it would be important to evaluate a. his or her resting energy expenditure. b. his or her appetite and interest in food. c. whether he or she has diarrhea and malabsorption. d. his or her ability to swallow.

ANS: D As ALS progresses, many affected patients have difficulty swallowing; difficulty speaking may be associated with loss of function of nerves in this area. It may be helpful to measure resting energy expenditure, but this would be secondary to evaluating their ability to swallow. The patient may have diminished appetite, but whether they should be encouraged to eat depends on whether they have dysphagia. Diarrhea and malabsorption do not usually occur in patients with ALS.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Physiological Integrity

4. Whenever possible, comatose patients should be fed a. a full liquid diet. b. enterally. c. through peripheral parenteral nutrition. d. through central parenteral nutrition.

ANS: B

Comatose patients should be fed enterally whenever possible to maintain integrity of the gut.

Parenteral nutrition is expensive, less physiologically sound, and unnecessary for most patients.

Unconscious patients cannot be fed orally.

DIF: Cognitive Level: Remembering

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5. A child who is following a ketogenic diet to help control seizures is most likely to need help in coping with a. early satiety. b. hunger. c. nausea. d. lethargy.

ANS: B Children following a ketogenic diet and their families are likely to need support in dealing with hunger because ketogenic diets are low in volume and energy intake is usually restricted. They are unlikely to experience early satiety with the small amount of food; nausea and lethargy are not common problems.

DIF: Cognitive Level: Applying

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6. If a child is following a ketogenic diet for treatment of epilepsy, the nurse would want to ensure that the child is receiving supplements of a. essential amino acids. b. pancreatic enzymes. c. vitamin D. d. vitamin C.

ANS: C Low-dose vitamin D supplements are important for reducing the increase risk of bone fracture in children who follow ketogenic diets. They have no need for additional amino acids. Digestion is not impaired, and so pancreatic enzymes are not needed. Extra vitamin C is not specifically needed by this population.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment | Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

7. A helpful strategy to prevent development of Guillain–Barré syndrome would be to a. avoid sexual contact with affected individuals. b. drink only pasteurized milk. c. use gloves to avoid contact with infected blood. d. avoid eating home-canned food.

ANS: B Guillain–Barré syndrome often occurs after infection with Campylobacter jejuni; common sources of this infection are unpasteurized milk, undercooked poultry, and contaminated water.

The syndrome is not spread by sexual contact or via infected blood. Home-canned foods may be infected with Clostridium botulinum, not C. jejuni.

DIF: Cognitive Level: Applying

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8. If a patient suspects that her migraine headaches are triggered by certain foods, the first step would be to a. keep a headache-food diary. b. evaluate blood antibody levels.

c. use an elimination diet. d. avoid eating the offending foods.

ANS: A The first step in evaluating causes of migraines would be to keep a headache-food diary. Patients should not avoid or eliminate nutrient-rich foods unless they are shown to be causative. Testing of blood antibody levels may be helpful if food allergies are suspected, but this would follow keeping the diary.

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9. When you evaluate a patient with multiple sclerosis, your greatest nutrition-related concern would be a. reliance on a caregiver to prepare and serve food. b. the patient’s frustration with loss of independence. c. reliance on preprepared processed foods. d. food being one of the few things the patient still enjoys.

ANS: C Reliance on preprepared processed foods would be a concern because processed foods tend to have high levels of sodium, which can promote inflammatory and autoimmune responses. The availability of a caregiver to prepare and serve food and the possibility that food is one of the few things the patient still enjoys usually have a positive effect on nutritional status. The patient’s frustration with loss of independence would not necessarily have an adverse nutritional effect unless the patient is severely depressed.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance 10. As multiple sclerosis progresses, it is most important to monitor the patient’s a. ability to self-feed. b. blood glucose levels. c. the degree of depression. d. blood lipid levels.

ANS: A Ability to self-feed will have the greatest effect on nutritional status in patients with multiple sclerosis. Depression may also influence food intake but to a lesser degree. Blood glucose and lipid levels are not usually a primary concern.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance 11. During a home visit to a patient with Parkinson’s disease one afternoon, your main concern would be that a. family members are bringing the patient home-cooked meals. b. the patient drinks coffee throughout the day. c. the patient has snacks next to his or her chair. d. the patient has not eaten yet that day.

ANS: D

Patients with Parkinson’s disease often struggle to meet their dietary needs because energy expenditure is increased as a result of tremors, dyskinesias, and rigidity; also, preparing and eating meals become more difficult. If the patient has not eaten anything by the afternoon, he or she is unlikely to achieve adequate intake. Drinking coffee is not a specific concern for patients with Parkinson’s disease. Meals brought by family members and having snacks where the patient sits will help maintain adequate intake.

DIF: Cognitive Level: Analyzing

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12. In the clinic, a patient with newly diagnosed Parkinson’s disease tells you that he or she wants to do whatever is possible to slow the progression of the disease. The best dietary advice you could give would be to a. avoid foods with high amounts of oxalate and phytate. b. eat several small meals each day so as to ensure adequate protein and energy intake. c. reduce intake of saturated fat, cholesterol, and sodium. d. follow a Mediterranean diet and eat foods with high amounts of antioxidants.

ANS: D A Mediterranean style of eating and foods high in antioxidants may help slow the progression of Parkinson’s disease. Avoiding foods with high oxalate levels is recommended only for patients who develop calcium oxalate kidney stones; avoiding foods with high amounts of phytate is not usually recommended. Maintaining adequate energy and protein intake would help the patient maintain strength and nutritional status but would not necessarily slow the progression of the disease. Limiting intakes of saturated fat, cholesterol, and sodium would be beneficial for a patient with cardiovascular disease but not for a patient with Parkinson’s disease.

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13. The easiest way to help patients increase their intake of antioxidants is to a. give them a list of high-antioxidant foods. b. encourage intake of fruits and vegetables with a variety of colors. c. recommend growing their own vegetables or buying organic vegetables. d. offer classes to teach patients how to prepare and cook fruits and vegetables.

ANS: B The best way to get a variety of antioxidants is to eat plenty of fruits and vegetables with a variety of colors. Giving patients a long list of foods, growing vegetables at home, or teaching classes may be helpful but would necessitate more work for patients. Organic vegetables do not necessarily have higher amounts of antioxidants.

DIF: Cognitive Level: Applying

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14. The best diet for prevention of stroke is a. low in sodium and fat. b. rich in dietary fiber and olive oil. c. high in low-fat dairy products. d. mostly plant foods and fish.

ANS: D All of these recommendations may be of some value in preventing cardiovascular disease and reducing risk of stroke. Omega-3 fatty acids, fruits and vegetables with high levels of antioxidants, and whole grains are especially helpful for prevention of thrombotic strokes.

DIF: Cognitive Level: Analyzing

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15. If a 78-year-old man has had a stroke and has difficulty feeding himself, the best strategy is to a. provide encouragement, support, and assistance as needed. b. have a caregiver feed him to maintain adequate intake. c. encourage him but insist that he feed himself to relearn this skill. d. provide enteral feedings until adequate oral intake is established.

ANS: A When someone has had a stroke and has difficulty feeding himself, he should be encouraged to self-feed but given assistance as needed; the goal is not only to foster independence and relearning but also to ensure adequate nutrient intake to aid recovery. If the caregiver takes over feeding, the patient will not relearn the skill, and if he is left to feed himself, he may not achieve adequate intake. Enteral feedings are sometimes necessary but should not be begun unless adequate oral intake cannot be achieved by the patient with the caregiver’s assistance.

DIF: Cognitive Level: Applying

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16. If a client is suddenly unable to speak, seems confused, and has trouble walking, it is most likely that he or she has a. Alzheimer’s disease. b. Parkinson’s disease. c. had a cerebrovascular accident (CVA), or stroke. d. had myocardial infarction, or heart attack.

ANS: C

These symptoms are consistent with a CVA. A heart attack would produce chest pain radiating down the left arm and shortness of breath. Alzheimer’s disease and Parkinson’s disease may produce similar symptoms, but the onset is gradual rather than sudden.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment

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17. The person who would be most likely to develop anorexia nervosa is a a. young mother working full-time outside the home. b. high school student with a strong core group of friends. c. man with a high-stress job and depression. d. high-achieving shy college freshman.

ANS: D Anorexia nervosa is often found in introverted, perfectionistic, insecure high school students and college students. Stress and depression are more likely to be associated with overeating; anorexia nervosa in this setting is rare. Young mothers working full time are not a group at high risk group for anorexia nervosa. Having a good core group of friends in high school would decrease likelihood of anorexia nervosa.

DIF: Cognitive Level: Applying

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18. A client would be considered to have binge eating disorder if he or she a. overeats at Thanksgiving and family holiday meals. b. skips breakfast or lunch most days and eats more at dinner. c. eats large amounts of food alone when stressed. d. adds extra workouts when he or she eats large meals.

ANS: C A characteristic of binge eating disorder is rapid, out-of-control, secretive eating in response to stress. Eating more than usual at holiday meals is part of normal social behavior. Eating more at dinner after skipping breakfast or lunch is not healthy, but this is not disordered eating. Adding extra workouts after a large meal may be a healthy strategy or, in extreme cases, may develop into bulimia nervosa.

DIF: Cognitive Level: Applying

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19. If a college-age woman tells you that she often uses laxatives or diuretics to make sure she has a flat stomach and goes without meals or exercises for several hours before special events to make sure she fits into some of her favorite clothes, she probably has a. anorexia nervosa. b. binge-eating disorder. c. bulimia nervosa. d. malnutrition.

ANS: C Purging with laxatives, diuretics, and exercise is a hallmark of bulimia nervosa. Anorexia nervosa is characterized by extreme restriction in food intake, usually without purging. Patients with binge-eating disorder frequently struggle with out-of-control consumption of very large amounts of food. Any eating disorder may result in malnutrition, but this is not necessarily the case.

DIF: Cognitive Level: Applying

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20. The most important aspect of treatment for eating disorders is a. developing a personalized daily eating and exercise plan for each patient. b. making conscious food choices in response to hunger and satiety cues, as well as awareness of emotions. c. achieving and maintaining a healthy weight and optimal nutrient intake. d. redefining societal norms for body weight and personal value and success.

ANS: B Treatment of eating disorders should focus on helping patients be aware of and respond to hunger and satiety cues, helping them be aware of their emotions and find healthy coping mechanisms, and helping them make conscious food choices. Developing a personalized eating and exercise plan may be helpful, but if it is too rigid, it will reinforce the eating disorder rather than treating it. As eating patterns become healthier, weight and nutrient intake should also become healthier, but these concerns are secondary to treating the underlying eating disorder.

Redefining societal norms may help prevent eating disorders, but it will not happen quickly enough to treat existing eating disorders.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity | Client Needs: Health Promotion and Maintenance

21. A diet rich in antioxidant-rich foods would be especially helpful for a patient with a. sleep disorder. b. bipolar disorder. c. schizophrenia. d. addictions.

ANS: C

A diet rich in antioxidants is helpful for everyone but especially for patients with schizophrenia.

Oxidative stress plays a role in schizophrenia, and antioxidant-rich foods may be helpful.

Antioxidants have general health benefits for everyone but have no specific benefit for patients with sleep disorders, bipolar disorders, or addictions.

DIF: Cognitive Level: Applying

REF: Pages 407-410

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

22. If a patient has bipolar disorder, post-traumatic stress disorder, and depression, it is important to a. encourage adequate intake of protein and energy. b. focus on underlying emotional issues rather than food. c. evaluate alcohol intake and potential substance abuse. d. decrease intake of saturated fat and sodium.

ANS: C Patients with mood disorders and depression often try to self-medicate with alcohol and other substances, which may lead to abuse or dependence. Energy and protein intake are not usually specific concerns, although nutrient intake may sometimes be inadequate or excessive. Some nutritional interventions to improve diet quality are helpful because they are more likely to achieve remission with good nutritional status. Decreasing intake of saturated fat and sodium is important for patients with cardiovascular disease but not for those with mood disorders.

DIF: Cognitive Level: Analyzing

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23. Patients with depression may benefit from ensuring adequate intake of a. tryptophan. b. methionine. c. potassium. d. vitamin B12.

ANS: A Tryptophan is a precursor of brain serotonin, levels of which are deficient in many persons with depression. Methionine, potassium, and vitamin B12 are all essential nutrients but do not have a specific role in treating depression.

DIF: Cognitive Level: Remembering

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24. A food choice that provides a good source of tryptophan is a. turnips. b. oatmeal. c. Sorbet. d. zinc supplement.

ANS: A A mixed diet of protein and carbohydrate should provide adequate amounts of tryptophan, the precursor of serotonin. It includes turkey, chicken, milk, potatoes, pumpkin, sunflower seeds, turnip and collard greens, and seaweed as food sources.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity | Client Needs: Psychosocial Integrity

25. If a patient attends a wine and cheese party and is then admitted to the emergency room with a severe headache and found to have severe hypertension, he or she may a. be taking a monoamine oxidase inhibitor (MAOI). b. be sensitive to resveratrol, an antioxidant found in red wine. c. have acute alcohol poisoning. d. be suffering from a foodborne infection.

ANS: A A hypertensive crisis may occur when patients taking an MAOI for treatment of depression eat foods rich in tyramine, such as aged cheeses and red wine. Sensitivity to resveratrol is not common. Alcohol poisoning would present with loss of motor coordination and consciousness. A foodborne infection may cause headache, but does not usually cause hypertension.

DIF: Cognitive Level: Analyzing

REF: Page 402 | Page 408

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

26. Risk of overweight and chronic disease would be elevated in a a. young woman who has migraine headaches every month. b. nurse who switches from working day shifts to working night shifts. c. patient with advanced Alzheimer’s disease. d. middle-aged man who loses 30 lb in 6 months.

ANS: B Working nights is associated with weight gain and increased risk of cardiovascular diseases, diabetes, and cancer, probably because of disrupted sleep-wake cycles. Monthly migraine headaches are usually associated with hormonal changes and do not usually affect risk of overweight and chronic disease. Patients with Alzheimer’s disease are more likely to lose weight because of inadequate food intake. Loss of a little over 1 lb per week is a healthy rate of weight loss and would contribute to decreased risk for chronic disease.

DIF: Cognitive Level: Applying REF: Page 399 | Page 401 | Page 403 | Page 404 | Page 409 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

27. If an alcoholic person has a normal body mass index, it is likely that he or she

a. is also malnourished. b. exercises consistently. c. eats a healthful diet. d. is currently sober.

ANS: A If an alcoholic person has a normal body mass index, he or she is probably malnourished because energy that should be coming from nutrient-dense foods is being obtained from alcohol instead.

Alcoholic people may be quite functional and may exercise consistently, but this is less likely.

People with alcoholism commonly do not eat healthful diets. It is possible that the patient may not be drinking currently and therefore is not obtaining extra energy from alcohol, but this is also less likely.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Assessment

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28. A supplement that may help patients with insomnia to normalize their sleep patterns is a. magnesium. b. melatonin. c. dopamine. d. caffeine.

ANS: B Melatonin may help patients with disordered sleep. Magnesium does not have roles related to sleep. Dopamine is produced by the body but is not given as supplements. Caffeine tends to disrupt rather than promote sleep.

DIF: Cognitive Level: Understanding REF: Page 409 TOP: Nursing Process: Planning | Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

29. The optimal diet to protect against depression is a. made up of familiar and favorite foods. b. high in dietary fiber and protein. c. a vegetarian diet. d. high in fruits, vegetables, and fish.

ANS: D Foods rich in antioxidants, such as fruits and vegetables, and foods rich in omega-3 fatty acids, such as fish, are protective against depression. A vegetarian diet may contain plenty of fruits and vegetables, but unless it is a vegan diet, it may contain large amounts of high-fat dairy; also, vegetarian diets do not include fish. High protein and fiber intakes are not necessarily helpful.

Eating familiar and favorite foods may be comforting in the short term but does not promote long-term health.

DIF: Cognitive Level: Applying

REF: Page 408

TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

30. For a patient with anorexia nervosa, enteral feedings may be helpful, when accepted, to a. feed the patient without his or her being aware. b. restore gastrointestinal function. c. increase the rate of weight gain. d. provide measurable intakes of nutrients.

ANS: C

Enteral feedings increase the rate of weight gain in patients with anorexia nervosa, which improves physical and emotional outcomes. Although enteral feedings provide measurable intake of nutrients, oral intake can still be measured and is preferred when possible. Patients who are anxious about eating may find enteral feedings easier than oral intake, but they would still be aware of the feedings. Gastrointestinal function is maintained equally by oral and enteral feedings.

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity | Client Needs: Physiological Integrity Chapter 20: Nutrition in Cancer and HIV/AIDS Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

1. When someone smokes cigarettes and drinks three alcoholic beverages a day, he or she is contributing to his or her cancer risk via a. initiation. b. metastasis. c. promotion. d. progression.

ANS: C

Cigarettes and alcohol contribute to cancer risk by promoting abnormal cell growth in cells that are already mutated. Initiation is the stage in which the DNA in a normal cell is mutated.

Progression is the stage in which the abnormal cells spread outside their original location.

Metastasis is the spread of cancer to secondary sites. The DNA of the cell undergoes mutation in the initiation stage of carcinogenesis. Promotion is the second stage, in which abnormal cell growth occurs. Progression is the third stage, in which cancer cells spread beyond their original location. Metastasis is formation of cancer in secondary sites.

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2. Someone who uses sunscreen and wears UV protective clothing and hats to prevent development of skin cancer may need to a. use light therapy to prevent seasonal affective disorder. b. consume extra vitamins C and E and other dietary antioxidants. c. ensure adequate intake of vitamin D from fortified foods and supplements. d. consume additional fluids to replace sweat losses caused by additional clothing.

ANS: C Dietary antioxidants, found in fruits and vegetables, as well as in some other foods, may help protect against carcinogenesis. Electrolytes, amino acids, and monounsaturated fatty acids are all important in maintaining good nutritional status but do not help protect against carcinogenesis.

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3. Fruits and vegetables help prevent cancer because they have high amounts of a. phytosterols.

b. vitamins. c. antineoplastics. d. antioxidants.

ANS: D Fruits and vegetables have high amounts of antioxidants that help prevent DNA mutation that leads to cancer. Antioxidants have antineoplastic qualities, but this is not what they are called.

Fruits and vegetables contain vitamins, but not all vitamins help prevent cancer. Phytosterols are found in plant oils and help lower blood cholesterol level.

DIF: Cognitive Level: Remembering

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TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

4. A dietary change that would help prevent cancer, according to the National Cancer Institute recommendations, is a. eating vegetarian meals two or more times a week. b. choosing organic, pesticide-free fruits and vegetables. c. eating five or more daily servings of fruits and vegetables. d. consuming three or more daily servings of low-fat dairy products.

ANS: C Eating five of more daily servings of fruits and vegetables would help prevent cancer. Eating vegetarian meals two or more times a week may help prevent cardiovascular disease. Choosing organic, pesticide-free fruits and vegetables would help protect the environment. Consuming three or more daily servings of low-fat dairy products would help prevent osteoporosis and hypertension.

DIF: Cognitive Level: Understanding REF: Page 415

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MSC: Client Needs: Health Promotion and Maintenance

5. Factors that contribute to loss of lean body mass in many patients with cancer that are outside the patient’s control include a. hypermetabolism. b. inadequate protein intake. c. inadequate energy intake. d. drug noncompliance.

ANS: A Hypermetabolism may be caused by release of cytokines as part of the cancer process; this is outside the patient’s control. It may be difficult to maintain adequate intakes of protein and energy and to comply with drug regimens, but these factors are within the patient’s control.

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6. A patient in whom cancer has been newly diagnosed is about to begin intense chemotherapy. She tells you that the only good thing about this diagnosis is that she will now be able to lose weight without even trying. The most appropriate nursing response would be to a. encourage the patient to celebrate the positive aspects of the disease. b. encourage adequate nutrient intake to maximize tolerance of chemotherapy. c. reinforce the need to achieve and maintain ideal body weight. d. emphasize eating the right types of foods rather than an amount of food.

ANS: B

Patients tolerate chemotherapy better when they are able to maintain good nutritional status.

Even though weight loss may seem like a positive side effect, it could have a negative effect if nutrient stores are depleted. Minimizing loss of lean body mass and maximizing nutrient stores are more important than attaining ideal body weight in patients with cancer. Making good food choices is important, but eating enough food to maintain lean body mass stores is more important.

DIF: Cognitive Level: Analyzing

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TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

7. If a patient is going to have surgery to remove cancer of the esophagus, it is important to a. prevent poor food intake as a result of depression by warning the patient that the surgery may be disfiguring. b. emphasize complete abstinence from cigarette smoking and use of alcoholic beverages. c. provide nutrition support to reverse malnutrition caused by difficulty eating during the disease progression. d. encourage the patient to enjoy favorite foods to maximize intake.

ANS: C Many patients with head and neck cancer enter surgery with protein-energy malnutrition because the disease may have prevented adequate intake; nutrition support to reverse malnutrition can greatly improve outcomes. Warning a patient about being disfigured may not prevent depression.

Abstinence from cigarette smoking and alcoholic beverages is wise, but is not necessarily the first priority. Enjoying favorite foods may be helpful to attain adequate intakes of energy, but good sources of protein and micronutrients should also be emphasized.

DIF: Cognitive Level: Analyzing

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MSC: Client Needs: Physiological Integrity

8. If a patient has dumping syndrome after surgery to remove a tumor, he or she has probably had a a. vagotomy. b. gastrectomy. c. pancreatectomy. d. small bowel resection.

ANS: B Dumping syndrome often occurs after a full or partial gastrectomy. Vagotomy may cause gastric stasis, diarrhea, and fat malabsorption. Pancreatectomy may cause type 1 diabetes and malabsorption of many nutrients. Small bowel resection may cause malabsorption of multiple nutrients, depending on the site and extent of resection.

DIF: Cognitive Level: Applying

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9. Bone marrow cells and cells lining the gastrointestinal tract are more susceptible than other cells to damage caused by chemotherapy because they a. are target cells for drugs. b. have a rapid turnover rate. c. are exposed to higher doses of the drugs. d. absorb more of the drugs than they excrete.

ANS: B Bone marrow cells and cells lining the gastrointestinal tract have a rapid turnover rate, which makes them highly susceptible to damage caused by chemotherapy. The drugs do not target these cells specifically, nor are the cells exposed to higher doses of the drugs. The effect of chemotherapy drugs on these cells is not related to absorption and excretion.

DIF: Cognitive Level: Understanding REF: Page 417

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10. If a patient with cancer is receiving a combination of chemotherapeutic agents that is known to interfere with bone marrow, special attention should be given to prevention of a. dehydration. b. foodborne illness. c. nausea and vomiting. d. loss of bone mass.

ANS: B The effects of chemotherapy on bone marrow cause immunosuppression because bone marrow produces many immune factors; therefore, it would be especially important to avoid risk of foodborne illness. Certain types of chemotherapy may cause nausea, vomiting, or diarrhea (which may cause dehydration) or may interfere with calcium metabolism, causing loss of bone mass, but these side effects are not caused by the drugs’ effects on bone marrow.

DIF: Cognitive Level: Applying

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11. If a patient has cancer and is being treated with chemotherapy, the greatest food safety concern is a. avoiding pesticide residues. b. potential food-drug interactions. c. choosing natural food products. d. preventing foodborne illness.

ANS: D

Individuals undergoing chemotherapy have weakened immune systems and therefore need to be especially careful to prevent foodborne illness. Concerns about pesticide residues are no greater for patients with cancer than for the rest of the population. Food-drug interactions may be a concern for specific individuals but are not related to food safety. Choosing natural food products is not necessarily beneficial and is not a particular concern for patients receiving chemotherapy.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

12. If a patient is receiving radiation therapy to the head and neck, he or she may need a. moist and semiliquid foods because of loss of saliva. b. dry foods because of taste changes. c. extra fluids and electrolytes because of diarrhea. d. extra dietary fiber and fluids to prevent constipation.

ANS: A Radiation of the head and neck may damage salivary glands; therefore, moist and semiliquid foods may be needed. The patient may experience taste changes, but dry foods do not help with this problem. Diarrhea and constipation are more common with radiation to the abdomen and pelvis.

DIF: Cognitive Level: Applying

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13. Patients who have just received bone marrow transplants should not eat a. canned tuna. b. soft cheeses. c. mayonnaise.

d. steamed vegetables.

ANS: B Patients who have just received a bone marrow transplant have immunosuppression as a result of the transplantation and drug therapies; thus they should avoid potential sources of foodborne illness, such as soft cheeses made from unpasteurized milk. Canned tuna, commercial mayonnaise, and steamed vegetables carry a lower risk for causing foodborne illness.

DIF: Cognitive Level: Applying

REF: Pages 417-419

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

14. Patients who receive bone marrow transplants often require parenteral nutrition. Some oral intake is important to help a. achieve adequate nutrient intake. b. provide nutrients that cannot be infused. c. maintain the integrity of the small intestine. d. maintain a sense of normality for the patient.

ANS: C Some oral or enteral intake is important for patients receiving bone marrow transplants and parenteral nutrition to help maintain the integrity of the small intestine. It is possible to achieve adequate intake through parenteral nutrition; all nutrients can be infused if parenteral nutrition is carefully planned. Oral intake does help maintain some normality for the patient, but this is not the main reason for using it.

DIF: Cognitive Level: Understanding REF: Page 417 MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Planning

15. If a patient with immunosuppression needs to follow a low-bacterial diet, a meal that he or she should avoid is a. Caesar salad dressing with alfalfa sprouts. b. breakfast cereal with milk. c. homemade bread with butter. d. chicken breast sandwich with mayonnaise.

ANS: A Patients with immunosuppression who need to follow a low-bacterial diet should avoid Caesar salad dressing made with raw eggs and alfalfa sprouts. Commercial dressings are safe, and the other salad ingredients would be safe as long as they are washed. Breakfast cereal, pasteurized milk, homemade or store-bought bread, butter, cooked chicken, and mayonnaise may all be included as part of a low-bacterial diet.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance | Client Needs: Safe and Effective Care Environment

16. The Patient-Generated Subjective Global Assessment tool a. should not be used as a basis for interventions because the data are subjective. b. provides a method for assessing the psychosocial effects of cancer on the patient. c. allows for early identification of patients who have potential or actual nutritional deficits. d. allows patients to evaluate their own nutritional status without the input of a registered dietitian.

ANS: C

The Patient-Generated Subjective Global Assessment tool allows for early identification of patients who have potential or actual nutritional deficits. Some parts of the form are completed by the patient, but others are completed by the registered dietitian, and the results are scored and evaluated by a registered dietitian. The data are subjective but vital for recognizing early signs of malnutrition and initiating early intervention. The form does not evaluate psychosocial status.

DIF: Cognitive Level: Understanding REF: Page 418 | Page 421 | Page 422 TOP: Nursing Process: Assessment

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17. Patients who are experiencing nausea or vomiting may find it easiest to tolerate foods such as a. chicken noodle soup. b. a turkey sandwich. c. chicken curry with rice. d. taco salad with jalapenos.

ANS: B Patients experiencing nausea and vomiting usually find it easiest to tolerate bland, low-fat foods with minimal odor, served cold or at room temperature, with limited fluids at mealtimes; the turkey sandwich would probably be tolerated best. Chicken noodle soup is usually served hot and is mostly fluid. Chicken curry is served hot, is highly seasoned, and has a strong aroma.

Taco salad with jalapenos would be very spicy.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

18. For patients infected with the human immunodeficiency virus (HIV), complex highly active antiretroviral therapy (HAART) regimens require a. avoidance of alcohol and nonprescription medications. b. self-monitoring of blood glucose levels.

c. following a neutropenic diet protocol. d. careful timing around meals and snacks to promote absorption.

ANS: D HAART drug regimens can be complex, and administration of each drug needs to be planned around timing and content of meals and snacks to maximize absorption. Use of alcohol and prescription medications should be checked with the pharmacist, but complete avoidance is not necessarily mandatory. A neutropenic diet may be helpful for prevention of foodborne illness but is not necessary to support drug therapy. HAART may have an adverse effect on blood glucose levels, but self-monitoring of blood glucose is not needed for everyone using HAART.

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19. If a patient develops HIV-associated lipodystrophy syndrome (HALS), the best dietary recommendation is to a. maintain adequate protein and energy intake so as to reduce muscle loss. b. use medium-chain triglycerides and avoid lactose. c. avoid raw, undercooked, or unpasteurized foods. d. follow a Mediterranean diet and take omega-3 fatty acid supplements

ANS: D A Mediterranean-style diet and omega-3 fatty acids may help ameliorate HALS. Maintaining adequate protein and energy intake to reduce muscle loss is important for overall nutritional health; medium-chain triglycerides and avoiding lactose may help patients with diarrhea; and avoiding raw and undercooked foods will help prevent foodborne illness, but these are not related to HALS.

DIF: Cognitive Level: Analyzing

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20. If a patient with HIV/AIDs is experiencing diarrhea, a good way to increase energy and protein intakes would be to a. add skim milk powder to shakes and soups. b. add butter to hot cereals, vegetables, rice, and noodles. c. eat three main meals daily, each with a serving of meat or fish. d. use peanut butter on toast or as a dip for fruits and vegetables.

ANS: D Adding peanut butter would add protein and energy. Adding skim milk powder would add protein and energy, but it also contains lactose, which may exacerbate diarrhea. Adding butter provides additional energy but not protein. Intake is usually better when eating is spread between several small meals and snacks rather than three main meals.

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21. If a patient with HIV/AIDS has been feeling very weak and whose weight has dropped from 180 lb to 160 lb in 4 weeks, he or she would be considered to have a. opportunistic infections. b. lipodystrophy or HALS. c. AIDS-related wasting syndrome. d. AIDS-related depression.

ANS: C

Involuntary loss of more than 10% of body weight in 1 month with chronic diarrhea, weakness, or fever is characteristic of AIDS-related wasting syndrome; loss of 20 lb from and original weight of 180 lb is greater than 10%. Lipodystrophy is characterized by body composition changes and metabolic alterations. Opportunistic infections and depression may or may not be associated with weight loss.

DIF: Cognitive Level: Applying

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22. Strategies that may help maximize food intake in patients with HIV/AIDS include a. eating several small meals and snacks daily. b. drinking 1 to 2 glasses of water with each meal. c. not eating unless really hungry, to avoid nausea. d. taking a daily multivitamin and mineral supplement.

ANS: A Patients with HIV/AIDS can help maximize their food intake if they eat several small meals and snacks daily. Drinking water with meals tends to fill the stomach so that the patient will actually consume less food and fewer nutrients. Not eating unless really hungry will also decrease food intake, especially if the patient’s appetite is poor. Taking a daily multivitamin and mineral supplement will not help increase food intake and will not increase energy and protein intake.

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TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

23. One of the reasons that nutrition therapy is so important for patients with HIV/AIDS is that it is an area in which a. patients can have some control of their medical care. b. their needs are not affected by the disease process.

c. interventions can have curative effects on the disease. d. they do not need the involvement of health care providers.

ANS: A Nutrition therapy is very important for patients with HIV/AIDS because they can make their own choices and work to improve their nutritional status; thus they can have some control of their medical care. Patients’ nutrient needs are greatly affected by the HIV/AIDS disease process.

Nutrition interventions cannot help cure HIV/AIDS. Patients with HIV/AIDS still need the involvement of health care providers to help them achieve optimal nutritional status.

DIF: Cognitive Level: Understanding REF: Page 424

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24. The factor that contributes most to malnutrition in patients with HIV/AIDS is a. opportunistic infections. b. fear of weight gain. c. use of antiretroviral therapy. d. increase in physical activity.

ANS: A Opportunistic infections contribute to malnutrition in patients with HIV/AIDS because they often cause nutrition-related problems such as sore mouth, nausea, vomiting, diarrhea, fatigue, and fever, which lead to increased nutrient needs, decreased nutrient intake, or both. Patients using antiretroviral therapy may fear weight gain and lipodystrophy, but malnutrition is less common in patients who use these drugs. If patients with HIV/AIDS feel well enough to increase their physical activity level, they are unlikely to suffer from malnutrition.

DIF: Cognitive Level: Analyzing

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25. Patients infected with HIV who develop hypogonadism are most likely to experience a. loss of body fat. b. weight gain. c. loss of muscle mass. d. dehydration.

ANS: C Patients with hypogonadism experience fatigue that makes it difficult to prepare and consume food; this may contribute to malnutrition and loss of muscle mass. Loss of body fat may occur but is less pronounced. Weight gain is less common. Dehydration as a result of diarrhea, vomiting, or fever is not directly related to hypogonadism.

DIF: Cognitive Level: Analyzing

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26. To minimize risk of infection with Cryptosporidium, patients with HIV/AIDS should a. eat yogurt that contains live cultures. b. avoid eating canned fruits and vegetables. c. avoid eating undercooked meat, poultry, fish, or eggs. d. drink only filtered water or water than has been boiled for 1 minute.

ANS: D

To minimize risk of infection with Cryptosporidium (a water-borne pathogen), the Centers for Disease Control and Prevention recommend that patients with weakened immune systems, including those with HIV/AIDS, drink only filtered water or water than has been boiled for 1 minute. Eating yogurt that contains live cultures may help prevent or minimize diarrhea.

Avoiding undercooked meat, poultry, fish, or eggs helps decrease the risk of experiencing other foodborne illnesses. Eating canned fruits and vegetables is generally safe for patients with HIV/AIDS.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance | Client Needs: Safe and Effective Care Environment

27. Patients with cancer who undergo irradiation of the lower abdomen are likely to experience a. nausea. b. vomiting. c. diarrhea. d. constipation.

ANS: C Patients with cancer who undergo irradiation of the lower abdomen are likely to experience damage to the gastrointestinal tract in the radiated area, which causes malabsorption and diarrhea. Patients who receive radiation in the upper abdomen may experience nausea and vomiting as a result of damage to the stomach. Patients receiving radiation do not usually experience constipation.

DIF: Cognitive Level: Understanding REF: Page 417 TOP: Nursing Process: Assessment

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28. A seasoning that may help stimulate food intake in patients with taste abnormalities is

a. lemon juice. b. soy sauce. c. honey. d. garlic.

ANS: A Foods that may help stimulate food intake in patients with taste abnormalities include those that are tart, such as lemon juice. Salty (soy sauce), sweet (honey), and bland (garlic) seasonings are less likely to help overcome taste abnormalities.

DIF: Cognitive Level: Applying

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29. An important nutritional goal for patients with cancer or HIV/AIDS is to a. eat several meals a day. b. avoid use of supplements. c. improve quality of life. d. maintain usual eating habits.

ANS: C The overarching goal of nutrition interventions for patients with cancer or HIV/AIDS is to improve quality of life by enjoying eating and feeling strong enough to participate in normal daily activities. Eating several meals a day is a strategy to help achieve this goal, but it is not a goal. Patients should try to focus on eating food rather than using supplements, but it is not necessary to avoid supplements completely. Patients may need to modify their usual eating habits to achieve optimal nutritional status and improve their quality of life.

DIF: Cognitive Level: Applying

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TOP: Nursing Process: Planning | Nursing Process: Evaluation

MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance

30. Patients experiencing diarrhea should make sure they have a generous intake of a. fat. b. fluids. c. protein. d. dietary fiber.

ANS: B It is important for patients with diarrhea to ensure adequate fluid intake. High intake of fat may exacerbate diarrhea. An adequate intake of protein helps maintain the integrity of gastrointestinal health, which minimizes diarrhea, but protein intake is not the first concern during acute diarrhea. Excessive amounts of dietary fiber may also exacerbate diarrhea.

DIF: Cognitive Level: Understanding REF: Page 426 | Page 427 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Physiological Integrity | Client Needs: Health Promotion and Maintenance