TEST BANK for Nursing Leadership from the Outside In. 1st Edition by Greer Glazer, Joyce J. Fitzpatr

Chapter 01: Wellness Nutrition Test Bank MULTIPLE CHOICE 1. Informal education includes education experiences that occur through daily activities, such as 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. completing a first aid course at the local Red Cross facility.

ANS: B

Watching a television show about diabetes is an example of informal education. Attending a workshop would be considered nonformal education; a high school course or a Red Cross first aid course would be considered formal education.

PTS: 1 DIF: Cognitive Level: Application REF: p. 2 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 2. Health is the merging and balancing of five physical and psychologic dimensions of health

that include a. psychologic, physical, anthropometric, social, and spiritual dimensions. b. financial, emotional, ethnic, spiritual, and mental dimensions. c. physical, intellectual, emotional, social, and spiritual dimensions. d. physical, economic, ethnic, emotional, and anthropometric dimensions.

ANS: C

The five physical and psychologic dimensions of health are physical health, intellectual health, emotional health, social health, and spiritual health.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 3 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. An example of poor eating habits that may affect emotional health is a. eating late at night at the pizza parlor. b. eating six small meals throughout the day. c. eating three meals a day plus two snacks. d. missing meals because of poor planning or being too busy to eat.

ANS: D

Missing meals may cause low blood sugar which can cause anxiety or confusion or make it difficult to control emotions.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 4 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 4. A group of strategies used to increase the level of health of individuals, families, groups, and

communities is known as a. wellness. b. health promotion.

c. tertiary prevention. d. nutritional assessment.

ANS: B

Strategies used to increase the level of health of individuals, families, groups, and communities are known as health promotion. Wellness refers to a lifestyle that enhances our health. Tertiary prevention is limited to interventions with people who have already developed a disorder. Nutritional assessment is the process of determining nutritional status.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 4-6 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. An example of community support for health promotion is a. teaching a young mother safe food preparation skills. b. watching a television show exposé about industry errors in food processing. c. labeling fresh poultry packages with information about proper food storage. d. being aware that Salmonella can be spread because of inadequate food preparation

skills.

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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 4 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 6. An example of a technique for health promotion is a. a client who exercises 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 bring about a change in health, such as teaching a teenager how to choose healthier fast foods. Exercising regularly contributes to wellness, but is not bringing about a change in health unless this is a change in behavior. A wider availability of fresh produce does not promote health, unless the supermarket uses specific strategies to encourage their consumption. Information about the relationship between nutrients and disease is simply information unless it is used to promote behavior change.

PTS: 1 DIF: Cognitive Level: Application REF: p. 4 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 7. For the efficient functioning and maintenance of the body, a person needs to consume

sufficient amounts of a. fiber. b. nutrients. c. minerals. d. supplements.

ANS: B

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

Fiber and minerals are both needed, but each only represents one type of nutrient.

Supplements are not always necessary because sufficient nutrients can often be obtained from food.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 8 | pp. 10-11 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 more than 50 years old. c. dietary guidelines recommended for older adults. d. MyPyramid 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 MyPyramid are separate documents from Healthy People 2020.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 5-6 | p. 11 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. A healthy female client asks what she can do to prevent the development of type 2 diabetes.

The strategies you discuss with her are considered a. primary treatment. b. primary prevention. c. secondary prevention. d. tertiary prevention.

ANS: B

Prevention of the development of type 2 diabetes before the disorder develops 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 7 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 10. As a home health care nurse, you are visiting a 70-year-old client who has just returned home

from the hospital after being treated for coronary artery disease. The medical nutrition therapy or diet therapy developed for him by the hospital dietitian is a. primary treatment. b. primary prevention. c. secondary prevention. d. tertiary prevention.

ANS: D

This is an example of tertiary prevention to minimize complications and help 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. Primary treatment is not a recognized term.

PTS: 1 DIF: Cognitive Level: Planning REF: p. 7 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 11. A nutrient that can be made by the body is called a. essential. b. complete. c. incomplete. d. nonessential.

ANS: D

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

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 8-9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. Nutrients that do not yield energy include a. minerals, vitamins, and water. b. protein, water, and vitamins. c. water, vitamins, and carbohydrates. d. minerals, vitamins, and protein.

ANS: A

Minerals, vitamins, and water are all nutrients that do not yield energy. Protein and carbohydrates both yield energy; each provides 4 kcals per gram.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 8-10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 13. Glucose is the a. sweetest of all sugars. b. most efficient form of energy for the brain. c. only carbohydrate found in fruits and sugars. d. carbohydrate to avoid to prevent diabetes.

ANS: B

Glucose provides the most efficient form of energy for the brain (and muscles too). Fructose and sucrose are both sweeter than glucose so it is not the sweetest sugar. Various other carbohydrates are found in fruits and sugars. Avoiding glucose does not prevent diabetes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. The nutrient that provides the highest number of kcals per gram is a. protein.

b. alcohol. c. fat. d. carbohydrate.

ANS: C

Fat provides the highest number of kcals: 9 per gram. Protein and carbohydrate each provide 4 kcals per gram. Alcohol provides 7 kcals per gram PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 9-10 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 15. A cup of frozen yogurt contains 24 g carbohydrate, 2 g fat, and 4 g protein. The total number

of kcals in the frozen yogurt is a. 110. b. 130. c. 140. d. 162.

ANS: B

24 g carbohydrate provides 24  4 = 96 kcals. 2 g fat provides 2  9 = 18 kcals. 4 g protein provides 4  4 = 16 kcals. Therefore the total kcals in the frozen yogurt is 96 + 18 + 16 = 130 kcals.

PTS: 1 DIF: Cognitive Level: Application REF: p. 9 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 16. Combinations of amino acids link together to form a. protein. b. carbohydrates. c. dietary fiber. d. lipids.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. Amino acids that must be consumed from plant and animal foods are called _____ amino

acids. a. nonessential b. essential c. formative d. biologic ANS: B

Amino acids that must be consumed from plant and animal foods are called essential amino acids. Nonessential amino acids can be formed by the body from other nutrients. Formative amino acids and biologic amino acids are not recognized terms.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. Lipids provide the best source of a. essential amino acids. b. body-building materials. c. glucose for the brain. d. dense energy for the body.

ANS: D

Because lipids provide more energy per gram than any other nutrient (lipids provide 9 kcals per gram; protein and carbohydrate provide 4 kcals per gram and alcohol provides 7 kcals per gram), they are the best source of dense energy for the body. They do provide some body-building materials: phospholipids are an important part of the structure of cell membranes. However proteins and minerals probably contribute more than lipids to building body structure. Lipids cannot be converted to glucose in the body.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 8-9 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 19. The category of nutrients that has a role in the production of hormones and helps protect body

organs is a. lipids. b. fibers. c. protein. d. carbohydrates.

ANS: A

Many lipids are used in the body to form hormones and lipids provide a protective layer of padding around body organs. Dietary fiber does not leave the gastrointestinal tract. Protein is an important part of many body structures but does not necessarily protect body organs; proteins may act as carriers for hormones, but are not used to make the hormones themselves.

Carbohydrates are a source of energy and have no real role in body structure or hormonal regulation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 8-9 TOP: Nursing Process: Analysis MSC: Client Needs: Physiological integrity 20. Triglycerides, phospholipids, and sterols are categories of a. lipids. b. vitamins. c. minerals. d. carbohydrates.

ANS: A

Lipids are made up of triglycerides, phospholipids, and sterols. Categories of vitamins are fat soluble and water soluble. Minerals are divided into major minerals and trace minerals.

Carbohydrates are simple carbohydrate, complex carbohydrates, and dietary fiber.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 8-9 TOP: Nursing Process: Analysis MSC: Client Needs: Physiological integrity

21. Water soluble and fat soluble describe the two classes of a. fiber. b. vitamins. c. minerals. d. carbohydrates.

ANS: B

Vitamins are either water soluble or fat soluble. Dietary fiber is indigestible carbohydrate.

Minerals are classified as major minerals or trace minerals. Carbohydrates are simple carbohydrate, complex carbohydrates, and dietary fiber.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. A category of nutrients that assists other nutrients with metabolic functions throughout the

body is a. water. b. protein. c. vitamins. d. minerals.

ANS: C

Vitamins indirectly assist other nutrients through the complete processes of digestion, absorption, metabolism, and excretion. Water provides a fluid medium and a transport system for body processes. Protein makes up many body structures, enzymes, and components of the immune system. Minerals serve structural purposes and are found in body fluids.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. If a mine worker was 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. carbohydrate. c. water.

d. vitamins.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Application REF: p. 10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. Combining classic concerns of deficiency diseases with interest to reduce the risk of chronic

diet-related diseases is the focus of the a. Healthy People 2020. b. Dietary Reference Intakes (DRIs). c. Tolerable Upper Intake Level (UL). d. Estimated Energy Requirement (EER).

ANS: B

DRIs combine the classic concerns of deficiency diseases that were the original focus of nutrient recommendations with the contemporary interest to reduce the risk of chronic diet-related diseases such as coronary artery disease, cancer, and osteoporosis. UL is the level of nutrient intake that should not be exceeded to prevent adverse health risks. The EER aims to maintain good health by providing energy intake levels to maintain individuals’ body weights within specific age, gender, height, weight, and physical activity categories. Healthy People 2020 seeks to strengthen policy and practice to improve health.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 11 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 26. The best course of action to provide adequate amounts of vitamins and minerals is to a. promote weight loss. b. eat a variety of foods. c. eat at least 3 meals per day. d. consume a high-fiber, low-fat diet.

ANS: B

Including a variety of foods increases the likelihood of obtaining adequate amounts of vitamins and minerals. Loss of weight will not contribute to adequate nutrient intake. Eating at least 3 meals per day may help increase nutrient intake to some extent, but they could still be meals that provide a limited assortment of foods. Similarly, a high-fiber, low-fat diet could consist of foods that are relatively low in vitamins and minerals.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 10-12 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 27. If a nurse wants to evaluate a client’s dietary intake, he or she may use a. anthropometric measurements, 24-hour recall, and/or a food record. b. computer dietary analysis and biochemical laboratory testing. c. diet history, a food record, and/or computer dietary analysis. d. measurements of limbs, analysis of body fluids, and a diet history.

ANS: C

Methods to assess dietary intake include use of a diet history, a food record, and/or computer-assisted dietary analysis. Anthropometric measurements (including measurements of limbs) and biochemical laboratory testing (including analysis of body fluids) are used to help assess nutritional status, but not dietary intake.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity

REF: pp. 15-16

28. If a nurse wants to assess a client’s nutritional status, he or she may use a. dietary standards, dietary behaviors, Acceptable Macronutrient Distribution

Ranges, and biochemical analysis. b. biochemical analysis, food records, computerized dietary analysis, and Tolerable

Upper Intake Level. c. Recommended Dietary Allowances, clinical examination, psychosocial behaviors,

and risk assessment. d. dietary evaluation, clinical examination, biochemical analysis, and anthropometric

measurements.

ANS: D

Nutritional status is assessed using a combination of dietary evaluation, clinical examination, biochemical analysis, and anthropometric measurements. Dietary standards Acceptable Macronutrient Distribution Ranges, Tolerable Upper Intake Level, and Recommended Dietary Allowances may be used to evaluate data obtaining using these methods. Dietary behaviors, psychosocial behaviors, food records, and computerized dietary analysis may be used as part of dietary evaluation.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity

REF: p. 15

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 they would be described as having a. malnutrition. b. nonnutrition. c. overnutrition. d. disordered eating.

ANS: A

An imbalance of nutrients and/or energy (in this case, high intake of some nutrients and low intake of energy) is called malnutrition. Overnutrition only refers to excessive intake or nutrients and/or energy. Disordered eating refers to unusual eating habits that may or may not lead to some form of malnutrition. Nonnutrition is not a recognized term.

PTS: 1 DIF: Cognitive Level: Application REF: p. 15 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 30. A professional trained in normal and clinical nutrition, food science, and food service

management who is credentialed by the Commission on Dietetic Registration of the American Dietetic Association is a

a. b. c. d.

registered nurse (RN). registered dietitian (RD). clinical nutritionist (CN). certified home economist (CHE).

ANS: B

Only registered dietitians meet these professional standards. Clinical nutritionists have a masters or doctoral degree in nutrition but do not have the other credentials. A registered nurse does not have in-depth clinical nutrition, food science, and food service training.

Certified home economists do not have clinical nutrition training.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 16 TOP: Nursing Process: Planning MSC: Client Needs: Safe and effective care environment

Chapter 02: Personal and Community Nutrition Test Bank MULTIPLE CHOICE 1. The type of influence that a desire for sweet and salty flavored foods has on food preferences

is a. b. c. d.

genetic. learned. physiologic. environmental.

ANS: A

A preference for sweet and salty foods is genetically determined. Environmental effects are the same as learned effects, preferences caused by cultural and socioeconomic influences.

Physiology has relatively little influence on food preferences.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 21 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 2. A teenage 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 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 21 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity

3. A mother tells you that she does not allow her young children to eat while the 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 a. the genetic factor of preference for sweet and salty tastes. b. the influence of ethnicity on preference for sour tastes. c. the children’s weights when they were born and their weights now. d. the 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 impact on their own future food choices. Preventing young children from eating while watching television will have only short-term impact and they are likely to join 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 if the children currently have a healthy weight for their height (although there birth weight is probably not relevant), but these have less immediate impact on the nutritional health of this family.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 21 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial integrity 4. Economics is a significant factor influencing the nutritional status of communities. To

overcome economic disadvantage, public health efforts include a. the MyPyramid food guidance system. b. educational programs on food safety. c. the U.S. government’s Food Stamp Program. d. public service announcements on healthy eating.

ANS: C

The Food Stamp Program provides coupons to buy nutritious foods for individuals and families with incomes below certain levels. This can help improve the nutritional status of economically challenged families. The other public health efforts listed are not specifically aimed at people who have an economic disadvantage.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 21 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. Between 1970 and 2000, nutritional concern centered on reducing nutrient excesses. Before

1970, the focus was to reduce a. consumption of lipids. b. low-carbohydrate diets. c. nutrient deficiencies. d. prevention of infectious disease.

ANS: C

Before 1970, most nutritional problems were attributed to nutrient deficiency. Later on, research showed the association between excessive lipid intakes and chronic disease.

Low-carbohydrate diets gained popularity for weight loss after 1970. Prevention of infectious disease is not a direct nutritional concern.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 21-22 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

6. If he is genetically susceptible, an older man who has eaten a high-fat, high-salt diet all his life

has a high risk of developing a. genetic disorders, hypertension, and diabetes. b. hypertension and sickle cell anemia. c. viral infections requiring antibiotics. d. coronary artery disease, hypertension, and diabetes.

ANS: D

Coronary artery disease, hypertension, and diabetes are all more common in individuals who consume high-fat, high-sodium diets. Risk of genetic disorders, sickle cell anemia, and viral infections is not affected by dietary fat and sodium intakes.

PTS: 1 DIF: Cognitive Level: Application REF: p. 22 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. Of the following, the most important overall dietary modification to help reduce 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 evidence library shows that shifting to a more plant-based diet is one of four significant modifications to our 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 be higher in fat, sugar, and sodium and lower in nutrients than foods without preservatives). Buying locally grown foods may be a good agricultural and economic practice, but does not affect health status. Eating more animal-based foods would be the opposite of what is recommended.

PTS: 1 DIF: Cognitive Level: Application REF: p. 23 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 8. One way to help clients follow the Dietary Guidelines for Americans is to encourage them to

use a. b. c. d.

Healthy People 2020.

MyPyramid.

The Food Stamp Program.

The Exchange Lists for Meal Planning.

ANS: B

MyPyramid is designed to help clients implement the recommendations of the Dietary Guidelines for Americans. Healthy People 2020 sets national targets for health promotion.

The Food Stamp Program provides coupons to buy nutritious foods for individuals and families with low incomes. The Exchange Lists for Meal Planning are intended primarily for patients with diabetes and those who need to lose weight; they help patients choose appropriate portion sizes to control their intake of fat, protein, carbohydrate, and energy.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 24-29 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. The MyPyramid food guidance system is a a. food guide intended to increase intake of fruits and vegetables. b. nutrient guide that categorizes foods by their fat, sodium, and fiber content. c. food guide that helps consumers meet their nutrient needs and limit dietary

excesses. d. nutrient guide aimed to promote weight loss by controlling intake of fat-soluble vitamins.

ANS: C

The MyPyramid food guidance system helps consumers include foods that meet their nutrient needs and limit intake of dietary components that are often eaten in excess. For many consumers, following MyPyramid will increase their intake of fruits and vegetables, but this is only one part of the recommendations. MyPyramid groups foods according to their nutrient content, but not fat, sodium, and fiber specifically. Intake of fat-soluble vitamins has no effect on weight loss.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 24-25 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 10. The ―fruits & veggies—more matters‖ slogan is part of a campaign designed to increase

intake of fruits and vegetables among a. school-age children. b. people living in urban areas. c. low-income individuals and families. d. all Americans.

ANS: D

―Fruits & veggies—more matters‖ is part of the National Fruit and Vegetable Program, designed to increase intake of fruits and vegetables among all Americans. It is not specifically targeted at any age, demographic, or socioeconomic group.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 28-29 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 11. A meal planning guide that would be helpful for a patient who needs to closely monitor their

intake of kcals, carbohydrates, protein, and fat is the a. National Fruit and Vegetable Program. b. MyPyramid food guidance system. c. Dietary Guidelines for Americans. d. Exchange Lists for Meal Planning.

ANS: D

The Exchange Lists for Meal Planning groups foods according to their kcal, carbohydrate, protein, and fat content and lists serving sizes that contain specific amounts of each of these.

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 give general advice but do not translate this into specific amounts of foods.

MyPyramid would help patients achieve healthy intakes of kcals, carbohydrate, protein, and fat, but would not be specific enough for them to monitor their intake closely.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 28-29 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

because fruits and vegetables a. are natural appetite suppressants. b. displace high-fat foods from the diet. c. are rich in antioxidants and phytochemicals. d. decrease absorption of fat from foods.

ANS: B

Fruits and vegetables displace high-fat foods from 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 28 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. Fish consumption is increasing in the United States as a result of a. greater availability of fresh and frozen fish. b. increased use of fish in processed foods. c. dietary recommendations to consume lighter-colored protein sources. d. recognition that protein from fish is superior to other protein sources.

ANS: A

Fish consumption is increased because of the availability of frozen and refrigerated storage techniques. Use of fish in processed foods has not increased. Dietary recommendations encourage use of more poultry and fish and less red meat, but do not describe them in terms of color. Fish contains high quality protein, but it is not superior to the protein in other animal foods.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 31 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 14. If a client wants to use the food label to check the number of kcals in a product, they should

also check the a. calories from fat. b. servings per container. c. % Daily Value. d. ingredient list.

ANS: B

The number of kcals in a product is stated for a standard serving size of that food. The client needs to multiply the kcals per serving by the number of servings in the container to know how many kcals it contains. The calories from fat are not related to the total number of kcals in the food. The % Daily Value describes the nutrient content of the food rather than its caloric value. The ingredient list does not give any information about kcals.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 32-34 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 15. The most useful part of the food label for a client who wants to make sure they choose foods

high in nutrients is the a. % Daily Value. b. health claims. c. organic seal. d. amount of nutrients per serving.

ANS: A

The % 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 is high or low in a specific nutrient related to that particular health claim, but 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 only listed for some nutrients; it would not give any information about vitamins and minerals in the food because these are only listed as % Daily Values.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 32-36 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 16. If a food package has the radura symbol, showing that the food has been irradiated, a

consumer can know that the food a. should not be eaten by pregnant women. b. will have a cooked taste and texture. c. had to be treated to remove contaminants. d. may have an extended shelf life.

ANS: D

Irradiation extends the shelf life of foods by destroying microorganisms, mold, and parasites.

Irradiated foods are safe for pregnant women. Irradiation does not give foods a cooked taste and texture. Irradiation is used to destroy normal levels of microorganisms, mold, and parasites in foods, rather than to treat contaminated foods.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 41-43 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 32-34 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. They have also approved use of a health claim stating the relationship between calcium intake and decreased risk of osteoporosis, but this is not directly relevant to a pregnant women. The other two associations are not approved for health claims on food labels.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 35-36 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 19. If a patient has cancer and is being treated using chemotherapy, their 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 cancer patients 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 37 TOP: Nursing Process: Planning MSC: Client Needs: Safe and effective care environment 20. Use of food preservatives and flavor enhancers and the addition of vitamins A and D to milk

are examples of a. nutritional additives. b. artificial ingredients. c. intentional food additives. d. incidental food additives.

ANS: C

Use of food preservatives and flavor enhancers and addition of vitamins A and D to milk are examples of intentional food additives; they are added to improve the quality of the food in some way. Incidental food additives contaminate or inadvertently become part of the food.

Vitamins A and D add nutritional value, but food preservatives and flavor enhancers are added for other beneficial reasons. The term ―artificial ingredients‖ does not differentiate between those added intentionally and those present as contaminants or added inadvertently.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 37 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 21. An example of an incidental food additive is a. vitamin A in nonfat milk. b. irradiation of herbs and spices. c. artificial color in soft drinks. d. traces of a pesticide found in bottled apple juice.

ANS: D

Traces of pesticide found in bottled apple juice is an example of an incidental food additive; it is not added to the juice to improve its quality, but is there because the pesticides were used in growing the apples and traces contaminate the juice. Vitamin A is added to nonfat milk to improve its nutritional value and artificial color is added to soft drinks to improve their appearance; both of these are intentional food additives. Irradiation of herbs and spices is a process, not an additive.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 37 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 22. It is essential that each sector of the food chain follow correct food handling procedures in

order to a. meet nutrient guidelines. b. have a safe food supply. c. have tasty food products. d. maintain an inexpensive food supply.

ANS: B

Food can become unsafe if it is mishandled at any point in the food chain between the farm and the plate; therefore correct food handling procedures protect the safety of the food supply.

Food handling procedures may affect the nutrient content and taste of foods to some extent, but these effects are much less significant. Correct food handling procedures are not necessarily linked to cost of food production.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 37-40 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and effective care environment 23. Cutting vegetables on the same cutting board that has been used to cut up raw chicken is an

example of a. saving time and energy resources. b. cross-contamination that could spread harmful bacteria. c. a potential problem only if the chicken was not refrigerated. d. a food safety problem if the vegetables and chicken are eaten at different meals.

ANS: B

This is an example of cross-contamination because bacteria in the raw chicken may contaminate the vegetables. This may save time, but could be very hazardous to health. Even refrigerated raw chicken can harbor harmful bacteria. This practice is risky, regardless of whether the foods will be eaten at the same or different meals.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 40-41 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and effective care environment 24. An environmental benefit of some genetically engineered crops is that a. they are easier to harvest. b. they contain fewer common allergens. c. they may be grown using fewer pesticides. d. foods made from them have a longer shelf life.

ANS: C

Crops may be genetically engineered so that they produce their own natural pesticides that are harmful to insects but not to humans and animals; they therefore require use of fewer pesticides which is beneficial to the environment. Crops may also be genetically engineered to make them easier to harvest, to contain fewer common allergens, and to produce foods with a longer shelf life. However these effects would not have a direct benefit for the environment.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 36-37 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and effective care environment 25. Consuming only well-cooked hamburgers would be most likely to help reduce the risk of

foodborne illness caused by a. Vibrio vulnificus. b. Escherichia coli. c. Clostridium botulinum. d. Listeria monocytogenes.

ANS: B

Foodborne illness caused by E. coli has been linked to consumption of undercooked hamburgers and can be prevented by thorough cooking of the meat. Vibrio vulnificus causes foodborne illness due to consumption of raw or undercooked seafood, especially shellfish.

Clostridium botulinum produces a toxin in improperly prepared home-canned foods. Listeria monocytogenes may be found in unpasteurized dairy products, sliced deli meats, smoked fish, hot dogs, and deli-prepared salads.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 39-40 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and effective care environment 26. If thirty patients developed foodborne illness after eating at a particular restaurant, the doctor

or hospital may report the outbreak to the a. Partnership for Food Safety Education. b. U.S. Department of Agriculture (USDA). c. U.S. Food and Drug Administration (FDA). d. Centers for Disease Control and Prevention (CDC).

ANS: D

The Centers for Disease Control and Prevention keeps statistical data on foodborne illness so outbreaks would be reported to them. The Partnership for Food Safety Education educates consumers and food workers about safe food handling. USDA and FDA help ensure that food is produced using safe practices.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 37-40 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and effective care environment 27. A ―reasonable certainty of no harm‖ describes a. consumer guidelines for food safety. b. international standards for food additives. c. food industry standards for food production. d. federal standards for pesticide residues in foods.

ANS: D

The ―reasonable certainty of no harm‖ is a federal standard for pesticide residues in foods that replaces the former zero tolerance. This phrase is not used in connection with consumer guidelines for food safety, international standards for food additives, or food industry standards for food production.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 37-40 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 28. At the grocery store, one important way consumers can help prevent foodborne illness is to

check the a. ingredient list. b. sell-by or use-by date. c. Nutrition Facts panel. d. type of packaging used.

ANS: B

Foodborne illness may be caused by consumption of food with expired sell-by or use-by dates; therefore consumers should check dates on food packages at the grocery store.

Information included in the ingredient list and Nutrition Facts panel is not directly relevant to prevention of foodborne illness. The type of packaging used is unlikely to be a food safety concern.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 37-40 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and effective care environment 29. An individual would be described as having an external locus of control if they a. write out a shopping list each week and generally only buy foods on their list. b. try to eat mostly foods produced using organic and sustainable farming practices. c. had decided to eat a turkey sandwich, but end up ordering pizza with friends. d. try to influence their 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 43 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 30. Eating homemade ice cream made with raw eggs increases the risk for a. Shigella. b. norovirus. c. listeriosis. d. salmonellosis.

ANS: D

Salmonellosis may occur after consumption of raw or undercooked eggs. Shigella and norovirus are associated with infected food handlers who have poor hygiene. Listeriosis is associated with consumption of unpasteurized dairy products, sliced deli meats, smoked fish, hot dogs, and deli-prepared salads.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 39 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and effective care environment

Chapter 03: Digestion, Absorption, and Metabolism Test Bank 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 does not make digestion itself possible. Smell and taste are not related to peristalsis.

PTS: 1 DIF: Cognitive Level: Application REF: p. 50 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. An example of mechanical digestion includes 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 and secretin are enzymes that cause chemical breakdown of food; bile causes emulsification of the fats.

PTS: 1 DIF: Cognitive Level: Application REF: p. 50 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. Valves to control the movement of food in and out of the stomach are called a. reflux regulators. b. peristalsis muscles. c. sphincter muscles. d. segmentation muscles.

ANS: C

Sphincter muscles control the movement of food in and out of the stomach. They do help prevent reflux, but this is not their name. They are not involved in peristalsis. Segmentation occurs as circular and longitudinal muscles cause food to move backwards and forwards in the gut.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 51 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. A substance that works only on a specific class of nutrient is called a(n) a. bolus. b. chyme. c. gastrin. d. enzyme.

ANS: D

Enzymes work on specific classes of nutrients to change them from one form to a simpler form. A bolus is a ball-shaped mass of chewed food that is swallowed. Chyme is the semiliquid mixture of food mass and secretions in the stomach. Gastrin is a hormone secreted by the stomach mucosa.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 52 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 are secreted in one place in the body and have actions in another place in the body; therefore they are a type of chemical messenger. 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 52 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. Chewing is an example of mechanical digestion. Peristalsis and segmentation help propel food along the gastrointestinal tract and mix food with intestinal secretions.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 50 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. Mechanical breakdown of food is a function of 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 so it is not involved in breakdown.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 49-52 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. A bolus is a ball of a. masticated food ready to be swallowed. b. fat emulsified with bile and intestinal secretions. c. mucus that helps move food along the gastrointestinal tract. d. indigestible fiber mixed with the waste products of digestion.

ANS: A

A bolus is a ball of masticated food mixed with saliva and ready to be swallowed. Emulsified fat and mucus do not form a ball. Indigestible fiber and waste products are known as feces.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 50 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. Gastrin is a(n) a. hormone that allows glucose to enter cells. b. enzyme that assists protein digestion. c. hormone needed for reproductive functions. d. hormone that increases the release of gastric juices.

ANS: D

Gastrin is a hormone that increases the release of gastric juices in response to stomach distension. The hormone that allows glucose to enter cells is insulin. Gastrin is not an enzyme, although it does stimulate secretion of gastric juices that contain enzymes. Gastrin does not have a role in reproductive functions.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 52 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. The small intestine is the major site of 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 not excretion. Peristalsis occurs throughout the digestive tract and mechanical digestion occurs in the mouth and stomach.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 53 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. The villi of the small intestine increase its capacity for a. digestion. b. absorption. c. excretion. d. elimination.

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 and elimination do not occur in the small intestine.

PTS: 1 DIF: Cognitive Level: Application REF: p. 53 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. The absorptive cells of the villi are covered by a. hairlike projections called microvilli. b. hormones that control digestive processes. c. enzymes that speed absorption of nutrients. d. layers of circular and longitudinal muscle.

ANS: A

The villi are covered with microvilli that enhance absorption. Hormones are not found inside the digestive tract. Enzymes cause digestion of food, not absorption. The layers of circular and longitudinal muscle are around the outside of the gastrointestinal tract, not on the inside lining.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 53 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

13. Secretions of the pancreas neutralize the a. acidic chyme entering the duodenum. b. acidic chyme leaving the duodenum. c. bolus flowing down the esophagus. d. low-density lipoproteins leaving the liver.

ANS: A

Pancreatic secretions contain bicarbonate that decreases the acidity of chyme from the stomach. Acidic chyme enters the duodenum, neutralized chyme leaves the duodenum. The bolus goes down the esophagus but is not acidic until it is mixed with acidic stomach secretions. Low-density lipoproteins leave the liver in the blood stream and are not affected by pancreatic secretions into the intestines.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 51-52 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. Release of digestive secretions into the small intestine is caused by a. enzymes that are released when food enters the stomach. b. enzymes that are released when food enters the small intestine. c. hormones that are released when food enters the stomach. d. hormones that are released when chyme enters the small intestine.

ANS: D

Hormones that are released when chime enters the small intestine cause the release of digestive secretions into the small intestine. Hormones control the release of digestive secretions; digestive secretions contain enzymes that digest macronutrients. The hormones that signal release of digestive secretions into the small intestine are triggered when chime enters the small intestine. If they were released when food entered the stomach, digestive secretions would be released into the small intestine too early and could cause damage.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 52-53 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, so feces would be liquid. Feces would not be dry if they large intestine was not removing water. The large intestine does not have a significant impact on the acidity or alkalinity of feces.

PTS: 1 DIF: Cognitive Level: Application REF: p. 54 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. The esophagus is a structure that a. produces and releases digestive enzymes but not hormones. b. does not produce digestive enzymes but does release hormones. c. does not produce or release digestive enzymes or hormones.

d. produces only small amounts of digestive enzymes or hormones.

ANS: C

The esophagus does not produce or release digestive enzymes or hormones. It simply transports food boluses from the mouth to the stomach.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 50-51 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. The mouth, stomach, small intestine, and colon describe the a. order in which food travels during reverse peristalsis. b. pathway blood travels after leaving the liver. c. pathway of hormones that release intestinal secretions. d. order in which food moves through the gastrointestinal tract.

ANS: D

The mouth, stomach, small intestine, and colon describe the order in which food moves through the gastrointestinal tract. Reverse peristalsis would reverse this order. After it leaves the liver, blood does not flow to these organs in order. Hormones travel in the blood stream, not along the gastrointestinal tract.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 49 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. Facilitated diffusion is a type of absorption that requires a special carrier to transport a

molecule across the cell membrane and a. requires energy. b. does not require energy. c. is also called pinocytosis. d. is also called passive diffusion.

ANS: B

Facilitated diffusion allows absorption of molecules into cells from an area of low concentration to an area of high concentration; it uses a carrier protein but does not require energy. In pinocytosis a nutrient or liquid is engulfed by part of the cell membrane and taken into the cell in a vacuole. Passive diffusion does not use a special carrier protein; nutrients pass from an area of high concentration to an area of low concentration.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 54-55 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. Active transport is a. also called passive diffusion. b. the diffusion process that requires energy. c. the absorption process that requires energy. d. the absorption process that sometimes requires energy.

ANS: C

Active transport is an energy-dependent process for absorbing nutrients. It is not passive because it always requires energy. It is not diffusion because it involves absorption against the concentration gradient.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 54 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. Nutrients are truly inside the body when they are a. swallowed. b. digested. c. absorbed. d. metabolized.

ANS: C

Nutrients need to be absorbed to be truly inside the body. When they are swallowed and even when they are digested, they are inside the gastrointestinal tract, but have not crossed through the walls to enter the body. Metabolism occurs after nutrients are absorbed and part of the body.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 54 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 similar functions to the stomach relative 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 54-55 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. An example of catabolism is a. conversion of glucose to glycogen. b. the breakdown of glucose to provide energy. c. the synthesis of protein from amino acids. d. use of enzymes to digest protein and release amino acids.

ANS: B

Catabolism is the breakdown of food components into small particles, releasing energy as heat and chemical energy. An example of this is the breakdown of glucose to provide energy.

Conversion of glucose to glycogen is an example of anabolism, because a smaller substance (glucose) is used to form a larger molecule (glycogen). Synthesis of protein from amino acids is another example of anabolism. Use of enzymes to digest protein is a function of digestion, not related to anabolism and catabolism which are metabolic functions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 57 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

23. Waste products are excreted from the body by the a. lungs, kidneys, and large intestine. b. liver, kidneys, and pancreas. c. skin, small intestine, and large intestine. d. lungs, liver, and spleen.

ANS: A

Waste products are excreted by the lungs (carbon dioxide and water), the kidneys (metabolic waste and excess vitamins and minerals), and the large intestine (in feces). The liver processes metabolic products but does not excrete them. The pancreas, small intestine, skin, and spleen do not play a role in excretion.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 57 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 and vegetables and whole grains) are likely to result in constipation. Diarrhea may be caused by stress, but 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 59 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

Vomiting and diarrhea both cause abnormal loss of fluid which can lead to dehydration.

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

PTS: 1 DIF: Cognitive Level: Application REF: pp. 58-60 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 26. A person that complains that they have problems with gas, bloating, and diarrhea if they eat

breakfast cereal with milk but not if they eat 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, so it ferments in the intestines causing gas, bloating, and diarrhea. Milk allergy may also cause diarrhea, but would probably also cause skin rash and/or asthma. Gluten intolerance would not be affected by milk intake.

Irritable bowel syndrome would probably not produce symptoms after eating foods with milk but not after eating foods without milk.

PTS: 1 DIF: Cognitive Level: Application REF: p. 59 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 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 are not needed to do so.

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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 49-50 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 28. The esophagus is the a. muscular tube used for excretion of waste products. b. pathway through which enzymes and hormones travel. c. pathway that blood follows within the body from organ to organ. d. muscular tube along which a food bolus travels from the mouth to the stomach.

ANS: D

The esophagus is the tube that carries a food bolus from the mouth to the stomach. Waste products are excreted from the rectum, the kidneys, and the lungs. Blood, enzymes, and hormones do not follow such a specific pathway in the body.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 50-51 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. Metabolism is the process by which a. absorbed nutrients are used to break down body structures. b. absorbed nutrients are used to break down and maintain body structures and

functions. c. excreted nutrients are used by the body for energy and to form and maintain body

structures and functions. d. absorbed nutrients are used by the body for energy and to form and maintain body

structures and functions.

ANS: D

Metabolism is the process by which absorbed nutrients are used by the body for energy and to form and maintain body structures and functions. Absorbed nutrients are used to maintain body structures and functions, but not to break down body structures. Excreted nutrients are not available to be used by the body.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 57 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 30. Vomiting is a. reverse peristalsis. b. forward peristalsis. c. an eating disorder. d. gastroesophageal reflux.

ANS: A

Vomiting is reverse peristalsis. Instead of food moving down the GI tract, the peristalsis muscles move the contents of the stomach back through the esophagus and forcefully out the mouth. Forward peristalsis would cause food to continue through the gastrointestinal tract.

Vomiting is usually involuntary and not connected with an eating disorder. Gastroesophageal reflux causes food from the stomach to back up into the esophagus, but is less intense than vomiting.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 58-59 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

Chapter 04: Carbohydrates Test Bank MULTIPLE CHOICE 1. Plants use carbon dioxide, water, and the sun’s energy in the process of photosynthesis to

synthesize a. fat. b. protein. c. carbohydrate. d. alcohol.

ANS: C

Plants synthesize carbohydrate via photosynthesis. Fat and protein are produced by other metabolic processes in the plants. Living plants do not usually produce alcohol, although stored fruit or grain may ferment and produce some alcohol.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 63 TOP: Nursing Process: Assessment 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 64-65 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. Sucrose, maltose, and lactose are examples of a. disaccharides. b. polysaccharides. c. monosaccharides. d. complex carbohydrates.

ANS: A

Sucrose, maltose, and lactose each consist of two units of carbohydrate and are therefore disaccharides. Monosaccharides consist of one carbohydrate unit; polysaccharides and complex carbohydrates consist of several carbohydrate units.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 64-65 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 4. Glucose is a _____, often called _____ sugar. a. disaccharide; blood b. monosaccharide; blood c. disaccharide; milk d. monosaccharide; milk ANS: B

Glucose is a monosaccharide and is the form of carbohydrate that travels in the blood, often called blood sugar. Glucose is not a disaccharide. Lactose is the disaccharide often called milk sugar.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 64-65 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Compared 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 69-70 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 a _____ 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 are high in 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 74-77 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. Ketones are produced when insufficient _____ is available and the body has to metabolize

_____ for energy. a. carbohydrate; fat b. fat; carbohydrate c. carbohydrate; protein d. protein; carbohydrate ANS: A

Ketones are produced when insufficient carbohydrate is available and the body has to metabolize fat for energy. Ketones are intermediate products of fat metabolism that can build up and cause potentially lethal ketoacidosis. Ketones are not produced when protein is metabolized for energy PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 67 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. 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.

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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 70-72 TOP: Nursing Process: Planning 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 so it does not usually contribute to dental caries.

PTS: 1 DIF: Cognitive Level: Application REF: p. 72 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 10. Bacteria have a role with _____ in causing _____. a. fiber; diabetes b. fiber; tooth decay c. sugar; diabetes d. sugar; tooth decay ANS: D

Bacteria ferment sugars in the mouth to cause tooth decay. Bacteria do not have a role in development of diabetes. Adequate intake of dietary fiber may help prevent diabetes. Intake of dietary fiber does not directly influence tooth decay, although foods high in dietary fiber may displace more sugary foods from the diet which would help prevent tooth decay.

PTS: 1 DIF: Cognitive Level: Application REF: p. 72 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 11. Sorbitol, mannitol, and xylitol are a. forms of alcohol that provide 7 kcals/g. b. sugar alcohols that provide 2-3 kcals/g. c. carbohydrates that provide 4 kcals/g. d. artificial sweeteners that provide negligible kcals.

ANS: B

Sorbitol, mannitol, and xylitol are sugar alcohols that provide 2-3 kcals/g. They do not have the same drug effect as noncarbohydrate alcohol that provides 7 kcals/g. They are carbohydrates, but do not provide 4 kcals/g. They are not artificial sweeteners and they do provide significant kcals.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 73 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 12. Aspartame should not be consumed by a. infants and school-age children. b. individuals who suffer from migraines. 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-age children, although there may be no reason for them to consume it. Some individuals report that they get headaches after they consume aspartame, not everyone who gets migraines should avoid aspartame. Use of food sweetened with aspartame rather than sugar will provide fewer kcals and so will not help individuals gain weight, but this does not mean that for underweight people to avoid aspartame.

PTS: 1 DIF: Cognitive Level: Application REF: p. 73 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 13. Cellulose is an example of a(n) a. soluble fiber. b. insoluble fiber. c. soluble protein. d. insoluble protein.

ANS: B

Cellulose is an example of an insoluble fiber. It is not soluble in water and it is not a protein.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 76 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 14. Diets low in fiber may increase the risk of a. hip fracture, constipation, and colon cancer. b. diverticular disease, hypertension, and colon cancer. c. diverticular disease, constipation, and dementia. d. diverticular disease, constipation, and colon cancer.

ANS: D

A high intake of dietary fiber helps reduce the risk of diverticular disease, constipation, and colon cancer. Fiber intake is not related to risk of hip fracture, hypertension, or dementia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 76-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 15. Eating a bowl of oatmeal for breakfast every day may help prevent _____ because it contains

_____. a. heart disease; soluble fiber b. high blood pressure; potassium c. hypoglycemia; complex carbohydrate d. osteoporosis; calcium and vitamin D ANS: A

Oatmeal helps prevent heart disease because it contains soluble fiber that 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 high in 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 only contain a significant amount of calcium and vitamin D if it is made or eaten with milk and so would not necessarily help prevent osteoporosis.

PTS: 1 DIF: Cognitive Level: Application REF: p. 76 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 ferment dietary fiber in the colon. They are only used as an energy source by epithelial cells in the colon.

PTS: 1 DIF: Cognitive Level: Application REF: p. 67 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 will be digested and absorbed as glucose.

Excess glucose will be converted to glycogen; this process is called glycogenesis. The other three processes would 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 67 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. A fiber intake of 15 g daily would be considered to be _____ daily intake for dietary fiber. a. the minimum recommended b. below the optimal range of c. within the optimal range of d. above the optimal range of ANS: B

A fiber intake of 15 g is below the optimal range of daily intake for dietary fiber. The recommended range is 20 to 38 g/day.

PTS: 1 DIF: Cognitive Level: Application REF: p. 76 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 19. Dietary fiber is fermented by a. salivary amylase. b. pancreatic amylase. c. bacteria in the colon. d. bacteria in the rectum.

ANS: C

Dietary fiber is fermented by bacteria in the colon. Human enzymes (salivary and pancreatic amylase) cannot digest dietary fiber. By the time feces reach the rectum, they are largely solid and little fermentation takes place.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 76-78 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. The dietary intervention of increasing consumption of fruits and vegetables is most

appropriate to relieve a. vomiting. b. diarrhea. c. constipation. d. osteoporosis.

ANS: C

Foods high in dietary fiber, such as fruits and vegetables, can help relieve constipation by increasing fecal bulk. Vomiting is usually a response to a viral or toxic substance and is not relieved by specific foods. Fruits and vegetables may exacerbate diarrhea and are not directly related to osteoporosis.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 76-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 21. Most of the body’s energy intake should be supplied by a. fat. b. protein. c. vitamins. d. carbohydrates.

ANS: D

Most of the body’s energy should be supplied by carbohydrates. Fat provides an important, but lesser, source of energy. Protein can be used as an energy source if needed, but should not be the body’s primary energy source. Vitamins help the body obtain energy from carbohydrate, protein, and fat, but do not contribute energy themselves.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 65-69 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. corn flakes cereal.

ANS: A

Lentil soup would have a low glycemic index. A low glycemic index means that a food produces a relatively small increase in blood glucose level. Lentils are high in fiber which tends to decrease glycemic index. Bagels, sports drinks, and corn flakes are relatively low in fiber.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 68-69 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 23. Most carbohydrate digestion occurs in the a. mouth. b. stomach. c. small intestine. d. large intestine.

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. Very little digestion takes place in the large intestine.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 66-67 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. Glucose is the preferred source of energy for the _____ systems. a. blood and immune b. heart and respiratory c. brain and central nervous d. muscular and motor nerve ANS: C

Glucose is the main source of energy for the brain and central nervous system. Other body systems are able to use glucose or fat for energy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 69 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. After a meal, insulin is the _____ that helps lower blood _____ levels. a. enzyme; glucagon b. enzyme; epinephrine c. hormone; glucose d. hormone; sucrose ANS: C

Insulin is a hormone, not an enzyme. It lowers blood glucose levels after a meal by causing cells to absorb glucose from the blood. Glucagon is a hormone that has the opposite effect, causing blood glucose levels to rise when they start to fall between meals. Epinephrine is another hormone that increases blood glucose levels in response to acute stress. Blood does not contain sucrose.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 67-69 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 26. The type of diabetes that may be prevented by maintaining a healthy weight and exercising

regularly is type _____ diabetes mellitus. a. 1 b. 2 c. 3 d. 4 ANS: B

Type 2 diabetes mellitus may be prevented by maintaining a healthy lifestyle and weight.

Type 1 diabetes is caused by autoimmune destruction of the pancreatic cells that produce insulin and is not affected by lifestyle. Type 3 and type 4 diabetes mellitus do not exist.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 80-81 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 are 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 79 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 28. Diabetes mellitus (DM) is a disease caused by malfunctions in a. protein digestion. b. carbohydrate digestion. c. protein metabolism. d. carbohydrate metabolism.

ANS: D

Diabetes is a disorder of carbohydrate metabolism. Carbohydrate digestion is not impaired in individuals with diabetes and protein digestion and metabolism are not affected.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 80 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

29. A client has problems removing glucose from his blood because his pancreas no longer makes

insulin. He has a. hypoglycemia. b. lactose intolerance. c. type 1 diabetes mellitus. d. type 2 diabetes mellitus.

ANS: C

If the client is not longer producing insulin, he has type 1 diabetes mellitus. Hypoglycemia is caused by erratic food intake or overproduction of insulin. Lactose intolerance is caused by inability to produce the enzyme lactase, which causes failure to digest lactose in milk. In type 2 diabetes, the pancreas still produces insulin, but the body’s cells are not able to use it properly.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 80 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiological integrity 30. Weight loss and exercise are main features of the treatment for a. hypoglycemia. b. lactose intolerance. c. type 1 diabetes mellitus. d. type 2 diabetes mellitus.

ANS: D

Weight loss and exercise are the main features of treatment for type 2 diabetes mellitus.

Hypoglycemia is treated by eating foods containing carbohydrate and protein at regular intervals throughout the day. Lactose intolerance is treated by avoiding intake of foods that contain large amounts of lactose or by taking pills that contain the enzyme lactase when these foods are eaten. Type 1 diabetes mellitus is treated by balancing food intake and insulin injections.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 80-81 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

Chapter 05: Fats Test Bank MULTIPLE CHOICE 1. The nutrient that provides the densest energy source is a. fat. b. protein. c. alcohol. d. carbohydrate.

ANS: A

Fat provides the densest energy source. Fat provides 9 kcal/g; protein and carbohydrate each provide 4 kcal/g; alcohol provides 7 kcal/g.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 85-86 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

2. Sex hormones, bile, and vitamin D are formed in the body from a. sterols. b. triglycerides. c. phospholipids. d. chylomicrons.

ANS: A

The body uses sterols to make sex hormones, bile, and vitamin D. Triglycerides are used for energy and stored fat. Phospholipids are important in cell membranes. Chylomicrons are the first lipoproteins formed after absorption of lipids from the blood.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 87 | p. 90 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. If a patient receiving fat-free parenteral nutrition develops eczema, the patient may have 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. Vitamin C deficiency is not affected by fat intake; symptoms 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 86 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiological integrity 4. Hydrogenation of vegetable oils _____ their shelf life and makes them _____ harmful to

health. a. decreases; less b. increases; less c. decreases; more d. increases; more ANS: D

Hydrogenation of vegetable oils increases their shelf life because the double bonds are removed so the fatty acids are less vulnerable to oxidation. It also makes them more harmful to health because it forms trans fatty acids.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 88-90 TOP: Nursing Process: Assessment 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. Glycerol plus two fatty acids is a diglyceride. Glycerol does not combine with amino acids. Triglycerides do not form in triangular chains.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 87-88 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. A polyunsaturated fatty acid is a fatty acid with _____ bond(s) on the carbon chain. a. one double b. no double c. oxidized d. two or more double ANS: D

Polyunsaturated fatty acids have two or more double bonds on the carbon chain. Fatty acids with one double bond on the carbon chain are monounsaturated; those with no double bonds are saturated. Polyunsaturated fatty acids are vulnerable to oxidation, but this is not part of their structure.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 89-90 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. If a client wants to lose 1 lb of body fat each week, they would need to make sure that their

daily calorie intake was lower than their daily energy needs by _____ kcals/day. a. 350 b. 500 c. 900 d. 3500 ANS: B

One pound of body fat contains 3500 kcals. To create a weekly deficit of 3500 kcals, daily energy intake would need to be less than daily energy expenditure by 3500 ÷ 7 = 500 kcals.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 86-87 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 8. In their natural form, most oils come from _____ products and most solid fats come from

_____ products. a. natural; processed b. organic; refined c. animal; plant d. plant; animal ANS: D

In their natural form, most oils come from plant products and most solid fats come from animal products. A few plant fats, such as coconut and palm oil, are naturally solid and a few animal fats, such as fish oil, are naturally liquid. Food processing may make fats more solid (by hydrogenation), but not necessarily. Some natural fats, such as butter and lard, are solid rather than liquid. Organic fats are not necessarily more liquid. Refining refers to processing grains to remove the bran and germ and does not affect the consistency of the oil.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 94-95 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 the 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), diglyceride (two fatty acids), or triglyceride (three fatty acids). There is never more than one glycerol molecule attached to a fatty acid and glycerol molecules do not vary in their degree of saturation or unsaturation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 89-90 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 10. By interfering with blood clotting, omega-3 fatty acids appear to lower the a. risk of hypertension. b. risk of heart disease. c. levels of serum triglyceride. d. levels of serum cholesterol.

ANS: B

Omega-3 fatty acids help decrease risk of heart disease by preventing formation of clots that may block arteries that are narrowed by atherosclerotic plaques. Omega-3 fatty acids do not decrease blood pressure or serum levels of triglyceride and cholesterol.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 89 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 11. Overall energy intake can be greatly affected by relatively small changes in intake of a. protein. b. carbohydrate. c. fat. d. alcohol.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Application REF: pp. 85-86 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 12. The number of kcals provided by 23 g of fat is a. 92. b. 161. c. 207. d. 230.

ANS: C

Fat contains 9 kcal/g. Therefore 23 g fat contain 23  9 = 207 kcals.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 85-86 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. If dietary analysis shows that fat provides 31% of an individual’s energy intake, their fat

intake would be considered to be a. below the recommended range. b. within the recommended range. c. above the recommended range. d. generally recognized as safe.

ANS: B

The Acceptable Macronutrient Distribution Range for fat is 20% to 35% of kcals; therefore 31% is within the recommended range. ―Generally recognized as safe‖ is a term used for food additives.

PTS: 1 DIF: Cognitive Level: Application REF: p. 92 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 14. Meat, dairy products, and nuts are major sources of _____ in the diet. a. fat b. fiber c. vitamins d. carbohydrate ANS: A

Meat, dairy products, and nuts are major sources of dietary fat (even though some meats and dairy products can be very low in fat; overall these food groups contribute significant dietary fat). Nuts provide dietary fiber, but meat and dairy products do not. These foods contain some vitamins but are not considered major sources. Dairy products and nuts contain a little carbohydrate but meat is almost carbohydrate free.

PTS: 1 DIF: Cognitive Level: Application REF: p. 89 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 15. Hydrogenation is the process by which a liquid oil is made _____ solid and _____ stable. a. less; more b. more; more c. less; less d. more; less

ANS: B

Hydrogenation makes a liquid oil more solid and more stable by saturating the unsaturated fatty acids, making it more saturated.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 94-95 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 16. A client with coronary artery disease tells you that they always look for foods that are labeled

―cholesterol free.‖ Foods with this label may still promote heart disease if they are high in a. monounsaturated fat and cis fat. b. polyunsaturated fat and trans fat. c. saturated fat and trans fat. d. medium chain triglycerides and cis fat.

ANS: C

High intakes of saturated fat and trans fat increase blood cholesterol levels and contribute to coronary heart disease. Monounsaturated fat and polyunsaturated fat may slightly decrease serum cholesterol levels if eaten in moderation and so do hot promote heart disease. Intakes of medium chain triglycerides and cis fat are not directly related to heart disease.

PTS: 1 DIF: Cognitive Level: Application REF: p. 98 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 89 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. High levels of trans fatty acids are found in a. vegetable oils. b. coconut and palm oil. c. meats and dairy foods. d. vegetable oil shortening.

ANS: D

Trans fatty acids are found in vegetable oil shortening; they are formed when the liquid oil is hydrogenated to form a hard, stable fat. Vegetable oils, coconut and palm oil, and meats and dairy foods contain fat in the natural cis form.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 94-95 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

19. Antioxidants can be used to preserve fats without the addition of a. hydrogen. b. hydrogen and carbon. c. hydrogen and oxygen. d. hydrogen, water, and carbon.

ANS: A

Antioxidants provide a way to preserve unsaturated fats without addition of hydrogen.

Hydrogenation is used to stabilize and unsaturated fats. This process only adds hydrogen, not carbon, oxygen, or water.

PTS: 1 DIF: Cognitive Level: Application REF: p. 96 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 20. A special property of phospholipids that makes them valuable 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 90 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. Most fat enters the lymphatic system after a. absorption. b. circulation. c. metabolism. d. hydrogenation.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Application REF: pp. 91-92 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. If a client has a total blood cholesterol of 246 mg/dL and a low-density lipoprotein cholesterol

level of 172 mg/dL, their blood cholesterol level would be considered to be a. low. b. desirable. c. borderline high. d. high.

ANS: D

Total and LDL-cholesterol levels 240 and 150 mg/dL are considered high. Desirable total and LDL-cholesterol levels are 200 and 130 mg/dL, respectively; borderline high levels are 200-239 and 130-159 mg/dL, respectively.

PTS: 1 DIF: Cognitive Level: Application REF: p. 97 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 23. High levels of low-density lipoproteins are associated with an increased risk of a. diabetes mellitus. b. high levels of HDL. c. coronary artery disease. d. high blood pressure and stroke.

ANS: C

High levels of low-density lipoproteins are associated with increased risk of coronary artery disease. They do not have a direct effect on risk of diabetes mellitus or high blood pressure and stroke. LDL and HDL levels are not necessarily related.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 97 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 24. The best way to decrease blood cholesterol level is to decrease dietary intake of a. cholesterol. b. saturated fat. c. monounsaturated fat. d. polyunsaturated fat.

ANS: B

The dietary factor that has the greatest impact on blood cholesterol levels is saturated fat intake because it causes the body to make more cholesterol. Cholesterol intake has less impact because most cholesterol is manufactured by the body. Blood cholesterol levels may be slightly inversely related to intake of monounsaturated and polyunsaturated fat.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 97-98 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 their small intestine. c. needs to gain weight after surgery and chemotherapy to treat bowel cancer. d. has high serum total cholesterol and low-density lipoprotein cholesterol levels.

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 would not be especially beneficial for a client who needs to gain weight. They do not influence serum cholesterol levels.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 91-92 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

26. A good lunch choice for someone who wants to increase their intake of omega-3 fatty acids

would be a. peanut butter and jelly sandwich. b. lentil soup. c. salad with olive oil dressing. d. tuna salad sandwich.

ANS: D

Fatty fish, such as tuna, are an excellent source of omega-3 fatty acids, so the tuna salad sandwich would be the best choice. Peanut butter and olive oil are high in monounsaturated fatty acids. Lentil soup is likely to be low in fat.

PTS: 1 DIF: Cognitive Level: Application REF: p. 89 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 27. Emulsification occurs so that dietary fat can be _____ by enzymes in the digestive tract. a. dissolved b. oxidized c. broken down d. hydrogenated ANS: C

Emulsification increases the surface area of fat droplets in the digestive tract so that they are more accessible to be broken down by enzymes.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 90 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 28. A substance that increases the solubility of fats to facilitate their digestion and absorption is a. bile. b. stomach acid. c. salivary lipase. d. glycerol.

ANS: A

Bile increases the solubility of fats to facilitate their digestion and absorption. Stomach acid does not affect solubility of fats. Salivary lipase begins fat digestion but does not affect solubility. Glycerol is part of the structure of triglycerides, but does not increase their solubility.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 91-92 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. Overly restricting the fat intake of infants may lead to failure to thrive. Infants depend on

dietary fat and cholesterol for formation of a. energy stores and bones. b. brain and bones. c. brain and nerve tissue. d. energy stores and nerve tissue.

ANS: C

Infants need dietary fat and cholesterol for formation of brain and nerve tissue. Fat makes an important contribution to energy stores, but energy can be obtained from carbohydrate and protein. Bone formation is not dependent on dietary intake of fat and cholesterol.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 100 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 using 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 as well as psychologic 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 she usually prepares food and suggest ways 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 is unlikely to be acceptable 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 are unlikely to be maintained by the client.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 101 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance

Chapter 06: Protein Test Bank MULTIPLE CHOICE 1. Protein is needed by the body because it provides a. energy. b. peptides. c. fatty acids. d. amino acids.

ANS: D

The body needs protein because it provides amino acids, needed to make all the proteins in the body. Excess protein can be used to provide energy, but the body does not need it for this purpose because it can obtain energy from carbohydrate and fat. Protein is made up of peptides, strings of amino acids joined together, but these are only needed by the body because of the amino acids they supply. Protein does not supply fatty acids.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 105 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

2. The amount of protein that most Americans eat is a. less than we need. b. more than we need. c. about the amount we need. d. very different from day to day.

ANS: B

Most Americans eat more protein than we need.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 113 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. In addition to carbon, hydrogen, and oxygen, amino acids also contain a. nitrogen. b. potassium. c. iron. d. sodium.

ANS: A

The amino groups in amino acids contain nitrogen. Amino acids do not contain potassium, iron, or sodium.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 105 TOP: Nursing Process: Analysis MSC: Client Needs: Health promotion and maintenance 4. Nine of the 20 amino acids are considered essential because they a. contain sulfur. b. are found only in animal proteins. c. cannot be manufactured by the body. d. are the only amino acids used to make body proteins.

ANS: C

These amino acids are considered essential because they cannot be manufactured by the body and must be eaten in food. Some amino acids do contain sulfur, but this is not related to them being essential or nonessential. Essential amino acids are found in both animal and plant proteins. All amino acids, essential and nonessential, are used to make body proteins.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 105-106 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Nonessential amino acids can be made by the liver using 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 105 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. The secondary structure of proteins refers to the a. combination of polypeptide chains. b. sequence of amino acids in the chain. c. strong bonds between loops of the chain. d. straight, folded, or coiled shape of the amino acid chain.

ANS: D

The secondary structure of proteins refers to the straight, folded, or coiled shape of the amino acid chain. The combination of polypeptide chains is the quaternary structure. The sequence of amino acids in the chain is the primary structure. The strong bonds between loops of the chain is the tertiary structure.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 108 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. A client may be in a danger of their body proteins becoming denatured if they have 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 denature proteins.

PTS: 1 DIF: Cognitive Level: Application REF: p. 108 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. The enzyme that begins digestion of protein in the stomach is a. pepsin. b. renin. c. trypsin. d. protease.

ANS: A

The enzyme that begins protein digestion in the stomach is pepsin. Renin is another enzyme secreted in the stomach in infants; it coagulates milk protein to keep it in the stomach longer to allow more time for digestion, but it does not begin protein digestion. Trypsin continues protein digestion in the small intestine. Peptidases are important in completing breakdown of peptides into amino acids.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 108 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. Loss of muscle tissue during recovery from a serious accident is an example of a. anabolism. b. catabolism.

c. deamination. d. metabolism.

ANS: B

During recovery from a serious accident, the physical stress and immobility cause loss of muscle tissue through catabolism. Anabolism occurs when new protein is being formed during growth or healing. Deamination is one part of catabolism; it refers to removal of the amino group when amino acids are broken down. Metabolism is a general term that includes both anabolism and catabolism.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 109-110 TOP: Nursing Process: Analysis MSC: Client Needs: Physiological integrity 10. The vitamin that is essential for absorption of amino acids is a. vitamin B6. b. folate. c. vitamin A. d. vitamin E. ANS: A

Vitamin B6 (pyridoxine) is needed as a carrier for absorption of amino acids. Folate, vitamin A, and vitamin E have other essential roles in the body, not related to protein absorption.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 109 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. An example of a situation in which positive nitrogen balance occurs 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 body would be in negative nitrogen balance.

PTS: 1 DIF: Cognitive Level: Application REF: p. 110 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. The main structural protein found in connective tissues, bone, and teeth is called a. fibrin. b. albumin. c. collagen. d. hemoglobin.

ANS: C

The main structural protein found in connective tissues, bone, and teeth is called collagen.

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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 111 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 13. Proteins that are produced by the immune system in response to specific foreign viruses and

bacteria are called a. hormones. b. antibodies. c. lipoproteins. d. enzymes.

ANS: B

Proteins that are produced by the immune system in response to viruses and bacteria are called antibodies. Hormones are chemical messengers in the body that are sometimes proteins.

Enzymes are protein catalysts in the body. Lipoproteins are proteins that carry lipids in the bloodstream.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 111 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. An important role of proteins in the body includes a. temperature regulation. b. acid-base balance. c. conduction of nerve impulses. d. elimination of waste products.

ANS: B

An important role of proteins in the body includes acid-base balance. Proteins do not have a major role in temperature regulation, conduction of nerve impulses, or elimination of waste products.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 111 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. The protein that carries oxygen in muscles is called a. ferritin. b. oxyglobin. c. myoglobin. d. hemoglobin.

ANS: C

The protein that carries oxygen in muscles is called myoglobin. Ferritin is a protein that carries iron in the bloodstream. Oxyglobin does not exist. Hemoglobin is a protein that carries oxygen in the bloodstream.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 111 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. Phenylketonuria is caused by a. excessive intake of phenylalanine. b. failure to break down excess phenylalanine. c. inadequate intake of phenylalanine during pregnancy. d. inability to digest proteins that contain phenylalanine.

ANS: B

Phenylketonuria is caused by failure to break down excess phenylalanine. It is a genetic disorder and is not caused by excessive intake of phenylalanine, inadequate intake of phenylalanine during pregnancy, or inability to digest proteins that contain phenylalanine.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 112 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 112

18. Incomplete protein a. has no nutritional value in the diet. b. is mostly found in foods of animal origin. c. has been denatured by contact with heat, acid, or alkali. d. contains inadequate amounts of one or more essential amino acids.

ANS: D

Incomplete protein contains inadequate amounts of one or more essential amino acids. It still has nutritional value and may be combined with another incomplete protein to provide complete protein. Incomplete proteins are found mostly in plant foods. Denaturing proteins does not affect their amino acids content and make them incomplete.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 112

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. Oatmeal and toast are both 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 112-113

20. A measurement of the quality of food protein based on the amount that is retained in the body

after digestion, absorption, and excretion is a. biologic value. b. amino acid score. c. protein efficiency ratio. d. urinary urea excretion.

ANS: A

The measurement of food protein quality that is based on the amount retained in the body after digestion, absorption, and excretion is biologic value. Amino acid score measures the amino acid content of a food compared with a reference protein. Protein efficiency ratio measures the effects of different proteins on weight gain in rats. Urinary urea excretion measures the amount of nitrogen excreted from the body; this includes nitrogen from breakdown of endogenous (body) proteins and exogenous (food) proteins.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 113 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. Men generally require more protein than women because they a. are more active. b. have more lean body mass. c. have a higher metabolic rate. d. use dietary protein less efficiently.

ANS: B

Men generally require more protein than women because they have more lean body mass than women; lean body mass requires more protein to maintain. Men are not necessarily more active than women. They do have a high 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 women.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 113 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 22. The protein needs of athletes are a. lower than those of nonathletes. b. the same as those of nonathletes. c. higher than those of nonathletes. d. currently being determined by researchers.

ANS: C

Athletes have high protein needs than nonathletes (1.2 to 1.7 versus 0.8 g/kg, respectively).

Most Americans consume the amount of protein recommended for athletes, so most American athletes do not need to increase their protein intake.

PTS: 1

DIF: Cognitive Level: Comprehension

REF: p. 113

TOP: Nursing Process: Planning

MSC: Client Needs: Health promotion and maintenance

23. The Recommended Dietary Allowance (RDA) for protein for a healthy adult who weighs 60

kg is _____ g/day. a. 36 b. 48 c. 60 d. 72 ANS: B

The RDA for protein for a healthy adult is 0.8 g/kg per day. Therefore the RDA for an adult who weighs 60 kg is 0.8  60 = 48 g/day.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 113-114

24. A vegan diet contains a. plant foods only. b. mostly raw foods. c. plant foods plus eggs. d. plant foods plus fish.

ANS: A

Vegan diets contain only plant foods. Diets that contain mostly raw foods are macrobiotic diets. Diets than contain plant foods plus eggs are ovo-vegetarian diets. Diets that contain plant foods plus fish are pescetarian diets (these diets also usually include eggs and milk).

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 114-115

25. Strict vegan diets may be associated with low intakes of a. vitamins A and D. b. vitamins B12 and D. c. folate and vitamin C. d. vitamin E and selenium.

ANS: B

Strict vegan diets do not contain any vitamin B12 (only found in animal products) and vitamin D (mostly obtained from fortified milk). Vegan diets contain plenty of carotenoids which the body can convert into vitamin A, and plenty of folate, vitamin C, vitamin E, and selenium.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 115 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 26. A Jew 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 Jew who follows a strict kosher diet would not eat a cheeseburger because they are not allowed to eat meat and dairy together. Macaroni and cheese and a bean and cheese burrito both contain only dairy. Roast beef with mashed potatoes is acceptable as long as the beef has been slaughtered appropriately.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Psychosocial integrity

REF: p. 116

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 fist and one fourth of most dinner plates would make the serving size too large. A dollar bill is flat and therefore does not give a 3-dimensional serving size.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 117

28. Kwashiorkor is a type of malnutrition usually caused by a. intake of incomplete protein sources. b. excessive intakes of protein and fluid. c. inadequate intakes of protein and energy. d. inadequate protein intake with adequate energy intake.

ANS: D

Kwashiorkor is usually caused by inadequate protein intake with adequate energy intake.

Intake of incomplete protein sources could contribute to inadequate protein intake, but does not address the adequate energy intake found in kwashiorkor. Excessive intakes of protein and fluid would not cause malnutrition. Inadequate intakes of protein and energy cause marasmus.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 118 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. Examples of individuals who may have an increased risk of malnutrition include a. inactive middle-aged men. b. sleep-deprived adolescents. c. children with chronic infections. d. breast-fed 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 119-120 TOP: Nursing Process: Assessment, 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 a sandwich every lunchtime. 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 a sandwich every lunchtime is an example of ―chaining.‖ Chaining involves linking two behaviors; soon the individual will always want to eat a piece of fruit whenever they eat a sandwich. 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Psychosocial integrity

REF: p. 121

Chapter 07: Vitamins Test Bank MULTIPLE CHOICE 1. A secondary deficiency of a vitamin occurs when a. dietary intake of two or more vitamins is inadequate. b. absorption is inadequate or excessive amounts are excreted. c. dietary intake is less than the physiologic need of the individual. d. the vitamin deficiency is accompanied by protein-energy malnutrition.

ANS: B

Secondary deficiency of a vitamin occurs when absorption is inadequate or excretion is excessive. Inadequate dietary intake of two or more vitamins causes multiple primary deficiencies. Dietary intake below physiologic needs is primary deficiency. Vitamin deficiency almost always occurs when an individual has protein-energy malnutrition.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 124-125 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. teenage competitive athlete. b. elderly man living independently. c. college-age girl living with roommates.

d. newborn breastfed infant.

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. Teenage athletes and college students usually consume enough food to ensure adequate vitamin intake. Vitamin deficiencies are rare among breastfed newborn infants.

PTS: 1 DIF: Cognitive Level: Application REF: p. 124 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. Deficiencies are likely to develop most rapidly with low intakes 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 129 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 127 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. The amount of thiamine that the body needs is related to a. dietary intake of protein. b. exposure of the skin to sunlight. c. the amount of energy expended. d. physiologic and emotional stress.

ANS: C

Thiamine needs are related to metabolic rate (i.e., energy expenditure) because thiamine is a coenzyme in energy metabolism. Thiamine is not directly involved in protein metabolism.

The vitamin where requirements are inversely related to skin exposure to sunlight is vitamin D. Physiologic and emotional stress do not affect thiamine needs.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 127-129 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 6. Deficiency of thiamine is characterized by a. muscle weakness, loss of coordination, and tachycardia. b. dermatitis, altered nerve function, and convulsions. c. skin rash, hair loss, loss of appetite, and depression. d. gingivitis, poor wound healing, and increased risk of infection.

ANS: A

Symptoms of deficiency of thiamine include muscle weakness, loss of coordination, and tachycardia. Dermatitis, altered nerve function, and convulsions are symptoms of vitamin B 6 deficiency. Skin rash, hair loss, loss of appetite, and depression are symptoms of biotin deficiency. Gingivitis, poor wound healing, and increased risk of infection are symptoms of vitamin C deficiency PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 129-130 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. The riboflavin in milk is protected by a. pasteurization. b. homogenization. c. storing milk under refrigeration. d. using nontransparent containers.

ANS: D

Riboflavin is destroyed by ultraviolet light, so it is protected by use of nontransparent containers. Pasteurization destroys pathogenic bacteria. Homogenization prevents separation of milk and cream. Refrigerated storage increases the shelf life of milk.

PTS: 1 DIF: Cognitive Level: Application REF: p. 130 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 8. The most significant source of riboflavin in the United States is a. milk. b. eggs. c. meats. d. whole grains.

ANS: A

The most significant source of riboflavin in the United States is milk. Eggs, meats, and whole grains are all good but lesser sources of riboflavin.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 130

9. Historically, deficiency of niacin was sometimes misdiagnosed as a. alcoholism. b. mental illness. c. viral infection. d. iron deficiency anemia.

ANS: B

Niacin deficiency was sometimes misdiagnosed as mental illness because of it causes symptoms of dementia. Alcoholism may contribute to niacin deficiency. Niacin deficiency is not generally related to viral infection or iron deficiency anemia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 131 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.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 131

11. Pyridoxine functions in the body as a coenzyme in metabolism of a. fat. b. protein. c. carbohydrate. d. energy.

ANS: B

The active form of pyridoxine, pyridoxal phosphate, functions in the body as a coenzyme in the metabolism of protein and amino acids. It is not involved in metabolism of fat, protein, or energy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 132 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. A disorder in infants that is associated with inadequate intake of folate during pregnancy is a. spina bifida. b. cystic fibrosis. c. Down syndrome. d. macrocytic anemia.

ANS: A

Inadequate intake of folate during pregnancy is associated with spina bifida in infants. Cystic fibrosis and Down syndrome are genetic disorders. Macrocytic anemia is caused by an overt deficiency of folate, but is not usually found in infants in association with poor maternal intake during pregnancy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 132 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 13. Adequate intake of folic acid is especially important for a. competitive athletes. b. infants and young children. c. women of childbearing age. d. pregnant and lactating women.

ANS: C

Adequate intake of folic acid is especially important for women of childbearing age because adequate folate status during the first month of pregnancy helps prevent neural tube defects (spina bifida). Pregnant and lactating women have higher folic acid needs than nonpregnant women, but it is important to encourage adequate folic acid intake in all women of childbearing age because neural tube defects occur very early in pregnancy, before most women even realize they are pregnant. Competitive athletes, infants, and young children do not have special needs related to folic acid.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 132-133 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 14. 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 133-134

15. 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 B 12 deficiency. Iron deficiency anemia is (as its name suggests) associated with deficiency of iron, not folate.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 134 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. The substance produced by the stomach that is necessary for absorption of cobalamin is a. intrinsic factor. b. pernicious factor. c. hydrochloric acid. d. pyridoxal phosphate.

ANS: A

The substance produced by the stomach that is necessary for absorption of cobalamin is intrinsic factor. Pernicious factor does not exist; pernicious anemia is caused by cobalamin deficiency. Hydrochloric acid is produced by the stomach, but is used to activate the enzyme pepsin (which helps digest proteins). Pyridoxal phosphate is the active form of pyridoxine or vitamin B6; it is not produced by the stomach or related to absorption of cobalamin.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 135 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. Deficiency of vitamin B12 may cause damage to the a. skin. b. eyes. c. heart. d. nerves.

ANS: D

Deficiency of vitamin B12 may cause damage to the brain, optic nerves, and peripheral nerves.

Vitamin B12 deficiency is not associated with damage to the skin, eyes, or heart.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 135 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. An example of a meal high in 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance 19. Pantothenic acid is required for a. absorption of amino acids.

REF: pp. 135-136

b. conduction of nerve impulses. c. regulation of body temperature. d. metabolism of carbohydrates, fats, and protein.

ANS: D

Pantothenic acid is part of coenzyme A, required for metabolism of carbohydrates, fats, and protein. It is not involved in absorption of amino acids, conduction of nerve impulses, or regulation of body temperature.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 136 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. 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, and tryptophan.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 136 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. Vitamin C deficiency causes scurvy, which is characterized by a. weakening of connective tissues. b. diarrhea, dermatitis, and dementia. c. degeneration of nerves and muscles. d. iron deficiency anemia and weight loss.

ANS: A

Vitamin C deficiency causes breakdown of connective tissues. Diarrhea, dermatitis, and dementia are characteristic of niacin deficiency. Degeneration of nerves and muscles are not associated with deficiency of a specific vitamin. Vitamin C deficiency may be associated with iron deficiency anemia because vitamin C enhances absorption of nonheme iron. Vitamin C deficiency is not generally associated with weight loss.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 136-137 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. Lifestyle behaviors that increase vitamin C requirements include a. shift work. b. vegan diet. c. high fat intake. d. smoking cigarettes.

ANS: D

Smokers require more vitamin C than nonsmokers. Shift work, vegan diet, and fat intake do not affect vitamin C needs.

PTS: 1

DIF: Cognitive Level: Knowledge

REF: pp. 136-137

TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 23. 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, so cooking for the minimum amount of time preserves vitamin C. Vitamin C is water-soluble, so cooking methods that use water cause loss of vitamin C into the cooking liquid. Stir-frying cooks vegetables quickly without adding water. Boiling and canning both cause loss of vitamin C because of use of water. Oven roasting is a slow cooking method so more vitamin C is lost.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 137

24. Vitamin A may be obtained by the body from precursors called a. calciferols. b. carotenoids. c. rhodopsins. d. tocopherols.

ANS: B

The body can form vitamin A from carotenoids. Calciferols have vitamin D activity.

Tocopherols have vitamin E activity. Rhodopsin is a substance formed from vitamin A in the retina.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 138-141

25. An eye disorder associated with vitamin A deficiency is a. myopia. b. retinopathy. c. double vision. d. xerophthalmia.

ANS: D

Vitamin A deficiency causes xerophthalmia. Myopia (near sight), retinopathy, and double vision are not related to vitamin deficiencies.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 140 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 26. Vitamins that function as antioxidants in the body include a. vitamins C and E. b. vitamins D and K.

c. pyridoxine and biotin. d. folate and vitamin B12.

ANS: A

The two vitamins that function as antioxidants in the body are vitamins C and E. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 141 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 27. The Adequate Intake (AI) for vitamin D increases in older adults because 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 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 of vitamin D needs. They do not necessarily require more total vitamin D than younger adults for bone health; they need more from foods because their skin manufactures less.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 14-142 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 28. Symptoms of vitamin D toxicity include a. lethargy and loss of coordination. b. rickets, osteomalacia, and osteoporosis. c. blistered skin, joint pain, and liver damage. d. high levels of calcium in the blood and urine.

ANS: D

Vitamin D toxicity causes high levels of calcium in the blood and urine because vitamin D enhances calcium absorption. Lethargy and loss of coordination indicates thiamine deficiency.

Rickets, osteomalacia, and osteoporosis indicate vitamin D deficiency (not toxicity). Blistered skin, joint pain, and liver damage are signs of vitamin A toxicity.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 143 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Safe and effective care environment 29. Vitamin E requirements are related to intake of a. protein. b. vitamin C. c. polyunsaturated fats. d. monounsaturated fats.

ANS: C

Vitamin E needs are related to intake of polyunsaturated fats because vitamin E prevents their oxidation. Vitamin E needs are not related to intakes of protein, vitamin C, and monounsaturated fats.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 143 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 30. An example of a meal high in 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 fruit provide smaller amounts.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 144

31. Long-term antibiotic use may be associated with vitamin K deficiency because antibiotics a. prevent absorption of vitamin K. b. kill gut bacteria that synthesize vitamin K. c. break down dietary vitamin K in the intestines. d. impair blood clotting and increase vitamin K requirements.

ANS: B

Antibiotics kill gut bacteria that synthesize vitamin K, so long-term use of antibiotics may cause vitamin K deficiency. Antibiotics do not interfere with vitamin K absorption, break down dietary vitamin K in the intestines, impair blood clotting, or increase vitamin K requirements.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 144

32. The first step to ensuring 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 would not be the first step.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 144

33. Many Americans use vitamin supplements on a regular basis because 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 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 146 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial integrity

Chapter 08: Water and Minerals Test Bank 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 150 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 2. Hard water contains high levels of minerals such as a. iron and zinc. b. lead and sulfur. c. sodium and potassium. d. calcium and magnesium.

ANS: D

Hard water contains calcium and magnesium. Some natural water sources contain iron (this water may stain sinks and appliances brown). Lead is considered a contaminant in water.

Softened water contains sodium. Zinc, sulfur, and potassium are not usually found in water.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 151 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 152 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. Within the body, water helps to a. dissolve lipids. b. store excess energy. c. insulate nerve fibers. d. regulate body temperature.

ANS: D

Within the body, water helps to regulate body temperature by absorbing and distributing heat throughout the body and via perspiration. Lipids do not dissolve in water. Water does not contain energy. Nerve fibers are insulated by myelin, not water.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 153 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Maintenance of physiologic equilibrium within the body is known as a. hemostasis. b. homeostasis. c. water balance. d. metabolic regulation.

ANS: B

Maintenance of physiologic equilibrium within the body is known as homeostasis. Hemostasis is not a recognized term. Water balance is only one aspect of homeostasis. Metabolic regulation describes homeostasis, but is not the recognized term for it.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 153 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. The hormone that causes the body to decrease sodium excretion is called a. adrenaline. b. aldosterone. c. alanine. d. antidiuretic hormone (ADH).

ANS: B

The hormone that causes the body to decrease sodium excretion is aldosterone. Adrenaline is released in response to stress. Alanine is an amino acid, not a hormone. ADH causes the kidneys to decrease water excretion.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 155 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. The primary intracellular electrolyte is a. sodium. b. calcium. c. potassium. d. magnesium.

ANS: C

The primary intracellular electrolyte is potassium. Sodium is the primary extracellular electrolyte. Calcium and magnesium are not electrolytes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 155 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 tiredness, but not disorientation. Severe malnutrition may affect mental acuity, but is less likely than dehydration. Edema causes swelling, but does not usually affect orientation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 155 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. Edema may be caused by inadequate intake of a. protein. b. sodium. c. chloride. d. potassium.

ANS: A

Edema may be caused by inadequate intake of protein if protein levels in the body become so low that cellular fluid levels become imbalanced. Edema may be caused by high, not low, sodium levels and is not caused by low chloride or potassium levels.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 155 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 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 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 157 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 11. Daily dietary calcium intake affects 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 160 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. Beverages that contain substances that decrease absorption of calcium include 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.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 160

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. taking a daily multivitamin supplement. d. taking a 30 minute walk most days.

ANS: D

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

PTS: 1 DIF: Cognitive Level: Application REF: p. 165 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 14. An example of a food high in phosphorus is a. rice. b. carrot. c. cheese. d. banana.

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 PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 166 | p. 170

15. A good source of calcium for someone who follows a strict vegetarian (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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 163 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 16. Magnesium deficiency may occur in association with a. lactation. b. type 1 diabetes. c. excessive vomiting and diarrhea. d. dehydration attributable to heat exposure.

ANS: C

Magnesium deficiency may occur secondary to excessive vomiting and diarrhea. Lactation, type 1 diabetes, and dehydration due to heat exposure do not cause magnesium deficiency.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 166 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. This is the least processed of all these forms of corn. Food processing usually involves addition of sodium.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 167-168 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. A sodium intake of 2100 mg daily of a healthy adult would be considered a. below the Adequate Intake (AI). b. within the recommended range. c. below the maximum recommended level. d. above the maximum recommended level.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Health promotion and maintenance

REF: p. 167

19. Signs of potassium deficiency include a. excessive thirst and urination. b. muscle weakness and confusion. c. shortness of breath and dizziness. d. twitching of muscles and convulsions.

ANS: B

Signs of potassium deficiency include muscle weakness and confusion. Excessive thirst and urination is a sign of high blood glucose levels associated with uncontrolled diabetes.

Shortness of breath and dizziness may be caused by cardiac failure or other causes. Twitching of muscles and convulsions may have many causes but are not caused by potassium deficiency.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 168 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. Foods that contain chloride usually also contain a. sodium. b. calcium. c. potassium. d. magnesium.

ANS: A

Chloride in foods is usually associated with sodium. It is not usually found in foods in association with calcium or magnesium. Some salt substitutes contain potassium chloride, but chloride is not associated with potassium in foods.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 169 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

21. Young women require more dietary iron than young men a. because they absorb iron less efficiently. b. to compensate for their lower muscle mass. c. to replace blood losses during menstruation. d. because they recycle hemoglobin more rapidly.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 169-171 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 22. The form of dietary iron that is absorbed most easily is a. heme iron. b. nonheme iron. c. free iron. d. supplemental iron.

ANS: A

Heme iron is absorbed most easily. Nonheme iron is absorbed less efficiently. Iron in foods is not described as ―free.‖ Iron supplements contain nonheme iron which is absorbed less efficiently.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 171 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 23. The effects of iron deficiency are caused by a. increased blood pressure. b. increased risk of blood clotting. c. decreased ability of the blood to transport oxygen. d. decreased numbers of muscle fibers and brain cells.

ANS: C

The effects of iron deficiency are caused by decreased ability of the blood to transport oxygen.

Blood pressure, blood clotting, muscle fibers, and brain cells are not immediately affected by iron deficiency.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 171 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. Hemosiderosis, storage of too much iron in the body, is most likely to occur in a. a man who drinks 5 or more alcoholic beverages every night. b. an adolescent who drinks 4 or more soft drinks daily. c. a toddler who prefers drinking milk to eating meals. d. a pregnant woman who takes iron supplements.

ANS: A

Hemosiderosis is most likely to occur in a man with a high intake of alcohol. Adolescents who have high intakes of soft drinks are likely to have high intakes 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 173 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 a. eating refined grains. b. making breads with yeast. c. eating fortified grains. d. soaking grains before making bread.

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 it 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 173-174

26. The main 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 food, but this is not a reliable source. Residues of cleaning products may provide some dietary iodine, but this is not usually enough to be significant.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 174

27. Deficiency of iodine reduces thyroxine production, which causes a. microcytic anemia. b. fever and dehydration. c. delayed wound healing. d. lethargy and weight gain.

ANS: D

Deficiency of iodine causes lethargy and weight gain. Microcytic anemia may be caused by iron deficiency. Fever and dehydration are not related to nutrient deficiencies. Delayed wound healing may be caused by deficiencies of zinc or vitamin C. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 174 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 28. Dietary fluoride is important to a. decrease staining of teeth. b. decrease sensitivity of teeth. c. stimulate production of saliva. d. increase the strength of tooth enamel.

ANS: D

Dietary fluoride is important to increase the strength of tooth enamel. It does not decrease staining or sensitivity of teeth or stimulate production of saliva.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 175

29. In the United States, low intake of selenium may be associated with increased risk of a. cancer. b. osteoporosis. c. hypertension. d. type 2 diabetes.

ANS: A

Low intakes of selenium may be associated with increased risk of cancer because selenium functions as an antioxidant which protects cells from damage. Selenium is not associated with risk of osteoporosis, hypertension, or type 2 diabetes.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 175 TOP: Nursing Process: Assessment 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 accumulation of zinc and chromium does not have specific names.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 176 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 177 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 32. Apart from lowering dietary sodium intake, dietary changes that may help decrease high

blood pressure include a. decreasing intake of dairy products. b. increasing intake of vegetable protein. c. increasing intake of calcium and magnesium. d. replacing saturated fats with polyunsaturated fats.

ANS: C

Dietary changes that may help decrease high blood pressure include increasing intake of calcium and magnesium. 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 177-178 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 179 TOP: Nursing Process: Assessment MSC: Client Needs: Psychological integrity

Chapter 09: Energy Supply and Fitness Test Bank MULTIPLE CHOICE 1. The fuel for all body processes that traps energy released from food is (are) 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 185 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. Energy-supplying nutrients are eventually broken down to a. glucose and fatty acids. b. ketone bodies and urea. c. free radicals and oxygen. d. carbon dioxide and water.

ANS: D

All energy-supplying nutrients are eventually catabolized to carbon dioxide and water.

Glucose and fatty acids are products of digestion of carbohydrates and fat; they are not end products of metabolism. Ketone bodies are produced when fat is used for energy; they are later broken down to carbon dioxide and water. Urea is a byproduct in the breakdown of amino acids for energy. Free radicals and oxygen are not generally produced in metabolism of energy-yielding nutrients.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 185 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. 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 _____ kcals. a. 27 b. 108 c. 118 d. 133 ANS: C

Protein provides 4 kcals/g; fat provides 9 kcals/g; carbohydrate provides 4 kcals/g. Therefore, the soup contains (5  4) + (2  9) + (20  4) = 20 + 18 + 80 = 118 kcals.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance 4. Aerobic glycolysis occurs in the a. nucleus. b. cytoplasm. c. membrane. d. mitochondria.

REF: p. 187

ANS: D

Aerobic glycolysis occurs in the mitochondria. Anaerobic glycolysis occurs in the cytoplasm.

The cell nucleus and membrane are not sites of energy metabolism.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 185 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Before they enter the tricarboxylic acid (TCA) cycle, fatty acids are broken down to a. keto acids. b. pyruvic acid. c. ketone bodies. d. acetyl coenzyme A. ANS: D

Fatty acids are broken down to acetyl coenzyme A before they enter the TCA cycle. Keto acids are formed as protein is metabolized to release energy. Pyruvic acid is a substance that is formed as nutrients are converted to acetyl coenzyme A. Ketone bodies are formed when fat is metabolized to release energy and there is insufficient oxygen for aerobic glycolysis.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 185 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. In order to be used as an energy source, amino acids have to undergo a. beta-oxidation. b. deamination. c. glycogenesis. d. ketogenesis.

ANS: B

Amino acids undergo deamination, removal of the amino group, before they can be metabolized to release energy. Beta-oxidation is part of the process of metabolism of fatty acids. Glycogenesis is the process by which glycogen is formed from glucose. Ketogenesis is the formation of ketone bodies when fat is used for energy and there is insufficient oxygen for aerobic glycolysis.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 185-186 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. Energy for short-term, high-intensity activities such as sprinting is obtained mostly via a. adrenaline release. b. aerobic pathways. c. anaerobic pathways. d. oxidation of fatty acids.

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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning

REF: pp. 185-186

MSC: Client Needs: Physiological integrity 8. If someone goes on a long hike, after 4 hours most of their energy will be obtained from a. glucose. b. glycogen. c. fatty acids. d. amino acids.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Application REF: pp. 185-187 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. Basal metabolic rate represents a. total energy expenditure. b. the amount of energy expended while at rest. c. the amount of energy expended in physical activity. d. the amount of energy required to support life-sustaining processes.

ANS: D

Basal metabolic rate is the amount of energy required to support life-sustaining processes. It is close to the amount of energy expended while at rest (resting energy expenditure), although this includes some of the energy used to digest food and for activity. Basal metabolic rate, physical activity, and thermic effect of food make up total energy expenditure.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 187-188 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. Of the following, the person who would be expected to have the highest energy expenditure is

a(n) a. active man. b. sedentary man. c. active woman. d. sedentary woman.

ANS: A

An active man would have the highest energy expenditure. Generally, men have higher energy expenditures than women and active people have higher energy expenditures than sedentary people.

PTS: 1 DIF: Cognitive Level: Analysis TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 187-188

11. The process by which the body uses energy to adjust to changes in environmental conditions

is called a. homeostasis. b. thermoregulation.

c. adaptive thermogenesis. d. the thermic effect of food.

ANS: C

Adaptive thermogenesis is the process by which the body uses energy to adjust to changes in physical and biologic conditions. Homeostasis refers to the overall process of maintaining a constant environment in the body in response to changing conditions. Thermoregulation refers to maintenance of constant temperature in the body. The thermic effect of food is the energy used to digest, absorb, metabolize, and store food.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 189-190 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. Stretching and exercises that increase flexibility are important for a. maintaining cardiovascular fitness. b. increasing muscular strength. c. moving muscles to their full extent without injury. d. building endurance for longer bouts of exercise.

ANS: C

Exercises that involve stretching and increasing flexibility help move muscles to the full extent without injury. Aerobic exercise maintains cardiovascular fitness and builds endurance.

Resistance exercise increases muscular strength.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 189-190

13. The amount of physical activity needed to maintain physical fitness depends on the a. time of day. b. ambient temperature. c. intensity of the activity. d. the 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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 189

14. Health benefits generally associated with strength training include a. weight loss. b. increased bone density. c. decreased risk of cancer. d. improved sleep patterns.

ANS: B

Strength training forces bones to react to the stresses placed on them by becoming stronger.

Strength training may promote weight loss, depending on the type of exercise, but this is not necessarily so. Exercise overall may decrease risk of some types of cancer and improve sleep patterns, but this is not specifically associated with strength training.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 192-193

15. 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 193-194

16. An athlete’s kcal intake is 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 kcal needs of individuals vary greatly. Hunger is subjective and does not necessarily indicate whether energy intake is appropriate.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 194

17. If an athlete weighed 150 lbs at the beginning of an athletic event and weighed 146 lbs at the

end of the event because of water lost in sweat, their athletic performance towards the end of the event would be a. improved. b. unaffected. c. impaired. d. unpredictable.

ANS: C

Loss of 4 lbs 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 194-195 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. The best indicator of fluid loss during a workout is a. thirst. b. urine volume. c. 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 affected by other variables.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 194-195 TOP: Nursing Process: Planning, Evaluation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 19. Sports drinks may be preferable to water for athletes who a. produce large volumes of sweat. b. exercise for longer than 90 minutes. c. experience hunger during workouts. d. exercise daily for at least 30 minutes.

ANS: B

Sports drinks may be beneficial for athletes who exercise for longer than 90 minutes, 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 195 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 20. 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 high in carbohydrate, such as breakfast cereal, help replace glycogen stores. Raw carrots are low in energy; string cheese and scrambled eggs provide mostly protein and fat.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 195-196

21. Carbohydrate loading increases glycogen stores in muscles by combining a. moderate exercise and low fat intake. b. rest and increased carbohydrate intake. c. intense exercise and decreased carbohydrate intake. d. intense exercise and high intake of complex carbohydrates.

ANS: B

Carbohydrate loading is most effective in increasing glycogen stores when high carbohydrate intake is combined with tapered exercise 3 days before competition to allow the muscles to rest.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: pp. 195-196

22. The person who is mostly likely to need to be concerned about the adequacy of their 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 kcal intake.

ANS: D

Female athletes often do not consume sufficient kcals 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 body builders and moderately active men and women are likely to consume enough protein in their regular diet.

PTS: 1 DIF: Cognitive Level: Application REF: p. 196 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 23. When an athlete eats more protein or amino acids than he or she needs, the extra amino acids

are a. b. c. d.

stored in the amino acid pool. used to increase muscle mass. converted to storage protein by the liver. deaminated and used as an energy source.

ANS: D

Excess amino acids are deaminated and used as an energy source. The body cannot store amino acids or protein and only increases muscle mass in response to exercise.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 196-197 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 24. Athletes who exercise regularly are able to exercise for longer, partly because their body uses

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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 197 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 25. An example of an athlete who is most likely to benefit from a multivitamin/mineral

supplement that provides 100% of the 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/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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 197

26. An ergogenic aid that may have proven beneficial effects is a. ginseng. b. creatine. c. arginine. d. carnitine.

ANS: B

There is some evidence that creatine may enhance energy levels. Ginseng, carnitine, and arginine (an amino acid) have not been found to have any proven effect on athletic performance.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Safe and effective care environment

REF: pp. 197-198

27. An example of a beverage that may have an 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 197-198

28. Competitive athletes are vulnerable to marketing claims about supplements and ergogenic aids

because a. supplements are often cheaper than a balanced diet. b. a slight increase in performance can allow them to win. c. very little is known about appropriate foods for athletes. d. supplements are more readily available than healthful foods.

ANS: B

Competitive athletes are great targets for marketing supplements and ergogenic aids because very small differences in performance can make the difference between winning and losing.

Supplements are usually more expensive than buying a balanced diet. There is a considerable amount of knowledge about appropriate foods for athletes. Healthful foods are generally more readily available than supplements.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 197 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care environment 29. During exercise, the digestive process a. speeds up. b. slows down. c. stops completely. d. favors breakdown of fat over carbohydrates.

ANS: B

During exercise, blood flow to muscles increases and blood flow to the digestive tract decreases, so the digestive process slows down. Metabolism of fat increases and metabolism of carbohydrate decreases during exercise, but this does not affect digestion of fat and carbohydrate.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 199 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 30. The process by which one person learns a healthful lifestyle behavior by following the

example of another person is known as a. chaining. b. modeling. c. projecting. d. replicating.

ANS: B

Modeling is replicating or imitating the behavior of someone else, using them as a model or example for your own behavior. Chaining is linking a healthful behavior with another behavior in daily life. Projecting is blaming one’s behavior on outside influences or other people. Replicating is a research terms that refers to whether a similar study will produce the same results as an earlier study.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Psychosocial integrity

REF: pp. 199-200

Chapter 10: Management of Body Composition Test Bank MULTIPLE CHOICE 1. An individual has a distorted body image when a. his or her body has abnormal proportions. b. his or her perception of his or her body differs from reality. c. he or she is dissatisfied with his or her personal appearance. d. he or she focuses on changing a specific body part.

ANS: B

A distorted body image means that an individual’s perception of his or her body differs from reality. The distortion is the difference between perception and reality rather than an actual distortion in body proportions. Distorted body image is often associated with dissatisfaction with personal appearance, but an individual may have an accurate body image and still be dissatisfied.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 203-204 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 2. Cultural influences have had a greater influence on body perception during the past few

decades because of the increase in a. mass media. b. food availability. c. medical services. d. health knowledge.

ANS: A

Mass media present ―desirable‖ body images that affect how people view their own bodies.

Food availability and medical services do not affect body perception. Health knowledge may affect how we view our bodies, but to a lesser degree than mass media.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 203-205 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Psychosocial integrity 3. A healthy and positive body image is associated with a. adoption of a range of healthy lifestyle behaviors. b. achievement of a healthy weight and body composition. c. freedom from prejudice against overweight and underweight individuals.

d. realistic evaluation and acceptance of our positive and negative attributes.

ANS: D

Individuals with a healthy and positive body image evaluate themselves realistically and accept their positive and negative attributes. They may or may not adopt healthy lifestyle behaviors, achieve a healthy weight and body composition. They will probably tend to be less prejudiced against overweight and underweight individuals, but this is not necessarily so.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning, Evaluation MSC: Client Needs: Psychosocial integrity

REF: pp. 203-204

4. Body mass index (BMI) is a. the ratio of waist circumference to hip circumference. b. weight in kilograms divided by the square of height in meters. c. an indicator of personal satisfaction with current body weight. d. weight in kilograms divided by waist circumference in centimeters.

ANS: B

Body mass index = weight (kg) ÷ height (m) 2. The ratio of waist circumference to hip circumference is known as waist-to-hip ratio. Body mass index indicates degree of overweight or underweight but not personal satisfaction with current body weight. Weight divided by waist circumference is not used in clinical practice.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 205-206 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Risk of mortality in adults is lowest for those with a body mass index that is between a. 15 and 20. b. 20 and 25. c. 25 and 30. d. 30 and 40.

ANS: B

Lowest risk of mortality is associated with a BMI between 20 and 25. Risk of mortality increases slightly with lower BMIs and increases exponentially with higher BMIs. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 206 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 6. The increased risk of mortality in individuals with a very low body mass index is probably

related to a. low levels of body fat. b. inadequate fat intake. c. low levels of lean body mass. d. failure to store energy from ingested food.

ANS: C

Risk of mortality in individuals with a very low BMI is probably related to low levels of lean body mass, often related to smoking or disease. Low levels of body fat and inadequate fat intake are less likely to be associated with increased risk of mortality. Failure to store energy from ingested food is rare.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 205-206 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 7. Fat stored in the abdominal area is called _____ fat. a. gynoid b. visceral c. essential d. subcutaneous ANS: B

Fat stored in the abdominal area is called visceral fat. Gynoid fat is stored around the hips, buttocks, and thighs. Essential fat protects vital organs in the body. Subcutaneous fat is all storage fat, regardless of the site of storage.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 205 | pp. 210-211 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. Metabolic syndrome is associated with increased risk of a. diabetes mellitus. b. thyroid disorders. c. digestive disorders. d. leukemia and lymphoma.

ANS: A

Metabolic syndrome increases risk of atherosclerosis, heart disease, stroke, and diabetes mellitus. Even though the thyroid gland regulates body metabolism, it is not associated with metabolic syndrome. Digestive disorders, leukemia, and lymphoma are also not related to metabolic syndrome.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 207 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 9. Obesity may be a contributing factor in development of a. osteoporosis. b. alcoholism. c. sleep apnea. d. multiple sclerosis.

ANS: C

Obesity increases risk of sleep apnea. Risk of osteoporosis is actually inversely related to obesity. Alcoholism is not related to obesity. Multiple sclerosis is an autoimmune disease and is not related to obesity.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment

REF: p. 207

MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 10. Adverse effects of obesity that are not life threatening but decrease quality of life include a. arthritis. b. heart disease. c. diabetes mellitus. d. high blood pressure.

ANS: A

Obesity increases risk of all of these disorders. Arthritis is not life threatening, but decreases quality of life. Heart disease, diabetes mellitus, and high blood pressure all increase risk of mortality.

PTS: 1 DIF: Cognitive Level: Application REF: p. 209 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 11. Restrained eating is defined as a. avoiding certain types of foods. b. limiting food intake to certain times of day. c. ceasing to eat when hunger has been satisfied. d. limiting food intake to less than natural appetite.

ANS: D

Restrained eating means restricting food intake below one’s natural appetite. Avoiding certain types of foods is picky eating. Restrained eaters may or may not limit food intake to certain times of day. Ceasing to eat when hunger has been satisfied would be considered normal eating.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 209 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 12. If an individual says they have a desire for dessert after they have eaten a meal they are

describing their a. thirst. b. satiety. c. hunger. d. appetite.

ANS: D

Desire for food is appetite. Physiological need for food is experienced as hunger. Satiety describes a lack of desire for more food, often accompanied by a feeling of fullness. Thirst describes a desire for fluid.

PTS: 1 DIF: Cognitive Level: Application REF: p. 209 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Psychosocial integrity 13. 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 210 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 14. If a health practitioner wants to assess whether an underweight woman is too thin, he or she

may ask her a. if she has lost weight recently. b. if other family members are underweight. c. whether she has a normal appetite. d. whether 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 would not indicate whether her weight is below a healthy range.

PTS: 1 DIF: Cognitive Level: Application REF: p. 210 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 15. If a woman’s waist measurement is 34 inches and her hip measurement is 40 inches, her

waist-to-hip ratio would be considered to be a. associated with a high risk of chronic disease. b. unrelated to risk of chronic disease. c. associated with a low risk of chronic disease. d. associated with a high risk of acute disease.

ANS: A

This woman’s waist-to-hip ratio is 34 ÷ 40 = 0.85. 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 of chronic disease.

PTS: 1 DIF: Cognitive Level: Application REF: p. 211 TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 16. Compared to women, it appears to be easier for men to lose weight because a. men have more willpower than women. b. men tend to be more active than women. c. visceral fat is lost more easily than lower body fat. d. lower body fat is lost more easily than visceral fat.

ANS: C

Men generally have more visceral fat, which is easier to lose than lower body fat (which is more common in women). Willpower and levels of activity are not different in men versus women.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 211 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 17. Excess fat is stored in our bodies as a. fatty acids in the liver. b. glycogen in the muscles. c. glycerol in cell cytoplasm. d. triglycerides in adipocytes.

ANS: D

Excess body fat is stored as triglycerides in special cells called adipocytes. The liver cannot store fatty acids. Glycerol is not stored in the body. Excess fat cannot be converted to glycogen.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 211 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. The increase in the number of adipocytes in the body during growth spurts is known as a. mutation. b. maturation. c. hyperplasia. d. hypertrophy.

ANS: C

The increase in number of adipocytes is known as hyperplasia. Hypertrophy refers to an increase in cell size. Mutation describes changes that occur in cells, for example in cancer or genetic defects. Maturation describes a time-related process.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 211 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. The best way to accurately 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 they are easier to measure.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 212-213 TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 20. To lose a pound of body fat in a week, daily energy expenditure would have to increase by

about _____ kcals. a. 350 b. 500 c. 700

d. 3500 ANS: B

One pound of fat represents 3,500 kcals. To lose a pound of fat in a week, daily energy expenditure would need to increase by 3,500 ÷ 7 = 500 kcals.

PTS: 1 DIF: Cognitive Level: Application REF: p. 213 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 21. The causes of obesity are largely a. genetic. b. cultural. c. multifactorial. d. environmental.

ANS: C

May factors contribute to obesity, including genetic, cultural, hormonal, and environmental factors. The cause of obesity is therefore multifactorial.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 214-215 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. 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 our bodies defend a set level of body fatness. Therefore if weight or fatness falls below this level, the individual is likely to experience increased hunger until they regain 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 216-217 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 23. Factors that appear to help reduce the body’s set point for body weight and body fatness

include a. regular aerobic exercise. b. decreased protein intake. c. use of weight loss medications. d. use of specific vitamin supplements.

ANS: A

It is very difficult to reduce the body’s set point for body weight and body fatness; regular aerobic exercise seems to be the most effective intervention. Protein intake, weight loss medications, and vitamin supplements do not affect set point.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 216-217 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 24. A major problem associated with cycles of weight loss and weight gain is a. decreased ability to metabolize body fat. b. loss of sensitivity to physiologic hunger cues. c. a false sense of empowerment and control of body weight. d. hormonal imbalances triggered by changes in body fat levels.

ANS: B

Cycles of weight loss and regain result in loss of sensitivity to physiologic hunger cues. The body’s ability to metabolize body fat is unaffected. Usually individuals who lose and regain weight feel loss of control rather than empowerment. Weight cycling does not generally affect hormone balance.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 219 TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity | Client Needs: Psychosocial integrity 25. To maintain a healthy weight, the most important goals are related to changes in a. behaviors. b. food intake. c. physical activity. d. supplement use.

ANS: A

Maintaining a healthy weight depends on adopting healthy behaviors and attitudes towards food rather than focusing on food intake or physical activity alone. Supplement use does not influence body weight.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 219

26. 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 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 practitioner may help or hinder the process of determining behavioral goals, but is not the focus of the process.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 219

27. If a client wants to relearn to pay attention to hunger and satiety cues, they may find it helpful

to a. b. c. d.

keep a journal of perceived emotions. establish a regular pattern of meals. eat all their food at home. avoid eating until they are 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 them identify their hunger and satiety. Eating all food at home is probably not realistic for most clients. Avoiding eating until very hungry is likely to result in erratic food intake and overeating.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 221

28. The best way to maintain lean body mass is to a. avoid weight loss. b. exercise regularly. c. decrease dietary fat intake. d. ensure adequate protein intake.

ANS: B

Exercise helps maintain lean body mass (muscle). Weight loss causes some loss of lean body mass and ensuring 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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 222

29. National programs that aim to reverse the trend of increasing body weight should focus on a. smoking cessation. b. maintenance of ideal body weight. c. monitoring annual weight changes. d. achievement of a healthier body weight.

ANS: D

Achievement of healthier body weight is a more realistic goal than maintenance of ideal body weight; it is more likely to encourage success. Monitoring annual weight changes allows researchers to describe trends, but not to reverse them. Smoking cessation improves health, but is more likely to be associated with weight gain than with weight loss.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 30. Our main attitude towards food should be one of a. self-control.

REF: p. 223

b. necessity. c. enjoyment. d. healthy choices.

ANS: C

We should be able to enjoy and take pleasure in eating foods. At times we may need to exercise self-control when we are not hungry. Eating contributes greatly to our quality of life and should be more than a necessity in our lives. We can make healthy food choices but this should not become a joy-killing focus of our lives.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Psychosocial integrity

REF: p. 224

Chapter 11: Life Span Health Promotion: Pregnancy, Lactation, and Infancy Test Bank MULTIPLE CHOICE 1. Increased levels of progesterone in pregnancy cause relaxation of smooth muscle, which can

cause a. nausea. b. headache. c. diarrhea. d. constipation.

ANS: D

Progesterone causes relaxation of smooth muscle, which slows intestinal transit and may cause constipation. The cause of nausea in pregnancy is uncertain. Headache and diarrhea do not usually occur with pregnancy.

PTS: 1 DIF: Cognitive Level: Application REF: p. 229 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. If a woman has had preeclampsia and hypertension in a previous pregnancy, during this

pregnancy she 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. Therefore, a woman with preeclampsia and hypertension should continue her regular sodium intake. She should follow a well-balanced diet including plenty of protein to replace urinary losses and with adequate vitamins and minerals. She should not restrict protein intake, and iron and calcium supplements are not generally recommended.

PTS: 1 DIF: Cognitive Level: Application REF: p. 229 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

3. An increase in oxygen needs during pregnancy results in increased a. stamina. b. blood pressure. c. bowel motility. d. basal metabolic rate (BMR).

ANS: D

Increased oxygen needs during pregnancy result in increased BMR. Stamina may actually decrease because the fetus places extra demands on the body. Increases in blood pressure may sometimes occur but are not caused by increased oxygen needs. Bowel motility generally decreases during pregnancy because of high progesterone levels.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 229

4. The increase in plasma volume during pregnancy may appear to cause a. lower plasma levels of sodium. b. higher plasma levels of sodium. c. lower blood levels of hemoglobin. d. higher blood levels of hemoglobin.

ANS: C

Increased plasma volume causes hemodilution so that blood levels of hemoglobin are lower.

The body maintains constant plasma sodium levels.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 229 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Intrauterine growth retardation may be caused by a. poor weight gain during pregnancy. b. gestational diabetes during pregnancy. c. excessive weight gain during pregnancy. d. excessive use of vitamin and mineral supplements.

ANS: A

Intrauterine growth retardation is associated with poor weight gain during pregnancy.

Gestational diabetes and excessive weight gain during pregnancy are more likely to result in a large infant. Excessive use of vitamin and mineral supplements may be dangerous but is not associated with intrauterine growth retardation.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 229-230 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. For a woman with a healthy weight before pregnancy, gaining 25 to 35 pounds during

pregnancy is considered to be a. too low for a healthy pregnancy. b. too high for a healthy pregnancy. c. the current recommended range for weight gain. d. the current range for weight gain for a woman experiencing gestational diabetes.

ANS: C

The recommended range for weight gain for 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 prepregnant weight.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 229-230

7. A weight gain of 15 to 25 pounds during pregnancy is recommended for a. a teenage girl. b. an overweight woman. c. an underweight woman. d. all women regardless of weight.

ANS: B

A weight gain between 15 and 25 pounds during pregnancy is recommended for a woman who is overweight prior to pregnancy (BMI 25.0-29.9). Pregnant teens and underweight women should gain 28 to 40 lbs. Recommended ranges for weight gain are based on prepregnant weight and individual variables.

PTS: 1 DIF: Cognitive Level: Application REF: p. 230 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 8. Weight gain during pregnancy is a variable that is highly correlated with a. zinc status. b. bone density. c. calcium status. d. infant birth weight.

ANS: D

Weight gain during pregnancy is highly correlated with infant birth weight. Zinc status, bone density, and calcium status of the infant are usually maintained at the expense of the mother’s stores.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 229-230 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. A woman needs to increase her kcal intake by about 300 kcals daily during a. all three trimesters of pregnancy. b. the first and second trimesters of pregnancy. c. the second and third trimesters of pregnancy. d. the 6 months before conception through the first trimester.

ANS: C

Energy needs increase by about 300 kcals/day during the second and third trimesters of pregnancy. Before pregnancy and during the first trimester, energy needs are not increased.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 229-230 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 10. A woman who is 4 months pregnant and has already gained 25 pounds should

a. b. c. d.

eat a low-calorie diet to help her lose the extra weight. modify her food intake if it is excessive but not attempt to lose weight. take a multivitamin/mineral supplement and consume 1200 kcal a day. work hard not to gain any more weight during the remainder of the pregnancy.

ANS: B

A weight gain of 25 pounds in the first 4 months of pregnancy is high. However, pregnancy is not a time to restrict energy and food intake and attempt to lose weight. The mother should focus on following a well-balanced eating plan, modifying her food intake if it is excessive.

1200 kcals/day would be insufficient to support a healthy pregnancy; taking a multivitamin/mineral supplement cannot compensate for inadequate food intake.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 229-230 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 11. To prevent neural tube defects, the U.S. Public Health Service and the American Academy of

Pediatrics now recommend adequate intake of a. protein by women of childbearing age. b. protein by women in the first trimester of pregnancy. c. folic acid by women of childbearing age. d. folic acid by women in the first trimester of pregnancy.

ANS: C PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 234 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. Vouchers for food are benefits of the a. La Leche League. b. United States Department of Agriculture Assistance Program. c. Special Supplemental Program for Women, Infants, and Children. d. U.S. Public Health Service and the American Academy of Pediatrics.

ANS: C

The Special Supplemental Program for Women, Infants, and Children (WIC), overseen by the United States Department of Agriculture (USDA), provides vouchers for nutrient dense foods to low-income women with infants and young children. The La Leche League provides support to breastfeeding mothers. The U.S. Public Health Service and the American Academy of Pediatrics work together to recommend adequate intakes of folic acid for women of childbearing age to help prevent neural tube defects. The USDA does not have an ―Assistance Program.‖ PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 234 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 13. The amount of iron needed during pregnancy is a. difficult to achieve without taking a supplement. b. easy to achieve with a well-balanced diet. c. the same as the amount needed by nonpregnant women. d. less than for nonpregnant women because there are no menstrual losses.

ANS: A

Pregnant women need almost twice as much iron as nonpregnant women because of the expansion in maternal red 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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 234

14. Dietary calcium needs of pregnant women are a. higher than for nonpregnant women to form the fetal skeleton. b. higher than for nonpregnant women because intestinal absorption decreases. c. the same as for nonpregnant women because intestinal absorption increases. d. lower than for nonpregnant women because calcium metabolism is more efficient.

ANS: C

Pregnant women need the same amount of dietary calcium as nonpregnant women because increased intestinal absorption compensates for the increased needs to form the fetal skeleton.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 235

15. Teratogens are a. additives that may adversely affect the course of a pregnancy. b. substances known to cause malformations in the unborn fetus. c. hormones known to cause malformations in the unborn fetus. d. carcinogens that may increase the risk of cancer in the fetus.

ANS: B

A teratogen is an agent that is capable of producing a malformation or a defect in the unborn fetus. They may include additives or hormones. Teratogens are not necessarily carcinogenic.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 235

16. To prevent fetal alcohol syndrome, alcohol should be a. avoided throughout pregnancy. b. avoided in the first trimester of pregnancy. c. limited throughout pregnancy. d. limited in the first trimester of pregnancy.

ANS: A PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 235-236 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance 17. A drug that appears to be safe when used in moderate amounts during pregnancy is a. alcohol. b. nicotine. c. isotretinoin. d. caffeine.

ANS: D

Caffeine is safe when used in moderate amounts during pregnancy. Alcohol causes fetal alcohol syndrome and there is no safe level of consumption. Nicotine (from cigarettes) increases risk for several adverse outcomes including prematurity, low birth weight, SGA, stillbirth, placenta previa (location in lower uterine area), abruptio placentae (separation from uterine wall), and, postnatally, sudden infant death syndrome (SIDS). Isotretinoin is an acne medication that causes fetal malformations.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 235

18. Pregnant women who smoke have a high risk of giving birth to an infant with a. obesity. b. macrosomia. c. low birth weight. d. average birth weight.

ANS: C

Smoking during pregnancy increases the risk of having an infant with low birth weight.

Infants of mothers with gestational diabetes may have macrosomia and be larger than normal.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 236 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 19. During pregnancy, women should a. not exercise at all. b. exercise for 15 minutes daily. c. avoid very strenuous exercise. d. take cool showers after exercise sessions.

ANS: C

During pregnancy, women should avoid very strenuous exercise. They may exercise moderately, especially if they were active before becoming pregnant. They do not need to exercise for any specific amount of time each day or take cool showers after exercise.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 236-237

20. If a woman in her last trimester of pregnancy has marked edema, she may have a. heart failure. b. dehydration. c. preeclampsia. d. sodium overload.

ANS: C

After 20 weeks of gestation, marked edema, hypertension, and proteinuria are symptoms of preeclampsia. In nonpregnant individuals, edema may be a sign of heart failure or sodium overload. Dehydration does not cause edema.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 237-238 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. 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 using 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 it is not necessary to avoid it completely. If gestational diabetes cannot be controlled using diet and exercise, insulin may be used, but oral diabetes mediations are not used during pregnancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 238-239 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 22. High bioavailability of nutrients and resistance to infection are a. known to decrease risk of allergies. b. two of the advantages of breastfeeding. c. two of the disadvantages of breastfeeding. d. advantages that formula preparations are able to mimic.

ANS: B

High nutrient bioavailability and resistance to infection are two advantages of breastfeeding.

Formula cannot fully mimic these advantages. Breastfeeding does reduce risk of allergies, but not due to these factors.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 240

23. Prolactin is the hormone that a. is responsible for milk let-down. b. is responsible for milk synthesis. c. prepares the body for pregnancy. d. is responsible for relaxing muscle tone during pregnancy.

ANS: B

Prolactin primarily stimulates milk synthesis. Oxytocin is responsible for milk let-down.

Progesterone and estrogen prepare the body for pregnancy. Progesterone relaxes muscle tone during pregnancy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 240-241 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. Nursing by the infant results in a. sustained milk production. b. increased body fat in the infant. c. increased body fat in the mother.

d. increased digestibility of breast milk.

ANS: A

Nursing by the infant stimulates prolactin secretion which promotes milk production. Nursing does lead to weight gain in the infant, but not specifically body fat. It is likely to decrease, rather than increase, maternal body fat. Breast milk is easily digested but its digestibility is not affected by the infant nursing.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 240-241

25. Excess protein in an infant’s diet is a problem because a. it causes edema. b. it increases renal solute load. c. it results in excessive caloric intake. d. the gastrointestinal (GI) tract is too immature to absorb it.

ANS: B

Excess protein is a problem because the immature infant kidney may be unable to handle the high renal solute load. Low protein intake, but not high protein intake, may cause edema.

Excess protein intake does not necessarily result in excessive calorie intake if it takes the place of carbohydrate and fat. The infant’s gastrointestinal tract seems to be able to absorb excess protein.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 243

26. Infants may need supplements of a. iron, fluoride, and vitamin D. b. calcium, magnesium, and vitamin D. c. iron, zinc, and vitamin E. d. calcium, fluoride, and vitamin E. ANS: A

Infants may need supplements of iron, fluoride, and vitamin D. Breast milk and infant formula are good sources of calcium, magnesium, zinc, and vitamin E. PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 243-244

27. Vitamin K is the _____-soluble vitamin routinely given to _____. a. water; new mothers b. fat; new mothers c. water; newborns d. fat; newborns ANS: D

Vitamin K is a fat-soluble vitamin routinely given to newborns, usually by injection, to prevent hemorrhaging. It is not water soluble and is not given to new mothers.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 244 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 28. Infants less than one year old should not be fed a. crackers. b. egg yolk. c. cow’s milk. d. fruit juice.

ANS: C

Cow’s milk is not suitable for infants less than one year old because it contains high levels of sodium and protein and the high renal solute load may cause dehydration. Fruit juice may be introduced after age 6 months. Crackers and egg yolk may be introduced after age 9 months.

PTS: 1 DIF: Cognitive Level: Application REF: p. 245 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 29. To prevent baby bottle tooth decay, infants should not be allowed to sleep with a bottle

containing 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 246-247

30. Tube feeding is often required by babies born before 34 weeks of gestation because a. they are unable to chew. b. their taste buds are immature. c. they lack a coordinated suck-swallow reflex. d. they cannot digest breast milk or infant formula.

ANS: C

Babies born before 34 weeks of gestation often require tube feedings because their suck-swallow reflex is uncoordinated. No infants are able to chew when they are born.

Maturity of taste buds does not influence feeding method. Many premature infants are able to digest breast milk or infant formula; if they cannot, they may need parenteral feedings.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 248

Chapter 12: Life Span Health Promotion: Childhood and Adolescence Test Bank

MULTIPLE CHOICE 1. In feeding children, adults are responsible for determining a. children’s likes and dislikes. b. the amount of food consumed. c. the quantity and quality of foods prepared. d. the amount of time taken to consume foods.

ANS: C

Parents and caregivers are responsible for providing nutritious foods for children. It is up to the children to decide whether, how much, and how quickly they eat. Children determine their own food likes and dislikes.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 254 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 2. Children should be fed a. three times per day only. b. only when they request food. c. at about the same times each day. d. three meals and three snacks each day.

ANS: C

Parents and caregivers should provide meals and snacks at about the same times each day.

Regular meals and snacks help support successful learning and growth and help children feel secure. Most children need more than three meals a day; the specific number of meals and snacks varies for each family and each child. If children are only fed when they request food, the family will not eat meals together and the social aspect of eating will be lost.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 254 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 3. The best way to encourage children to consume adequate nutrients with less than 30% of kcals

from fat is to a. avoid fast food and fried foods. b. follow a vegan eating pattern. c. use low-fat foods and take a vitamin/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 kcals from fat. It is not necessary to completely avoid fat food and fried foods, 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/mineral supplement does not compensate for omitting fruits, vegetables, and whole grains.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation

REF: pp. 254-255

MSC: Client Needs: Health promotion and maintenance 4. Children ages 1 to 3 years have an increasing sense of a. privacy. b. isolation. c. dependence. d. independence.

ANS: D

Toddlers are dealing with issues of autonomy and like to assert their newly discovered independence. They are not usually concerned with privacy or isolation. They are still very dependent on their parents, but less so than in infancy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 255 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 5. If a 2-year-old is drinking 4 cups of milk daily, they are probably drinking a. too little milk to provide sufficient calcium for their growing skeleton. b. about the right amount of milk to meet their nutrient needs. c. about the right amount of milk provided they are at a healthy weight. d. too much milk, which may displace other important foods from their diet.

ANS: D

Children ages 1 to 3 years should drink 2 to 3 8-oz cups of milk per day. Therefore, 4 cups of milk is probably too much, and may displace other important foods from their diet.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 255-256

6. Excessive juice intake may be a problem for young children because a. high potassium intakes may be harmful. b. it may displace more nutrient-dense foods. c. excessive fluid intake may cause kidney damage. d. fruit juice contains substances that may be addictive.

ANS: B

Excessive juice intake may displace more nutrient-dense foods from the diet because it provides kcals with few nutrients. The high potassium and fluid intakes are not harmful and juice does not contain addictive substances.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 256

7. Children ages 4 to 6 years are more likely to eat steamed green beans if they are presented a. as green bean casserole. b. highly seasoned. c. alone as a snack between meals. d. separated from other foods on the plate.

ANS: D

Children ages 4 to 6 tend to accept foods more easily if they are served separately from other foods on the plate, rather than mixed with other foods in a casserole. Children do not usually favor highly seasoned foods. Green beans alone would not provide sufficient kcals for a between-meal snack for children.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 256-257 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 8. If a child does not like a food when they try it for the first time a. their preference should be respected and they should not be encouraged to try it

again. b. they should be offered a reward if they eat a reasonable amount of the food. c. they should be encouraged to eat at least five bites to see if their taste buds adjust. d. they should be offered the food at least 8 to 10 times before deciding whether they

like 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 256

9. It is important for parents to teach children to a. recognize internal hunger cues. b. recognize external hunger cues. c. eat the same amount of food each day. d. monitor their weight on a regular basis.

ANS: A

Parents can help children develop healthy eating patterns by teaching them to recognize and respond to internal hunger cues, to eat when they are hungry and stop when they are satisfied.

External cues are not really hunger, but are more environmental influences that may cause overeating if the child is not responsive to internal hunger cues. Children’s food intake may vary greatly from day to day because variations in appetite are common. Children should not monitor their weight regularly; instead they should focus on healthy eating and exercise habits and trust their bodies to maintain a healthy weight.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 258

10. The best way for a parent to encourage their toddler to eat a variety of foods is to a. offer rewards for trying new foods. b. make new foods look like favorite foods. c. allow free access to foods at all times. d. eat a variety of foods themselves.

ANS: D

Parents can encourage their toddlers to eat a variety of foods by modeling this behavior and eating a variety of foods themselves. It is not helpful to offer rewards for trying new foods; parents want children to learn that eating well is its own reward. Parents should not allow free access to foods at all times but should serve regular meals and snacks at about the same time eat day. Disguising foods to look like favorite foods simply creates suspicion and negative feelings toward new foods.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 254

11. 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 263-264 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 12. The National School Lunch Program provides a. free lunches for all schoolchildren. b. reduced-price lunches for all schoolchildren. c. lunches only for children from low-income families. d. lunches at varying costs depending on family income.

ANS: D

The National School Lunch Program provides lunches free, at reduced cost, or at full cost, depending on family income. Meals are available to all schoolchildren, but the cost depends on family income.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 260 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. An example of a breakfast that would meet the School Breakfast Program requirements would

be a. b. c. d.

scrambled egg, bacon, toast, and orange juice. cold breakfast cereal with milk, toast with honey. toast with peanut butter, banana, and milk. 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 of meat and/or bread and cereal. Toast (bread serving), peanut butter (meat serving), banana (fruit serving), and milk (milk serving) meets this requirement. Scrambled egg (meat serving), bacon (meat serving), toast (bread serving), and orange juice (fruit serving) is missing milk. Cold breakfast cereal (bread serving ), milk (milk serving), and toast with honey (bread serving) is missing fruit. Turkey sausage (meat serving), hash browns with ketchup (vegetable serving), and milk (milk serving) is missing a serving of meat or bread.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Evaluation MSC: Client Needs: Health promotion and maintenance

REF: p. 260

14. To promote good eating habits in adolescents, adults should a. discuss the reasons for good food choices with adolescents. b. design daily menus and provide only the specific foods on the menu. c. create guidelines for dietary patterns and provide appropriate food choices. d. model good food behaviors and allow adolescents to make their own choices.

ANS: C

Adults can help promote good eating habits in adolescents by creating guidelines for dietary patterns and providing appropriate food choices. Simply discussing reasons for good food choices provides education without tools. Designing menus and providing only these foods does not teach adolescents to make good choices on their own. Modeling good food behaviors and allowing adolescents to make their own choices does not provide sufficient guidance.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Psychosocial integrity

REF: p. 261

15. Adolescent boys generally require more protein than adolescent girls because a. boys become taller than girls during adolescence. b. lean body mass increases more in boys than in girls during adolescence. c. hormonal differences allow adolescent girls to use protein more efficiently than

adolescent boys. d. foods high in protein are also high in minerals, and boys have higher mineral needs

than girls during adolescence.

ANS: B

Adolescent boys generally need more protein than adolescent girls because they are developing more lean body mass. Height does not affect protein needs as much as development of lean body mass, and adolescent boys are not necessarily taller than girls.

Adolescent girls’ hormones do not cause them to use protein more efficiently than boys. Boys do need more of some minerals than girls because of their increased body size, but this is not the reason for their increased protein needs.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 262

16. It is especially important to make sure that teenage girls obtain adequate calcium because

a. b. c. d.

calcium is lost from the body during menstruation. adolescent girls require more calcium than adolescent boys. lactose intolerance is especially common in adolescent girls. adolescent girls often have inadequate intakes of calcium-rich foods.

ANS: D

Calcium intake is a concern for teenage girls because they often have inadequate intakes of calcium-rich foods. Iron, not calcium, is lost from the body during menstruation. Adolescent girls and boys have the same calcium needs. Lactose intolerance is not especially common in adolescent girls.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 262

17. 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 using 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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 262-263

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

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 263 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. Children become overweight because of a. sedentary lifestyles. b. excessive portion sizes. c. consumption of high-fat foods.

d. a combination of several factors.

ANS: D

Many factors contribute to overweight in children. These factors include sedentary lifestyles, excessive portion sizes, and consumption of high-fat foods, as well as eating more snacks, eating more food away from home, spending large amounts of time watching television or playing computer games, genetics, and lack of adult supervision after school.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 263 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity | Client Needs: Physiological integrity 20. 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 need to evaluate and address factors contributing to obesity 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 their height increases until they reach a healthy weight for their height.

PTS: 1 DIF: Cognitive Level: Application REF: p. 263 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 21. An example of a child who is at high risk for iron-deficiency anemia is one a. who has allergies to milk and nuts. b. living in an African American low-income family. c. whose parents both work full time. d. who eats most of their 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 intakes of calcium, but would probably not have low intakes of iron. Working parents and eating food away from home are not known to be related to iron-deficiency anemia.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 265-266 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Psychosocial integrity 22. In children, the most common food allergens include a. wheat, barley, oats, and milk. b. peanuts, milk, eggs, and wheat. c. fish, shellfish, tree nuts, and peanuts. d. eggs, strawberries, oranges, and tree nuts.

ANS: B

The most common food allergens in children are peanuts, milk, eggs, and wheat. Seafood allergies are common in older children and adults. Allergies to barley, oats, tree nuts, strawberries, and oranges occur less commonly.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 267-268 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 23. The most serious, potentially life-threatening reaction to a food allergen is a. dermatitis. b. anaphylaxis. c. syncope (fainting). d. gastrointestinal bleeding.

ANS: B

The most serious, potentially life-threatening reaction to a food allergen is anaphylaxis, in which the airway becomes swollen and blocked, causing unconsciousness. Dermatitis, syncope, and gastrointestinal bleeding may be problematic, but are not life threatening.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 267-268 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. A true food allergy involves the _____ system. a. immune b. digestive c. respiratory d. cardiovascular ANS: A

In a true food allergy, the immune system reacts to a substance in food as if it needed to protect the body from a foreign substance. Food allergies may cause reactions in the digestive or respiratory systems, but these are secondary effects, not primary responses. The cardiovascular system is not usually involved in food allergy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 267-268 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. Food allergies are treated by a. use of antihistamine medications. b. avoiding all sources of the offending food. c. taking supplemental digestive enzymes to break down the offending protein. d. gradual desensitization to the offending protein under medical supervision.

ANS: B

The only way to treat food allergies is to avoid all sources of the offending food. Use of antihistamine medications may blunt the allergenic response, but should not be relied upon because of the risk of anaphylaxis. Supplemental digestive enzymes cannot reliably digest the offending protein before it makes contact with the digestive system. With allergies, sensitivity to the offending protein tends to increase, rather than decrease, with repeated exposure.

PTS: 1

DIF: Cognitive Level: Comprehension

REF: pp. 267-268

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 26. A food that includes ―sodium caseinate‖ and ―lactalbumin‖ in the list of ingredients should be

avoided by individuals with a(n) _____ allergy. a. egg b. milk c. wheat d. peanut ANS: B

Caseinate and lactalbumin are made from proteins found in milk and should be avoided by individuals with a milk allergy. Individuals with allergies to egg, wheat, and peanut would not be affected by these ingredients.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 268

27. Eating disorders are generally caused by a. unresolved emotional conflicts. b. a desire to achieve a healthy weight. c. dietary restrictions imposed by families. d. a desire to achieve a high level of fitness.

ANS: A

Eating disorders are generally caused by unresolved emotional conflicts. Even though the presenting behaviors are food-related and may be connected to a desire to achieve a certain weight or fitness level, the underlying problem is emotional and psychological, not nutritional.

Dietary restrictions imposed by families may contribute to disordered eating, but are not the root cause.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 268 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 28. If a parent often finds empty food wrapper’s in their teenage daughter’s bedroom, if she

spends several minutes in the bathroom right after every meal, and if she exercises for more than an hour every day, the parent may suspect a. bulimia nervosa. b. anorexia nervosa. c. binge-eating disorder. d. chronic dieting syndrome.

ANS: A

Bulimia nervosa is characterized by episodes of binge eating (food wrappers may be evidence of this), and compensatory behaviors including purging (time spent in the bathroom after meals may signal vomiting), and excessive exercise. Anorexia nervosa is characterized by refusal to maintain weight above a certain low value and fear of gaining weight; this would be demonstrated by restricted food intake and/or excessive exercise. Binge-eating disorder is characterized by episodes of binge eating (the food wrappers may suggest this), but without compensatory behaviors. Chronic dieting may be associated with several eating disorders, but is not a defined syndrome.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 270-271 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 29. For individuals with binge eating disorder, episodes of binge eating may be triggered by a. stressful events. b. nutrient deficiencies. c. periods of relaxation. d. unintended weight loss.

ANS: A

Episodes of binge eating may be triggered by stressful events because of poor coping skills and loss of self-control. Binge eating is not triggered by nutrient deficiencies and is less likely to occur during periods of relaxation or after unintended weight loss.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 269-270 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 30. An important part of nutrition intervention for clients with eating disorders includes a. eating all foods with other people present. b. separating food behaviors from emotional issues. c. limiting exercise to no more than 30 minutes daily. d. keeping a record of food and exercise habits.

ANS: B

Nutrition intervention for clients with eating disorders includes separating food and weight-related behaviors from emotional and psychological issues. It may be helpful for these clients to eat with other people present to help them normalize their eating patterns, those who exercise excessively may need to limit their exercise, and a record of food and exercise habits may be helpful (especially if combined with a record of emotions experienced). However, these are not necessarily included in treatment.

PTS: 1 DIF: Cognitive Level: Application REF: p. 266 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance | Client Needs: Psychosocial integrity

Chapter 13: Life Span Health Promotion: Adulthood Test Bank MULTIPLE CHOICE 1. As adults age, they are likely to want to add _____ to their food. a. less salt b. more salt c. less 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 due to loss of taste buds. Some older adults may choose to use salt substitutes to avoid using excess sodium; however, their use is not widespread.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 282

2. The term productive aging refers to a. production of offspring to continue the life cycle. b. holding a productive job throughout all stages of adulthood. c. an ability to stay active and healthy throughout all stages of adulthood. d. development of attitudes and skills that support adaptation to the transitions of life.

ANS: D

Productive aging means development of attitudes and skills that prepare an individual to adapt to the transitions of life and maintain a personal sense of experiencing a productive, meaningful life. It is not necessarily related to having children, job productivity, or levels of activity and health. Productive aging means adapting definitions of success at each stage of the aging process.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 278 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 3. Growth is usually complete by the a. early 20s for men and women. b. late teens for men and women. c. late teens for women and early 20s for men. d. late teens for men and early 20s for women.

ANS: C

Growth is usually complete by the late teens for women and early 20s for men.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 279 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 279 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Calcium and iron intakes may be inadequate in young women because a. hectic lifestyles and stress reduce the bioavailability of these minerals. b. they have high intakes of processed foods, which tend to be poor sources of these

minerals.

c. intake of foods high in these minerals may be restricted because of attempts to lose

weight. d. requirements for these minerals are very high and cannot be met without using

supplements.

ANS: C

Young women may have inadequate intakes of calcium and iron because they may restrict foods that are good sources of these nutrients to try to control their weight. Bioavailability is not affected by stress. Processed foods tend to be poor sources of calcium and iron, but young women do not necessarily have high intakes of processed foods. Requirements for these minerals can be met with a well-planned diet without use of supplements.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 279 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. One way a 50-year-old individual can help maintain their 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 their diet includes adequate amounts of high-quality protein. d. decreasing their 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 with help prevent increases in body fat, but will not help maintain lean body mass.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 279-280 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 7. Older women require less dietary iron than younger women because older women have a. decreased turnover of red blood cells. b. decreased iron losses after menopause. c. replacement of hemoglobin with myoglobin. d. lower levels of activity, requiring less oxygen to be transported to the cells.

ANS: B

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

Hemoglobin is the oxygen-carrying pigment in blood, myoglobin is the oxygen-carrying pigment in muscles, and one does not replace the other with age. Older women are not necessarily less active than younger women.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 279-280 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. A man may be at increased risk for prostate cancer if he a. eats large portions of red meat several times per week. b. eats eggs for breakfast most mornings.

c. drinks two or more alcoholic beverages daily. d. drinks two or more glasses of milk daily.

ANS: A

Prostate cancer is positively associated with intake of dietary fat, especially saturated fat. The most aggressive type of prostate cancer is associated with intake of animal fat. Therefore a man is at increased risk of prostate cancer if he eats large portions of red meat several times per week. Eating eggs for breakfast most mornings, drinking two or more alcoholic beverages daily, and drinking two or more glasses of milk daily are not associated with risk of prostate cancer.

PTS: 1 DIF: Cognitive Level: Application REF: p. 289 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. If an older adult is confused, they may have a deficiency of a. iron. b. zinc. c. water. d. protein.

ANS: C

Confusion is often caused by dehydration in older adults (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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 281 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. Factors that lead to decreased fluid intake in older adults include a. decreased sweating. b. fear of incontinence. c. decreased salt intake. d. preference for food rather than fluids.

ANS: B

Older adults may restrict their fluid intake because of fear of incontinence. Older adults do not usually have lower salt intakes or prefer food rather than fluids. They may sweat less, which makes them more sensitive to heat but does not usually cause them to decrease fluid intake.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 290 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Psychosocial integrity 11. An older adult’s nutritional status may decline if they have arthritis because a. it is associated with loss of appetite. b. their ability to prepare food may be impaired. c. taste changes may cause food to be unappetizing. d. it 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 280-281 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. A program that may benefit homebound older adults is the a. Supplemental Nutrition Assistance Program. b. Congregate Meals Program. c. Home-Delivered Meals Program. d. Emergency Food Assistance Program.

ANS: C

Homebound older adults may benefit from the Home-Delivered Meals Program. This provides one meal a day that may contribute significantly to nutrient intake. The Food Stamp Program helps people of all ages with low incomes buy nutritious foods. The Congregate Meals Program provides meals for older adults; these meals are served at a community center so it also provides an opportunity for social interaction. The Emergency Food Assistance Program helps provide food for low-income households, including elderly people.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 287

13. Older adults require more dietary vitamin D than younger adults because a. breakdown of vitamin D is increased. b. absorption of vitamin D is less efficient. c. their skin is less able to synthesize vitamin D. d. body fat levels are higher, and vitamin D is fat soluble.

ANS: C

Older adults require more dietary vitamin D because their skin is less able to synthesize vitamin D. They do not break down more vitamin D and are still able to absorb vitamin D. Older adults do not necessarily have higher body fat levels.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 282 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. Absorption of vitamin B12 may be decreased in older adults because of decreased a. intestinal motility. b. production of bile by the liver. c. production of intrinsic factor by the stomach. d. synthesis of vitamin B12 by intestinal bacteria.

ANS: C

Older adults may produce less intrinsic factor, which may decrease vitamin B 12 absorption.

Vitamin B12 absorption is not affected by intestinal motility or bile production. Bacterial vitamin production occurs in the large intestine, after most vitamin B 12 absorption has occurred, so bacterial production is not very important.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 282 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

15. Sensitivity of taste receptors may be altered if an individual has an inadequate intake of a. zinc. b. iron. c. vitamin C. d. vitamin B12.

ANS: A

Inadequate zinc intake decreases sensitivity of taste receptors. Inadequate intakes of iron and vitamin B12 are associated with anemia. Inadequate intakes of vitamin C cause poor wound healing.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 282 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. In older adults, weakening of muscles along the gastrointestinal tract may cause a. diarrhea. b. constipation. c. colon cancer. d. bloating and gas.

ANS: B

Weakening of muscles along the gastrointestinal tract may cause constipation in older adults because the muscles do not push food along as powerfully. Diarrhea would be more likely to occur if the muscles became stronger. Bloating and gas may accompany constipation, but this is a secondary rather than a primary effect. Colon cancer is not associated with weakening of intestinal muscles.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 282 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 282-284 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. A reason that dehydration may be a problem in older adults is that a. older adults sweat more in hot weather. b. the lungs evaporate more water during respiration. c. the ability of the kidneys to concentrate urine decreases. d. water absorption from the gastrointestinal tract decreases.

ANS: C

Dehydration may be a problem in older adults because the kidneys’ ability to concentrate urine decreases with age. Older adults actually sweat less in hot weather than younger adults.

Their lungs do not evaporate more water during respiration and water absorption from the gastrointestinal tract does not decrease (if it did, older adults would experience diarrhea).

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 282-284 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. The Nutrition Screening Initiative is intended to help a. identify adults older than 65 who are at nutritional risk. b. identify individuals of all ages who are at nutritional risk. c. determine the level of nutritional risk in older adults in the nation. d. implement strategies to prevent nutritional risk in adults more than 65 years old.

ANS: A

The Nutrition Screening Initiative provides a screening tool to help identify adults older than 65 who are at nutritional risk. It is used by individual health practitioners and does not provide national data on levels of nutritional risk. It is used to identify individuals who would benefit from nutrition interventions to prevent overt malnutrition, rather than preventing nutritional risk.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 285 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 20. In adults over age 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 over age 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 intakes.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Health promotion and maintenance

REF: pp. 282-284

21. The Child and Adult Care Food Program helps provide food for a. school-age children and institutionalized older adults. b. children and adults with physical and mental disabilities while they attend daycare

facilities. c. low-income families caring for preschool-age children and dependent elderly

family members. d. children up to age 12, senior citizens, and certain handicapped people who

participate in daycare programs.

ANS: D

The Child and Adult Care Food Program provides meals and snacks for children up to age 12 and to senior citizens and specific categories of handicapped people participating in daycare programs that are nonprofit, licensed, or receive agency approval.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 287 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 22. 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 are high in 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 are high in fat and added sugar may help decrease kcal intake, but it is not necessary to avoid them altogether.

PTS: 1 DIF: Cognitive Level: Application REF: p. 285 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial integrity | Client Needs: Health promotion and maintenance 23. The Supplemental Nutrition Assistance Program (SNAP) provides a. emergency food supplies for people living below the poverty level. b. a list of foods that meet specific nutrient and health requirements. c. coupons toward the purchase of foods for people with low income. d. nutrition supplements for at risk individuals and families.

ANS: C

SNAP provides coupons that people with low incomes can use to buy food. The Emergency Food Assistance Program provides extra food supplies for people living below the poverty level. None of the food programs provides a list of foods that meet specific nutrient and health requirements or provide nutrition supplements.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 287

24. The Emergency Food Assistance Program supplements the dietary intake of low-income

households by distributing basic commodities and a. providing education on preparation of low-cost foods. b. reducing government-held surplus dairy commodities. c. distributing excess commodities to developing nations. d. providing specific nutrient-dense foods for young children and older adults.

ANS: B

TEFAP supplements the dietary intake of low-income families at the same time as reducing surplus dairy commodities. The program does not include an education component. It is a domestic program and does not provide food to other nations. It is available to people of all ages, not just to young children and older adults.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 287

25. The Senior Nutrition Program provides meals for ___ age 60 years or older. a. anyone b. disabled adults c. low-income adults d. socially isolated adults ANS: A

The Senior Nutrition Program provides inexpensive meals, education, and socialization for all adults age 60 and over. It does not specifically target disabled, low-income, or socially isolated adults.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 287

26. Chewing and swallowing difficulties in older adults increase the risk of a. vomiting. b. hiatal hernia. c. food asphyxiation. d. gastroesophageal reflux.

ANS: C

Chewing and swallowing difficulties in older adults increase the risk of food asphyxiation.

Vomiting is caused by infection or foodborne illness. Gastroesophageal reflux is caused by a weakening of the sphincter between the esophagus and the stomach. Hiatal hernia is caused by part of the stomach pushing up through the diaphragm; this is often related to gastroesophageal reflux.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 287-288 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 27. If someone is under continued stress and starts to experience severe stomach pain, they may

have a. dysphagia. b. food asphyxiation. c. a peptic ulcer. d. loss of intrinsic factor.

ANS: C

Long-term stress can stimulate excessive stomach acid secretion and contribute to peptic ulcer formation. Dysphagia means difficulty swallowing, associated with food asphyxiation, but not usually caused by stress. Stress does not affect production of intrinsic factor.

PTS: 1 DIF: Cognitive Level: Application REF: p. 288 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Psychosocial integrity 28. After menopause, women have an 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 288 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. 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 high in fat and sugar. d. alcoholics often eat in bars that serve a limited number of foods.

ANS: B

Alcohol provides kcals but no nutrients and 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 high in fat and sugar. Many alcoholics drink at home and so are not limited to foods served in bars.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 289-290 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 30. An example of rationalizing is a. restricting food intake by rationing food. b. coping with stress 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 291-293 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity

Chapter 14: Nutrition in Patient Care Test Bank

MULTIPLE CHOICE 1. In-depth nutrition interventions are provided by a. nurses. b. physicians. c. nutrition therapists. d. registered dietitians.

ANS: D

The entire health-care team may be involved in various aspects of nutrition care of patients, but in-depth nutrition interventions are the responsibility of the registered dietitian. Nurses help identify patients at nutrition risk who may benefit from nutrition assessment by a registered dietitian; they also ensure that patients receive their food and are able to eat it.

Physicians order diets for patients and have some awareness of their nutrition needs. Nutrition therapists are not recognized health professionals.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 295 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. An example of a common cause of iatrogenic malnutrition is a. scheduling of daily tests that prevents the patient from eating meals. b. family members and friends bringing patients food from home. c. small portion sizes of hospital food and absence of snacks. d. errors in ordering and delivery of meals for hospital patients.

ANS: A

A common cause of iatrogenic malnutrition is scheduling frequent tests that require patients to fast before the test and that may continue 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 295 | p. 305 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. Noninvasive measurements of height, weight, circumferences, and skinfold thickness are

known as _____ measurements. a. objective b. mechanical c. biochemical d. anthropometric ANS: D

Noninvasive measurements of height, weight, circumferences, and skinfold thickness are known as anthropometric measurements. Biochemical measurements include blood and urine tests. Both anthropometric and biochemical measurements are objective. Some anthropometric measurements are mechanical, but this is not a recognized term.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 300 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

4. For adults who are unable to stand, height may be estimated by measuring a. knee height. b. stated height. c. head circumference. d. wrist circumference.

ANS: A

For adults who are unable to stand, height may be estimated by measuring knee height. Stated height is not necessarily accurate. Head circumference is used to measure growth in children, but is not related to height and is not usually used in adults. Wrist circumference is related to body frame size, but not height.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 301 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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 – 140) ÷ 140  100 = 7 ÷ 140  100 = 5%.

PTS: 1 DIF: Cognitive Level: Application REF: p. 302 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. If a patient weighed 150 lbs one month ago and now weights 140 lbs, their weight loss would

be considered to be a. insignificant. b. mild. c. moderate. d. severe.

ANS: D

Percent weight loss = (150 – 140) ÷ 150 x 100 = 10 ÷ 150 x 100 = 6.67%. Loss of >5% of body weight in one month is considered severe.

PTS: 1 DIF: Cognitive Level: Application REF: p. 302 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 302 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. A client with a BMI of 18 would be considered to be a. underweight. b. normal weight. c. overweight. d. severely 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 303 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. All hospitalized patients must be screened to determine whether they are at nutritional risk a. if they report recent weight loss. b. if their diagnosis is nutrition-related. c. within 48 hours of hospital admission. d. within 2 weeks of hospital admission.

ANS: C

JCAHO requires that all hospitalized patients must be screened to determine whether they need in-depth nutrition assessment within 48 hours of hospital admission. Weight loss and nutrition-related diagnoses are only two of the many possible factors that contribute to nutritional risk.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 298 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. Measurements of serum albumin level are used to determine a. immune function. b. visceral protein status. c. somatic protein status. d. adequacy of protein intake.

ANS: B

Serum albumin level is a good index of visceral protein status. It is not a good indicator of immune function, although values do tend to decrease during infection. Somatic protein status is assessed using measurements that estimate muscle size. Serum albumin level does decrease if protein intake is inadequate over long periods, but it does not demonstrate day to day adequacy of protein intake. Also, protein intake may be reasonable, but a patient may have low serum albumin if they have unusually high protein needs, for example due to burns or infection.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 303-304 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. An enlarged thyroid gland may indicate a deficiency of

a. b. c. d.

iron. iodine. folate. vitamin B12.

ANS: B

An enlarged thyroid gland may be a goiter, a sign of iodine deficiency. Deficiencies of iron, folate, and vitamin B12 cause different types of anemia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 305 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. If staff are concerned about whether a patient in an acute-care or long-term care facility is

eating enough, they may conduct a a. diet history. b. kcalorie count. c. 24-hour diet recall. 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 kcalorie count to determine what the patient is actually eating. A diet history depends on the patient’s recall and does not give a quantitative assessment of food intake. A 24-hour diet recall also depends on the patient’s recall and only shows what the patient ate in the previous 24 hours which may not be representative of their usual food intake.

Menu analysis shows what is available to the patient, but does not measure what the patient actually ate.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 305-306 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 13. 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 level between 2.4 and 2.9 mg/dL indicates moderate malnutrition; therefore a patient with a serum albumin level of 2.5 g/dL may be at high nutritional risk. Soft diets are altered in texture but are still nutritionally adequate. Tube feedings are also nutritionally adequate if administered correctly. Weight gain does not necessarily indicate nutritional risk.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 303-304 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. Clear liquid diets are appropriate for patients a. who are unable to chew. b. who are experiencing nausea. c. who have difficulty swallowing. d. during the first 24 hours after major surgery.

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. Patients who have difficulty swallowing often have the most trouble swallowing liquids and so a clear liquid diet could be unsafe.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 308-309 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 15. One advantage of a full liquid diet is that it a. is low in saturated fat and high in fiber. b. is suitable for patients with lactose intolerance. c. is likely to be tolerated by patients with dysphagia. d. provides more protein and kcals than a clear liquid diet.

ANS: D

Full liquid diets provide more protein and kcals than a clear liquid diet and can even provide an adequate diet if very carefully planned. However, full liquid diets tend to be high in saturated fat (from dairy products) and low in 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 309-310 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. Enteral feeding is preferred over parenteral nutrition whenever possible because enteral

feeding a. is more satisfying for the client. b. allows the client to be ambulatory. c. reduces the risk of foodborne illness. d. maintains gut function and integrity.

ANS: D

Enteral feeding is preferred over parenteral nutrition whenever possible because enteral feeding helps maintain gut function and integrity. It is not necessarily more satisfying for the client, although the presence of food in the intestines may help create a feeling of satiety.

Ability for the client to be ambulatory is similar for enteral and parenteral nutrition. Enteral feeding can cause foodborne illness; this is not a problem with parenteral nutrition because food does not enter the gut, but parenteral nutrition may be associated with sepsis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 310-311 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Safe and effective care environment 17. Commercial enteral formula products are preferred over home-blended formulas because

commercial products a. have a better flavor and are more appealing to patients. b. are synthetic and therefore do not require refrigeration. c. are cheaper and are more likely to be covered by medical insurance programs.

d. have a more consistent composition and are less likely to be contaminated with

bacteria.

ANS: D

Commercial enteral formula products are preferred over home-blended formulas because commercial products have a more consistent nutrient composition and are less likely to be contaminated with bacteria. They do not usually taste as good as home-blended formulas, but this is not very important because they are fed via tube and are not tasted in the mouth. Once opened, commercial formulas still require refrigeration because their high nutrient content can support rapid growth of bacteria. They may be more expensive and are not necessarily covered by medical insurance programs.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 310-312 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Safe and effective care environment 18. A patient who has had a stroke and needs enteral feedings because they cannot chew or

swallow but who has no other medical problems can be fed using 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 using a standard polymeric formula. These formulas are not necessarily isotonic; isotonic formulas may be used if a patient develops diarrhea. Modular formulas are used for specific medical conditions requiring 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 311 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 19. Elemental formulas contain a. partially or fully hydrolyzed nutrients. b. the basic intact nutrients of an adequate diet. c. elemental minerals in a readily bioavailable form. d. single macronutrients such as glucose polymers, protein, or lipids.

ANS: A

Elemental formulas contain partially or fully digested nutrients. They generally provide an adequate diet, but do not contain intact, undigested nutrients. They do not necessarily contain specific forms of minerals. Formulas that contain a single macronutrient are called modular formulas.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 311 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 20. 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; this would include a comatose patient.

Regular polymeric formulas can be administered into the stomach, not into the small intestine.

Feeding tubes can be passed through the nose or through a stoma into the stomach or into the small intestine; the nose is usually only used 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 does not affect whether feedings are administered into the stomach or small intestine.

PTS: 1 DIF: Cognitive Level: Application REF: p. 310 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 21. A PEG tube is a a. personal enteric gastrostomy tube. b. permanent enteral gastric feeding tube. c. percutaneous endoscopic placement of a gastrostomy. d. polymeric enteral formula gastrointestinal delivery system.

ANS: C

The abbreviation PEG is used for a percutaneous endoscopic placement of a gastrostomy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 312-313 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 22. Rapid infusion of hypertonic enteral formulas may cause a. aspiration. b. osmotic diarrhea. c. weight gain. d. high blood pressure.

ANS: B

Rapid infusion of hypertonic enteral formula may draw water into the intestines and cause osmotic diarrhea. Tube placement and patient position affect aspiration, not formula molarity and infusion rate. Weight gain would be caused by administration of more kcals than the patient needs, not by hypertonicity or infusion rate. Enteral formula infusion does not generally affect blood pressure.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity

REF: p. 314

23. Bolus enteral feedings are appropriate only when the feeding tube administers the formula

into the a. esophagus. b. stomach. c. duodenum. d. jejunum.

ANS: B

Bolus feedings should only be administered into the stomach because a larger volume is administered at one time and the duodenum and jejunum cannot hold this larger volume.

Enteral feedings are not administered into the esophagus.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 313-314 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 24. 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. This shows 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 kcal 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 will not demonstrate adequacy.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 298-300 TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological integrity 25. To reduce the risk of aspiration, patients who are receiving enteral tube feedings should be

positioned a. sitting upright. 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 310-311 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity | Client Needs: Safe and effective care environment 26. The appropriate type of parenteral feeding for a patient who will need intravenous nutrition

for several months or years is _____ nutrition. a. central parenteral b. peripheral venous c. peripheral parenteral d. intravenous parenteral 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.

Intravenous nutrition refers to both central and peripheral parenteral nutrition.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 318-319 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 27. The form of carbohydrate used in parenteral nutrition is a. glucose polymers. b. dextrose polymers. c. glucose monohydrate. d. dextrose monohydrate.

ANS: D

The form of carbohydrate used in parenteral nutrition is dextrose monohydrate. Nutrient polymers require digestion and cannot be administered intravenously.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Intervention MSC: Client Needs: Physiological integrity

REF: p. 319

28. Intravenous lipid emulsions are used as part of parenteral nutrition to prevent fatty acid

deficiency and a. increase patient satiety. b. provide a source of fat-soluble vitamins. c. add kcals without increasing osmolality. d. add kcals with minimal expense.

ANS: C

Intravenous lipid emulsions are used to add kcals to parenteral nutrition without increasing osmolality. Amino acids and dextrose can add kcals, 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 320 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 29. In patients receiving parenteral nutrition, high blood glucose levels may be caused by a. inadequate infusions of potassium. b. rapid infusions of high levels of dextrose. c. use of peripheral rather than central parenteral nutrition. d. infusion of too much amino acid that is deaminated and converted to glucose.

ANS: B

In patients receiving parenteral nutrition, high blood glucose levels may be caused by rapid infusions of high levels of dextrose. Potassium does not affect glucose tolerance. Use of peripheral versus central routes does not affect glucose tolerance (and generally less glucose is infused via the peripheral route). Excess amino acids are deaminated within cells and do not usually cause high blood glucose levels.

PTS: 1

DIF: Cognitive Level: Comprehension

REF: p. 320

TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity 30. During transitions from parenteral or enteral tube feedings to oral feedings, patients should be

monitored to make sure 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 make sure that they achieve adequate nutrient intakes. Hypoglycemia may develop if parenteral nutrition is discontinued too quickly, but not after stopping enteral feedings. 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 322 TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological integrity

Chapter 15: Nutrition and Metabolic Stress Test Bank MULTIPLE CHOICE 1. The adverse effects of malnutrition on the gastrointestinal tract result in a. decreased absorption of fluids and electrolytes from food. b. increased bacterial activity inside the gastrointestinal tract. c. decreased transit time for food passing through the GI tract. d. increased risk of spread of bacteria from the GI tract into the rest of the body.

ANS: D

Malnutrition can lead to a decrease in integrity of the gastrointestinal tract that allows bacteria to spread from inside the intestines to the rest of the body. Usually, the intestines are still able to absorb fluids and electrolytes and transit time does not decrease. Bacterial activity inside the gastrointestinal tract does not necessarily increase or decrease.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 326-327 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. The adverse effects of malnutrition on the skin may result in a. excessive sweating. b. slow wound healing. c. increased hair growth. d. reddening and soreness.

ANS: B

Malnutrition decreases skin density and slows wound healing. Fevers and infection may cause excessive sweating, reddening and soreness, but these symptoms would not be caused by malnutrition. Malnutrition tends to decrease hair growth or cause hair to become brittle and easily pluckable.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 326-327 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. One of the most stressful physical traumas is a. a fracture in a long bone. b. a low-grade fever (<100° F). c. minor surgery requiring a general anesthetic. d. a burn that covers >40% of body surface area.

ANS: D

Burns that cover >40% of body surface area increase metabolic rate more than fractures, low-grade fevers, and minor surgery. Long bone fractures increase metabolic rate 10% to 30%, fever increases metabolic rate 2% for every degree above normal, surgery increases metabolic rate up to 20%, and burns increase metabolic rate 85% to 105%.

PTS: 1 DIF: Cognitive Level: Application REF: p. 331 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. Glycogen stores are usually depleted after an individual fasts for _____ hours. a. 2 to 4 b. 4 to 8 c. 8 to 12 d. 12 to 18 ANS: C

Liver glycogen stores can maintain blood glucose level for 8 to 12 hours of fasting.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 328

5. During the first few days of starvation, the brain obtains glucose that is produced from a. glycogen via glycolysis. b. fatty acids via lipogenesis. c. amino acids via gluconeogenesis. d. branched-chain amino acids via deamination.

ANS: C

During starvation, after glycogen stores are depleted (after 8 to 12 hours), the body uses protein from muscle to produce glucose via gluconeogenesis. Glycolysis is part of the process used to obtain energy from glucose. Lipogenesis is the process by which the body forms fat from excess fatty acids and glycerol. Deamination is the first part of the process of using amino acids to form glucose via gluconeogenesis; all amino acids can be used to form glucose, not just branched chain amino acids.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 328 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. After several days of starvation, the body tissues obtain more of their energy from a. glucose. b. glycogen. c. amino acids.

d. ketone bodies.

ANS: D

As starvation continues, body tissues obtain more of their energy from ketone bodies. Ketone becomes the main source of body energy; glucose and glycogen stores are depleted. Amino acids from muscle stores are still catabolized to provide energy for the brain and red corpuscles, but this represents a small portion of total energy needs.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 328-329 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. During starvation, the body conserves energy by a. decreasing metabolic rate. b. shivering to create warmth. c. sleeping for shorter periods of time. d. sweating to reduce body temperature.

ANS: A

The body conserves energy during starvation by decreasing metabolic rate. Shivering and sweat production both require energy and increase metabolic rate. Energy use is at its lowest during sleep, so sleeping less would increase energy needs.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 329 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. A major difference between starvation and stress is that metabolic rate _____ during

starvation and _____ during stress. 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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 329-331

9. Major hallmarks of the ebb phase of stress are a. hypothermia and lethargy. b. nausea, vomiting, and diarrhea. c. increased catabolism of macronutrients. d. hyperthermia and increased nitrogen excretion.

ANS: A

Hypothermia, lethargy, and decreased oxygen consumption are characteristics of the ebb phase of stress. Nausea, vomiting, and diarrhea are not caused by any phase of stress.

Increased catabolism of macronutrients, hyperthermia, and increased nitrogen excretion occur in the flow phase of stress.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 329-330

10. Seventy-two hours 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 ebb phase (commonly known as shock) for 36 to 48 hours. By 72 hours after the injury, they would be in the flow phase and would be highly hypermetabolic.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 329

11. Patients with poor nutritional status before surgery are at high risk for pneumonia or wound

infections after surgery because a. they are likely to lose more blood and body fluids during surgery. b. they are likely to already have pneumonia or infections before surgery. c. they have an increased prevalence of nausea and vomiting after surgery. d. their nutrient stores may be inadequate to meet increased needs during recovery.

ANS: D

Patients who are malnourished are more likely to develop infections or pneumonia after surgery because their nutrient stores may be inadequate to meet increased needs for recovery and healing. Their bodies need extra protein, energy, vitamins, and minerals to form new tissues. Malnourished patients do not necessarily lose more blood and body fluids during surgery and are not more likely to have nausea and vomiting after surgery. If they have pneumonia or infections before surgery, it is likely that surgery would be delayed unless absolutely necessary.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 331

12. During severe stress, such as major burns over large areas of the body, protein needs may

increase to as high as _____ g/kg body weight. a. 1.2 b. 1.5 c. 2.0 d. 2.5 ANS: C

During severe stress, protein requirements can increase to as high as 2.0 g/kg body weight.

During moderate stress, protein requirements may be as high as 1.5 g/kg body weight.

PTS: 1

DIF: Cognitive Level: Knowledge

REF: p. 331

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological integrity

13. As patients age, their body composition changes, and their fluid needs during recovery a. increase. b. decrease. c. do not change. d. vary with the type of metabolic stress.

ANS: B

Fluid needs per kilogram body weight during recovery decrease with age. This is because lean body mass decreases with age and is not affected by the type of metabolic stress.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 331 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 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 lung 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 331 | p. 333 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. During stress, giving patients extra insulin does not always decrease their high blood glucose

levels because a. the ratio of glucagon to insulin is increased. b. the extra insulin stimulates glucose production. c. the number of insulin receptors on cells decreases. d. high blood glucose levels help protect the body against infection.

ANS: A

Giving patients extra insulin does not always decrease high blood glucose levels in stressed patients because the ratio of glucagon to insulin is increased. Insulin stimulates uptake of glucose by cells; it does not stimulate glucose production. Stress does not change the number of insulin receptors on cells. High blood glucose levels tend to increase risk of infection rather than protecting the body against infection.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 331 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. During stress and recovery, it is especially important that patients achieve adequate intakes of a. iron, folate, and vitamin B12.

b. vitamin C, vitamin A, and zinc. c. potassium, thiamine, and niacin. d. vitamin K, vitamin D, and calcium.

ANS: B

Adequate intakes of vitamin C, vitamin A, and zinc are especially important during stress and recovery. Needs for most micronutrients increase, but these three are especially important.

Vitamin C is needed for collagen formation for wound healing. Vitamin A and beta-carotene are important for healing of epithelia and as antioxidants. Zinc increases the tensile strength of healing wounds.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 334 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 338-339

18. The activity factor used to estimate energy requirements for patients prescribed bed rest is a. 1.1. b. 1.2. c. 1.3. d. 1.5.

ANS: B

For patients on bed rest, basal energy expenditure should be multiplied by an activity factor of 1.2 to estimate energy needs.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 332

19. If someone has a limited food budget and becomes malnourished because they only eat one

small meal a day, they would have a. primary malnutrition. b. secondary malnutrition. c. anorexia nervosa. d. iatrogenic malnutrition.

ANS: A

Eating only one small meal a day results in inadequate intake of nutrients; this is primary malnutrition. Secondary PEM results from inadequate nutrient consumption caused by some disease state that impairs food consumption, interferes with nutrient absorption, or increases nutritional requirements. Anorexia nervosa refers to voluntary limitation of food intake because of a distorted body image. Iatrogenic malnutrition refers to poor food intake in hospitalized patients because of hospital routines including tests and treatments.

PTS: 1 DIF: Cognitive Level: Application REF: p. 334 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. If a patient has very low levels of serum visceral proteins and poor wound healing but does

not look overtly malnourished, they are likely to have a. hyperglycemia. b. refeeding syndrome. c. kwashiorkor. d. marasmus.

ANS: C

Low serum levels of visceral proteins and poor wound healing in a patient with normal fat and somatic protein stores are signs of kwashiorkor, an acute form of protein-energy malnutrition.

Marasmus refers to a more chronic form of protein-energy malnutrition in which muscle and fat stores are depleted but visceral protein levels remain normal. Hyperglycemia would not cause low serum levels of visceral proteins, although it may contribute to poor wound healing and risk of infection. Symptoms of refeeding syndrome include malabsorption, cardiac insufficiency, congestive heart failure, respiratory distress, convulsions, and coma.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 335-336 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. For individuals with marasmus, overly aggressive repletion of nutrients may cause a. dumping syndrome. b. refeeding syndrome. c. nausea and vomiting. d. rapid increases in body fat.

ANS: B

Reintroducing nutrients too quickly to someone with marasmus can result in metabolic complications known as refeeding syndrome. Dumping syndrome occurs in patients who have undergone removal of all or part of their stomach. Nausea and vomiting is not usually caused by refeeding. Overly aggressive refeeding may lead to rapid increases in weight, but these would be caused by fluid retention not increases in body fat.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 335-336 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 22. During refeeding of a patient with protein-energy malnutrition, it is important to provide

adequate amounts of a. iron, folate, and vitamin B12. b. vitamin C, vitamin A, and zinc. c. calcium, vitamin D, and vitamin K.

d. phosphorus, potassium, and magnesium.

ANS: D

Increases energy and protein intakes trigger rapid anabolism in the starved body. The anabolism requires large amounts of phosphorus, potassium, and magnesium. If these nutrients are not available in adequate amounts, blood levels fall, causing various cardiac problems and cellular hypoxia. Other nutrients are also important, but do not need to be provided in amounts exceeding the DRI. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 335 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 23. When refeeding patients with protein-energy malnutrition, it is important to limit intake of a. fluid. b. sodium. c. potassium. d. phosphorus.

ANS: B

When refeeding patients with protein-energy malnutrition, it is important initially not to give them too much sodium. This can lead to a rapid expansion of extracellular fluid volume and fluid retention. Adequate fluid intake is important. During refeeding, patients need extra potassium and phosphorus to support anabolism.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 335

24. Multiple organ dysfunction syndrome (MODS) usually results in a. a hypermetabolic state. b. a hypometabolic state. c. marasmus. d. kwashiorkor.

ANS: A

MODS usually results in a stress response and a hypermetabolic state. Marasmus or kwashiorkor may result if the patient is already poorly nourished or if nutrition support is inadequate, but protein-energy malnutrition is not generally a result of MODS. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 331 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. Patients with multiple organ dysfunction syndrome (MODS) benefit most from _____

feedings. a. oral b. enteral c. central parenteral d. peripheral parenteral ANS: B

Patients with MODS benefit from enteral feedings to maintain integrity and health of the gastrointestinal tract. These feedings may be oral or enteral tube feedings, depending on the patient’s ability to eat. Parenteral nutrition does not have the same effect in maintaining the gut.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 331 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 26. After surgery, patients may resume oral intake when a. they have bowel sounds. b. their appetite returns. c. they are able to sit upright. d. their blood glucose level is normal.

ANS: A

After surgery, patients may resume oral intake when they have bowel sounds, because this indicates that their 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 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 336 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 27. Optimal recovery from surgery is promoted by a. use of enteral tube feedings to supplement oral intake. b. initiation of parenteral nutrition support immediately after surgery. c. use of a clear liquid diet for at least 24 to 48 hours to reduce intestinal stress. d. progression of the diet from liquids to solid foods as quickly as is reasonable.

ANS: D

Optimal recovery from surgery is promoted by progression of the diet from liquids to solid foods as quickly as is reasonable to promote optimal nutrient intake. Most patients do not need to supplement their oral diet with enteral tube feedings or parenteral nutrition support. A clear liquid diet should be used for as short a time as possible because it is not necessary to reduce intestinal stress.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 336 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 28. A burn that destroys the entire epidermis, dermis, and underlying subcutaneous tissue is

classified as 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 is a third-degree burn. First-degree burns involve only the epidermis. Second-degree burns involve the epidermis and dermis. Nonthermal burns are caused by electricity, chemicals, or radiation and may be first, second, or third degree.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 336-339 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. During the first 24 to 48 hours after a major burn, the focus of nutrition care is a. provision of adequate protein. b. prevention of nausea and vomiting. c. replacement of fluids and electrolytes. d. education concerning nutrient needs.

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 is important long term, but is not the first priority in this early treatment period. Patients do not usually experience nausea and vomiting.

Patients are usually hospitalized for a long period after a major burn and do not need education concerning their nutrient needs while they are receiving acute care.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 337

30. Energy needs of burned patients are influenced by the a. patient’s activity level. b. patient’s emotional stress level. c. percentage of total body surface area (TBSA) 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, 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.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 337-338

Chapter 16: Interactions: Complementary and Alternative Medicine, Dietary Supplements, and Medications Test Bank MULTIPLE CHOICE 1. If an individual has a back problem and seeks treatment using 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) used at the same time as conventional medicine (spine clinic). Traditional medicine would mean only attending 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 using scientific methods. Alternative medicine replaces traditional Western methods with non-Western healing approaches.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 342-346 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 2. The merging of conventional therapies with established complementary and alternative

medicine is known as _____ medicine. a. alternative b. integrative c. naturopathic d. homeopathic ANS: B

The merging of conventional therapies with established complementary and alternative medicine is known as integrative medicine. Alternative medicine replaces conventional therapies with non-Western healing methods. Naturopathic medicine is based on the use of the body’s natural healing forces to recover from disease and to achieve wellness. Homeopathic medicine is an alternative medical system in which a small amount of a diluted substance is prescribed to relieve symptoms for which the same substance, given in larger amounts, will cause the same symptoms.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 343 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 3. Traditional Chinese medicine is based on balance and restoration of a. natural immunity. b. yin and yang forces. c. natural healing forces. d. body, mind, and spirit.

ANS: B

Traditional Chinese medicine is based on balance and restoration of yin and yang forces. Qi gong enhances circulatory and immune function. Naturopathic medicine uses the body’s natural healing forces. Ayurveda focuses on diet and herbal remedies that use body, mind, and spirit for healing.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 343 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 4. A macrobiotic diet may help support recovery of individuals with cancer when used along

with conventional cancer treatments because it

a. b. c. d.

is high in protein, minerals, and vitamins. restricts intake of carcinogens and mutagens. is low in fat and high in fiber and plant foods. starves cancer cells while nourishing healthy cells.

ANS: C

A macrobiotic diet is low in fat and high in fiber and plant foods, which may help recovery of individuals with cancer when combined with conventional cancer treatments. It may be high in minerals and vitamins, but is generally low in protein. It is believed to be low in toxins, but is not necessarily low in carcinogens and mutagens. It does not change the availability of nutrients for cancer cells versus healthy cells.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: p. 345

5. To provide a nutritional ―safety net,‖ patients may be encouraged to take a

multivitamin/multimineral supplement that contains a. specific nutrients which cannot be obtained from the food supply in adequate amounts. b. 100% or less of the Dietary Reference Intakes (DRIs) for most micronutrients. c. at least 100% of the DRIs for most micronutrients. d. specific nutrients that are found to be lacking in their diet using dietary analysis.

ANS: B

Patients may be encouraged to take a multivitamin/multimineral supplement that contains 100% or less of the DRIs for most micronutrients to help provide a nutritional ―safety net.‖ Most people can obtain sufficient nutrients from food if the diet is carefully planned.

Supplementation of amounts exceeding 100% of the DRIs could cause nutrient imbalances or toxicity. Some subgroups of the population may be advised to consume supplements of specific nutrients, but this type of ―safety net‖ recommendation is based on age, gender, and other factors, rather than individual nutrient analysis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 346 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 6. The Dietary Supplement Health and Education Act (DSHEA) of 1994 considers dietary

supplements to be a. foods. b. drugs. c. nutrients. d. food additives.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 346-347 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. Dietary supplements are regulated by the a. Centers for Disease Control and Prevention (CDC).

b. Environmental Protection Agency (EPA). c. U.S. Food and Drug Administration (FDA). d. U.S. Department of Agriculture (USDA).

ANS: C

Dietary supplements are regulated by the FDA. Foods regulated by USDA include meat and poultry; CDC monitors outbreaks of foodborne illness; and EPA monitors water safety.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 347 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 8. Before a manufacturer can distribute a product that contains a new dietary ingredient, it must

provide data that demonstrate a. the safety and efficacy of the product. b. that the product is distinct from other available products. c. that the quality of the product can be maintained consistently. d. that the product has been safely used by study subjects for at least 2 years.

ANS: A

Before manufacturers distribute products that contain new dietary ingredients, they must provide data to the FDA that demonstrates the safety and efficacy of the product. The product does not need to be distinct from other available products. The FDA is concerned with safety rather than quality. Safety does not need to be demonstrated over a specific length of time.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 347 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 9. Foods that contain physiologically active food components are called a. probiotics. b. functional foods. c. dietary supplements. d. complementary foods.

ANS: B

Functional foods contain physiologically active food components. Probiotics contain live microorganisms thought to be beneficial to the body. Dietary supplements contain natural or synthetic nutrients in an isolated form. ―Complementary‖ is used to describe nontraditional therapies used alongside conventional treatments, rather than to describe foods.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 348 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 10. 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 should be discussed with a physician or pharmacist. Taking the herbal preparation separately from drugs may not help, depending on how long the drug(s) and herb(s) remain active in the body.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 348-351 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 11. 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 they 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 FDA, not by the USDA. PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 348-351

12. Drug-drug or nutrient-drug interactions are likely to occur if the number of medications and/or

supplements used by a patient is _____ or more. a. 3 b. 5 c. 8 d. 10 ANS: C

The rule of eight states that if a patient uses more than eight medications and/or supplements, they are likely to have some drug-drug or nutrient-drug interactions.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 348 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 13. Unintended effects of drugs are called a. risks. b. side effects. c. secondary benefits. d. complementary effects.

ANS: B

Unintended effects of drugs are called side effects; they may be adverse or advantageous.

Risks are unwanted adverse outcomes that may be associated with drugs. Secondary benefits are advantageous effects of the drug beside its original intended purpose. ―Complementary‖ is used to describe use of non-traditional therapies alongside conventional treatments; it is not used to describe drug effects.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 348 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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 following an organ transplant. 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 349-351 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. If a patient with depression takes a selective serotonin reuptake inhibitor (SSRI), the nurse

may want to ask them about use of herbal products because of potential interactions if they are 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. PTS: 1 DIF: Cognitive Level: Application REF: p. 348 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 16. If a patient with arthritis develops iron-deficiency anemia, he or she should be asked about use

of a. b. c. d.

alcoholic beverages. stool softeners and laxatives. caffeinated foods and beverages. nonsteroidal antiinflammatory drugs.

ANS: D

Nonsteroidal antiinflammatory drugs can cause intestinal bleeding, which may lead to iron-deficiency anemia. Alcoholic beverages, stool softeners, laxatives, and caffeine are not common causes of iron-deficiency anemia.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 351-352 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. Nurses should ask patients about their use of over-the-counter medications because a. they 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 352-354 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. Most drug absorption occurs in the a. esophagus. b. stomach. c. small intestine. d. large intestine.

ANS: C

Most drug absorption occurs in the small intestine. Drugs disintegrate and dissolve in gastric juices in the stomach, but most are not absorbed here. Nothing is absorbed in the esophagus.

Generally only water and a few nutrients are absorbed in the large intestine; some drugs can be absorbed from the rectum if they are administered as rectal suppositories.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 354 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. Compared with when a drug is taken on an empty stomach, if it is taken with food it will be a. excreted more slowly. b. excreted more quickly. c. absorbed more slowly. d. absorbed more quickly.

ANS: C

Food delays the rate at which the drug leaves the stomach and so it enters the small intestine more gradually and is absorbed more slowly. Drugs are excreted by the kidneys, so the presence of food in the stomach does not affect the rate of drug excretion.

PTS: 1 DIF: Cognitive Level: Application REF: p. 354 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. Drugs used to lower serum cholesterol levels may decrease absorption of a. minerals. b. amino acids.

c. fat-soluble vitamins. d. water-soluble vitamins.

ANS: C

Antihyperlipidemic drugs may decrease absorption of fat-soluble vitamins because they bind fat-soluble vitamins and bile making them unavailable to the body. These drugs also lower absorption of iron, vitamin B12, and folate, but do not affect absorption of other minerals and water-soluble vitamins. Absorption of amino acids is not affected by these drugs.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 354 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. Older adults may be at risk for potassium depletion if they use both a. certain diuretics and laxatives. b. decongestants and antihistamines. c. beta blockers and cholesterol-lowering drugs. d. antacids and nonsteroidal antiinflammatory drugs.

ANS: A

Potassium-depleting diuretics may cause potassium deficiency, especially if used in combination with laxatives that can also cause potassium loss. Decongestants, antihistamines, beta blockers, cholesterol-lowering drugs, antacids, and nonsteroidal antiinflammatory drugs do not have a significant effect on potassium status.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 354 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. If a patient is taking a drug that causes nausea, he or she may be advised to a. drink liquids only. b. eat only starchy and bland foods. c. eat spicy foods to stimulate the appetite. d. drink liquids between rather than with meals.

ANS: D

Drinking liquids between rather than with meals can help reduce nausea. Drinking liquids only may increase nausea. Reactions to starchy, bland, and spicy foods are very individual and these foods do not necessarily decrease or increase nausea.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 354-357 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 23. If a patient is taking a drug that causes dry mouth, he or she may be advised to a. choose soft, moist foods. b. use mouthwash between meals. c. drink liquids only until the problem resolves. d. choose dry foods to stimulate saliva production.

ANS: A

Soft, moist foods are easier to eat for patients with dry mouths because they do not require saliva to swallow. Using mouthwash between meals may further dry the mouth. Drinking only liquids may help with the dry mouth but is likely to result in inadequate nutrient intake. Dry foods do not stimulate saliva production and a patient with a dry mouth will be unlikely to be able to eat them.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 352-354 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 24. A meal that should not be eaten by a patient who takes a monoamine oxidase inhibitor

(MAOI) is a. vegetable omelet with grapefruit juice. b. salami and parmesan cheese sandwich. c. split pea and ham soup with crackers. d. beef and vegetable stir fry with rice.

ANS: B

Patients who take MAOIs should avoid foods that contain tyramine, including salami and aged cheeses such as parmesan. Grapefruit or grapefruit juice should be avoided by patients who take certain other drugs, but does not affect MAOIs. None of the other foods listed are high in tyramine.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 356-357

25. If a patient uses a monoamine oxidase inhibitor (MAOI) and they develop a headache, heart

palpitations, and high blood pressure, they may have eaten food containing a. caffeine. b. licorice. c. alcohol. d. tyramine.

ANS: D

Monoamine oxidase inactivates tyramine, found in some foods. Without monoamine oxidase, tyramine increases release of norepinephrine, which causes potentially dangerous increases in blood pressure, heart palpitations, pallor, and headache. Caffeine, licorice, and alcohol cause drug-nutrient interactions with other drugs.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 356-357

26. A fruit juice that may increase the bioavailability of certain drugs and may have serious

consequences is _____ juice. a. orange b. cranberry c. pineapple d. grapefruit ANS: D

Grapefruit or grapefruit juice increases bioavailability and therefore increases beneficial or adverse effects of several drugs. Orange, cranberry, and pineapple juices do not have this effect.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 357-358

27. Individuals who are taking the anticoagulant warfarin to prevent formation of blood clots

should limit their intake of foods high in vitamin a. A. b. K. c. B12. d. D. ANS: B

Warfarin is a vitamin K antagonist and prevents activation of the storage form of vitamin K. High intakes of vitamin K reduce the efficacy of the drug. Vitamins A, B 12, and D do not affect the action of warfarin.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 356-357 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 28. When administering medications to patients receiving tube feedings, to ensure that the correct

form of the medication is used and that it is compatible with the enteral formula, the best person to consult is the a. physician. b. pharmacist. c. registered nurse. d. registered dietitian.

ANS: B

Pharmacists have the most comprehensive knowledge about drug-drug and drug-nutrient interactions. The registered dietitian also has some expertise about drug-nutrient interactions.

Physicians and nurses generally have less knowledge on this topic.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 362-363 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 29. When administering medications to tube-fed patients, crushed medications should be mixed

with a. water. b. fruit juice. c. diluted enteral formula. d. full-strength enteral formula.

ANS: A

Crushed medications should be mixed with water when given to tube-fed patients. The feeding tube should also be flushed with water before and after administration of the drug to prevent any mixing with formula. Medications should not be mixed with fruit juice or with diluted or full-strength enteral formula because this may alter the bioavailability of the drug or nutrients in the formula or could clog the feeding tube.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 362-363 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 30. Health care providers need to ask specific questions to find out about patients’ use of herbal

products because a. many individuals do not consider these to be drugs or supplements. b. patients may not be aware of the ingredients in supplements that they take. c. patients may be spending unnecessary money on products that have no efficacy. d. patients generally do not want medical staff to know that they use herbal products.

ANS: A

It is important to ask specific questions to find out about patients’ use of herbal products because many individuals consider these to be natural and harmless and do not consider them to be drugs or supplements. Patients are usually aware of at least the main ingredients in supplements that they take. Health care providers may be able to help patients avoid spending money on products that have no efficacy, but they are more concerned about the safety of these products and potential interactions with drugs and nutrients. Most patients are open about their use of herbal products unless they perceive that the health care provider disapproves of their use.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 358 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

Chapter 17: Nutrition for Disorders of the Gastrointestinal Tract Test Bank MULTIPLE CHOICE 1. The purpose of diet therapy for patients with dysphagia is to avoid a. sepsis. b. reflux. c. vomiting. d. aspiration.

ANS: D

Diet therapy for patients with dysphagia centers around providing food and beverages in a form that can be swallowed without entering the lungs (i.e., preventing aspiration). Aspiration of food may lead to pneumonia, but not usually sepsis. Patients with dysphagia have difficulty swallowing, but not usually with reflux or vomiting.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 371-372 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 2. The three stages of swallowing are the _____ phases. a. early, middle, and late b. oral, laryngeal, and epiglottal c. bolus, pharyngeal, and posterior d. oral, pharyngeal, and esophageal ANS: D

The three stages of swallowing are the oral, pharyngeal, and esophageal phases, referring to where each stage occurs. The larynx and epiglottis are not involved in swallowing.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 371-373 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 3. If a patient has difficulty swallowing, the best position for meals is a. lying flat. b. sitting upright. c. lying on one side. d. leaning backward slightly.

ANS: B

The safest eating position for someone who has trouble swallowing is sitting upright. This allows gravity to help food pass along the esophagus. Leaning back slightly would make it easier for food to enter the airway. It is difficult to swallow when lying flat, even for patients without dysphagia; for patients with dysphagia this position would be very likely to cause aspiration. Lying on one side is less dangerous than lying flat, but is still dangerous for patients with dysphagia.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 372

4. A nurse may suspect that a patient has difficulty swallowing if he or she a. requests frequent snacks between meals. b. coughs frequently before and after swallowing. c. prefers to drink using a straw rather than from an open cup. d. tends to gulp beverages and eat foods without adequate chewing.

ANS: B

Coughing frequently before and after swallowing may indicate difficulty swallowing.

Requesting frequent snacks between meals is simply a sign of hunger. Preference for using straws is not linked with dysphagia. Patients with dysphagia tend to pocket food in their mouths and chew longer than necessary rather than swallowing foods too quickly.

PTS: 1 DIF: Cognitive Level: Application REF: p. 372 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. If it is left untreated, gastroesophageal reflux disease (GERD) may lead to a. esophagitis. b. hiatal hernia. c. peptic ulcer disease. d. dumping syndrome.

ANS: A

Untreated GERD may lead to esophagitis, inflammation of the lower esophagus, because stomach acid irritates the esophageal mucosa. Hiatal hernia may cause GERD, but not the reverse. Peptic ulcer disease and dumping syndrome are not related to GERD. PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning

REF: p. 375

MSC: Client Needs: Physiological integrity 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 with spicy salsa.

ANS: C

Foods and beverages that relax the lower esophageal sphincter (allowing stomach contents to back up) include alcohol, carminatives (oil of peppermint or spearmint, garlic, onion), chocolate, high-fat foods (fried foods, high-fat meats, cream sauces, gravies, margarine/butter, cream, oil, salad dressings). Fried chicken and pasta salad are both 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.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 376

7. A patient has a higher risk of peptic ulcer disease (PUD) if they are a chronic user of a. certain antibiotics. b. laxatives and stool softeners. c. magnesium-aluminum antacids. d. nonsteroidal antiinflammatory drugs.

ANS: D

Risk of PUD increases with chronic use of nonsteroidal anti-inflammatory drugs. Certain antibiotics and magnesium-aluminum antacids may decrease risk of PUD. Laxatives and stool softeners do not affect risk of PUD. PTS: 1 DIF: Cognitive Level: Application REF: p. 377 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. Nutrition therapy for peptic ulcers should be individualized, but most patients should a. eat a diet high in fiber. b. eat a diet low in fat. c. avoid sources of caffeine. d. drink several glasses of milk daily.

ANS: C

Most patients with peptic ulcers should avoid foods and beverages that contain caffeine.

Drinking several glasses of milk daily used to be recommended but has not been proven to be helpful. Eating a diet high in fiber and low in fat is recommended for good health but does not have any specific benefit for patients with peptic ulcers.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 378

9. Patients who have undergone total or partial gastrectomy may experience

a. b. c. d.

esophagitis. lactose intolerance. peptic ulcer disease. dumping syndrome.

ANS: D

Patients who have undergone total or partial gastrectomy 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. Esophagitis and peptic ulcers are not necessarily more common after gastrectomy. Lactose intolerance is not more likely to occur because lactase is produced in the small intestine, which remains intact after gastrectomy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 378 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. Nutrition therapy for dumping syndrome includes a. drinking thickened liquids and increasing protein intake. b. avoiding caffeinated beverages and decreasing fat intake. c. avoiding snacks between meals and increasing intake of high-calcium foods. d. drinking liquids between meals and limiting intake of simple carbohydrates.

ANS: D

Nutrition therapy for dumping syndrome includes drinking liquids between meals and limiting intake of simple carbohydrates. Drinking thickened liquids is recommended for patients with dysphagia. Avoiding caffeinated beverages and decreasing fat intake is recommended for patients with gastroesophageal disease. Avoiding snacks between meals may help someone who wants to lose weight and increasing intake of high-calcium foods would help prevent or treat osteoporosis.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 378

11. Patients with celiac disease should avoid foods that contain a. rice, soy, and peanuts. b. maize, corn, and flax. c. wheat, rye, and barley. d. rice, quinoa, and millet.

ANS: C

Patients with celiac disease need to avoid foods that contain gluten, found in wheat, rye, and barley. Rice, soy, peanuts, maize, corn, flax, quinoa, and millet do not contain gluten.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 12. An example of a meal that may contain gluten is a. baked chicken breast with rice. b. pork chop with sweet potatoes. c. grilled steak with baked potato. d. meatloaf with mashed potatoes.

REF: pp. 378-380

ANS: D

Meatloaf is often made with breadcrumbs which contain 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 cooking.

PTS: 1 DIF: Cognitive Level: Application REF: p. 380 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 13. Individuals with lactose intolerance may tolerate foods that contain small amounts of lactose

if they are a. consumed with other foods. b. well cooked rather than raw. c. consumed with foods that contain vitamin D. d. derived from goat’s milk rather than cow’s milk.

ANS: A

Individuals with lactose intolerance may tolerate foods that contain small amounts of lactose if they are consumed with other foods. Cooking foods that contain lactose does not improve tolerance. Vitamin D does not improve lactose tolerance. Goat’s milk is not better tolerated than cow’s milk by people with lactose intolerance; both contain lactose.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 380-381

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 they have low intakes because they avoid milk.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 15. Major symptoms of inflammatory bowel disease include a. nausea and vomiting. b. constipation and flatulence. c. diarrhea and abdominal pain. d. weight gain and excessive thirst.

ANS: C

REF: p. 381

Inflammatory bowel disease causes diarrhea and abdominal pain. Nausea and vomiting are not common because this disease affects the small and large intestine and not the stomach.

Malabsorption produces diarrhea rather than constipation. Patients are more likely to lose weight (because of malabsorption) rather than gain weight. Excessive thirst is not associated with inflammatory bowel disease.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 381 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. The basic meal plan for patients with inflammatory bowel disease should be a. high protein, low fat. b. low kcal, high fat. c. high kcal, low protein. d. high kcal, high protein.

ANS: D

Patients with inflammatory bowel disease benefit from a diet high in kcals and protein to compensate for malabsorption. Fat intake should be moderate to provide adequate kcals within a healthful diet.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 381

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 381 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 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 due to malabsorption.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

REF: pp. 381-384

19. When the entire colon and rectum have been removed, the patient would have a. a colostomy. b. constipation. c. an ileostomy. d. dumping syndrome.

ANS: C

When the entire colon and rectum have been removed, the patient would have an ileostomy. A colostomy is creation of an artificial anus on the abdominal wall. Removal of the colon and rectum causes fluid effluent, the opposite of constipation. Dumping syndrome is caused by a partial or total gastrectomy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 381-384 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. As effluent progresses through the colon, it becomes more a. solid. b. liquid. c. acidic. d. alkaline.

ANS: A

As effluent progresses through the colon, water is absorbed and it becomes more solid.

Alkalinity and acidity do not generally change.

PTS: 1 DIF: Cognitive Level: Application REF: p. 384 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. Short-bowel syndrome occurs in patients who have undergone removal of large portions of

the a. b. c. d.

colon. stomach. large intestine. small intestine.

ANS: D

Patients who have undergone removal of large portions of the small intestine have short bowel syndrome. Removal of the colon results in a colostomy; removal of the stomach causes dumping syndrome; removal of the large intestine results in an ileostomy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 384 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. Patients with short bowel syndrome sometimes require parenteral nutrition support to achieve

adequate intakes of nutrients and kcals. It is important for them to return to enteral feedings as soon as possible to prevent a. loss of sense of taste. b. loss of lean body mass.

c. atrophy of the intestinal tract. d. essential fatty acid deficiency.

ANS: C

It is important for patients with short bowel syndrome to return from parenteral to enteral feedings as soon as possible to prevent atrophy of the intestinal tract. Sense of taste is not usually affected by use of parenteral nutrition. Lean body mass and essential fatty acid status are maintained as long as adequate nutrients are administered.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 384 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 23. Infection and inflammation of pouchlike protrusions from the muscular layer of the colon is

known as a. diverticulitis. b. diverticulosis. c. Crohn’s disease. d. inflammatory bowel disease.

ANS: A

Infection and inflammation of pouchlike protrusions in the colon is known as diverticulitis. If the protrusions are not inflamed or infected, the condition is called diverticulosis. Crohn’s disease is an inflammatory disorder in the small and/or large intestine. Inflammatory bowel disease includes Crohn’s disease and chronic ulcerative colitis, an inflammatory disorder in the large intestine only.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 384-385 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. For patients with diverticulosis who are not experiencing active inflammation and infection,

the recommended diet is a. pureed. b. low in fiber. c. high in fiber. d. high in protein.

ANS: C

For patients with diverticulosis who are not experiencing active inflammation and infection, the recommended diet is high in fiber to prevent straining during defecation. During acute episodes of inflammation and infection, oral intake may be withheld to allow bowel rest and gradually resumed as symptoms subside. A pureed diet, low-fiber diet, and high-protein diet are not used for patients with diverticulosis.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: pp. 384-385

25. When 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 are generally high in 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 be higher in nutrients in general. Requirements for fat-soluble vitamins are not generally affected by fiber intake.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 385

26. Gas in the colon may often be caused by a. consumption of carbonated beverages. b. swallowing air while eating or drinking. c. fermentation of foods by intestinal bacteria. d. passage of gas into the colon through the colon wall.

ANS: C

Gas in the colon is often caused by fermentation of foods by intestinal bacteria. Consumption of carbonated beverages and swallowing air while eating or drinking causes belching, but not gas in the colon. Some gas is absorbed into the body through the colon wall, but not the other way around.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 385 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 27. A common dietary cause of constipation is a. megacolon or Hirschsprung’s disease. b. inadequate intakes of dietary fiber and fluids. c. chronic intake of excessive amounts of caffeine. d. inadequate intakes of fruit and vegetable juices.

ANS: B

A common dietary cause of constipation is inadequate intake of dietary fiber and fluids.

Caffeine does not cause constipation. Fruit and vegetable juices add fluid, but not fiber, so they do not decrease constipation. Megacolon or Hirschsprung’s disease is a nondietary and rare cause of constipation.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity 28. An example of a high-fiber breakfast is a. bagel and cream cheese with juice. b. cornflakes with milk and sliced banana. c. scrambled eggs with biscuits and honey. d. oatmeal and whole-wheat toast with jam.

ANS: D

REF: pp. 385-386

An example of a high-fiber breakfast is oatmeal and whole wheat toast with jam because both the oatmeal and toast are whole grains and therefore high in fiber. Bagels are usually made from refined flour; both refined flour and juice lose dietary fiber during processing.

Cornflakes are made from refined corn and bananas are only fair sources of fiber. Eggs are animal products and so do not contain dietary fiber. Biscuits are made from refined flour.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

REF: p. 388

29. Chronic diarrhea is usually caused by a. foodborne pathogens. b. inadequate protein intake. c. intestinal irritation or malabsorption. d. excessive intake of dietary fiber.

ANS: C

Chronic diarrhea is usually caused by gastrointestinal irritation or malabsorption. Foodborne pathogens are a common cause of acute diarrhea. Inadequate protein intake and excessive intake of dietary fiber do not usually cause diarrhea.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 386 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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, 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.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 386

Chapter 18: Nutrition for Disorders of the Liver, Gallbladder, and Pancreas Test Bank MULTIPLE CHOICE 1. A common disorder in patients who abuse alcohol is a. diarrhea. b. fatty liver. c. cholecystitis. d. viral hepatitis.

ANS: B

Fatty liver is the earliest form of alcoholic liver disease. Alcohol abuse does not cause diarrhea or cholecystitis. Viral hepatitis is caused by viral infection.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 390 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. It is possible to reverse fatty infiltration of the liver by a. losing weight. b. reducing fat intake. c. increasing protein intake. d. removing the underlying cause.

ANS: D

Fatty infiltration of the liver can be reversed by removing the underlying cause. This may be alcohol abuse, excessive kcal intake, obesity, complications of drug therapy (e.g., corticosteroids, tetracyclines), total parenteral nutrition, pregnancy, diabetes mellitus, inadequate intake of protein (e.g., kwashiorkor), infection, or malignancy. Losing weight and reducing fat intake will only help if the underlying cause for that individual is related to weight and fat intake. Increasing protein intake will only help if the cause is kwashiorkor.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 390 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 3. A type of hepatitis that is transmitted via the fecal-oral route is hepatitis a. A. b. B. c. C. d. D. ANS: A

Hepatitis A is transmitted via the fecal-oral route. Hepatitis B and D are transmitted parenterally or sexually. Hepatitis C is transmitted via blood or serum (sharing of contaminated needles, razors, toothbrushes, nail files, barber’s scissors, tattooing equipment, body piercing, or acupuncture needles).

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 391 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 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. Hepatitis E causes flu-like aches and pains, including headache. Dehydration may occur if patients have nausea and vomiting.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 392-393 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

5. The recommended diet for patients with hepatitis is a well-balanced diet with a. low protein content. b. supplemental electrolytes. c. no alcoholic beverages. d. limited amounts of alcohol.

ANS: C

Total abstinence from alcohol is imperative for patients with hepatitis. The diet should be high in protein and kcals; supplemental electrolytes are not generally needed.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 390

6. An individual may be at risk for hepatitis E 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

Hepatitis E 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 prepared by street vendors, are not common sources.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 393-394 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 7. For patients with hepatitis, a significant barrier to maintaining an adequate intake of kcals is a. malabsorption. b. fat intolerance. c. loss of appetite. d. increased metabolic rate.

ANS: C

Patients with hepatitis often have very little appetite, which makes it hard for them to achieve adequate oral intake of nutrients. Patients with hepatitis do not usually have problems with malabsorption, fat intolerance, or increased metabolic rate.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Implementation MSC: Client Needs: Physiological integrity

REF: p. 394

8. In cirrhosis of the liver, liver cells a. decrease in number and increase in size. b. are displaced by growth of tumors. c. become disconnected because of breakdown of connective tissue. d. are replaced by accumulations of fibrous connective tissue and fat.

ANS: D

In cirrhosis of the liver, liver cells are replaced by accumulations of fibrous connective tissue and fat. The cells die, so they do decrease in number, but do not increase in size. Liver tumors are caused by cancer, not cirrhosis. Cirrhosis does not cause breakdown of connective tissue.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 394 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. A low-fiber, soft diet is recommended for patients with a. hepatitis A. 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 hepatitis A should follow a high-protein, high-kcal diet; patients with cholelithiasis should follow a low-fat diet; patients with hepatic encephalopathy should restrict their protein intake.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 394

10. Patients with ascites should restrict their intake of a. protein. b. sodium. c. dietary fiber. d. saturated fat.

ANS: B

Patients with ascites should restrict their intake of sodium to limit fluid retention. Protein intake should not be restricted unless the patient has encephalopathy. Dietary fiber intake should only be limited if the patient has esophageal varices. Intake of saturated fat does not need to be limited.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 394

11. If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be

developing a. fatty liver. 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, as the brain is influenced by compounds that have been absorbed from the intestine and have not been metabolized by the liver. Fatty liver 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 does not usually cause confusion.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 394 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. Drugs that are used to treat hepatic encephalopathy include a. antidepressants. b. diuretics and steroids. c. neomycin and lactulose. d. laxatives and stool softeners.

ANS: C

Neomycin is an antibiotic used to sterilize the bowel to decrease the amount of urea that can be converted to ammonia. Lactulose is used to lower stool pH which traps ammonia in the colon. Antidepressants are ineffective because the mental problems associated with encephalopathy are related to metabolism rather than depression. Diuretics are used to treat ascites associated with cirrhosis, but are not used for encephalopathy. Steroids are not effective. Lactulose is used to lower stool pH, not for its laxative and stool softening effects.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Implementation MSC: Client Needs: Physiological integrity

REF: p. 395

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(n) a. alcoholic. b. light drinker. c. moderate drinker. d. heavy drinker.

ANS: C

Someone who drinks 1-2 drinks per day is considered a moderate drinker. A heavy drinker consumes 3 or more drinks daily. A light drinker is not defined. Alcoholism is a disabling addictive dependence on alcohol, usually characterized by intake of significantly more than 1-2 drinks daily.

PTS: 1 DIF: Cognitive Level: Application REF: p. 395 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 14. Moderate daily alcohol intake may help reduce risk of a. cancer. b. stroke. c. hypertension. d. heart disease.

ANS: D

Moderate alcohol intake may help reduce risk of heart disease. Risk of many types of cancer increases with increasing alcohol intake. Risk of hypertension increases with alcohol intake.

Risk of stroke is not linked to alcohol intake.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 395 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

15. If a patient with cirrhosis of the liver seems to be vulnerable to development of hepatic

encephalopathy, his or her diet may be supplemented with a formula that contains _____ acids. a. essential fatty b. essential amino c. aromatic amino d. branched-chain amino ANS: D

Patients who are vulnerable to development of hepatic encephalopathy may be given a formula that contains branched-chain amino acids and restricted aromatic amino acids to ensure adequate protein intake with minimal ammonia production. Essential fatty acids and essential amino acids do not help prevent hepatic encephalopathy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 395-396 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 16. An adequate kcal intake is especially important for patients with cirrhosis of the liver to

prevent a. muscle catabolism. b. development of ascites. c. essential fatty acid deficiency. d. loss of appetite and taste acuity.

ANS: A

Adequate intake of kcals helps prevent breakdown of muscle to provide energy in patients with cirrhosis of the liver. Adequate kcal intake does not prevent ascites, essential fatty acid deficiency, and loss of appetite and taste acuity.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 395-396 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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

Patients with end-stage liver disease often accumulate fluid due to 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 396 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. After liver transplantation, long-term nutrition management may need to be tailored to help

prevent a. weight loss, anorexia, and nausea. b. ascites, edema, and electrolyte imbalances.

c. cirrhosis, hepatic encephalopathy, and hepatic coma. d. excessive weight gain, hypertension, and hyperlipidemia.

ANS: D

Long-term nutrition management after a liver transplant needs to be tailored to help prevent excessive weight gain, hypertension, and hyperlipidemia. Weight loss, anorexia, and nausea do not usually occur. Ascites, edema, and electrolyte imbalances may occur immediately after the transplant, but do not usually persist long term. Cirrhosis, hepatic encephalopathy, and hepatic coma do not occur after a successful transplant.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 396-397 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 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. man who smokes and eats eggs for breakfast every day. 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, 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.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 397-398 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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 combined 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. Intake of excessive amounts of cholesterol and fat and bacterial infection are not associated with gallbladder disease.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 397-398 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. If a patient experiences chronic symptoms of cholelithiasis and cholecystitis, the

recommended nutrition therapy is a. a low-fat diet. b. gradual weight loss. c. increased fluid intake. d. a low-cholesterol diet.

ANS: A

A low-fat diet is used to treat painful symptoms associated with cholelithiasis and cholecystitis. Gradual weight loss may be beneficial in the long term, but will not decrease painful symptoms. Increased fluid intake and a low-cholesterol diet do not alleviate symptoms.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 398

22. After surgical removal of the gallbladder (cholecystectomy), long-term dietary

recommendations are a. a low-fat, low-cholesterol diet. b. high protein and fluid intakes. c. a well-balanced diet with no other restrictions. d. small, frequent meals to ensure adequate intake.

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 long term. High protein and fluid intakes and small, frequent meals are not needed.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 398

23. Pancreatitis results in a. excessive production of digestive enzymes and bicarbonate, causing duodenal

ulcers. b. decreased production of digestive enzymes and bicarbonate, causing malabsorption

of fats and proteins. c. increased production of pancreatic hormones, causing a decrease in blood glucose

levels. d. decreased production of pancreatic hormones, causing an increase in blood glucose

levels.

ANS: B

Pancreatitis causes decreased production of digestive enzymes and bicarbonate, causing malabsorption of fats and proteins. Duodenal ulcers do not occur. Pancreatitis affects mainly the exocrine pancreas, so blood glucose levels are unaffected.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 398-399 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. During acute episodes of pancreatitis, patients often require a. a clear liquid diet. b. a high-protein diet. c. a high-fat, high-kcal diet. d. enteral or parenteral nutrition.

ANS: D

During acute episodes of pancreatitis, patients often need enteral nutrition infused into the jejunum, further down the gut than would cause pancreatic stimulation. An oral feeding can cause pancreatic stimulation and acute pain.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: pp. 398-399

25. When patients with pancreatitis are able to tolerate enteral feedings, the recommended

formula is usually a _____ formula infused into the _____. a. low-fat elemental; jejunum. b. low-fat elemental; duodenum. c. high-kcal, high-protein; jejunum. d. high-kcal, high-protein; duodenum.

ANS: A

Enteral feedings for patients with pancreatitis should be low-fat elemental formulas infused into the jejunum to decrease pancreatic stimulation. High-kcal, high-protein formulas and infusion into the duodenum would both increase pancreatic stimulation.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: p. 399

26. Cystic fibrosis is caused by a. a genetic defect. b. cigarette smoking. c. bacterial infection. d. inadequate folate intake.

ANS: A

Cystic fibrosis is an autosomal recessive inherited disease (i.e., it is caused by a genetic defect). The lung problems seen in cystic fibrosis are not caused by smoking cigarettes.

Frequent lung infections are a symptom, rather than a cause of the disease. Inadequate folate intake is linked to increased risk of neural tube defects.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 399-400 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 27. 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-kcal diet, multivitamin supplements, and enzyme replacement therapy.

ANS: D

Patients with cystic fibrosis require a high-kcal 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. Patients have impaired secretion of enzymes, 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 intakes may exceed the DRI, but needs are met by increased food intake.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

REF: pp. 399-400

28. One of the most important tools for coping with the reality of a serious chronic disease such as

cystic fibrosis is a. having a sense of humor. b. avoiding talking about it. c. making friends only with others who have the same disease. d. making friends only with others who do not have the same disease.

ANS: A

A sense of humor is a helpful coping mechanism for patients with chronic diseases such as cystic fibrosis. Avoiding talking about it simply magnifies fears and causes isolation. It is probably helpful for patients to have friends who have the disease who can identify with its struggles and friends who do not have the disease who can provide a sense of normalcy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 400 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial integrity 29. Infants with cystic fibrosis a. should be fed specially designed infant formulas. b. should receive vitamin and mineral supplements. c. may be breastfed with use of enzyme replacement therapy. d. should delay introduction of weaning foods if they are underweight.

ANS: C

Infants with cystic fibrosis may be breastfed or fed infant formula along with enzyme replacement therapy. They may need supplemental fat and carbohydrate to add kcals, but do not need specially designed infant formulas or vitamin and mineral supplements. Guidelines for adding weaning foods are the same as for healthy infants.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Implementation MSC: Client Needs: Physiological integrity

REF: p. 399

30. A bottle of beer that contains 13 g of carbohydrates and 16 g of alcohol provides _____ kcals. 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 provide (13  4) + (16  7) = 52 + 112 = 164 kcals.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 401-403

Chapter 19: Nutrition for Diabetes Mellitus Test Bank MULTIPLE CHOICE 1. A person is diagnosed as having diabetes mellitus if his or her fasting blood glucose level on

two occasions is greater than _____ mg/dL. a. 90 b. 120 c. 126 d. 156 ANS: C

Diabetes mellitus is diagnosed as fasting blood glucose level >126 mg/dL on two occasions.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 405 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. Long-term complications of diabetes mellitus include a. arthritis, rheumatism, and osteoporosis. b. retinopathy, nephropathy, and neuropathy. c. impaired immunity and opportunistic infections. d. dermatitis, nephrotic syndrome, and detached retina.

ANS: B

Long-term complications of diabetes mellitus include retinopathy, nephropathy, and neuropathy. Diabetes mellitus can increase risk and severity of infection indirectly due to poor circulation and high blood glucose levels, but immunity is not impaired. Arthritis, rheumatism, osteoporosis, dermatitis, nephritic syndrome, and detached retina are not associated with diabetes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 405-406 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. The type of diabetes therapy that seems to be most effective in decreasing and delaying the

complications of diabetes is a. psychotherapy. b. intensive therapy. c. combined therapy. d. conventional therapy.

ANS: B

Intensive therapy is most effective in decreasing and delaying the complications of diabetes because it allows better control of blood glucose levels. Psychotherapy may help patients cope with psychological concerns about their disease, but will not delay complications.

Conventional therapy may help prevent complications if blood glucose levels are well controlled, but this is less likely than with intensive therapy. Combined therapy is not a recognized term.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 406 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 4. The three main symptoms of untreated type 1 diabetes mellitus are a. polyphagia, polyuria, and polydipsia. b. neuropathy, nephropathy, and retinopathy. c. confusion, loss of coordination, and headaches. d. fatigue, loss of appetite, and frequent infections.

ANS: A

Polyphagia, polyuria, and polydipsia are hallmarks of untreated type 1 diabetes mellitus.

Neuropathy, nephropathy, and retinopathy are long-term complications associated with diabetes mellitus. Confusion, loss of coordination, headaches, fatigue, and loss of appetite are not associated with diabetes mellitus. Patients with diabetes may be more susceptible to infection and make take longer to heal if their blood glucose levels are elevated and if they have impaired circulation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 407-411 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 411 | p. 416 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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 disease. Male gender, preference for sweet foods, recurrent viral infections, and stress are not risk factors for type 2 diabetes.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 413-414 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. In individuals with type 2 diabetes, insulin production is generally a. absent. b. normal. c. decreased. d. increased.

ANS: D

Insulin production is generally increased in individuals with type 2 diabetes. The body produces more insulin in an attempt to lower elevated blood glucose levels, but the insulin is not effective because the cells fail to respond to the insulin.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 413-415 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. Type 2 diabetes is becoming more prevalent in children, largely because of a. increased intakes of refined sugar. b. increased awareness and diagnosis. c. the increasing prevalence of overweight children. d. inheritance of a dominant gene that causes the disease.

ANS: C

Type 2 diabetes is becoming more prevalent in children because of the increasing prevalence of overweight children. This is related to decreased activity levels and increased intake of kcals in general, not just from refined sugar. Increased awareness and diagnosis may account for a small portion of the increase in prevalence, but this is not the major cause. There is no specific dominant gene that causes type 2 diabetes in children.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 424-425

TOP: Nursing Process: Assessment

MSC: Client Needs: Health promotion and

maintenance

9. For individuals with diabetes mellitus, glycosylated hemoglobin (HgbA1c) levels should be less than a. 6%. b. 7%. c. 8%.

d. 10%.

ANS: B For individuals with diabetes mellitus, glycosylated hemoglobin levels should be less than 7%. This indicates overall maintenance of acceptable blood glucose levels.

PTS: 1

DIF: Cognitive Level: Knowledge

REF: p. 410

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

10. The ethnic group that has the lowest prevalence of type 2 diabetes mellitus is a. Native Americans. b. African Americans. c. Hispanic Americans. d. non-Hispanic whites.

ANS: D Prevalence of type 2 diabetes mellitus is lowest among non-Hispanic whites. Native Americans, African Americans, Hispanic Americans all have a relatively high prevalence of type 2 diabetes mellitus.

PTS: 1

DIF: Cognitive Level: Knowledge

TOP: Nursing Process: Assessment

REF: p. 415

MSC: Client Needs: Health promotion and

maintenance

11. Exogenous insulin is a required part of treatment for all individuals with a. type 1 diabetes mellitus. b. type 2 diabetes mellitus. c. gestational diabetes. d. impaired glucose tolerance.

ANS: A All individuals with type 1 diabetes mellitus require treatment with exogenous insulin. Many individuals with type 2 diabetes are treated with diet and exercise or diet, exercise, and oral hypoglycemic medications; only the most severe cases require exogenous insulin. Insulin is sometimes, but not always, prescribed for individuals with gestational diabetes. Impaired glucose tolerance is treated with diet and exercise only.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 411

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological integrity

12. The main difference between the different types of exogenous insulin is a. their shelf life. b. the concentration of the preparation. c. the type of solvent used to carry the insulin. d. the length of time they take to act in the body.

ANS: D The main difference between the different types of exogenous insulin is the length of time they take to act in the body. Their shelf life, concentration, and type of solvent are standard for all types of insulin.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 411-412

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological integrity

13. Sulfonylureas and meglitinides decrease blood glucose levels by a. stimulating insulin secretion. b. slowing the rate of absorption of glucose. c. providing an exogenous source of insulin. d. improving insulin sensitivity.

ANS: A Sulfonylureas and meglitinides decrease blood glucose levels by stimulating insulin secretion.

Alpha-glucosidase inhibitors and biguanides slow the rate of absorption of glucose. No oral drugs provide an exogenous source of insulin. Biguanides and thiazolidinediones improve insulin sensitivity.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 416

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological integrity

14. Patients with diabetes mellitus should exercise at times when their blood glucose level is _____ mg/dL. a. between 90 and 110 b. between 100 and 160 c. between 100 and 200 d. less than 250

ANS: C Ideally, patients with diabetes mellitus should exercise when their blood glucose level is between 100 and 200 mg/dL.

PTS: 1

DIF: Cognitive Level: Knowledge

REF: pp. 412-413

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

15. To prevent hypoglycemia after exercise, patients with type 1 diabetes should a. decrease their 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 carbohydrate-based foods.

PTS: 1

DIF: Cognitive Level: Application

REF: pp. 412-413

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

16. Patients with type 2 diabetes are most likely to maintain good metabolic control if they 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 kcals, fat, and complex carbohydrate. Avoiding eating during the evening and at night may help control kcal 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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TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

17. 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 using self-monitoring of blood glucose levels. Glycosylated hemoglobin level does not show day-to-day variations in blood glucose level. Iron deficiency anemia is diagnosed by measuring total hemoglobin level in patients with and without diabetes.

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DIF: Cognitive Level: Comprehension REF: pp. 414-415

TOP: Nursing Process: Evaluation

MSC: Client Needs: Physiological integrity

18. 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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19. An individual with a blood glucose level of 40 mg/dL would have a. hypoglycemia. b. a normal blood glucose level. c. hyperglycemia. d. impaired glucose tolerance.

ANS: A Hypoglycemia occurs when blood glucose level falls below 50 mg/dL; therefore 40 mg/dL is hypoglycemia. Normal blood glucose levels are about 80 to 100 mg/dL, although levels may increase to 140 mg/dL after meals. Blood glucose levels above 180 mg/dL would be considered hyperglycemia. Impaired glucose tolerance is diagnosed when fasting blood glucose levels are >100 mg/dL but <126 mg/dL.

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20. 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. Accidentally taking a double dose of insulin would cause hypoglycemia.

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21. Ketones accumulate in the blood during diabetic ketoacidosis because of increased metabolism of _____ and decreased metabolism of _____. a. fatty acids; glucose b. glucose; fatty acids c. amino acids; glucose d. glucose; amino acids

ANS: A Ketosis occurs because of an abnormal accumulation of ketones caused by metabolism of fatty acids for energy with decreased metabolism of glucose due to lack of insulin. Amino acid metabolism is not generally involved in diabetic ketoacidosis.

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22. 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 their breath, they may have a. hepatic encephalopathy. b. diabetic ketoacidosis (DKA). 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 DKA. However, with DKA the breath smells fruity because of ketones. If this is absent, 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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23. 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 less a. potatoes and/or rolls. b. chicken and gravy. c. green beans. d. of everything.

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

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

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

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25. 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. Beef jerky and string cheese do not provide carbohydrate. Peanuts provide some carbohydrate, but not enough to restore blood glucose levels after a workout. Milk provides carbohydrate in the form of lactose.

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TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

26. Sugar alcohols appear to be safe for use as sweetening agents, but their use may a. cause diarrhea. b. result in weight gain. c. have adverse effects on plasma lipid levels. d. displace more nutrient-dense foods in the diet.

ANS: A Use of sugar alcohols may cause diarrhea when used in large amounts. They contain fewer kcals than other forms of carbohydrate and so are less likely to result in weight gain. They do not affect plasma lipid levels and do not necessarily displace more nutrient-dense foods in the diet.

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maintenance

27. To facilitate compliance, the prescribed meal plan for patients with diabetes mellitus should a. include some favorite foods each week. b. be based on the patient’s usual eating habits. c. be tailored to achieve individual weight-loss goals. d. include meals and snacks eaten at the same time each day.

ANS: B To facilitate compliance, patient 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 so much effect on compliance.

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DIF: Cognitive Level: Comprehension REF: p. 424

TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial integrity

28. 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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REF: p. 421

TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

29. Patients with type 1 diabetes mellitus who are sick and unable to eat regular food should consume a. parenteral nutrition support. b. commercial liquid nutrition supplements. c. liquid, semiliquid, or soft sources of carbohydrates. d. noncaloric fluids only to minimize the increase in blood glucose level.

ANS: C Patients with type 1 diabetes mellitus who are sick and unable to eat regular food should consume liquid, semiliquid, or soft sources of carbohydrates to maintain their blood glucose level. Parenteral nutrition support is not usually necessary, unless the patient has severe vomiting. Commercial liquid nutrition supplements are not needed. Noncaloric fluids would prevent dehydration but would not provide carbohydrate to maintain their blood glucose level.

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DIF: Cognitive Level: Comprehension REF: pp. 421-422

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

30. 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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REF: p. 422

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31. Control of maternal blood glucose levels is important during pregnancy to protect the infant from development of a. obesity. b. macrosomia. c. type 1 diabetes mellitus. d. pancreatic insufficiency.

ANS: B It is important to control maternal blood glucose levels during pregnancy to prevent macrosomia in the infant. The infant may have higher fat stores than normal; this is called macrosomia rather than obesity. Increased maternal blood glucose levels do not cause type 1 diabetes mellitus or pancreatic insufficiency in the infant.

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32. 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.

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REF: p. 423

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33. Most children who develop type 2 diabetes are treated using diet, exercise, and a. family therapy. b. exogenous insulin. c. behavior modification. d. oral hypoglycemic agents.

ANS: D Most children who develop type 2 diabetes require oral hypoglycemic agents in addition to diet and exercise to achieve metabolic control. Exogenous insulin is used less often. Family therapy may help the family learn healthier coping mechanisms. Behavior modification may help patients adopt healthier food and exercise habits.

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Chapter 20: Nutrition for Cardiovascular and Respiratory Diseases Test Bank

MULTIPLE CHOICE

1. A risk factor for cardiovascular disease that may be modified by dietary or other lifestyle changes includes

a. male gender. b. family history. c. race and heredity. d. physical inactivity.

ANS: D A modifiable risk factors for cardiovascular disease includes physical inactivity. Male gender, family history, and race and heredity are all risk factors, but they cannot be modified by dietary or other lifestyle changes.

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maintenance

2. Atherosclerosis refers to a. chest pain that often radiates down the left arm. b. development of lesions in the endothelium of arteries. c. high levels of low-density lipoprotein (LDL) cholesterol in the blood. d. complete blockage of a coronary artery, also known as a heart attack.

ANS: B Atherosclerosis is development of lesions in the endothelium of arteries. Chest pain that radiates down the left arm may be angina pectoris or could be a myocardial infarction (heart attack). A high level of LDL cholesterol is one of the factors that contributes to atherosclerosis. Complete blockage of a coronary artery or heart attack may be caused by atherosclerosis.

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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 (CVA). 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. Peripheral vascular disease occurs when atherosclerosis causes blockages in the a. cerebral, vertebral, and carotid arteries. b. hepatic and renal arteries. c. pulmonary and myocardial arteries. d. abdominal aorta, iliac arteries, and femoral arteries.

ANS: D Peripheral vascular disease occurs when atherosclerosis causes blockages in the abdominal aorta, iliac arteries, and femoral arteries. Blockage of cerebral arteries causes stroke. Blockage of myocardial arteries causes heart attack. Blockage of the other arteries is less common.

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5. Cholesterol travels in the bloodstream in a. bile.

REF: pp. 433-434

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b. plaques. c. lipoproteins. d. blood cells.

ANS: C Cholesterol travels in the bloodstream in lipoproteins that contain lipids and proteins. Bile salts are made from cholesterol. Cholesterol forms plaques when it is deposited in blood vessels. Blood cells carry oxygen (red blood cells) or are part of the immune system (white cells) but do not carry cholesterol.

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6. Goals of therapy to reduce risk of cardiovascular disease focus on lowering levels of a. triglycerides. b. low-density lipoprotein (LDL) cholesterol. c. high-density lipoprotein (HDL) cholesterol. d. very low-density lipoprotein (VLDL) cholesterol.

ANS: B Primary goals of therapy to reduce risk of cardiovascular disease focus on lowering blood levels of LDL cholesterol. Lowering serum triglyceride levels and VLDL cholesterol levels and increasing HDL cholesterol levels also decreases cardiovascular risk, but are not the main focus.

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maintenance

7. A desirable serum total cholesterol level is <_____ mg/dL. a. 100

b. 130 c. 160 d. 200

ANS: D A desirable serum total cholesterol level is <200 mg/dL. Optimal LDL cholesterol level is <100 mg/dL. Near optimal/above optimal LDL cholesterol level is <130 mg/dL. Borderline high LDL cholesterol level is <160 mg/dL.

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maintenance

8. 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 level <150 mg/dL is considered normal, 150 to 199 mg/dL is considered borderline high, 200 to 499 mg/dL is considered high, and >500 mg/dL is considered very high.

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maintenance

9. Risk of cardiovascular disease is inversely associated with levels of a. total cholesterol. b. low-density lipoprotein (LDL) cholesterol.

c. high-density lipoprotein (HDL) cholesterol. d. very low-density lipoprotein (VLDL) cholesterol.

ANS: C Risk of cardiovascular disease is inversely associated with levels of HDL cholesterol.

Cardiovascular risk is positively associated with levels of total cholesterol, LDL cholesterol, and VLDL cholesterol.

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maintenance

10. Therapeutic lifestyle changes (TLCs) recommended to reduce the risk of coronary heart disease include reduced intake of _____ fat(s). a. total b. saturated c. monounsaturated d. polyunsaturated

ANS: B TLCs recommended to reduce the risk of coronary heart disease include reduced intake of saturated fats. Intake of total fat does not appear to affect LDL cholesterol level. Substitution of monounsaturated or polyunsaturated fats for saturated fats can help decrease LDL cholesterol levels; polyunsaturated fats may also decrease HDL cholesterol levels and so should be moderated.

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TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

11. Each 1% increase in dietary kcal from saturated fats is associated with an increase in LDL cholesterol level of about a. 2%. b. 4%. c. 5%. d. 7%.

ANS: A Each 1% increase in dietary kcal from saturated fats is associated with an increase in LDL cholesterol level of about 2%.

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12. Most dietary fat should be in the form of a. fat substitutes. b. fat-soluble vitamins. c. polyunsaturated fat. d. monounsaturated fat.

ANS: D Most dietary fat (up to 20% of energy intake) should be in the form of monounsaturated fat.

Polyunsaturated fat should contribute up to 10% of energy intake. Fat substitutes and fat-soluble vitamins do not provide dietary fat.

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REF: p. 436

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13. The type of fiber that is most effective in helping to decrease LDL cholesterol is

a. dietary fiber. b. soluble fiber. c. insoluble fiber. d. resistant starch.

ANS: B Addition of 5 to 10 g soluble fiber daily can decrease LDL cholesterol by 5%. Insoluble fiber and resistant starch do not have this benefit. Dietary fiber may be beneficial because it may include soluble fiber.

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REF: p. 436

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14. Most people experience reductions in LDL cholesterol if they limit dietary cholesterol intake to less than _____ mg/day. a. 100 b. 200 c. 300 d. 400

ANS: B Most people experience reductions in LDL cholesterol if they limit dietary cholesterol intake to less than 200 mg/day.

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REF: p. 436

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15. 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 will depend on the fat used for frying and any sauces added.

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16. 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-lowering medications. d. use of anti-thrombotic 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 should be added to TLC if needed to achieve further reductions in LDL-C. Antithrombotic medications are not used routinely (they may sometimes be used to reduce risk of blood clots). Stress reduction can help decrease cardiac risk, but is not the first step.

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17. Drug therapy should be initiated at the same time as therapeutic lifestyle change (TLC) only in patients who a. have severe hypercholesterolemia. b. are not using other prescription medications. c. have a family history of coronary heart disease. d. are unwilling to implement therapeutic lifestyle change.

ANS: A Drug therapy should only be initiated at the same as TLC in patients with severe hypercholesterolemia, who are unlikely to be able to decrease LDL cholesterol to desirable levels using TLC alone. The need for cholesterol-lowering medications is not related to use of other medications. Family history is one of many risk factors for coronary heart disease and does not necessitate immediate drug therapy.

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DIF: Cognitive Level: Comprehension REF: pp. 435-436

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18. Primary or essential hypertension is caused by a. unknown factors. b. sedentary lifestyle. c. excess sodium intake. d. being overweight or obese.

ANS: A Primary or essential hypertension is caused by unknown factors. 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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REF: p. 438

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19. If a patient’s blood pressure is 152/94 mm Hg, they have 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 stage 1 hypertension. Stage 1 hypertension is systolic blood pressure 140 to 159 mm Hg or diastolic blood pressure 90 to 99 mm Hg. Stage 2 hypertension is systolic blood pressure >160 mm Hg or diastolic blood pressure 110 mm Hg. Prehypertension is systolic blood pressure 120 to 139 mm Hg or diastolic blood pressure 80 to 89 mm Hg. Normal blood pressure is systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg.

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maintenance

20. Before drug therapy is considered, patients with mild to moderate hypertension should attempt to lower their blood pressure using lifestyle modifications for a. 3 to 6 weeks. b. 6 to 8 weeks.

c. 3 to 6 months. d. 6 to 8 months.

ANS: C Patients with mild to moderate hypertension should attempt to lower their blood pressure using lifestyle modifications for 3 to 6 months before drug therapy is considered.

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21. Risk of hypertension may be decreased by increasing intake of foods that are good sources of a. iron, zinc, and copper. b. selenium, chromium, and iodine. c. sodium, chloride, and bicarbonate. d. potassium, magnesium, and calcium.

ANS: D Increasing intake of foods rich in potassium, magnesium, and calcium can help decrease risk of hypertension. Intakes of iron, zinc, copper, selenium, chromium, iodine, chloride, and bicarbonate do not affect blood pressure. Increasing intake of foods high in sodium will generally increase blood pressure.

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TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

22. 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.

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maintenance

23. In America, 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, plus intakes of processed foods are 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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DIF: Cognitive Level: Comprehension REF: pp. 439-440

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24. 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 using medications rather than diet.

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25. One or 2 days after a myocardial infarction, patients are likely to best tolerate a. a clear liquid diet. b. mostly cold foods. c. small, frequent meals. d. three moderate meals a day.

ANS: C One or 2 days after a myocardial infarction, patients are likely to best tolerate small, frequent meals. A clear liquid diet is only used 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 smaller, more frequent meals.

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26. For patients with congestive heart failure, nutrition therapy focuses on a. restriction of dietary sodium intake. b. abstinence from alcoholic beverages. c. achievement and maintenance of a healthy weight. d. restriction of dietary saturated fats and cholesterol.

ANS: A Nutrition therapy for patients with congestive heart failure focuses on restriction of dietary sodium intake to reduce extracellular fluid. Abstinence from alcoholic beverages is not a focus of treatment. Dietary restrictions to lose weight or reduce intake of saturated fat and cholesterol may be harmful because patients often have increased energy needs and poor appetite. Restrictions in energy intake may contribute to cardiac cachexia.

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27. If patients with congestive heart failure experience cardiac cachexia, it is important to make sure that they have adequate intakes of a. vitamin C and iron. b. energy and protein. c. essential amino acids and essential fatty acids. d. dietary fiber and monounsaturated fats.

ANS: B It is important to make sure that patients with cardiac cachexia have adequate intakes of energy and protein to prevent further catabolism. If intakes of energy and protein are adequate, intakes of other nutrients are also likely to be adequate.

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28. 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 teens 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 kcal and nutrient intakes for growth and development. But 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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maintenance 29. Compared with a comparable regular food, a food product that claims to be ―light‖ must contain ____% fewer kcals or _____% less fat. a. 25; 75 b. 33; 33 c. 33; 50 d. 50; 33

ANS: C A ―light‖ version of a regular food must have 33% fewer kcal or 50% less fat than the regular product.

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maintenance

30. Malnourished patients with chronic obstructive pulmonary disease (COPD) require protein intakes that are a. relatively low to reduce the metabolic burden. b. the same as healthy patients. c. relatively high to increase ventilatory drive. d. higher than can be met by oral intake.

ANS: C Malnourished patients with COPD have relatively high protein requirements to help increase ventilatory drive and preserve muscle mass. Low protein intakes will contribute to malnutrition. Protein needs are higher than for healthy patients, but can be achieved using a well-planned diet.

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31. The respiratory quotient may be decreased by increasing the proportion of energy intake from a. fat. b. protein. c. carbohydrates. d. fat and carbohydrates.

ANS: A Respiratory quotient is lower when the proportion of energy intake from fat is higher. The respiratory quotient is the amount of carbon dioxide produced compared to the amount of oxygen used. Respiratory quotient is high for carbohydrate and low for fat.

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32. Most patients with acute respiratory failure require enteral or parenteral nutrition support because they a. require mechanical ventilation. b. often have difficulty swallowing. c. are too tired to consume an adequate diet. d. are unable to coordinate eating and breathing.

ANS: A Most patients with acute respiratory failure require enteral or parenteral nutrition support because they require mechanical ventilation and cannot eat normally with a breathing tube in place.

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TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological integrity

33. 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 result in excess carbon dioxide production. d. they may lead to development of diabetes mellitus.

ANS: C

Parenteral nutrition support for patients with acute respiratory failure should not use high glucose concentrations because they result in excess carbon dioxide production. Lipids should be used to provide a significant proportion of nonprotein kcals (1 to 2 g lipid per kg 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.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 447

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological integrity

Chapter 21: Nutrition for Diseases of the Kidneys Test Bank

MULTIPLE CHOICE

1. The overall function of the kidneys is to a. detect and eliminate body toxins. b. maintain thermal homeostasis in the body. c. maintain chemical homeostasis in the body. d. control biochemical metabolism in the body.

ANS: C The overall function of the kidneys is to maintain chemical homeostasis in the body.

Biochemical metabolism is controlled within cells. Most toxins are neutralized in the liver.

Thermal homeostasis is maintained by the skin and circulatory system.

PTS: 1

DIF: Cognitive Level: Knowledge

TOP: Nursing Process: Assessment

REF: p. 452

MSC: Client Needs: Physiological integrity

2. The individual units that carry out the work of the kidneys are called a. filters. b. tubules.

c. nephrons. d. capillaries.

ANS: C The individual units that carry out the work of the kidneys are called nephrons. Each nephron contains several tubules. Capillaries are the smallest blood vessels found in the kidney and throughout the body. The kidney filters the blood to remove waste products.

PTS: 1

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TOP: Nursing Process: Assessment

REF: p. 452

MSC: Client Needs: Physiological integrity

3. Nephrotic syndrome causes loss of excessive amounts of a. fluid. b. protein. c. sodium. d. calcium.

ANS: B In nephritic syndrome, damage to the capillary walls in the glomerulus cause loss of protein.

Excretion of fluid, sodium, and calcium are not excessive.

PTS: 1

DIF: Cognitive Level: Knowledge

TOP: Nursing Process: Assessment

REF: pp. 452-454

MSC: Client Needs: Physiological integrity

4. To control hypertension and edema, patients with nephrotic syndrome should restrict their intake of a. fluids. b. protein. c. sodium. d. energy.

ANS: C To help control hypertension and edema, patients with nephritic syndrome should restrict their intake of sodium. Fluid restriction is not necessary because patients still produce urine.

Protein and energy intakes should be adequate to prevent malnutrition and catabolism and replace urinary losses.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 452-454

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological integrity

5. ―Hidden‖ sources of sodium include 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 are low in sodium.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 454

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

6. In a patient with acute renal failure, a sudden gain in weight is usually caused by 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 patients have very little appetite so they are unlikely to gain fat and they are inactive 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.

PTS: 1

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TOP: Nursing Process: Assessment

REF: p. 454

MSC: Client Needs: Physiological integrity

7. Retention of excessive amounts of waste products of protein metabolism in the blood is known as a. oliguria. b. jaundice. c. nephritis. d. uremia.

ANS: D Retention of excessive amounts of waste products of protein metabolism in the blood (including urea) is known as uremia. Oliguria is low output of urine. Jaundice is buildup of bilirubin in the blood due to liver disease or failure. Nephritis is an inflammation of the kidney.

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8. For patients with renal failure, the best sources of protein are a. animal proteins. b. vegetable proteins. c. high-quality proteins. d. essential amino acids.

REF: p. 455

ANS: C For patients with renal failure, the best sources of protein are high-quality proteins. These are mostly animal proteins, but also include soy. Most vegetable protein has a lower biologic value. Patients with renal failure are able to digest whole proteins and do not need extra essential amino acids.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 455

TOP: Nursing Process: Planning

MSC: Client Needs: Health promotion and

maintenance

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 hemodialysis patients lose protein during treatments.

Protein is not lost in the urine and so protein needs are not affected by the volume of urine produced.

PTS: 1

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TOP: Nursing Process: Planning

REF: pp. 454-455

MSC: Client Needs: Physiological integrity

10. For patients in the oliguric phase of acute renal failure, fluid needs are a. less than 1 L. b. 1 mL/kg body weight. c. double the amount of output. d. the amount of output plus 500 mL.

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. The amount cannot be based on an arbitrary figure or body weight because the ability of the kidneys to produce urine varies greatly between patients.

PTS: 1

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REF: p. 455

TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

11. A gradual, irreversible loss of kidney function is called a. acute renal failure. b. chronic renal failure. c. nephrotic syndrome. d. dialysis-dependent renal failure.

ANS: B Gradual, irreversible loss of kidney function is called chronic renal failure. Acute renal failure is characterized by an abrupt loss of renal failure and is often reversible. Nephrotic syndrome is caused by damage to the glomerulus and is also often reversible. Patients with chronic renal failure often become dependent on dialysis, but loss of kidney function may progress gradually for several years before dialysis becomes necessary.

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DIF: Cognitive Level: Comprehension REF: pp. 455-457

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological integrity

12. Before development of end-stage renal disease, nutrition therapy for patients with chronic renal failure focuses on a. limiting intakes of sodium and fluid. b. limiting foods that produce toxic metabolic by-products. 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 by-products; this reduces the burden on the kidneys. Sodium and fluid intakes 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 by-products. Chronic kidney disease is irreversible so provision of adequate nutrients will not promote recovery, although it is important to maintain good nutritional status.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 455-457

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological integrity

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, so menus are not provided. It still requires the help of a registered dietitian 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 high in nutrients that must be limited.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 455-457

TOP: Nursing Process: Assessment

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 is high in phosphorus and biscuits are higher in sodium than other breads. The beans in the burrito provide lower-quality protein and are high in phosphorus; also, the tortilla chips are high in sodium (unless they are unsalted). Peanut butter provides lower-quality protein and is high in phosphorus; whole wheat bread is also high in phosphorus.

PTS: 1

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REF: pp. 455-457

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

15. A food that is restricted in patients who are receiving hemodialysis because it is high in phosphorus is a. banana. b. potato. c. egg. d. milk.

ANS: D

Milk is restricted in patients who are receiving hemodialysis because it is high in phosphorus.

Bananas and potatoes are high in potassium, not phosphorus. Eggs are not high in phosphorus and provide a good source of high-quality protein.

PTS: 1

DIF: Cognitive Level: Application

TOP: Nursing Process: Assessment

REF: p. 457

MSC: Client Needs: Health promotion and

maintenance

16. Medications used to reduce serum phosphorus levels should be taken a. with fluids. b. with meals. c. between meals. d. 1 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.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 458

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance

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 fat-soluble vitamins (including A and K) are not needed; vitamin A toxicity has sometimes developed in hemodialysis patients. Supplements of vitamin C and other water-soluble vitamins may be needed but do not need to be given in an active form.

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DIF: Cognitive Level: Comprehension REF: p. 458

TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity

18. In patients with chronic renal failure, inadequate production of the hormone erythropoietin causes a. anemia. b. uremia. c. hypertension. d. fluid retention.

ANS: A Erythropoietin stimulates bone marrow to produce red blood cells, so inadequate production in patients with chronic renal failure causes anemia. Uremia is caused by accumulation of nitrogenous waste products. Hypertension is caused by inadequate renin production. Fluid retention is caused by failure to produce urine and by sodium retention.

PTS: 1

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TOP: Nursing Process: Assessment

REF: p. 458

MSC: Client Needs: Physiological integrity

19. Patients treated with hemodialysis often require supplements containing a. trace elements. b. essential fatty acids. c. fat-soluble vitamins. d. water-soluble vitamins.

ANS: D Patients treated with hemodialysis often require supplements of water-soluble vitamins because of poor intake and losses during dialysis. Most patients do not need supplements of trace elements, essential fatty acids, and fat-soluble vitamins.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 458-459

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological integrity

20. In peritoneal dialysis, the peritoneum serves as the a. nephron. b. dialysate. c. homeostatic agent. d. dialysis membrane.

ANS: D In peritoneal dialysis, the peritoneum serves as the dialysis membrane. It serves some, but not all of the functions of a nephron. Dialysate is instilled into the peritoneal cavity. Homeostasis is achieved by balancing food and fluid intake with dialysis.

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REF: pp. 459-460

MSC: Client Needs: Physiological integrity

21. The type of peritoneal dialysis in which the patient receives four of five exchanges of dialysate every day, each dwelling in the peritoneal cavity for about 4 hours, is known as _____ peritoneal dialysis. a. intermittent b. nocturnal c. continuous cycling d. continuous ambulatory

ANS: D The type of peritoneal dialysis in which the patient receives four or five exchanges of dialysate every day, each dwelling in the peritoneal cavity for about 4 hours, is called continuous ambulatory peritoneal dialysis.

PTS: 1

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TOP: Nursing Process: Assessment

REF: pp. 459-460

MSC: Client Needs: Physiological integrity

22. Patients treated with peritoneal dialysis have higher dietary protein needs than those treated with hemodialysis because a. more protein is lost into the peritoneal dialysate. b. protein is needed for maintenance of the peritoneum. c. patients treated with peritoneal dialysis tend to be more active. d. peritoneal dialysis is a more efficient method of removal of nitrogenous waste.

ANS: A Patients treated with peritoneal dialysis have higher dietary protein needs that those treated with hemodialysis because more protein is lost into the dialysate. Maintenance of the peritoneum does not significantly increase protein needs and patients are not necessarily more active. Peritoneal dialysis is not more efficient than hemodialysis for removing nitrogenous waste.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 459-460

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological integrity

23. Patients treated with peritoneal dialysis have lower energy needs than those treated with hemodialysis because a. hemodialysis increases metabolic rate. b. peritoneal dialysis suppresses metabolic rate. c. dextrose is absorbed from the peritoneal dialysate. d. patients treated with peritoneal dialysis are less active.

ANS: C Patients treated with peritoneal dialysis have lower energy needs than those treated with hemodialysis because dextrose is absorbed from the peritoneal dialysate. Hemodialysis does not increase metabolic rate and peritoneal dialysis does not suppress metabolic rate. Patients treated with peritoneal dialysis are not less active.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 459-460

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological integrity

24. If blood phosphorus levels are elevated, patients may develop a. anemia. b. renal calculi. c. osteoporosis. d. osteodystrophy.

ANS: D Elevated blood phosphorus levels may lead to osteodystrophy (defective bone development).

Anemia in patients with chronic renal disease is caused by failure to produce erythropoietin.

Renal calculi are caused by various metabolic imbalances and by poor fluid intake.

Osteoporosis is caused by long-term inadequate intakes of calcium and vitamin D and lack of weight-bearing exercise.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 460

TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

25. Patients with diabetes mellitus and chronic renal failure who are treated using peritoneal dialysis may have difficulty controlling their diabetes because a. insulin is lost into the dialysate. b. glucose is absorbed from the dialysate. c. the combined food restrictions are so 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.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 459-460

TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

26. Immediately following renal transplantation, 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 Immediately after a renal transplant, 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.

PTS: 1

DIF: Cognitive Level: Comprehension REF: pp. 460-461

TOP: Nursing Process: Planning

27. Steroid therapy may result in a. lactose intolerance. b. glucose intolerance. c. hypertriglyceridemia.

MSC: Client Needs: Physiological integrity

d. increased protein needs.

ANS: B Steroid therapy may cause glucose intolerance. Steroids do not cause lactose intolerance, hypertriglyceridemia, or increased protein needs.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 461

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological integrity

28. Most renal calculi are composed of a. cystine. b. struvite. c. uric acid. d. calcium oxalate.

ANS: D The most common type of renal calculi is calcium oxalate. Cystine, struvite, and uric acid stones are less common.

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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

REF: pp. 461-462

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.

PTS: 1

DIF: Cognitive Level: Comprehension REF: p. 463

TOP: Nursing Process: Planning, 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. strawberry shortcake.

ANS: D Strawberries are one of the eight foods (spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries) that cause significant increases in urinary oxalate excretion; therefore strawberry shortcake may increase urinary oxalate levels. Ginger cookies, cinnamon rolls, and blueberry muffins would not increase urinary oxalate levels.

PTS: 1

DIF: Cognitive Level: Application

REF: p. 463

TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance Chapter 22: Nutrition in Cancer, AIDS, and Other Special Problems

Test Bank MULTIPLE CHOICE 1. The stage of carcinogenesis in which the deoxyribonucleic acid (DNA) of the cell undergoes

mutation is called a. initiation. b. metastasis. c. promotion.

d. progression.

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 470 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 2. Dietary factors that may help protect against carcinogenesis include a. electrolytes. b. amino acids. c. antioxidants. d. monounsaturated fatty acids.

ANS: C

Dietary antioxidants, found in fruits and vegetables as well as 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.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: pp. 471-472

3. Fruits and vegetables contain some specific chemicals that help prevent cancer, known as a. phytosterols. b. vitamins. c. antineoplastics. d. phytochemicals.

ANS: D

Fruits and vegetables contain phytochemicals that help prevent cancer. They 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.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Health promotion and maintenance

REF: p. 471

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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 471 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. The syndrome of loss of lean body mass and body fat stores that occurs in many patients with

cancer is called a. cachexia. b. anorexia. c. neoplasia. d. catabolism.

ANS: A

The syndrome of loss of lean body mass and body fat stores that occurs in many patients with cancer is called cachexia. Anorexia refers to loss of appetite or restriction of food intake without the metabolic effects that cause excessive wasting; anorexia may contribute to cachexia in patients with cancer. Neoplasia refers to the abnormal proliferation of cells seen in cancer. Catabolism refers to the breakdown of lean tissue and fat leads to wasting.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 471 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. Benefits of adequate dietary intake in patients with cancer include a. decreased risk of hypertension. b. increased tolerance of therapy. c. prevention of metastasis of the disease. d. prevention of hair loss during chemotherapy.

ANS: B

The benefits of adequate dietary intake in patients with cancer include increased ability to tolerate the effects of therapy. Hypertension is not usually related to cancer. Adequate dietary intake does not necessarily prevent metastasis of the disease or hair loss.

PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation, Evaluation MSC: Client Needs: Health promotion and maintenance

REF: p. 473

7. A common problem in patients with head and neck cancer, even before they undergo surgery,

is a. b. c. d.

dehydration. nausea and vomiting. protein-energy malnutrition. weight gain due to inactivity.

ANS: C

Many patients with head and neck cancer enter surgery with protein-energy malnutrition.

Dehydration, nausea, and vomiting are not common. Rather than gaining weight, most patients lose weight due to the cancer process and poor intake.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 484 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. If a patient has dumping syndrome after surgery to remove a tumor, they have 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 473 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 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 they exposed to higher doses of the drugs. The impact of chemotherapy drugs on these cells is not related to absorption and excretion.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 473-474 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. Effects of chemotherapy on bone marrow result in a. allergic reactions. b. immunosuppression. c. nausea and vomiting. d. loss of lean body mass.

ANS: B

The effects of chemotherapy on bone marrow cause immunosuppression because bone marrow produces many immune factors. Chemotherapy does not generally increase allergic reactions. Certain types of chemotherapy may cause nausea and vomiting or loss of lean body mass, but these side effects are not caused by the drugs’ effects on bone marrow.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 474 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. Side effects of radiation therapy are caused by damage to _____ cells _____ the treatment

range.

a. b. c. d.

healthy; within healthy; outside cancer; within cancer; outside

ANS: A

Side effects of radiation therapy are caused by damage to healthy cells within the treatment range. Radiation does not affect healthy cells or cancer cells outside the treatment range. The intended effect of radiation therapy is damage to cancer cells in the treatment range.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 474 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. An allogeneic bone marrow transplant uses bone marrow a. obtained from an identical twin. b. collected from a matched healthy donor. c. collected using hypoallergenic techniques. d. harvested from the patient before treatment.

ANS: B

An allogeneic bone marrow transplant uses bone marrow collected from a matched healthy donor. If the bone marrow is obtained from an identical twin, it is called syngenic. If the bone marrow is harvested from the patient before treatment, it is called autologous. Bone marrow is not collected using hypoallergenic techniques.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 475-477 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 13. Patients who receive bone marrow transplants often require parenteral nutrition. Some oral

intake is important to help a. achieve adequate nutrient intakes. b. provide nutrients that cannot be infused. c. maintain the integrity of the small intestine. d. maintain a sense of normalcy 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 intakes using parenteral nutrition; all nutrients can be infused if parenteral nutrition is carefully planned. Oral intake does help maintain some normalcy for the patient, but this is not the main reason for using it.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 475 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 14. A meal that a patient with immunosuppression who needs to follow a low-bacterial diet

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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 475 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care environment 15. 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 detection 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 detection 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 are vital in recognizing early signs of malnutrition and initiating early intervention. The form does not evaluate psychosocial status.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 476-477 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. Patients who are experiencing nausea or vomiting may find it easiest to tolerate foods like 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 low odor, served cold or at room temperature; the turkey sandwich would probably be tolerated best. Chicken noodle soup is usually served hot. Chicken curry is served hot, is highly seasoned, and has a strong aroma. Taco salad with jalapenos would be very spicy.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 476-477 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 17. Acquired immunodeficiency syndrome (AIDS) is caused by a a. fungus. b. parasite. c. rotavirus.

d. retrovirus.

ANS: D

AIDS is caused by a retrovirus. Fungal infections usually only occur on the skin or nails.

Parasitic infections are most common in the intestines, although they may travel to other parts of the body. Rotavirus is a virus that causes diarrhea.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 481-482 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. Infections that cause the morbidity associated with AIDS are called _____ infections. a. invasive b. neoplastic c. metastatic d. opportunistic ANS: D

Infections that cause the morbidity associated with AIDS are called opportunistic infections.

Neoplastic and metastatic are terms associated with cancer. Invasive infections occur when bacteria invade blood, muscle, and fat tissue, rather than infecting epithelia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 482 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. Nutritional problems associated with the use of highly active antiretroviral therapy (HAART)

include a. hypertension and stroke. b. nausea and food aversions. c. loss of lean body mass and body fat. d. hyperlipidemia and diabetes mellitus.

ANS: D

Nutritional problems associated with the use of HAART include hyperlipidemia and diabetes mellitus. Loss of lean body mass and body fat occur if HAART is not used. Nausea and food aversions are more common side effects of cancer treatment. Hypertension and stroke are not associated with use of HAART. PTS: 1 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity

REF: pp. 481-482

20. The Centers for Disease Control and Prevention (CDC) have defined AIDS-related wasting

syndrome as _____ loss of >10% of body weight in 1 month _____ chronic diarrhea, weakness, or fever. a. involuntary; without b. voluntary; without c. involuntary; with d. voluntary; with ANS: C

CDC has defined wasting syndrome as involuntary loss of >10% of body weight in 1 month with chronic diarrhea, weakness, or fever. Voluntary weight loss is caused by dieting, not wasting syndrome.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 482 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. 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 will tend to fill the stomach so that the patient will actually consume less food and 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 482 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 22. One of the reasons that nutrition therapy is so important for patients with HIV/AIDS is that it

is an area where a. clients 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, so 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 482 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial integrity 23. Factors that contribute to malnutrition in patients with HIV/AIDS include 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 and/or decreased nutrient intake. 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 483 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. Hypogonadism may contribute to malnutrition and wasting because of a. increased metabolic rate. b. dry mouth and stomatitis. c. fatigue and inability to prepare food. d. altered taste acuity and food aversions.

ANS: C

Patients with hypogonadism experience fatigue that makes it difficult to prepare and consume food; this may contribute to malnutrition and wasting. Hypogonadism is not associated with increased metabolic rate, dry mouth, stomatitis, altered taste acuity, or food aversions.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 483 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. Some types of antiretroviral therapy are associated with changes in body composition that are

referred to as a. lipodystrophy. b. hypogonadism. c. hyperlipidemia. d. wasting syndrome.

ANS: A

Antiretroviral therapy can cause a fat redistribution syndrome known as lipodystrophy.

Hypogonadism is a different endocrine-related problem that can occur in patients with AIDS. Hyperlipidemia is also associated with antiretroviral therapy, but this is not associated with changes in body composition. Wasting syndrome is generally prevented by use of antiretroviral therapy.

PTS: 1 DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment, Evaluation MSC: Client Needs: Physiological integrity

REF: p. 483

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, should 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 eating undercooked meat, poultry, fish, or eggs will help decrease the risk of experiencing other food borne illnesses. Eating canned fruits and vegetables is generally safe for patients with HIV/AIDS. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 485 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care environment 27. Patients with cancer who undergo radiation of their lower abdomen are likely to experience a. nausea. b. vomiting. c. diarrhea. d. constipation.

ANS: C

Patients with cancer who undergo radiation of their lower abdomen are likely to experience damage to the gastrointestinal tract in the radiated area, causing malabsorption and diarrhea.

Patients who receive radiation in the upper abdomen may experience nausea and vomiting due to damage to the stomach. Patients receiving radiation do not usually experience constipation.

PTS: 1 DIF: Cognitive Level: Application TOP: Nursing Process: Assessment, Analysis MSC: Client Needs: Physiological integrity

REF: p. 474

28. Foods that may help stimulate food intake in patients with taste abnormalities include those

that are a. tart. b. salty. c. sweet. d. bland.

ANS: A

Foods that may help stimulate food intake in patients with taste abnormalities include those that are tart or spicy. Salty, sweet, and bland foods do not help overcome taste abnormalities.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 480 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 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 their 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 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 484 TOP: Nursing Process: Planning, 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 intakes of fat may exacerbate diarrhea. An adequate intake of protein helps maintain the integrity of gastrointestinal health, which will minimize diarrhea, but protein intake is not the first concern during acute diarrhea. Excessive amounts of dietary fiber may also exacerbate diarrhea.

PTS: 1 DIF: Cognitive Level: Application REF: p. 480 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance