TEST BANK for Nutrition and Diet Therapy 12th Edition by Ruth Roth

Chapter 01 The Relationship of Nutrition and Health MULTICHOICE 1. Which of the following nutrients help build and repair body tissues?

(A) ​proteins (B) ​carbohydrates (C) ​fats (D) ​lipids Answer : (A)

2. Which of the following does NOT put an individual at risk for malnutrition?​ (A) ​eating too much (B) ​eating too little (C) ​an absorption disorder (D) ​eating a variety of foods Answer : (D)

3. Which of the following foods are considered to have a low nutrient density?

(A) ​potato chips (B) ​carrots (C) ​apples (D) ​steaks Answer : (A)

4. There are many cumulative effects of a poor, unbalanced diet. Which of these disease states is NOT attributable to a low-nutrient-density diet?​ (A) ​atherosclerosis (B) ​hypertension (C) ​obesity (D) ​chronic obstructive pulmonary disease

Answer : (D)

5. Which mineral is needed to prevent osteoporosis from occurring?​ (A) ​iron (B) ​magnesium (C) ​zinc (D) ​calcium Answer : (D)

6. A part of a nutrition assessment involves anthropometric measurements. What is measured during this type of assessment?​ (A) ​percentage of muscle mass (B) ​percentage of fat tissue only (C) ​percentage of fat and muscle tissue (D) ​percentage of body fluid Answer : (D)

7. What biochemical analysis of blood samples may indicate kidney failure?​ (A) ​serum albumin level (B) ​serum transferrin level (C) ​creatinine excretion (D) ​blood urea nitrogen Answer : (D)

8. What is the most common method of assessing a client's dietary history?​ (A) ​3-day food record (B) ​24-hour recall (C) 3-day food diary (D) ​3-day recall Answer : (B)

9. Which nutrient deficiency displays lesions at the corners of the mouth?​ (A) ​vitamin B (B) ​riboflavin (C) ​folic acid (D) ​iron Answer : (B)

10. Obesity can increase your risk of developing ____.​ (A) ​iron deficiency anemia (B) ​diabetes (C) ​kidney failure (D) ​osteoporosis Answer : (B)

11. Education in good nutritional health practices would eliminate many health problems that may be caused by malnutrition. Which of the following is the best method for teaching the young child good health habits?​ (A) ​a good health program in kindergarten (B) ​have the physician discuss nutrition with the child (C) ​imitation of adult behavior (D) ​imitation of eating habits of other children Answer : (C)

12. What is the most common form of nutrient deficiency in the United States?​ (A) ​niacin (B) ​iron (C) ​protein (D) ​vitamin C Answer : (B)

13. Which biochemical test measures protein status?​

(A) ​serum transferrin level (B) ​creatinine excretion (C) ​serum albumin level (D) ​serum creatinine level Answer : (C)

14. Which biochemical test indicates a depleted muscle mass?​ (A) ​serum transferrin level (B) ​creatinine excretion (C) ​serum albumin level (D) serum creatinine level Answer : (B)

15. Which blood test can indicate anemia?​ (A) ​hemoglobin test (B) ​red blood cell test (C) ​blood urea nitrogen (D) ​lipid profile Answer : (A)

16. Which test detects protein and sugar excretion in urine that can indicate kidney disease and diabetes?​ (A) ​blood urea nitrogen (B) ​creatinine excretion (C) ​urinalysis (D) ​serum creatinine level Answer : (C)

17. Which of the following is characteristic of poor nutritional status?​ (A) ​apathy

(B) ​shiny hair (C) ​clear eyes (D) ​erect posture Answer : (A)

18. Which of the following diseases is related to vitamin C deficiency?​ (A) ​anemia (B) ​goiter (C) ​scurvy (D) ​xerophthalmia Answer : (C)

19. Which of the following measures is NOT included in the lipid profile?​ (A) ​glucose (B) ​serum triglycerides (C) ​total serum cholesterol (D) ​high-density lipoproteins Answer : (A)

20. Goiter is a deficiency disease related to deficiency of what nutrient?​ (A) ​iron (B) ​iodine (C) ​calcium (D) ​folic acid Answer : (B)

21. Which of the following are inorganic nutrients?​ (A) ​carbohydrates (B) ​minerals (C) ​vitamins

(D) ​proteins Answer : (B)

ESSAY 22. Poorly shaped bones or teeth are a symptom of calcium and vitamin D deficiency. Discuss the relationship between these substances.​

Graders Info : Vitamin D is necessary for the utilization of calcium in the body.​ 23. Why is a social history important when doing a nutritional assessment?​

Graders Info : To determine whether the client has the financial resources to obtain the needed food and the ability to store and prepare the food.​ 24. List the methods, or means of data collection, used to complete an accurate nutritional assessment that is the framework for a dietary treatment plan.​

Graders Info : Social history, 24-hour diet recall, food diary for 3 to 4 days, computer analysis of the diet, review for any food-drug interactions, review of medical records, clinical examinations, and review of results of any biochemical tests and anthropometrical measurements.​ 25. The adolescent and the elderly are age groups that are very prone to malnutrition. Discuss the reasons for this.​

Graders Info : The adolescent responds to peer pressure to determine the types of foods consumed (chips, colas, candy, etc.), and the lifestyle of a teen (always on the go) may result in many skipped meals. The elderly are often alone, and mealtimes can be unpleasant and lonely, resulting in skipped meals and in eating poorly balanced meals. Living conditions often do not encourage a healthy appetite.

Financially, some elderly may not be able to afford fresh fruits and vegetables or the protein sources of foods.​ 26. Describe the appearance of an 18-year-old female who is at the optimal level of nutritional balance.​

Graders Info : Shiny hair, clear skin, clear eyes, erect posture, alert expressions, firm flesh on well-developed bone structure, healthy appetite, regular sleep and elimination habits, and positive emotional adjustments.​ 27. Describe the primary function(s) of each of the organic nutrients.​

Graders Info : The primary function of carbohydrates and fats is to provide energy. Proteins build and repair body tissues, and vitamins regulate body processes.​ 28. Wellness is a way of life that integrates mind, body, and spirit. What lifestyle habits will help one achieve wellness?​

Graders Info : Wellness can be accomplished through lifestyle habits such as focusing on healthy food choices, not smoking, participating in regular physical activity, and maintaining a healthy weight.​

TRUEFALSE 29. Appetite is the physiological need for food. Hunger is a psychological desire for food._________________________​ (A) True (B) False Answer : (B)

30. The essential nutrient water provides energy. _________________________​ (A) True (B) False Answer : (B)

31. Primary deficiencies are those an individual is born with, while secondary deficiencies are those caused by a disease condition associated with malabsorption and accelerated excretion or by the destruction of the nutrients. _________________________​

(A) True (B) False Answer : (B)

32. Biochemical tests include various blood, urine, and stool tests. A deficiency or toxicity can be determined by a visual analysis of the samples.______________________​ (A) True (B) False Answer : (B)

33. The deficiency disease beriberi is caused by inadequate niacin intake.____________________​ (A) True (B) False Answer : (B)

34. Osteoporosis is a dietary deficiency of calcium and vitamin D that causes bones to soften and may cause the spine to bend. _________________________ ​ (A) True (B) False Answer : (A)

35. The body must be provided with nutrients that are necessary for life. These nutrients are available only in food, must be obtained by the body's nutritional intake, and are known as essential nutrients. _________________________ (A) True (B) False Answer : (A)

36. Individuals with overnutrition are at risk for malnutrition and need intensive nutrition intervention. ​ (A) True (B) False

Answer : (A)

ESSAY 37. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

Problem nutrients for teen pregnancies include calcium, zinc, iron, vitamin A, vitamin C, folate, and protein. What are the needs of each of these nutrients for a pregnant teenager?​

Graders Info : Calcium: (under 18) 1,000 mg per dayVitamin A: 530 μg per day Zinc: 10.5 mg per day Vitamin C: 66 mg per day Iron: 23 mg per day Folate: 520 μg per day Protein: 0.88 g per kilogram per day ​ http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables

38. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

State three nursing diagnosis statements from the assessment data.​

Graders Info : Altered nutrition: less than body requirements related to adolescent pregnancy, when her own needs for growth and maturation are still high and eating habits are poor. Knowledge deficit related to nutritional requirements during pregnancy. Anxiety related to changes, discomforts, or emotional feelings resulting from pregnancy.​ 39. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

List nursing interventions to help Mary achieve an adequate nutritional status.​

Graders Info : Teach Mary nutritional needs during pregnancy and the characteristics of an adequate diet. Help Mary individualize her diet so that she achieves an adequate intake. Teach Mary strategies for coping with nutrition-related discomforts of pregnancy.​ Advise Mary to use nutritional supplements, vitamins, and iron appropriately. Consult with and make referrals to other professionals, dietitian, social services, and other programs developed to aid pregnant women, such as the Special Supplemental Program for Women, Infants, and Children (WIC).​

40. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

Mary's age, physical symptoms, and diagnosis will factor into her care. Teen pregnancy is impacted by several life cycle needs and also covers a broad range of developmental needs based on the pregnancy and the woman's age. Discuss the factors associated with nutrition and identify goals to help Mary obtain a successful outcome.​

Graders Info : Mary is a pregnant teenager. She still has the pressures of being a teenager and the demands of eating nutritionally. In addition to eating properly for the fetus, Mary is still growing and developing with her own nutritional needs. She may also have cravings related to fast foods or empty calories and possibly aversions to meat and eggs. Her list of "usual foods" shows how difficult it may be for her to change her dietary habits and eat healthily. Goal 1: Mary will verbalize understanding of the rationale for eating a nutritious diet. Goal 2: Mary will select foods and make a meal plan that adheres to dietary guidelines for a pregnant teen.​ 41. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must

also begin to eat properly to meet her nutritional needs and those of the infant.

Describe the usual weight gain recommended for a pregnant adolescent who is at the recommended weight for her height, for an overweight teen, and for an underweight teen.​

Graders Info : The recommended weight gain for a teenager should be at the higher end of the range. A gain of 1 pound (lb) per week in the second and third trimesters of pregnancy is advised. If the adolescent is underweight, a 40-lb gain is recommended; for normal weight, 35 lbs; and 25 lbs for an overweight teen. Generally, pregnant adolescents should consume no fewer than 2,000 calories per day. In many cases, higher caloric intakes are needed.​ 42. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

Contact the WIC program in your community. Discuss the benefits and goals and describe the positive outcomes.​

Graders Info : An individualized nutritional risk profile is developed for each person, and a specific nutritional rehabilitation program is determined. Goals are increased birth weight, decreased preterm delivery, and decreased maternal morbidity and perinatal morbidity and mortality.​ 43. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

When Mary hears the nurse tell her she will need to increase her caloric intake, her first response to the nurse was, "More chips, candy, colas." What is the nurse's response?​

Graders Info : The nurse must help Mary understand that the weight gain must be from desirable foods that are nutrient dense and emphasize the importance of choosing a varied diet. The empty calories that Mary prefers provide no nutritional value for her or the baby.​ 44. Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past 2 weeks. She has vomited "almost every day." Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test that confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.

Last menstrual period was estimated to be 2 months ago.

Menses onset began 4 years ago.

Ht: 5′8″ Wt: 125 lbs Medium frame size She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas.

Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

Before a meaningful exchange of information will occur with Mary, the nurse must first build a trusting relationship and establish good communication lines. Describe the setting that will be most conducive to beginning this dialogue. Who will be present? What will help Mary be relaxed and feel nonthreatened? Describe positive communication techniques that will be useful. How should the session begin?​

Graders Info : Development of a trusting relationship should begin with the nurse meeting with Mary alone. Allow her to be in a comfortable position. Sit on a couch next to her, not behind a desk with her facing you.

Use open-ended questions, exploratory statements; and body language that is nonthreatening so

Mary will feel comfortable. Don't ask leading questions such as, "You don't drink or smoke pot, do you?" Begin by talking about daily events to put Mary at ease. As the conversation progresses, use silence to allow Mary to gather her thoughts. Speak with Mary as an adult. Encourage questions from her.​ 45. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​ After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse. ​ Mr. Lew has no family or friends present and his level of awareness will greatly restrict data collection. List the data collection methods that are available considering Mr. Lew's condition.

Identify any tools you will need to collect assessment data to begin the planning phase.​

Graders Info : Data collection methods include a physical examination, including anthropometric measurements, a nursing history, and biochemical analyses. When Mr. Lew regains complete orientation, a dietary history and dietary recall can be done. Scales, tape measure, and a stethoscope are needed. A dietary history will be difficult to complete; however, the location of his body (in an alley) may indicate the type of lifestyle he has been leading. Tools needed will vary but may include paper, pencil, thermometer, stethoscope, sphygmomanometer, and watch.​ 46. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities

Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​ After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse. ​ ​List data that will be assessed.

Graders Info : Eyes should be bright and shiny; assess gums for caries, lesions, missing teeth, edema, and presence of bleeding; face and skin dry, scaly, or smooth and firm; tongue for redness, bumpiness, and roughness; nails firm and pink; posture; wasted appearance; reflexes; vital signs; fat-fold measures; height and weight.

47. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​ After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse. ​ Identify the biochemical analyses that should be monitored.​

Graders Info : Serum albumin, prealbumin, hematocrit, hemoglobin, electrolytes, glucose, BUN, cholesterol including triglycerides, uric acid, calcium, magnesium, enzymes, creatinine, iron, folate, and B12​ 48. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had

regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​ After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse. ​ Identify goals for Mr. Lew, relating to nutrition. Be specific as to protein needs.​

Graders Info : Mr. Lew will stabilize fluid and electrolyte balance within 24-48 hours; receive adequate nutrients to meet nutritional needs (typically 30-35 calories per kilogram of body weight); gain 0.25-0.5 lb/kg a week. Protein needs are greater in those recovering from alcoholism. Goal would be to consume 1-2 grams per kilogram of body weight daily. The extra protein is needed for cell growth and muscle and tissue repair. He will need to have protein added to meals as well as one to three snacks per day with added protein.​ Resource: Academy of Nutrition and Dietetics Nutrition Care Manual​

49. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​

​

After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse.

For each goal, what outcome data will verify that the goals have been met?​

Graders Info : ​Fluid intake and output will be balanced and vital signs will be normal. Nutritional therapy will be ongoing. Overall physical indicators may not be notable for several weeks, considering the time period it may have taken to reach the level of emaciation. Weight will be fluctuating at first; a stable weight with gain will validate the goal. An adequate diet for Mr. Lew will be necessary for the rest of his life. Laboratory values will be stable, within normal limits, within 48 hours. Mr. Lew will report consuming three meals a day with adequate protein as well as snacks between meals. He will report no alcohol consumption. He will also have improved appearance, less dry skin, decreased edema, and improved abdominal distention.

50. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​ After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse. ​ Of the goals identified, which is the highest in priority?​

Graders Info : Normal laboratory values are the highest priority. In his present condition, it is of utmost need to stabilize his body's fluid and electrolyte balance.​ 51. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​ After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse. ​ Identify nursing interventions to meet the identified goals.​

Graders Info : Weigh daily, monitor I & O hourly, monitor B/P, T, P, R rate, breath sounds, and edema. Monitor lab values: glucose, vitamins, minerals, trace elements, electrolytes, albumin/prealbumin, folate, zinc, and BUN. Mouth care every 2 hours. Offer small, frequent feedings. Collaborate with dietician for a progressive diet, high in nutrients. Monitor calorie count for 3 days, closely monitoring protein intake. Assess client's knowledge of a balanced diet. Provide positive reinforcement for food intake.​ 52. Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness.

The emergency medical team started an intravenous (IV), and upon arriving at the ER, Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included the following: ​ Physical appearance is unkempt and dirty.

Odor suggests consumption of alcohol is likely.

T 96, P 124, R 36, B/P 90/40 Very emaciated appearance Legs and arms very dry and flaky Mottled purplish areas to lower extremities Edema 3+ in ankles and lower legs Abdomen tight and distended Facial color and nail beds pale No response to painful or verbal stimuli ​ After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse. ​ Describe the role alcohol has played in Mr. Lew's nutritional status.​

Graders Info : Alcohol produces euphoria that results in depressed appetite and impacts the diet of a drinker.

People afflicted in this manner tend to eat very little. The alcohol is rich in calories and energy; however, alcohol provides empty calories. The more one drinks, the less food is eaten. Even when food is eaten, the alcohol interferes with the body's ingestion, digestion, absorption, metabolism, and excretion of nutrients. Nutrient deficiencies are an inevitable result of alcoholism.​

Chapter 02 Planning a Healthy Diet MULTICHOICE 1. Which of the following statements is NOT one of the overarching guidelines in the Dietary Guidelines for Americans, 2015-2020?​ (A) ​eat plenty of protein-rich foods (B) ​follow a healthy eating pattern across the life span (C) ​focus on variety, nutrient density, and amount (D) ​support healthy eating patterns for all Answer : (A)

2. Weight loss should not exceed ____.​ (A) ​1-1 1/2 pounds per week (B) ​5 pounds per week (C) ​10 pounds per week (D) ​15 pounds per month Answer : (A)

3. What is the recommendation for saturated fat intake for a healthy individual?​ (A) ​less than 10% of total calorie intake (B) ​35% or less of total calorie intake (C) ​45-50 g of fat daily (D) ​less than 50 g of fat a day Answer : (A)

4. E ​ xcessive amounts of sodium in the diet can contribute to ____.

(A) ​diabetes (B) ​low blood pressure (C) ​hypertension (D) ​kidney failure

Answer : (C)

5. According to the Dietary Guidelines for Americans, 2015-2020, what is the recommendation for consuming whole grains?​ (A) ​Strive to make half of all grains consumed be whole grains.

(B) ​Include as many grains as possible, regardless of type.

(C) ​Select foods that have whole grains listed as their last ingredient.

(D) ​Select white bread whenever possible.

Answer : (A)

6. With the introduction of MyPlate, which of the food groups shown on the old MyPyramid was left off?​ (A) ​grains (B) ​fats and oils (C) ​fruits (D) ​vegetables Answer : (B)

7. With what nutrient is milk fortified?​ (A) ​vitamin A (B) ​vitamin B12 (C) ​vitamin D (D) ​calcium Answer : (C)

8. Based on MyPlate, a 1,800-calorie diet would require how many cups of fruits and vegetables each day?​ (A) ​two cups (B) ​three cups (C) ​four cups (D) ​five to six cups

Answer : (C)

9. In what year did current nutrition labeling regulations become mandatory?​ (A) ​1990 (B) ​1992 (C) ​1994 (D) ​1995 Answer : (C)

10. Which of the following items must be included on a food label?​ (A) ​total carbohydrates and cholesterol per serving (B) ​vitamins E and D (C) ​all B vitamins (D) ​cost per serving Answer : (A)

11. "Low sodium" means ____.

(A) ​fewer than 120 mg per serving (B) ​fewer than 140 mg per serving (C) ​fewer than 35 mg per serving (D) ​no more than 45 mg per serving Answer : (B)

12. Chinese cooking may cause a problem for people with high blood pressure because of the extensive use of soy sauce, which is high in ____.​ (A) ​sugar (B) ​salt (C) ​iron (D) ​fat Answer : (B)

13. Foods prepared according to Jewish dietary laws are referred to as ____.​ (A) ​kosher (B) ​proper (C) ​Orthodox (D) ​ceremonial Answer : (A)

14. Jewish dietary law states that dairy products may not be prepared or eaten with ____.​ (A) ​vegetables (B) ​meat (C) ​bread (D) ​eggs Answer : (B)

15. Which of the following beverages does Seventh-Day Adventists consume?

(A) ​coffee (B) ​tea (C) ​alcohol (D) ​milk Answer : (D)

16. ​What type of vegetarian uses dairy products but no meat, poultry, or eggs?

(A) ​vegans (B) ​lacto-vegetarians (C) ​lacto-ovo vegetarians (D) ​omnivores Answer : (B)

17. For adults to receive substantial health benefits from exercise, which of the following is true?​ (A) ​At least 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic activity is necessary

each week.

(B) ​At least 75 minutes of moderate-intensity or 150 minutes of vigorous aerobic activity is necessary each week.

(C) ​Aerobic exercise should be performed in episodes of at least 30 minutes in order to be effective.

(D) ​Only aerobic exercise provides health benefits-strength training is not necessary.

Answer : (A)

18. MyPlate recommends that at least how many servings consumed from the grains group should be whole grains?​ (A) ​all (B) ​half (C) ​some (D) ​none Answer : (B)

19. All of the following can help increase total vegetable intake EXCEPT ________.​ (A) increase vegetable content of mixed dishes (B) ​blend vegetables into meals and snacks (C) ​increase protein added to dishes (D) ​eat a salad with meals Answer : (C)

20. Fruits provide all of the following EXCEPT ________. ​ (A) ​protein (B) ​vitamin A (C) ​vitamin C (D) ​potassium Answer : (A)

21. Daily Values on the label state the percentage of Daily Values of each nutritional item listed per serving, based on a daily diet of how many calories?​

(A) ​1,200 (B) ​1,500 (C) ​1,800 (D) ​2,000 Answer : (D)

22. When a registered dietitian plans a diet for a client, he or she should consider all of the following things EXCEPT ______.​ (A) ​client's likes (B) ​client's dislikes (C) ​client's food customs (D) ​dietician's beliefs Answer : (D)

ESSAY 23. Discuss nutritional deficiencies and other health risks that may be a result of excess alcohol use.​

Graders Info : One ounce of most alcoholic beverages contains approximately 80 calories and traces of nutrients.

Moderate drinkers have increased appetite, which increases food consumed, resulting in weight gain. Heavy drinkers lose their appetites, and that results in nutritional deficiencies. Excess alcohol causes cirrhosis, liver and brain damage, birth defects, and the risk of cancer of the throat or neck.​ 24. Examine the labels of five cans or packages of food products in your cabinet. Prepare a chart to compare the contents, per serving, of sodium, carbohydrates, calories, protein, fat, fiber, serving size, and sugar. What conclusions can you deduce from the chart?​

Graders Info : The student should recognize the label information as being of value to the consumer. The percentage of Daily Values of each nutritional item is listed per serving. Maximum and minimal amounts of nutrients are also noted. Students should recognize the elevated sodium levels in processed foods, as well as the total carbohydrates and sugar content, which tend to be elevated in different types of foods. In the effort to make the consumer more aware of diet as a factor in good health, health claims that link nutrients to health conditions are on the label. Comparing

manufacturers' data will make students more aware of the contents of some of the cheaper brands.​ 25. Discuss the diet as a link to health claims and food labeling.​

Graders Info : The diet has been linked to many health conditions. Health claims link specific conditions to a nutrient and list them on the label. This allows the consumer to make more appropriate food choices.

Examples include calcium and osteoporosis; sodium and hypertension; low saturated fat and cholesterol and high in fiber and coronary heart disease; low fat and high in fiber, antioxidants, and vitamins A and C and cancer; folic acid and neural tube defects; soy and cardiac disease. The food must also be a naturally good source (10% daily value) of at least one of the following nutrients: vitamins A and C, iron, calcium, or fiber. It also must have less than 20% of the daily value for total fat, saturated fat, cholesterol, and sodium.

26. List the eight healthy benefits of regular physical activity.​

Graders Info : Increases physical fitnessHelps build and maintain healthy bones, muscles, and joints Builds endurance and muscular strength Helps maintain weight Lowers risk factors for cardiovascular disease, colon cancer, and type 2 diabetes Helps control blood pressure Promotes psychological well-being and self-esteem Reduces feelings of depression and anxiety​

27. The most common nutrient deficiency in the world is the lack of _____________. It is more prevalent among four specific population groups. List them and describe why those population groups are more at risk. Describe how their diets can be altered to prevent the deficiency.​

Graders Info : Iron: Children under age 2 consume more milk instead of eating other food sources with iron.

Adolescents lack a nutritional diet because they eat more junk food than regular meals. Pregnant women need increased iron because the developing fetus depletes their blood cells. Women with heavy menstrual flow are at risk for decreased iron levels. Diet plans may vary, but clients should be encouraged to eat foods high in iron such as lean meats, poultry, fish, enriched breads, legumes, leafy green vegetables, dried fruits, and nuts.​ 28. List four foods that contain calcium and indicate how much of each food one would have to consume to equal the amount of calcium found in one 8-oz glass of milk.

Graders Info :

1 1/2 oz of cheddar cheese2 cups of cottage cheese 1 3/4 cups of ice cream 1 cup of yogurt​

29. MyPlate suggests that wine be consumed in moderation. Describe what this means and how it is different for men and women.​

Graders Info : Wine may be consumed with meals-one to two 5-oz glasses per day for men and one 5-oz glass per day for women.​ 30. Vegans avoid all animal products in their diet. Discuss what foods provide protein in a vegan diet and what nutrient deficiencies might result from consuming a vegan diet.​

Graders Info : Vegans use soybeans, chickpeas, meat analogues, and tofu as sources of protein in their diet. Vegans can show deficiencies of calcium; vitamins A, D, and B12; and protein.​

TRUEFALSE 31. Vegetables are a needed addition to the traditional Japanese diet. ______________________​ (A) True (B) False Answer : (B)

32. Beef is commonly eaten on the Mediterranean side of Italy. _________________________​ (A) True (B) False Answer : (B)

33. Calorie free means the product contains zero calories per serving. __________________​ (A) True (B) False Answer : (B)

34. Italians consume a healthy mix of pasta, rice, beans, olives, fruits, vegetables, and seafood in their diets. However, they would benefit from adding lower-fat meats to improve their diets. _________________________ (A) True (B) False Answer : (A)

35. The Japanese diet is almost totally deficient of milk sources. _________________________ (A) True (B) False Answer : (A)

36. Neural tube defects in the newborn may be caused by a folic acid deficiency. _________________________​ (A) True (B) False Answer : (A)

37. Fat free means a food contains less than 0.5 g of fat per serving. ____________________​ (A) True (B) False Answer : (A)

ESSAY 38. Haley, a 34-year-old single female, weighs 210 pounds, is 5′8″ tall and has a medium frame. The physician asks you to assist Haley in planning a diet that will allow her to lose 1 to 2 pounds per week. As you discuss Haley's diet with her, you determine that her typical diet consists of these foods: two pieces of bacon, two eggs, one slice of cheese on one biscuit with 8 oz of 2% milk for breakfast; 4 oz hamburger on a bun, one cup of fries, 32 oz of cola for lunch; two slices of a 12-inch loaded pizza, two cups of salad with 2 tbsp of ranch dressing, 32 oz sweet tea for dinner; and snacks of 6 oz lite yogurt, 1 oz of chips, 1 oz of pretzels, and diet cola throughout the day.

Use approximate measures to determine Haley's usual caloric intake for 1 day.​

Graders Info : 3,000-3,200 calories​ 39. Haley, a 34-year-old single female, weighs 210 pounds, is 5′8″ tall and has a medium frame. The physician asks you to assist Haley in planning a diet that will allow her to lose 1 to 2 pounds per week. As you discuss Haley's diet with her, you determine that her typical diet consists of these foods: two pieces of bacon, two eggs, one slice of cheese on one biscuit with 8 oz of 2% milk for breakfast; 4 oz hamburger on a bun, one cup of fries, 32 oz of cola for lunch; two slices of a 12-inch loaded pizza, two cups of salad with 2 tbsp of ranch dressing, 32 oz sweet tea for dinner; and snacks of 6 oz lite yogurt, 1 oz of chips, 1 oz of pretzels, and diet cola throughout the day.

You have determined that Haley lives alone and often eats from fast-food restaurants. She states that it seems to be cheaper than cooking for one person. When evaluating Haley's usual dietary intake, which food groups would you find lacking in her diet? In which vitamins, minerals, or nutrients would you expect her to be deficient?​

Graders Info : Fruits and vegetables, fiber, vitamins A, B-complex, C, E, and K, iron, calcium, and phosphorus.​ 40. Haley, a 34-year-old single female, weighs 210 pounds, is 5′8″ tall and has a medium frame. The physician asks you to assist Haley in planning a diet that will allow her to lose 1 to 2 pounds per week. As you discuss Haley's diet with her, you determine that her typical diet consists of these foods: two pieces of bacon, two eggs, one slice of cheese on one biscuit with 8 oz of 2% milk for breakfast; 4 oz hamburger on a bun, one cup of fries, 32 oz of cola for lunch; two slices of a 12-inch loaded pizza, two cups of salad with 2 tbsp of ranch dressing, 32 oz sweet tea for dinner; and snacks of 6 oz lite yogurt, 1 oz of chips, 1 oz of pretzels, and diet cola throughout the day.

A decrease of 500 calories per day will result in a 1-pound weight loss in 1 week. With this knowledge and the information you have collected about Haley, calculate a new total caloric intake for her to consume each day. How many total calories is Haley allowed per day? Devise a sample daily diet for Haley. Remember to include food items that will supply Haley with the vitamins, minerals, and nutrients she needs.

Graders Info : A meal plan of 2,200 calories will allow her to lose 2 pounds per week. A sample diet plan should include an adequate supply of fruits and vegetables and can have variation as long as it follows the recommendations in the Dietary Guidelines for Americans 2015-2020.

41. Haley, a 34-year-old single female, weighs 210 pounds, is 5′8″ tall and has a medium frame. The physician asks you to assist Haley in planning a diet that will allow her to lose 1 to 2 pounds per week. As you discuss Haley's diet with her, you determine that her typical diet consists of these foods: two pieces of bacon, two eggs, one slice of cheese on one biscuit with 8 oz of 2% milk for breakfast; 4 oz hamburger on a bun, one cup of fries, 32 oz of cola for lunch; two slices of a 12-inch loaded pizza, two cups of salad with 2 tbsp of ranch dressing, 32 oz sweet tea for dinner; and snacks of 6 oz lite yogurt, 1 oz of chips, 1 oz of pretzels, and diet cola throughout the day.

Haley plans to attend a local weight loss group, "Lose Weight the Healthy Way," and has invited you to make a presentation. Focus your presentation on the benefits of exercise to aid in weight loss.

Prepare a teaching plan for the presentation and an exercise plan that can be adaptable for a variety of individuals who may attend the group meeting.​

Graders Info : The teaching plan should include objectives, goals, and interventions. The exercise plan should encourage participants to get regular exercise two to three times per week. Interventions should include an exercise plan beginning with low-impact exercises with an emphasis on walking. The length of walking time and the impact, ranging from walk to jog, could vary, depending on the person's health status, age, or physical condition. This would make the activity plan adaptable or variable. Some participants may not be able to progress to the more rigorous workouts, but could focus on walking and gradually increase the time.​ 42. Haley, a 34-year-old single female, weighs 210 pounds, is 5′8″ tall and has a medium frame. The physician asks you to assist Haley in planning a diet that will allow her to lose 1 to 2 pounds per week. As you discuss Haley's diet with her, you determine that her typical diet consists of these foods: two pieces of bacon, two eggs, one slice of cheese on one biscuit with 8 oz of 2% milk for breakfast; 4 oz hamburger on a bun, one cup of fries, 32 oz of cola for lunch; two slices of a 12-inch loaded pizza, two cups of salad with 2 tbsp of ranch dressing, 32 oz sweet tea for dinner; and snacks of 6 oz lite yogurt, 1 oz of chips, 1 oz of pretzels, and diet cola throughout the day.

Determine the calories burned with specific types of exercise activity. Plan an exercise regimen based on Haley's height and weight.​

Graders Info : Haley needs to lose an additional 21 pounds to reach her goal weight of 175 pounds in 12 weeks.

(With the decrease in calories, she will lose 24 pounds.) An exercise session may burn an average of 300 calories. For example, low-impact dance aerobics burn 315 calories in 30 minutes and would burn approximately 0.6 pound per week if exercise is daily. The number of calories burned may be higher or lower depending upon the intensity level and one's actual body weight.​ 43. Haley, a 34-year-old single female, weighs 210 pounds, is 5′8″ tall and has a medium frame. The physician asks you to assist Haley in planning a diet that will allow her to lose 1 to 2 pounds per week. As you discuss Haley's diet with her, you determine that her typical diet consists of these foods: two pieces of bacon, two eggs, one slice of cheese on one biscuit with 8 oz of 2% milk for breakfast; 4 oz hamburger on a bun, one cup of fries, 32 oz of cola for lunch; two slices of a 12-inch loaded pizza, two cups of salad with 2 tbsp of ranch dressing, 32 oz sweet tea for dinner; and snacks of 6 oz lite yogurt, 1 oz of chips, 1 oz of pretzels, and diet cola throughout the day.

Haley requests a list of snacks she can use during her exercise period or when on break. Devise a list of high-energy, low-calorie, nutritious drinks or snacks. Include the caloric content of each.​

Graders Info :

1 cup yogurt, 127 calories; banana, 100 calories; apple, 80 calories; 2 tbsp raisins, 60 calories; 1/2 cup pears, 60 calories; 1 cup honeydew melon, 60 calories; 1/2 cup apple juice, 60 calories; 1/2 cup vegetables (most), 40-100 calories; 1/2 cup dry figs, 80 calories; 1 cup cantaloupe, 80 calories. Many choices are available that offer low caloric content with carbohydrates for energy.​ 44. A 5-year-old, Mark, weighing 40 pounds, has been diagnosed with milk allergies. You are going to assist the mother with planning nutritional care for the child. You want to ensure that Mark receives appropriate amounts of all nutrients, vitamins, and minerals.

Prior to planning care, you must gather facts about the nutritional status of this age group. What is the daily calcium recommendation for a 5-year-old?​

Graders Info : 1,100 mg​ USDA DRI tables, 2012

45. A 5-year-old, Mark, weighing 40 pounds, has been diagnosed with milk allergies. You are going to assist the mother with planning nutritional care for the child. You want to ensure that Mark receives appropriate amounts of all nutrients, vitamins, and minerals.

Prepare a diet plan with alternate food sources to meet the recommended amounts of calcium for this age group. Include food choices that are appropriate for this age and that supply all recommended vitamins, minerals, and nutrients.​

Graders Info : Students could include any diet plan with alternate food choices for calcium, such as sunflower seeds (an excellent choice for a young child), raisins, carrots, pinto beans, salmon, brown rice, ground beef, tofu, nuts. Plans will vary.

46. A 5-year-old, Mark, weighing 40 pounds, has been diagnosed with milk allergies. You are going to assist the mother with planning nutritional care for the child. You want to ensure that Mark receives appropriate amounts of all nutrients, vitamins, and minerals.

What other vitamins or minerals impact the absorption of calcium and should be included in this plan? List them. What foods must be included to ensure that these are ingested?​

Graders Info : Vitamin D and phosphorus are necessary for the absorption of calcium. Ensure that the mother is aware of the need for the child to get adequate play outdoors to get additional vitamin D. Phosphorus is found in foods that contain protein (meats, fish, legumes, poultry, eggs, and grains).

Sources rich in iron interfere with the absorption of calcium. These food sources should be consumed at separate meals or snacks.​

47. A 5-year-old, Mark, weighing 40 pounds, has been diagnosed with milk allergies. You are going to assist the mother with planning nutritional care for the child. You want to ensure that Mark receives appropriate amounts of all nutrients, vitamins, and minerals.

Nursing goals may include education of the primary caregivers regarding the child's nutritional requirements; correction of nutritional deficiencies; and achievement of an ideal weight in relation to height. What nursing interventions will be planned to meet these goals?​

Graders Info : Students should recognize that priority nursing interventions would be specific activities directed toward education of caregivers in all areas. When they are educated, the remaining goals will follow.

Plans of care need to be individualized and specific to each client. Following up with clients and families would be helpful for ongoing education as the child grows and changes, needs will grow and change.​ 48. A 5-year-old, Mark, weighing 40 pounds, has been diagnosed with milk allergies. You are going to assist the mother with planning nutritional care for the child. You want to ensure that Mark receives appropriate amounts of all nutrients, vitamins, and minerals.

To ensure that the dietary requirements will be met daily, dietary controls must be monitored while Mark is at school. Assist the mother in preparing a diet plan for breakfast and lunch at school.​

Graders Info : Breakfast could include a hot cereal of brown rice. Other choices could be eggs or hot or cold cereals garnished with raisins or chopped nuts. Lunch choices could include a portion of the calcium requirement from vegetables or pinto beans. Sunflower seeds make a good snack. When making a dietary plan, the student should realize that the calcium requirement of 800 mg can be divided between the three meals, or included in only one or two of the meals or in an afternoon snack.​

Chapter 03 Digestion Absorption and Metabolism MULTICHOICE 1. In what area of the stomach does the bolus of food first enter?​ (A) ​fundus (B) ​pylorus (C) ​body of the stomach (D) ​duodenum Answer : (A)

2. Which of the following is a hormone that triggers the release of gastric juices?​ (A) ​gastrin (B) ​pepsin (C) ​trypsin (D) ​secretin Answer : (A)

3. Which hormone causes the release of sodium bicarbonate to neutralize the acidity of chyme?​ (A) ​gastrin (B) ​pepsin (C) ​secretin (D) ​cholecystokinin Answer : (C)

4. Projecting from the small intestine are microscopic fingerlike projections known as ____.​ (A) ​villi​ (B) ​cilia​ (C) ​capillaries​ (D) ​lacteals Answer : (A)

5. What is the name of the process that takes released energy and builds new substances from simpler ones?​ (A) ​anabolism (B) ​catabolism (C) ​oxidation (D) ​metabolism Answer : (A)

6. Which of the following factors does not contribute to one's basal metabolic rate (BMR)?​ (A) ​lean body mass (B) ​daily activity (C) ​heredity (D) ​climate Answer : (B)

7. Which statement is true?​ (A) ​As lean body mass decreases, so does one's BMR. (B) ​As lean body mass decreases, one's BMR increases.

(C) ​There is no relationship between BMR and lean body mass.

(D) ​BMR is inversely related to lean body mass.

Answer : (A)

8. Metabolism is the body's ____.​ (A) ​use of energy to conserve nutrients (B) ​use of food to create energy (C) ​process whereby food is broken down into smaller parts (D) ​reduction of fats without the use of oxygen Answer : (B)

9. The process of digestion begins in the ____​.

(A) ​esophagus (B) ​stomach (C) ​mouth (D) ​small intestine Answer : (C)

10. What term is used to describe the movement caused by rhythmic contractions of the muscular wall of the gastrointestinal tract?​ (A) ​mechanical (B) ​chemical (C) ​peristalsis (D) ​hydrolysis Answer : (C)

11. Where does the final chemical digestion of carbohydrates occur?​ (A) ​mouth (B) ​stomach (C) ​esophagus (D) ​small intestine Answer : (D)

12. What is the lower end of the esophagus termed?​ (A) ​bolus (B) ​cardiac sphincter (C) ​ileum (D) ​duodenum Answer : (B)

13. Which one is NOT a role of hydrochloric acid in the stomach?​ (A) ​activates the enzyme pepsin

(B) ​destroys bacteria in food (C) ​destroys antibodies (D) ​aids in the solubility of iron and calcium Answer : (C)

14. What do lacteals absorb?​ (A) ​glucose and water-soluble vitamins (B) ​amino acids and enzymes (C) ​fatty acids, glycerol, and fat-soluble vitamins (D) ​minerals only Answer : (C)

15. After being absorbed into the small intestine, fructose and galactose are then carried to the ____.​ (A) ​stomach (B) ​small intestine (C) ​kidney (D) ​liver Answer : (D)

16. ____ is the process that uses released energy to convert substances to simpler products.​ (A) ​Aerobic metabolism (B) ​Catabolism (C) ​Anaerobic metabolism (D) ​Anabolism Answer : (B)

17. What factor might increase someone's BMR?​ (A) ​fever (B) ​aerobic exercise (C) ​strength training

(D) ​diet Answer : (A)

18. As people age, the lean body mass _______.​ (A) ​increases (B) ​stays the same (C) ​decreases (D) ​fluctuates Answer : (C)

19. How much of the daily caloric intake provides the energy used to process food?​ (A) ​100% (B) ​50% (C) ​25% (D) 10% Answer : (D)

20. ​_____________ is an enzyme that aids in the digestion of fats.

(A) ​Pancreatic amylase (B) ​Pancreatic lipase (C) ​Salivary amylase (D) ​Trypsin Answer : (B)

21. The __________ is the end of the stomach nearest the small intestine.​ (A) ​fundus (B) ​cardiac sphincter (C) ​duodenum (D) ​pylorus Answer : (D)

22. _________is an enzyme that aids in the digestion of proteins.​ (A) ​Pancreatic amylase (B) ​Carboxypeptidase (C) ​Pancreatic lipase (D) ​Bile Answer : (B)

ESSAY 23. Describe the function and the actions of the gallbladder. Include the action of the substances produced by the gallbladder.​

Graders Info : When food enters the small intestine, the gallbladder is triggered by the hormone cholecystokinin (which is produced by intestinal mucosal glands when fats enter) to release bile. Bile is produced in the liver and stored in the gall bladder. Bile aids in digestion by emulsifying fat. This allows the body to absorb fat more easily.​ 24. What are the activities of absorption that occur in the large intestine? Describe the movement of food residue through the large intestine that results in watery, liquid stools.​

Graders Info : ​Some nutrient and water absorption occurs in the large intestine. The colon wall secretes mucus as a protection from the acidic digestive juices in the chyme. The major functions of the large intestine are to absorb water, synthesize some B vitamins and vitamin K, and collect food residue. Undigested food is excreted as feces by way of the rectum. If diarrhea is present, this means the chyme and liquids have moved through the colon too rapidly to be absorbed; therefore, a liquid stool results, with little water or nutrient absorption taking place.

25. Describe the purpose of fiber in the diet. List the best food sources. ​

Graders Info : Fiber promotes health of the large intestine by helping soften stools and promoting regular bowel movements. The best sources include corn, wheat, celery, and apple skins.​ 26. Describe the progression of the basal metabolic rate (BMR) throughout the life cycle. What factors, in addition to age, result in a change in the BMR?​

Graders Info : Children require more kilocalories per pound of body weight because they are growing. As people age, the basal metabolic rate decreases. Women require more kilocalories during pregnancy and lactation. BMR increases during fever and for people living and working in extremely hot or cold climates. A person's BMR resembles that of his or her parents.​ 27. ​Calculate your basal metabolic rate. Calculate your usual caloric intake. Discuss the implications of your intake versus your metabolic rate.

Graders Info : The students should easily determine their total energy requirements. If the caloric intake exceeds their BMR, they will gain weight. If it is less, weight loss will occur.​ 28. ​What is digestion?

Graders Info : ​Digestion is the process whereby food is broken down into smaller parts, chemically changed, and moved through the gastrointestinal system.

29. What is the purpose of mechanical digestion?​

Graders Info : ​Mechanical digestion helps prepare food for chemical digestion by breaking it into smaller pieces.

TRUEFALSE 30. ​The cardiac sphincter prevents acid from flowing back into the esophagus. _________________________ (A) True (B) False Answer : (A)

31. Digestion is the process whereby food is broken down into smaller parts and is chemically changed. Digestion occurs in the stomach and small intestine only. _________________________ ​ (A) True

(B) False Answer : (B)

32. To be absorbed, nutrients must be in their most complex form. _________________________ ​ (A) True (B) False Answer : (B)

33. The hydrochloric acid that is secreted by the stomach lining makes iron and calcium more soluble. _________________________ ​ (A) True (B) False Answer : (A)

34. The inner wall of the small intestine is smooth. _________________________ ​ (A) True (B) False Answer : (B)

35. A mouthful of food ready to be swallowed is called chyme. _________________________​ (A) True (B) False Answer : (B)

36. Acid reflux disease is caused by malfunction of the pyloric sphincter. _____________________ ​ (A) True (B) False Answer : (B)

37. One kilocalorie is equal to 4.184 kilojoules. _______________________ ​ (A) True

(B) False Answer : (A)

ESSAY 38. Joe Brian, 6′3″ tall and 265 pounds, came to the physician with complaints of indigestion, heartburn, a bloated feeling, and occasional vomiting. He states that he sometimes wakes up with the taste of vomit in his mouth. He also complains of chest pain and states, "Sometimes I feel like I am having a heart attack." After performing an endoscopy, the physician diagnoses a hiatal hernia with esophageal reflux and esophagitis. The physician prescribes a histamine receptor antagonist and antacids before meals and at bedtime. ​ Describe the pathology that occurs when a hiatal hernia exists. Correlate each symptom with the medical diagnosis and describe the cause. ​

Graders Info : At the lower end of the esophagus is the cardiac sphincter, which prevents stomach acid from flowing back into the esophagus. When a hiatal hernia is present, the stomach protrudes through the opening and allows acidic content to flow back into the esophagus. After meals, the client should be positioned upright to prevent regurgitation that occurs with the reflux of the acidic content. The condition also causes pain and a bloating sensation. Treatment aims at preventing acid from being in contact with the esophageal tissue, which could predispose to cancer. ​ 39. Joe Brian, 6′3″ tall and 265 pounds, came to the physician with complaints of indigestion, heartburn, a bloated feeling, and occasional vomiting. He states that he sometimes wakes up with the taste of vomit in his mouth. He also complains of chest pain and states, "Sometimes I feel like I am having a heart attack." After performing an endoscopy, the physician diagnoses a hiatal hernia with esophageal reflux and esophagitis. The physician prescribes a histamine receptor antagonist and antacids before meals and at bedtime. ​ What additional symptoms that may occur should the client be made aware of? What are the complications of a hiatal hernia? ​

Graders Info : Chronic irritation from the acids may result in cancer. If the hernia is unmanageable with medical treatment, surgery may be performed. ​ 40. Joe Brian, 6′3″ tall and 265 pounds, came to the physician with complaints of indigestion, heartburn, a bloated feeling, and occasional vomiting. He states that he sometimes wakes up with the taste of vomit in his mouth. He also complains of chest pain and states, "Sometimes I feel like I am having a heart attack." After performing an endoscopy, the physician diagnoses a hiatal hernia with esophageal reflux and esophagitis. The physician prescribes a histamine receptor antagonist and antacids before meals and at bedtime. ​

Describe the relationship between the symptom "heartburn" and the heart. ​

Graders Info : The stomach acidity causes pain that is located in close proximity to the heart, thus "heartburn."

There is no direct relation to the heart. ​ 41. Joe Brian, 6′3″ tall and 265 pounds, came to the physician with complaints of indigestion, heartburn, a bloated feeling, and occasional vomiting. He states that he sometimes wakes up with the taste of vomit in his mouth. He also complains of chest pain and states, "Sometimes I feel like I am having a heart attack." After performing an endoscopy, the physician diagnoses a hiatal hernia with esophageal reflux and esophagitis. The physician prescribes a histamine receptor antagonist and antacids before meals and at bedtime. ​ What is the goal of the initial medical treatment? ​

Graders Info : Alleviating the symptoms. ​ 42. Joe Brian, 6′3″ tall and 265 pounds, came to the physician with complaints of indigestion, heartburn, a bloated feeling, and occasional vomiting. He states that he sometimes wakes up with the taste of vomit in his mouth. He also complains of chest pain and states, "Sometimes I feel like I am having a heart attack." After performing an endoscopy, the physician diagnoses a hiatal hernia with esophageal reflux and esophagitis. The physician prescribes a histamine receptor antagonist and antacids before meals and at bedtime. ​ What is the focus of nursing care? ​

Graders Info : To facilitate client education related to the lack of knowledge regarding the disease process. To teach behaviors, including dietary approaches, to relieve pain/discomfort from regurgitation of acidic gastric contents. ​ 43. Joe Brian, 6′3″ tall and 265 pounds, came to the physician with complaints of indigestion, heartburn, a bloated feeling, and occasional vomiting. He states that he sometimes wakes up with the taste of vomit in his mouth. He also complains of chest pain and states, "Sometimes I feel like I am having a heart attack." After performing an endoscopy, the physician diagnoses a hiatal hernia with esophageal reflux and esophagitis. The physician prescribes a histamine receptor antagonist and antacids before meals and at bedtime. ​ What nursing measures will the nurse perform? ​

Graders Info :

Include diet instructions, meal plans, and foods to avoid. Describe positioning after meals and physical activity. Evaluate the client's height and weight and describe the impact on his medical condition. Explain the relationship between the diagnoses and caffeine. ​ 44. Joe Brian, 6′3″ tall and 265 pounds, came to the physician with complaints of indigestion, heartburn, a bloated feeling, and occasional vomiting. He states that he sometimes wakes up with the taste of vomit in his mouth. He also complains of chest pain and states, "Sometimes I feel like I am having a heart attack." After performing an endoscopy, the physician diagnoses a hiatal hernia with esophageal reflux and esophagitis. The physician prescribes a histamine receptor antagonist and antacids before meals and at bedtime. ​ What assessment data will be monitored to evaluate if the goals have been met? ​

Graders Info : Evaluate the symptoms, indigestion, pain, heartburn, and bloating. Evaluate weight to determine if this remains a factor in the symptoms. Monitor caffeine intake. Have client keep a food and exercise diary that can be used to document progress. ​ 45. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

Determine her current recommended body weight based on her height and sex.

Graders Info : 111-146 pounds​ 46. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

Determine the number of additional calories she will need to ingest for proper nutrition for the fetus. ​

Graders Info : An increase of 300 calories is recommended. ​ 47. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

How many additional calories will be needed for lactation? What other substances need to be ingested in adequate amounts? ​

Graders Info : Five hundred (500) extra calories a day and increased amounts of fluids ​ 48. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

Is it appropriate for a pregnant woman to go on a weight loss program? Describe the rationale for your answer. ​

Graders Info : A pregnant woman must increase caloric intake by 300 calories daily. Moderate exercise in the form of walking or swimming is recommended. A weight loss program is not recommended. The only weight adjustments that should occur are when the person changes prepregnancy bad food habits and begins to eat a well-balanced diet with appropriate calories and nutrients. ​ 49. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

Ms. Moore tells you that she always ate the same whether she was pregnant or not. She also says that she never took vitamins or iron with her other pregnancies and that she doesn't see the need now. How will you teach her the importance of these dietary measures? ​

Graders Info : Keep in mind the general health, culture, religion, likes, and dislikes of the woman. Explain the needed changes in terms of the effect on the fetus. Emphasize and explain the need for increased nutrients such as iron and folic acid. Offer supporting literature from credible sources as needed.

There is information available regarding the need for supplementation that may have not been available with her past pregnancies. ​ 50. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

What additional assessment data will you need before planning her dietary goals and nursing measures? ​

Graders Info : Health history, physical examination data, family health history, usual dietary intake, cultural or religious beliefs that affect diet, socioeconomic status, activity or physical exercise, blood tests

including hemoglobin and hematocrit, and vital signs. ​ 51. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

List one dietary goal with nursing measures. ​

Graders Info : Demonstrate progressive, moderate weight gain, not to exceed 3-5 pounds the first trimester and 1 pound per week during the second and third trimesters. Diet education including foods with quality nutritional value; eat variety; avoid empty calories; increase fluids; avoid rich, highly-spiced, and fried foods. Have normal bowel elimination. Increase fluid intake; encourage intake of fresh fruits and vegetables; add high-fiber foods; moderate exercise; avoid laxatives and enemas.

52. M ​ ary Moore, who is 3 months pregnant with her fourth child, comes to the clinic for her monthly prenatal visit. You are doing client education regarding her nutritional status. She is 5′4″ tall and currently weighs165 pounds. She is planning on breast-feeding her baby.

What nutrients, vitamins, and minerals will she need to increase in order to sustain a good nutritional status? List foods that are good sources. ​

Graders Info : Calcium, three to four cups of milk; most vitamins need to be increased; fresh fruits and vegetables; protein, fish, eggs, cheese, milk, meats; water, 10 glasses daily.

Chapter 04 Carbohydrates MULTICHOICE 1. What is the name of the storage form of carbohydrate?

(A) glucose (B) lactic acid (C) glycogen (D) ketone Answer : (C)

2. The following condition can occur when too little carbohydrate is consumed to provide the energy needed by the body.

(A) diabetes (B) ketoacidosis (C) protein malnutrition (D) anorexia Answer : (B)

3. Before carbohydrates are absorbed they are changed to ____.

(A) glycogen (B) insulin (C) glucose (D) maltose Answer : (C)

4. Which of the following hormones controls the rate of glucose metabolism?

(A) insulin (B) glucagon (C) islets of Langerhans (D) steroids

Answer : (A)

5. High blood glucose is referred to as ____.

(A) hypoglycemia (B) hyperglycemia (C) diabetes mellitus (D) Crohn's disease Answer : (B)

6. The major source of energy for the body is provided by ____.

(A) water (B) vitamins (C) carbohydrates (D) minerals Answer : (C)

7. What is the simplest form of carbohydrate?

(A) glycogen (B) monosaccharides (C) disaccharides (D) polysaccharides Answer : (B)

8. What is an example of a polysaccharide?

(A) sucrose (B) starch (C) galactose (D) glucagon Answer : (B)

9. What is the tough outer covering of a grain kernel called?

(A) endosperm (B) exosperm (C) bran (D) germ Answer : (C)

10. Which part of the grain is full of B vitamins?

(A) endosperm (B) exosperm (C) bran (D) germ Answer : (D)

11. When the amount of glucose in the blood becomes excessively high, the condition is called ____.

(A) lactose intolerance (B) hyperglycemia (C) hypoglycemia (D) renal failure Answer : (B)

12. What are the waste products of carbohydrate metabolism?

(A) oxygen and water (B) nitrogen and oxygen (C) carbon dioxide and water (D) ammonia and urea Answer : (C)

13. What is another term for glucose?

(A) dextrin

(B) dextrose (C) table sugar (D) saccharine Answer : (B)

14. Which monosaccharide is a product of milk digestion?

(A) lactose (B) galactose (C) fructose (D) maltase Answer : (B)

15. Which disaccharide is produced by enzymatic action during the digestion of starch in the body?

(A) lactose (B) sucrose (C) maltose (D) glycogen Answer : (C)

16. Which of the following sugars is created during the fermentation process that produces alcohol?

(A) lactose (B) sucrose (C) maltose (D) glycogen Answer : (C)

17. _____ are a principal source of carbohydrate.

(A) Meats (B) Cereal grains (C) Eggs

(D) Liquids Answer : (B)

18. It is common for enriched grain products to have _____ added.

(A) iron (B) calcium (C) vitamin B12 (D) none of the above Answer : (A)

19. This sugar is distinct from other sugars because it is not found in plants.

(A) fructose (B) lactose (C) sucrose (D) glucose Answer : (B)

20. Potatoes are a good food source for _____.

(A) lactose (B) glycogen (C) monosaccharides (D) complex carbohydrates Answer : (D)

21. Insufficient lactase causes _____.

(A) lactose intolerance (B) milk allergy (C) constipation (D) all of the above Answer : (A)

ESSAY 22. Discuss the protein-sparing action of carbohydrates.

Graders Info : When enough carbohydrates are taken in to meet energy needs, proteins are spared to be used for their primary function of building and repairing tissues.

23. If there are insufficient carbohydrates in the diet to meet energy requirements, fat oxidation occurs. What is the impact of this on the metabolism of the body? What nutrients does the body use for energy?

Graders Info : If there are too few carbohydrates in the diet to fulfill the energy requirement, an abnormally large amount of fat is metabolized. If sufficient fats are not available, fat oxidation in the cells is not complete and substances called ketones are produced. The ketones accumulate in the blood and urine and upset the acid-base balance.

24. Compare and contrast the three groups of carbohydrates: monosaccharides, disaccharides, and polysaccharides.

Graders Info : Monosaccharides (glucose, fructose, and galactose) are the simplest forms (simple sugars) of carbohydrate. They require no digestion and are absorbed directly into the bloodstream from the small intestine. Disaccharides (lactose, maltose, and sucrose) are pairs of simple sugars. They must be converted to simple sugars before they can be absorbed. Polysaccharides (starch, glycogen, and fiber) are complex carbohydrates. They are found in plants and vegetables. These are very difficult to break down, and some fiber cannot be broken down.

25. Provide an explanation for the use of fiber in at least five medical conditions. Explain the rationale for each. What are the best food sources for fiber?

Graders Info : Fiber is helpful to clients who desire weight loss. It may decrease the risk of colon and rectal cancers by moving waste materials through the colon faster, which reduces the colon's exposure time to potential carcinogens. Fiber may also decrease risk of heart disease by decreasing serum cholesterol levels. Fiber helps prevent constipation, hemorrhoids, and diverticular disease. In addition, it may help reduce dental caries. Food sources for fiber include grains, vegetables, and fruits.

26. Discuss the metabolism of glucose. What is the function of glucose in the body? Which food sources are needed to obtain glucose? What controls the process of glucose metabolism? What does the body do with the glucose that is not needed?

Graders Info : Glucose is the form of carbohydrate that all others are converted into for eventual metabolism.

Glucose is found in corn syrup and in some fruits and vegetables. The central nervous system, red blood cells, and the brain use only glucose as fuel; therefore, a continuous source is needed. Unused glucose is converted to glycogen and stored in the liver and muscles. If the volume exceeds the amount that can be used or stored in the muscles or liver, it is stored as adipose tissue.

27. What is cellulose, why is it important, and in what foods is it found?

Graders Info : Cellulose is a primary source of dietary fiber. It is found in the skins of fruits, the leaves and stems of vegetables, and legumes. Highly processed foods, such as white bread, contain little if any cellulose because it is removed during processing. Humans cannot digest cellulose, so it has no energy value.

It is useful because it provides bulk for the stool.

28. Discuss the consequences of consuming too much fiber.

Graders Info : Eating too much fiber in a short time can produce discomfort, abdominal gas, and diarrhea. Fiber can also obstruct the gastrointestinal (GI) tract if intake exceeds 50 grams/day. Insoluble fiber has binders that can prevent the absorption of minerals such as calcium, iron, zinc, and magnesium.

TRUEFALSE 29. Ketoacidosis, a condition caused by the accumulation of ketones, or acids, in the blood and urine, upsets the acid-base balance of the body. This condition could cause a fatal coma. _________________________ (A) True (B) False Answer : (A)

30. Diabetes mellitus is the main cause of obesity in the United States. _________________________ (A) True

(B) False Answer : (B)

31. Carbohydrates are required by the body to furnish adequate fiber needed. _________________________ (A) True (B) False Answer : (A)

32. Carbohydrates are organic compounds composed of carbon, hydrogen, and oxygen and supply the major source of energy for the body. _________________________ (A) True (B) False Answer : (A)

33. The body needs a constant supply of energy; consequently, it stores approximately one-half of a 24-hour need of carbohydrates in the liver and muscles. _________________________ (A) True (B) False Answer : (A)

34. Carbohydrates provide approximately 30% of the calories for people living in the United States. _____________________ (A) True (B) False Answer : (B)

35. The starch in grain kernels is found primarily in the germ. ____________________ (A) True (B) False Answer : (B)

36. Disaccharides are simple sugars that may be absorbed from the intestine directly into the blood stream. ____________________ (A) True (B) False Answer : (B)

ESSAY 37. Jill, 78 years old, and Henry, 80 years old, have been married for 58 years. Although they have family members who do the grocery shopping, Jill does most of the cooking. Unfortunately, Jill and Henry both have dentures that fit poorly. They are unable to chew raw foods or tougher cuts of meats. Their diet primarily consists of soft foods such as potatoes, gelatin, bread, macaroni, and eggs. Physical examination revealed that both Jill and Henry are emaciated with wasting muscles in the legs.

With the above food sources in mind, what nutrients are Jill and Henry not receiving?

Graders Info : Vitamins, minerals, fiber, protein, and enough total calories.

38. Jill and Henry both have difficulty with constipation. What food sources provide fiber in the diet?

What food sources can you recommend to aid this problem? Why have they limited the fiber in their diet? What is the dietary requirement for fiber?

Graders Info : Fiber is found in fruits and vegetables. Beans provide fiber, as well as other cooked vegetables and fruits are recommended to increase their fiber intake. They have limited fiber due to the inability to chew raw fruits and vegetables or other tough-to-chew high-fiber foods. Twenty-five to thirty grams of fiber is recommended daily.

39. Develop a dietary plan for them and include a shopping list for the foods needed that they may give to a family member who shops for them.

Graders Info : Students should develop a plan with adequate sources of all nutrients, including fiber, and a food list to buy the foods. Beans and cooked fruits and vegetables should be included.

40. Jill and Henry consume a lot of carbohydrates. Why is this a common occurrence among the

elderly population?

Graders Info : Carbohydrates are a cheaper item and provide a higher satiety value.

41. Your friend, Sally, is 5′8″ tall and weighs 176 pounds. She has been on a weight loss diet that limits carbohydrates. She has lost 9 pounds in 10 days. She has told you she feels weak and dizzy at times, but she wants to lose more weight and plans to continue the diet until she loses 36 pounds.

What is the minimum amount of carbohydrates needed each day?

Graders Info : 50-100 g/day 42. What is the recommended weight loss per week?

Graders Info : 1-2 lbs 43. Why is she feeling weak and dizzy? What other symptoms may be an indication of a real problem for Sally?

Graders Info : Carbohydrates provide energy. Hypoglycemia, shaking, muscular contractions, sweating, headache, or ketosis could occur.

44. Explain the problems that may occur from a diet mildly deficient in carbohydrates and from a diet seriously deficient.

Graders Info : Mildly deficient diets can result in weight loss and fatigue. A very-low-carbohydrate diet could cause ketosis.

45. Using the minimum carbohydrate intake, assist your friend in planning a diet with the appropriate amounts.

Graders Info :

The student should make a diet plan with no fewer than 50 g of carbohydrates. It would be important to encourage her to consume more nutrient-dense carbohydrates such as fruits, vegetables, and whole grains, and to eliminate carbohydrates in the form of sweets and desserts.

46. What role does glycogen play in carbohydrate metabolism?

Graders Info : Carbohydrates are converted to glucose for use as energy. If excess glucose is present, it is converted and stored as glycogen in the liver and muscles. When it is needed for energy, it is broken down to glucose.

Chapter 05 Lipids Fats MULTICHOICE 1. Which of the following functions is NOT a role of fat in the body?

(A) provides energy (B) protects organs and bones from injury (C) a carrier for fat-soluble vitamins (D) helps the body store glucose Answer : (D)

2. Since the body does not synthesize all fatty acids, which fatty acid needs to be obtained through diet?

(A) glycerol (B) linoleic acid (C) beta-linoleic acid (D) arachidonic acid Answer : (B)

3. Olive oil, canola oil, and avocados are classified as what type of fat?

(A) monounsaturated (B) saturated (C) polyunsaturated (D) hydrogenated Answer : (A)

4. Omega-3 fatty acid is classified as a ____ fat.

(A) monounsaturated (B) saturated (C) polyunsaturated (D) hydrogenated

Answer : (C)

5. ____ is essential for the synthesis of bile, sex hormones, cortisone, and vitamin D. (A) Polyunsaturated fat (B) Cholesterol (C) Calcium (D) Hydrogenated fat Answer : (B)

6. An example of low-cholesterol food is ______.

(A) poached eggs (B) buttermilk biscuits (C) whole-wheat toast with jelly (D) boiled shrimp Answer : (C)

7. A healthful way to lower cholesterol is to _______.

(A) reduce the amount of saturated fat in the diet (B) avoid all dairy foods (C) increase simple carbohydrate intake (D) take prescription drugs to lower cholesterol Answer : (A)

8. Where is the primary location for fat digestion?

(A) large intestine (B) liver (C) small intestine (D) kidney Answer : (C)

9. Fats are carried and transported in the body via _______.

(A) lipoproteins (B) glycerol (C) gastric lipase (D) pancreatic lipase Answer : (A)

10. Which lipoprotein is termed as "bad" cholesterol?

(A) chylomicrons (B) VLDL (C) LDL (D) HDL Answer : (C)

11. How can one increase levels of HDL in the blood?

(A) take medication (B) exercise (C) high-fat diet (D) increase water intake Answer : (B)

12. In cells, fatty acids are broken down to ______.

(A) carbon dioxide and water (B) carbon dioxide and oxygen (C) oxygen and nitrogen (D) carbon dioxide, oxygen, and water Answer : (A)

13. ____ is a natural emulsifier that helps transport fat in the bloodstream.

(A) High-density lipoprotein

(B) Phospholipid (C) Lipase (D) Lecithin Answer : (D)

14. Why might fat alternatives cause health concerns?

(A) Long-term effects are unknown.

(B) They contain high concentrations of vitamins and minerals.

(C) They are high in calories.

(D) Fat alternatives do not cause health concerns.

Answer : (A)

15. Which of the following plant foods contains a considerable amount of fat?

(A) potatoes (B) tomatoes (C) olives (D) cucumbers Answer : (C)

16. What is an example of a visible fat?

(A) whole milk (B) cheese (C) cooking oil (D) pastries Answer : (C)

17. Which of the following foods contains saturated fat?

(A) olive oil (B) avocados (C) cream

(D) egg white Answer : (C)

18. Which of the following foods contains polyunsaturated fats?

(A) canola oil (B) cashew nuts (C) palm oil (D) sunflower oil Answer : (D)

19. During hydrogenation, which type of fatty acid is produced?

(A) trans-fatty acids (B) polyunsaturated acids (C) saturated acids (D) monounsaturated acids Answer : (A)

20. Which of the following foods contain cholesterol?

(A) margarine (B) skim milk (C) liver (D) egg whites Answer : (C)

21. Fats are NOT soluble in _____.

(A) water (B) benzene (C) ether (D) chloroform Answer : (A)

22. Lipoproteins are classified according to their _____.

(A) structure (B) mobility and density (C) chemical composition (D) location in the body Answer : (B)

23. What organ controls fat metabolism?

(A) kidney (B) liver (C) gallbladder (D) pancreas Answer : (B)

24. There is an association between a high-fat diet and _____ cancer.

(A) lung (B) cervix (C) prostate (D) stomach Answer : (C)

25. The Food and Nutrition Board's Committee on Diet and Health recommends that people reduce their fat intake to _____ of total calories.

(A) 25% (B) 35% (C) 20% (D) 30% Answer : (D)

ESSAY 26. Discuss the functions of fat in the body.

Graders Info : Fats are essential for functioning and structure of body tissues, carry fat-soluble vitamins, provide energy, protect organs and bones by serving as padding and support, provide insulation from cold, and provide a feeling of satiety.

27. Blood levels of cholesterol should not exceed _______________. List food sources that are low in cholesterol. Discuss ways to lower cholesterol. What is the RDA for cholesterol? Discuss the action of cholesterol and fiber.

Graders Info : 200 mg/dL. Low-cholesterol foods include bagels, avocados, dry roast peanuts, and English muffins.

Dietary fiber, exercise, and weight loss are thought to lower serum cholesterol levels. Daily intake should not exceed 300 mg. The cholesterol binds to the fiber and is excreted via feces.

28. Discuss the digestion of fats. Where does it occur? Explain the process. What additional substances produced by the body aid in the digestion of fats?

Graders Info : Chemical digestion of fats occurs mainly in the small intestine. Fats are not digested in the mouth.

Fats are digested only slightly in the stomach. Fats must mix well with the gastric juices before entering the small intestine. Bile emulsifies the fats and pancreatic lipase, an enzyme, reduces them to fatty acids and glycerol, which the body absorbs through the villi.

29. Research has developed Olestra, a product on the market that is used as a fat alternative. What food sources contain Olestra? How does the product impact absorption of vitamins and some nutrients? What are the positive effects and the negative effects of Olestra? One concern about Olestra and other newly developed products is that they will not reduce the actual fat content, but rather would increase it. Explain the rationale for this concern.

Graders Info : Olestra is approved for use only in potato chips, tortilla chips, and crackers. Olestra inhibits absorption of some vitamins and nutrients. In particular, the absorption of fat-soluble vitamins A, D, E, and K is inhibited. These vitamins have therefore been added to products containing Olestra.

Olestra contains no calories, but can cause diarrhea and cramps for some consumers. Some believe that people who use the Olestra food sources will not replace their high-fat snacks with the Olestra snacks, but will simply add the Olestra snacks and will continue to also eat the fatty foods.

30. What are essential fatty acids?

Graders Info : Essential fatty acids (EFAs) are necessary fats that humans cannot synthesize; EFAs must be obtained through the diet. EFAs are long-chain polyunsaturated fatty acids derived from linoleic, linolenic, and oleic acids. There are two families of EFAs: omega-3 and omega-9.

31. What are trans-fatty acids? What effect do they have on cholesterol levels? In what foods are they found?

Graders Info : Trans-fatty acids are produced when hydrogen atoms are added to monounsaturated or polyunsaturated fats to produce a semisolid product like margarine or shortening. A product is likely to contain a significant amount of trans-fatty acids if partially hydrogenated vegetable oil is listed in the first three ingredients on the label. The major sources of trans-fatty acids in the diet are baked goods and foods eaten in restaurants. Trans-fatty acids raise low-density lipoproteins and total cholesterol.

TRUEFALSE 32. Fats are present only in animal sources. _________________________ (A) True (B) False Answer : (B)

33. Linoleic acid is the only essential fatty acid required by the body. _________________________ (A) True (B) False Answer : (B)

34. Monounsaturated fats lower the amount of low-density lipoprotein in the blood when they replace saturated fats in one's diet. _________________________ (A) True (B) False Answer : (A)

35. Although cholesterol is thought to be a contributing factor in heart disease, it is essential for the body and is produced daily by the pancreas. _________________________ (A) True (B) False Answer : (B)

36. Fats are soluble in water. ___________________ (A) True (B) False Answer : (B)

37. Omega-6 fatty acids help lower the risk of heart disease. ______________________ (A) True (B) False Answer : (B)

ESSAY 38. Mr. Balboack, age 57, height 6′3″, weight 235 pounds, was admitted to your unit with a blood pressure of 196/102, pulse 92, respirations 24, and an oral temperature of 98.4°F. When you perform his assessment, he tells you he has been feeling weak and dizzy for several weeks and has had several "spells of chest pain." He says he has been laid off from his job and "thought maybe the stress was causing him to feel bad." His wife added that on two occasions, including the incident today, he had complained of chest pain, then seemed to "black out," and would not respond to her calling his name. She was frightened when this attack lasted longer than the previous one and called the ambulance to come to the home. The serum cholesterol level is 679 and isoenzymes indicate cardiac tissue damage. The physician makes the diagnosis of hypercholesterolemia, atherosclerosis, coronary heart disease, and possible myocardial infarction. Mrs. Balboack gives a history that includes cigarette smoking, two packs per day for 30 years, 8-10 cups of coffee a day, and a diet filled with many empty calories, much fat and carbohydrates, and very little fiber.

Describe the pathology that occurs within the cardiovascular system with the ingestion of coffee, nicotine, and fats.

Graders Info : Fats accumulate in the arteries and deposit plaque on the inside of the artery walls, which reduces the space for blood flow. When blood cannot flow through an artery near the heart, a heart attack

occurs. If the flow is near the brain, a stroke occurs. Additionally, the caffeine in coffee, nicotine in cigarettes, and high-fat foods contribute to the condition by causing narrowing of the vessels.

39. What impact does the lack of fiber in the diet have on cholesterol in the body?

Graders Info : Fiber is helpful in lowering serum cholesterol levels. Cholesterol binds to the fiber and is eliminated without being absorbed by the intestine.

40. What factors could have contributed to his weight?

Graders Info : His diet is full of empty calories and excess fats. He has been laid off from work and possibly had less activity and exercise than he needs to maintain a healthy body weight.

41. Discuss the cultural and emotional influences that play a role in this scenario.

Graders Info : Being laid off from work could lower his self-esteem or cause depression, both of which contribute to overeating. His coffee consumption and cigarette use increase the narrowing of blood vessels in his heart.

42. Develop a dietary plan to discuss with Mr. and Mrs. Balboack when his condition is stable. What types of foods does he need to add or remove from his diet? What tips can you offer to help him remove excess fats/lipids from his diet?

Graders Info : Dietary plan should include caloric restriction, fat reduction, decrease of carbohydrates, and addition of fiber, fruits, and vegetables. He needs to avoid high-fat dairy products, high-fat meats, processed foods, and fried foods. He needs to learn how to make healthier choices when eating fast foods and at restaurants. He also needs to be educated on how to read a food label to assist in making healthier choices.

43. Ms. Jared has a 16-year-old daughter whom she has suspected for several months may be anorexic. Reinay, her daughter, has always been weight conscious. She exercises daily as a member of the cheerleading squad. She is always on the go and never stops long enough to eat a meal with the family. Reinay has begun to ask her mother to get her particular foods at the grocery, such as lots of vegetables to be eaten raw, some apples, oranges, and bottles of water. She has begun to exercise two times a day and refuses all foods with fats. She is apparently on a fat-free diet. No amount of coaxing from her mother can get her to eat some of the chocolate cookies she loves so much. She is ingesting only raw vegetables, fruit, and water.

What indicators are clues to Reinay's weight-conscious habits?

Graders Info : Food choices and exercising two times a day in addition to the exercise with the cheerleading squad 44. What cultural, social, and emotional factors have contributed to Reinay's condition?

Graders Info : Being a teenager, being on the cheerleading squad where "thin is in," and her excessive interest in exercise. The social life of a teenager mandates very serious dietary controls, especially in this "beautiful" culture we live in today.

45. What is the recommended amount of fats needed daily by a 16-year-old?

Graders Info : Dietary guidelines recommend that the total intake should not exceed 30% of the day's total energy intake, and that for children and adolescents 4 to 18 years of age, between 25 to 35% of calories should be from fat. Deficiency symptoms occur with fat intakes below 10% of total daily calories.

46. What are the functions of fats, or lipids, in the diet?

Graders Info : Energy; oils provide a radiant complexion and hair; insulates the body from extremes of temperature; padding prevents damage to internal organs; in women's breasts it offers protection of mammary glands from heat and cold and cushions them against shock; helps maintain the structure and health of all cells.

47. Develop a teaching plan to induce Reinay to add fats to her diet.

Graders Info : Include the positive effects of fat intake (hair and skin condition). The description of harmful effects should be minimized. Teenagers do not usually respond positively to that type of discussion. Outline a diet plan that begins with a minimal amount of fat (at least 10% of total daily calories). As she accepts that, it should be gradually increased. Advance the plan slowly. Too fast an increase may have a negative impact, as it overwhelms the person with a feeling of being "fat."

48. Make a list of fat foods that would be the best sources to encourage Reinay to add fat to her diet.

Graders Info : Fish, use of vegetable oils for cooking, avocado, nuts, or olives 49. Ms. Jared is very concerned and has voiced to you that she will do whatever is necessary to "prevent Reinay from becoming sick, and maybe even worse." Schedule an appointment with the dietitian to develop a dietary plan for Reinay. Considering that you are a new graduate, what would be your recommendations?

Graders Info : Encourage her to provide counseling for Reinay. Be available to answer questions and offer teaching and information of which you are knowledgeable. Always refer them to your charge nurse for information you do not have.

Chapter 06 Proteins MULTICHOICE 1. Carbohydrates, fats, and proteins all contain the following elements: ____.

(A) carbon, hydrogen, and oxygen (B) carbon, hydrogen, and magnesium (C) carbon, nitrogen, and sulfur (D) nitrogen, carbon, and oxygen Answer : (A)

2. What types of proteins are consumed routinely by vegans?

(A) complete proteins (B) incomplete proteins (C) amino acids (D) high-quality proteins Answer : (B)

3. An insufficient intake of protein in the diet can affect the body in many ways. Which of the following can be a consequence of a low-protein diet?

(A) increased calcium levels (B) edema (C) insufficient levels of urea (D) increased cholesterol levels Answer : (B)

4. An enzyme secreted by the stomach that is essential for the digestion of protein is ____.

(A) pepsin (B) trypsin (C) carboxypeptidase (D) chymotrypsin

Answer : (A)

5. What does the National Research Council of the National Academy of Science recommend as a daily protein requirement for the average adult?

(A) 2.2 g protein per kilogram of body weight (B) 1 g protein per kilogram of body weight (C) 0.8 g protein per kilogram of body weight (D) 65 g of protein a day Answer : (C)

6. What is tofu made from?

(A) corn (B) legumes (C) chickpeas (D) soy milk Answer : (D)

7. Which enzyme finally reduces proteins to amino acids?

(A) chymotrypsin (B) carboxypeptidase (C) trypsin (D) intestinal peptidases Answer : (D)

8. Positive nitrogen balance occurs during pregnancy because ____.

(A) the amount of nitrogen excreted rises at that time (B) new tissue is being created (C) there is no catabolism occurring then (D) more nitrogen is lost during pregnancy than during other times Answer : (B)

9. A symptom of edema is ____.

(A) loss of weight (B) increased appetite (C) depression (D) constipation Answer : (C)

10. What are some effects of long-term protein-energy malnutrition?

(A) physical and mental retardation (B) cardiovascular disease (C) cancer (D) diabetes Answer : (A)

11. What disease is caused by malnutrition and results in dry hair and thin skin?

(A) vitamin A deficiency (B) marasmus (C) kwashiorkor (D) protein-energy malnutrition Answer : (B)

12. Which of the following is a symptom of kwashiorkor?

(A) diarrhea (B) weight loss (C) skin lesions (D) alopecia Answer : (C)

13. Which term indicates the protein status of a client with a severe burn?

(A) nitrogen balance

(B) negative nitrogen balance (C) positive nitrogen balance (D) complete protein Answer : (B)

14. Where is ammonia converted to urea?

(A) the cells (B) liver (C) kidneys (D) the blood Answer : (B)

15. Each gram of protein provides _____ calories.

(A) 4 (B) 7 (C) 9 (D) 11 Answer : (A)

16. Proteins may contain _____in addition to carbon, hydrogen, oxygen, and nitrogen.

(A) potassium (B) calcium (C) sulfur (D) sodium Answer : (C)

17. Which of these are examples of complementary protein foods?

(A) corn and beans (B) corn and rice (C) corn and bread

(D) rice and bread Answer : (A)

18. Digestion of protein begins in the _____.

(A) small intestine (B) stomach (C) mouth (D) esophagus Answer : (C)

19. Complementary proteins must be consumed in the same _____.

(A) day (B) meal (C) week (D) month Answer : (A)

ESSAY 20. Animal food sources have protein with the highest biologic value; however, they also provide saturated fats and cholesterol. List some low-fat animal sources that offer complete proteins but are low in saturated fats and cholesterol.

Graders Info : Fish, lean meats such as skinless chicken or turkey, lean pork such as center loin chop or Canadian bacon, lean beef such as sirloin, low-fat dairy products 21. Discuss the process of metabolism of proteins.

Graders Info : Some amino acids are released into the blood and are recycled to build new tissue and repair other tissue. All essential amino acids must be present to build and repair the cells as needed. When amino acids are broken down, the nitrogen-containing amine group is stripped off. This process is called

deamination. Deamination produces ammonia, which is released into the bloodstream by the cells.

The liver picks up the ammonia, converts it to urea, and returns it to the bloodstream for the kidneys to filter out and excrete. The remaining parts are used for energy or are converted to carbohydrate or fat and stored as glycogen or adipose tissue.

22. Trace the metabolism and digestion, mechanical and chemical, of protein through the body.

Describe the metabolism process and the utilization of the by-products and elimination of the waste.

Discuss the deamination of amino acids that produces ammonia and the specific actions that occur throughout the body. What is the impact of hormones and enzymes on these processes? Include digestion that begins in the mouth and ends in body tissues.

Graders Info : Mechanical digestion begins in the mouth. Chemical digestion begins in the stomach and continues through the small intestine, where enzymes aid in digestion. Deamination produces ammonia, which enters the liver and kidneys. The remaining parts are used for energy or are converted to carbohydrate or fat and stored as glycogen or adipose tissue. (Each of these processes should be discussed thoroughly.)

23. Discuss the impact of a high-protein diet on the body.

Graders Info : Intake of excess protein may cause persons to ignore essential fruits and vegetables. Complete proteins are high in saturated fats and cholesterol and may contribute to heart disease. There is a correlation between long-term high-protein diets and colon cancer, high calcium excretion, and a higher demand on the kidneys.

24. Discuss the impact of protein deficiency on the body.

Graders Info : Muscle wasting; thin arms and legs; serum protein deficiency will cause edema, loss of appetite, strength, and weight; slow wound healing; lethargy, and depression.

25. Describe the conditions under which the body would use protein as a source of energy.

Graders Info : Proteins can provide energy when the supply of carbohydrates and fats in the diet is insufficient to meet the body's needs.

26. Calculate the number of grams of protein that would be needed by a healthy adult who weighs 220 pounds.

Graders Info : Step 1: Divide body weight by 2.2 to obtain weight in kilograms220/2.2 = 100 kg Step 2: Multiply the answer obtained in step 1 by 0.8 (g of protein/kg of body weight) 100 × 0.8 = 80 Answer. 80 g

TRUEFALSE 27. Most animal sources are high-quality, complete proteins. _________________________ (A) True (B) False Answer : (A)

28. There are thousands of proteins in the human body. Heredity determines the specific types within each person. _________________________ (A) True (B) False Answer : (A)

29. Essential amino acids are necessary for growth and development and must be provided in the diet. There are 20 amino acids that are considered essential. _________________________ (A) True (B) False Answer : (B)

30. Tofu, an economical and nutritious meat replacement, is rich in high-quality proteins and B vitamins; however, it is high in sodium, which limits its use. _________________________ (A) True (B) False Answer : (B)

31. Single amino acid supplements are safe to consume because this is how they occur naturally in

food._________________________ (A) True (B) False Answer : (B)

32. The body uses the recycled amino acids as efficiently as those obtained from the diet. _____________________ (A) True (B) False Answer : (A)

33. Proteins are essential for the development of antibodies and, consequently, for a healthy immune system. ____________________________ (A) True (B) False Answer : (A)

34. Protein is the only one of the six essential nutrients that contains hydrogen. ___________________ (A) True (B) False Answer : (B)

ESSAY 35. Ariel, 19 years of age, was brought to the emergency room by her parents. She spilled a hot dish of boiling water on herself. She has second- and third-degree burns on her chest, abdomen, arms, and legs. Ariel is at risk for altered nutrition, less than body requirements, due to the hypermetabolic state in response to the burn.

What nutrient does Ariel need an increased amount of during this time? Why? Describe the increased metabolic demand for burn victims.

Graders Info :

The primary function of protein is to build and repair body tissues. Ariel is in need of increased amounts of protein to heal the burned tissues. The burn depletes the fluids and electrolytes in the body, and increases the metabolic rate in the effort to heal the tissue. Dehydration can easily occur.

36. The average adult daily requirement is 0.8 g of protein per kilogram of body weight. Ariel weighs 110 pounds. What is the adult daily requirement of protein for her?

Graders Info : 40 g of protein 37. When completing a nursing care plan for Ariel, based on protein and metabolic needs, what are the desired outcomes/evaluation criteria for Ariel?

Graders Info : Ariel's skin will heal as lost tissue is replaced and damaged skin is repaired. Ariel will maintain a fluid and electrolyte balance as manifested by normal labs and balanced intake and output.

38. What nursing actions/interventions will need to be performed to meet the desired outcomes?

Graders Info : Monitor intake and output. Maintain adequate intake of fluids (based on weight). Teach Ariel the importance of fluid intake. Determine favorite foods and drinks and offer those. Skin care, dressings as ordered.

39. Good nutrition is essential for the injured tissues to be healed. What type of diet does Ariel need to ensure healing? What foods are the best sources for her diet?

Graders Info : High protein and vitamin C; food sources of complete proteins include meat, fish, eggs, poultry, milk, and cheese. Vitamin C is in fresh fruits and vegetables.

40. What is the state of the nitrogen balance with a burn victim?

Graders Info : Negative nitrogen balance occurs when protein is being lost, as in conditions caused by burns and fevers.

41. Malnutrition is a major health problem in the world, especially for children. Mario, age 3, lives in

a country where the rate of malnutrition is high. In addition to enduring the lack of food, he frequently has diarrhea, which is a major factor. He has an extreme form of malnutrition, protein malnutrition, or kwashiorkor. In Ghana, the word kwashiorkor means "the sickness the older child gets when the next baby is born."

Correlate the above description of kwashiorkor with the intake of protein.

Graders Info : This disease appears when there is a sudden or recent lack of protein-containing foods. When a mother has a breast-feeding child and delivers another infant that is put to the breast, suddenly the older child's intake of protein is drastically reduced or stopped.

42. List the symptoms of kwashiorkor.

Graders Info : Edema, painful skin lesions, changes in the pigmentation of skin and hair 43. Why does edema occur in this state of malnutrition?

Graders Info : With an inadequate supply of protein for an extended period, muscle wasting will occur and arms and legs become very thin. An albumin (protein) deficiency will cause edema.

44. Discuss the effect of diarrhea on the electrolyte balance.

Graders Info : Watery diarrhea depletes fluid and electrolytes in the body.

45. Mario has an infected foot that was injured in a rock slide. Describe the impact of protein and immunity on Mario's injury.

Graders Info : Protein is necessary for healing of damaged body tissues. The long-term protein deficiency will cause decreased immunity to medical conditions. With decreased immunity and a lack of protein in the diet, Mario will have a difficult time with wound healing.

46. Since his younger sibling was born, Mario's diet has consisted mainly of grains. He lives in a remote area that makes it difficult for perishable foods to be transported in. What food sources are

of highest quality and are likely to be transported to his country?

Graders Info : Incomplete protein choices, plants, are more easily stored and are nonperishable in most cases.

Beans, legumes, grains, corn, and nuts are incomplete sources that can be served together to equal a complete protein.

47. Describe the dietary condition(s) that are present when children are extremely thin for their height, and contrast this with the reason children are short for their ages. Which is the most common sign for malnutrition in developing countries?

Graders Info : Children who are thin for their height are suffering from recent severe food restriction; and those who have stunted growth may have experienced long-term starvation. The child whose growth is stunted may look normal, but such stunting is the most common sign of malnutrition.

48. There are factors that determine the protein requirement an individual needs. List them.

Graders Info : Size, age, sex, physical (pregnancy, breast-feeding, surgery, burns, infection) and emotional conditions

Chapter 07 Vitamins MULTICHOICE 1. Which of the following nutrients enables the body to use energy?

(A) carbohydrates (B) vitamins (C) minerals (D) water Answer : (B)

2. _____ are organic compounds that are essential in small amounts for body processes.

(A) Carbohydrates (B) Vitamins (C) Minerals (D) Proteins Answer : (B)

3. What is the term used for foods that have been supplemented with vitamins?

(A) nutrient-dense (B) processed (C) enriched or fortified (D) nutrient-added Answer : (C)

4. An example of a fat-soluble vitamin is ____.

(A) vitamin C (B) vitamin B12 (C) niacin (D) vitamin K Answer : (D)

5. How can one avoid the loss of vitamins during cooking?

(A) cook vegetables slowly for 1 hour on stovetop (B) steam vegetables (C) use dressing with mineral oils (D) cook vegetables in an oven in lots of water Answer : (B)

6. Which vitamin is essential for maintaining a healthy immune system?

(A) vitamin B12 (B) vitamin A (C) alpha-tocopherol (D) cholecalciferol Answer : (B)

7. What is the consequence of vitamin D deficiency?

(A) rickets (B) scurvy (C) pellagra (D) dermatitis Answer : (A)

8. What is the best source of vitamin D? (A) milk (B) fortified milk (C) sunlight (D) cheese Answer : (C)

9. In which of the following situations is vitamin K NOT indicated?

(A) to clients with faulty fat absorption

(B) to a client after extensive antibiotic therapy (C) as an antidote for an overdose of a blood thinner (D) to prevent hemolytic anemia in premature infants Answer : (D)

10. What is one possible consequence of hypervitaminosis of vitamin A? (A) xerostomia (B) kidney disease (C) diabetes (D) liver damage Answer : (D)

11. What are the best dietary sources of vitamin ?K (A) green, leafy vegetables (B) cow's milk (C) corn (D) legumes Answer : (A)

12. Which vitamin B is essential for the metabolism of carbohydrates and some amino acids?

(A) thiamine (B) riboflavin (C) niacin (D) vitamin B6 Answer : (A)

13. Which vitamin B is stable in heat and is not destroyed during storage?

(A) thiamine (B) riboflavin (C) niacin

(D) vitamin B6 Answer : (C)

14. When a deficiency in this vitamin occurs, there is an increased chance of neural tube defects.

(A) thiamine (B) niacin (C) folate (D) cobalamin Answer : (C)

15. Deficiency of which vitamin can result in scurvy?

(A) vitamin C (B) vitamin D (C) vitamin B12 (D) vitamin A Answer : (A)

16. _____is the excess of one or more vitamins.

(A) Hypervitaminosis (B) Toxicity (C) Hypovitaminosis (D) Avitaminosis Answer : (A)

17. Vitamin _____ is also categorized as a prohormone.

(A) A (B) E (C) K (D) D Answer : (D)

18. _____ are an example of a precursor.

(A) Pantothenic acids (B) Carotenoids (C) Coenzymes (D) Antioxidants Answer : (B)

19. Which of the following is NOT a food source of biotin?

(A) milk (B) legumes (C) mushrooms (D) egg yolks Answer : (C)

20. The deficiency of vitamin D inhibits the absorption of _____ and _____ in the small intestine.

(A) potassium and calcium (B) calcium and biotin (C) phosphorus and potassium (D) phosphorus and calcium Answer : (D)

ESSAY 21. Describe why mineral oil should not be used as a laxative.

Graders Info : Mineral oil is not absorbed by humans. The oil picks up fat-soluble vitamins and carries them through the colon. The body is not able to absorb the vitamins.

22. Some vitamins are easily destroyed by light, air, heat, and water. Describe ways to preserve the vitamin during its preparation and cooking.

Graders Info : Buy freshest and unbruised produce and use raw if possible. Prepare fresh vegetables and fruits just before serving. Heat canned vegetables quickly and in their own juice. Follow package directions when using frozen vegetables and fruits. Use as little water as possible when cooking and have it boiling before adding vegetables. Steaming is better. Cover the pan and cook in as short a time as possible. Save the cooking liquid for later use in soups, stews, and gravies. Store fresh vegetables and most fruits in a cool, dark place.

23. Describe the relationship between vitamin A and cancer prevention.

Graders Info : Vitamin A is one of the antioxidant vitamins that protect the cells from destruction by oxygen.

Oxygen causes free radicals to form, which are highly reactive chemical compounds that damage cell structure and function. Such damage may contribute to some cancers and heart disease.

24. Describe the types of people who are prone to vitamin deficiencies.

Graders Info : Persons who do not eat a balanced diet, including alcoholics, the poor and incapacitated, the elderly, clients with serious diseases that affect appetite, intellectually disabled persons, and young children who receive inadequate care. Fat-soluble vitamin deficiency may occur in clients with chronic malabsorption diseases such as cystic fibrosis, celiac disease, and Crohn's disease.

25. Describe the use of vitamin E in premature infants and the elderly.

Graders Info : Vitamin E aids in the body's immune defenses by protecting the red blood cell membrane and preventing the hemolysis of red blood cells. It has been helpful in the prevention of hemolytic anemia among premature infants.

26. Describe the uses of vitamin K and its sources.

Graders Info : Vitamin K is essential for the proper clotting of blood. It is given to newborns to prevent intracranial hemorrhage. It is used for clients with faulty fat absorption, after extensive antibiotic therapy, after an overdose of anticoagulant, or to treat hemorrhage. Sources include broccoli, cabbage, spinach, kale, dairy products (cow's milk is a better source than human milk), eggs, meat, fruits, and cereal.

TRUEFALSE 27. A normal, healthy adult who eats a balanced diet needs a vitamin supplement that meets the daily minimum requirement. _________________________ (A) True (B) False Answer : (B)

28. The tolerable upper limits are a maximum level of daily intake that is recommended. _________________________ (A) True (B) False Answer : (B)

29. The U.S. Food and Drug Administration has determined that synthetic, or manufactured, vitamins are far superior in quality to those that occur naturally. _________________________ (A) True (B) False Answer : (B)

30. The major function of vitamin A is the promotion of calcium and phosphorus absorption in the body. _________________________ (A) True (B) False Answer : (B)

31. The deficiency of vitamin D in young children may cause night blindness. _________________________ (A) True (B) False Answer : (B)

32. Megadoses of vitamins can be toxic. _________________________

(A) True (B) False Answer : (A)

33. Vitamin C is a fat-soluble vitamin. _________________________ (A) True (B) False Answer : (B)

34. Vitamins are found in large amounts in foods. ____________________ (A) True (B) False Answer : (B)

ESSAY 35. Ms. Salmendos came to the clinic with her 12-year-old daughter, Melissa, for a school checkup.

She tells the nurse that she is on a vitamin regime that she began about 8 months ago. She says that she feels great, except for the occasional stomach upset and that she plans to start her daughter on a teen plan when she turns 13. She takes these vitamins: vitamins A, D, E, K, B complex that includes B6, thiamine, folate, and niacin, and C. What can you tell Ms. Salmendos about the toxic effects of these vitamins?

Graders Info : Vitamin A-birth defects, hair loss, dry skin, headaches, nausea, dry mucous membranes, bone and joint pain Vitamin D-deposits of calcium and phosphorus in soft tissues, kidney and heart disease, and bone fragility Vitamin E-relatively nontoxic and the excess is stored in adipose tissue Vitamin K-a form of anemia B complex that includes B6, thiamine, folate, and niacin: B6-depression, nerve damage Thiamine-no known ill effects from excess oral route Niacin-vasodilation of blood vessels Folate-could mask a B12 deficiency Vitamin C-elevated uric acid level, kidney stones, hemolytic anemia, and rebound scurvy

36. What should you tell her about vitamins in general, or the usual need for vitamins?

Graders Info : If a healthy individual eats a balanced diet, according to MyPlate, there is no need for additional dietary supplements.

37. Ms. Salmendos asks you, "Who are vitamins meant for, and why is it such a big business if people do not need supplements?"

Graders Info : Some people may have marginal deficiencies if they suffer from chronic illnesses, such as alcoholism, drug addiction, or cancer, or have medical conditions that limit food intake.

38. If only selected groups of people need vitamins, why do so many people take them?

Graders Info : People take them for the wrong reasons. They feel insecure about the quality of their diet. They believe that some vitamins will relieve stress. They want to prevent colds and minor illnesses. They think some vitamins will help prevent cancer. They think they will feel better. None of these reasons has been proven. The best advice is to eat a well-balanced diet.

39. Ms. Salmendos asks you why a friend of hers who has just found out she is pregnant was told by her physician that she should have been taking a vitamin, folate, prior to her pregnancy.

Graders Info : It is important for all women of childbearing age to take as much as double the recommended amount of folate. The latest research has associated folic acid deficiency with neural tube birth defects that occur in one out of every 1,000 births. These defects arise early in pregnancy. By recommending extra folate before pregnancy, the Public Health Service hopes to decrease the number of these defects. They also recommend that the extra folate come from foods, rather than supplements.

40. Ms. Salmendos asks, "If I do need a vitamin supplement, what type should I take?"

Graders Info : First, take the advice of your physician. If you need a vitamin, select one that meets the minimum daily requirement. Check the label for comparison. Avoid choosing one that has an excess amount of any ingredient.

41. Ms. Salmendos tells you that she feels that the drug companies have wrongly encouraged her to take vitamins. She wonders if the companies are truthful in their labeling.

Graders Info : Yes, they are. The Federal Drug Administration mandates correct labeling of all products. There are new labeling laws that include vitamin supplements.

Chapter 08 Minerals MULTICHOICE 1. To retain the minerals when cooking plant foods, one should ____.

(A) cook food in as much water as possible (B) fry foods in vegetable oil (C) steam foods (D) cook them as long as possible Answer : (C)

2. The two minerals that are major components of bones and teeth are ____.

(A) calcium and phosphorus (B) calcium and potassium (C) calcium and zinc (D) phosphorus and fluoride Answer : (A)

3. The vitamin that enhances the absorption of calcium is ____.

(A) vitamin C (B) vitamin D (C) vitamin B12 (D) vitamin B6 Answer : (B)

4. How does oxalic acid affect calcium absorption?

(A) can bind to calcium and prevent its absorption (B) enhances calcium absorption (C) enhances calcium utilization (D) decreases serum calcium Answer : (A)

5. Which food is most likely to enhance the absorption of iron?

(A) legumes (B) orange juice (C) whole grains (D) corn Answer : (B)

6. Which mineral is responsible for affecting the normal functioning of the thyroid gland?

(A) sodium (B) iron (C) iodine (D) selenium Answer : (C)

7. Which of the following is a major role of zinc in the body?

(A) component of enzyme that acts as an antioxidant (B) essential for growth and wound healing (C) helps keep the body in electrolyte balance (D) protects cells against oxidation Answer : (B)

8. Which mineral is associated with glucose metabolism?

(A) zinc (B) selenium (C) iron (D) chromium Answer : (D)

9. Which mineral is vital to both hard and soft body tissues?

(A) copper

(B) magnesium (C) manganese (D) fluoride Answer : (B)

10. The best source of this mineral is found in organ meats and shellfish.

(A) manganese (B) magnesium (C) copper (D) fluoride Answer : (C)

11. Where does 1% of calcium go when absorbed by the body?

(A) skeleton (B) teeth (C) blood (D) liver Answer : (C)

12. What factor can reduce the amount of calcium absorbed in the body?

(A) inadequate vitamin C (B) a high potassium intake (C) lack of weight-bearing exercise (D) lack of nonweight-bearing exercise Answer : (C)

13. Which mineral deficiency may result in rickets?

(A) zinc (B) calcium (C) iron

(D) magnesium Answer : (B)

14. Which mineral aids calcium in the formation of strong bones and teeth?

(A) phosphorus (B) iron (C) potassium (D) magnesium Answer : (A)

15. An insufficiency of this mineral may result in muscle tetany.

(A) magnesium (B) iron (C) iodine (D) calcium Answer : (D)

16. Which mineral aids in the process of blood clotting?

(A) magnesium (B) iron (C) iodine (D) chloride Answer : (A)

17. Which mineral deficiency may result in dwarfism and poor wound healing?

(A) selenium (B) iron (C) zinc (D) iodine Answer : (C)

18. What may occur as a result of dehydration?

(A) hypokalemia (B) hyperkalemia (C) edema (D) diabetic acidosis Answer : (B)

19. Which mineral's absorption is affected by an excessive use of antacids?

(A) sodium (B) potassium (C) phosphorus (D) calcium Answer : (C)

20. Wilson's disease is a result of an accumulation of _____ in the liver, brain, kidneys, and cornea.

(A) manganese (B) magnesium (C) copper (D) selenium Answer : (C)

21. Major minerals are required in amounts greater than _____ per day.

(A) 100 mg (B) 1,000 mg (C) 150 mg (D) 1,500 mg Answer : (A)

22. What mineral is the most prevalent mineral in the body?

(A) iron

(B) phosphorus (C) calcium (D) potassium Answer : (C)

23. Bone mass is acquired until one is approximately _____ years old.

(A) 18 (B) 30 (C) 50 (D) 65 Answer : (B)

24. Which major mineral is required for the transmission of nerve impulses?

(A) phosphorus (B) sulfur (C) potassium (D) iron Answer : (C)

25. _____ is a condition due to an inborn error of metabolism and causes excessive absorption of iron.

(A) Wilson's disease (B) Marasmus (C) Dwarfism (D) Hemochromatosis Answer : (D)

ESSAY 26. Describe the deficiency condition that occurs as a result of inadequate iodine in the body.

Graders Info : In an attempt to take up more iodine, the thyroid gland grows and forms a lump in the neck called a goiter.

27. Describe the source of minerals.

Graders Info : Minerals are found in water and natural foods. Minerals can also be obtained by eating plants grown in the soil or by eating animals (meat) that have eaten the plants.

28. Most minerals in food occur as salts. Describe preparation methods for foods that contain mineral salts.

Graders Info : The salts are soluble in water. Therefore, use as little water as possible, steam the foods, or save the excess water and use it in gravies, soups, or other sauces.

29. Describe the results of taking in excessive amounts of minerals.

Graders Info : When concentrated forms of minerals are taken on a regular basis, the amount is more than the body can handle and toxicity occurs. An excess of one mineral can cause a deficiency in another mineral. Excess minerals can also cause hair loss and changes in the blood, hormones, bones, muscles, blood vessels, and nearly all tissues.

30. Discuss factors that impact the absorption of iron.

Graders Info : Iron must be chemically changed to ferrous iron prior to absorption. This chemical action occurs in the stomach through the action of hydrochloric acid. Absorption can be enhanced by consuming foods with vitamin C at the same time as a food rich in iron. Vitamin C keeps the iron in the correct form for absorption. A meat protein factor is found in meat, poultry, and fish that also aids in the absorption of iron.

31. Explain how mineral salts are related to the concept of electroneutrality.

Graders Info : As mineral salts dissolve in water, they break into separate, electrically charged particles called ions. Positively charged ions are called cations. When negatively charged, they are called anions.

The cations and anions must be balanced within the body fluids to maintain electroneutrality.

32. Discuss the consequences of sodium toxicity.

Graders Info : An excess of sodium may cause edema. This edema adds pressure to artery walls that can cause hypertension. Thus, an excess of sodium is frequently associated with cardiovascular conditions such as hypertension and congestive heart failure.

TRUEFALSE 33. Minerals are present in all body tissues; however, they make up only 4% of body weight. _________________________ (A) True (B) False Answer : (A)

34. Refined foods or processed foods are the best source for many of the minerals needed to perform their role as body regulators. _________________________ (A) True (B) False Answer : (B)

35. Only the bones and teeth require calcium intake. _________________________ (A) True (B) False Answer : (B)

36. Potassium, in combination with calcium, is necessary for strong bones and teeth. _________________________ (A) True

(B) False Answer : (B)

37. The adequate intake of fluoride remains the same from infancy throughout the life cycle because the bones and teeth are fully developed by early adulthood. _________________________ (A) True (B) False Answer : (B)

38. Minerals are inorganic. This means they do not contain carbon. ____________________ (A) True (B) False Answer : (A)

39. Myxedema refers to hyperthyroidism in adults. ____________________ (A) True (B) False Answer : (B)

40. Zinc is a cofactor for more than 300 enzymes. ____________________ (A) True (B) False Answer : (A)

ESSAY 41. Ms. Jaye is having difficulty walking due to edema in her feet and legs. She has been taking diuretics and now she is also complaining of feeling weak and dizzy. Her potassium is low.

Describe the function of potassium.

Graders Info :

It maintains the fluid level within the cell and is necessary for transmitting nerve impulses and for muscular contractions.

42. Describe the relationship between the electrolytes, potassium and sodium, and edema.

Graders Info : Potassium maintains the fluid level within the cell and sodium maintains it outside the cell.

Normally, there is more potassium than sodium inside and more sodium than potassium outside the cell. When this balance is upset, the sodium amount increases, and so does the fluid level within the cell. This results in edema. If the sodium level outside the cell drops, fluid enters the cell to dilute the potassium level, thereby causing a reduction of extracellular fluid, which in turn causes a decrease in blood pressure and dehydration.

43. What conditions could cause a potassium deficiency, and what conditions could cause an excess potassium level?

Graders Info : Diarrhea, vomiting, diabetic acidosis, severe malnutrition, and excess use of laxatives or diuretics result in potassium deficiency. Hyperkalemia can be caused by dehydration, renal failure, or excess intake.

44. What are the symptoms of potassium deficiency?

Graders Info : Nausea, anorexia, fatigue, muscle weakness, and heart abnormalities are symptoms of deficiency.

45. List the best food sources of potassium.

Graders Info : Melons, oranges, bananas, peaches, mushrooms, brussels sprouts, potatoes, tomatoes, winter squash, lima beans, and carrots 46. What is the best food source of sodium?

Graders Info : Table salt 47. List the medical conditions that are impacted by the sodium and potassium level or by an

electrolyte imbalance.

Graders Info : The edema that results from an imbalance of sodium and potassium can cause hypertension or congestive heart failure.

48. Describe the risk factors of osteoporosis for Ms. James.

Graders Info : Risk factors include being a woman over 45 years old; women consume half the amount of calcium that men do; women's bone mass is lower than men's because of the small body frame; bone loss begins earlier in women than men; bone loss is accelerated after menopause.

49. Educate Ms. James regarding measures to delay or reduce bone loss.

Graders Info : An adequate intake of calcium, magnesium, fluoride, vitamins A and D, and moderate weight-bearing exercises like walking, running, or dancing impact calcium bone loss.

50. Describe the conditions that occur when blood calcium is above normal and below normal levels.

Graders Info : Elevated blood calcium levels may result in calcium rigor, which contracts the muscles and prevents them from relaxing. Decreased blood levels cause calcium tetany, which is an uncontrolled muscle contraction.

51. Ms. James asks you to recommend the best food sources of calcium.

Graders Info : Milk and milk products such as yogurt and cheese are the best sources. Some vegetables are good sources, such as mustard greens, kale, parsley, and broccoli. Other sources have been fortified with calcium such as bread, orange juice, and high-calcium milk.

52. Ms. James does not like milk. Give her a list of some alternate foods that are high in calcium.

Graders Info :

Yogurt and cheese are both high in calcium. Powdered nonfat dry milk can be used in cooking.

Puddings, custards, and baked foods can be made with milk. Small fish (such as sardines) and salmon are rich in calcium.

Chapter 09 Water MULTICHOICE 1. Water constitutes what percentage of body weight?

(A) between 20 and 30% (B) between 50 and 60% (C) between 30 and 40% (D) over 60% Answer : (B)

2. What hormone is excreted in response to dehydration?

(A) insulin (B) antidiuretic hormone (C) aldosterone (D) testosterone Answer : (B)

3. Which organ has the main role of helping electrolyte balance?

(A) liver (B) stomach (C) heart (D) kidneys Answer : (D)

4. Low blood pressure, dry skin, and fever are all symptoms of ____.

(A) sodium deficiency (B) anxiety (C) dehydration (D) hypertension Answer : (C)

5. A pH of 3 is considered ____.

(A) risky (B) basic (C) acidic (D) neutral Answer : (C)

6. When there is an increase in carbon dioxide in the blood, what occurs?

(A) heart rate increases (B) breathing rate increases (C) heart rate slows (D) breathing rate slows Answer : (B)

7. When the body is not able to balance the need for bases with the amount of acid retained, what condition might occur?

(A) alkalosis (B) renal failure (C) acidosis (D) kidney disease Answer : (C)

8. Which fluid is found in the intravascular fluid and glandular secretions?

(A) intracellular fluid (B) extracellular fluid (C) interstitial fluid (D) electrolyte fluid Answer : (B)

9. Water is a _____ for nutrients and waste products.

(A) solute (B) solvent (C) solution (D) none of the above Answer : (B)

10. What are the solutes that maintain the balance between intracellular and extracellular fluids?

(A) potassium, phosphorus, and chloride (B) sodium, potassium, and chloride (C) calcium, phosphorus, and potassium (D) sodium and copper Answer : (B)

11. When the sodium in the extracellular fluid is reduced, what condition might occur?

(A) dehydration (B) hypertension (C) cellular edema (D) nausea Answer : (C)

12. How much water loss can result in circulatory failure?

(A) 10% (B) less than 10% (C) 20% or more (D) 50% Answer : (C)

13. What is the average daily adult requirement for water?

(A) 1,800 mL (B) 5 mL for every calorie consumed

(C) 1 mL for every calorie consumed (D) at least 500 mL a day Answer : (C)

14. Which of the following conditions may arise with a positive water balance?

(A) hyperthyroidism (B) diabetes (C) low white blood cell count (D) congestive heart failure Answer : (D)

15. What is the pH of blood plasma in a healthy person?

(A) pH 6.8-7.1 (B) pH 7.35-7.45 (C) pH 7 (D) below pH 7 Answer : (B)

16. Which element is regulated by the buffer systems?

(A) oxygen (B) hydrogen (C) carbon dioxide (D) chloride Answer : (B)

17. What condition can occur when the body has suffered a loss of hydrochloric acid?

(A) acidosis (B) alkalosis (C) renal failure (D) hypertension

Answer : (B)

18. How many days can a human live without water?

(A) 30-45 (B) 3-5 (C) 15-30 (D) 10-14 Answer : (B)

19. Water lost by healthy individuals through urination, feces, perspiration, and respiration must be replaced in terms of _____.

(A) volume and electrolyte content (B) electrolyte content only (C) volume only (D) homeostasis Answer : (A)

20. _____ is the principal electrolyte in intracellular fluid.

(A) Chloride (B) Potassium (C) Sodium (D) Carbon dioxide Answer : (B)

21. Which of the following conditions does NOT cause accumulation of excess fluid in the body?

(A) hypothyroidism (B) heart failure (C) hypoproteinemia (D) hemorrhage Answer : (D)

22. The body has buffer systems that regulate _____ content in body fluids.

(A) sodium (B) hydrogen ion (C) potassium (D) chloride Answer : (B)

ESSAY 23. Describe why infants and the elderly are more vulnerable to water deprivation.

Graders Info : Infants have the greatest percentage of total body weight as water. They have a greater fluid intake and output, proportionally, than older children or adults; therefore, imbalances occur more frequently and more rapidly and infants adjust less quickly to these occurrences. The elderly have little storage for extra fluids and the least percentage of total body weight as water.

24. Describe the mechanism of thirst. Describe situations when thirst is not a reliable warning.

Graders Info : Thirst is a protective mechanism that alerts the individual to the need for fluids; however, thirst lags behind the body's need. A water deficiency that develops slowly may alert the body in time to consume adequate fluids to prevent dehydration, but one that occurs rapidly may not. In the elderly, the confused, and in infants, it is not a reliable guide.

25. List conditions when the need for fluids is increased.

Graders Info : Fever, hemorrhage, burns, diabetes mellitus, excessive perspiration, excessive urination, certain medications (such as diuretics), vomiting, or diarrhea 26. List the functions of water in the body.

Graders Info :

Component of all body tissues providing structure and form; participates in many chemical reactions; serves as solvent for minerals, vitamins, amino acids, glucose, and other small molecules or waste products; acts as lubricant and cushion around joints as a shock absorber; assists in regulation of body temperature by evaporation and perspiration; essential for hydrolysis and metabolism; aids in digestion; bathes eyes, spinal cord; makes up the amniotic fluid that surrounds the fetus.

27. List substances included in measurement of intake and output.

Graders Info : Fluids taken orally include gelatin, ice cream, soup, juice, water, coffee, soft drinks, and any other liquids taken in. Intake also includes fluids given through nasogastric tube, through gastrostomy or jejunostomy tubes, or intravenously. Output includes urine, diarrhea, vomitus, gastric suction contents, and drainage from any postsurgical drainage tubes.

28. What is a buffer system and what mixture maintains the body's main buffer system?

Graders Info : Buffer systems are protective systems regulating amounts of hydrogen ions in body fluids. A mixture of carbonic acid and sodium bicarbonate forms the body's main buffer system.

29. List good sources of fluid for clients who have difficulty swallowing thin liquids.

Graders Info : If the client has difficulty swallowing thin liquids, foods with the consistency of gelatin, fruit ices, yogurt, custards, or puddings may be desirable. Also, a powdered substance is available to thicken thin liquids so that they can be more easily swallowed.

TRUEFALSE 30. The average adult's body contains approximately 75% water. _________________________ (A) True (B) False Answer : (B)

31. In order to meet the body's fluid needs, the intake of fluids should be at least 1 L more than the output. _________________________ (A) True

(B) False Answer : (B)

32. The cerebrum regulates thirst. _________________________ (A) True (B) False Answer : (B)

33. If your body needs 2,000 calories daily, then you should consume 1,000 mL of water in order to maintain hydration and fluid balance. _________________________ (A) True (B) False Answer : (B)

34. The percentage of body weight that is water is higher in males than females because men have more muscle tissue than women. __________________________ (A) True (B) False Answer : (A)

35. The fluid found between cells is called intracellular fluid. _______________________ (A) True (B) False Answer : (B)

36. The body must excrete 1,500 mL of water each day to rid the body of the waste products of metabolism. _________________________ (A) True (B) False Answer : (B)

ESSAY 37. Mrs. Smythe, age 79, has had vomiting and diarrhea for 1 week, resulting in an 11-pound weight loss. She is pale, she has dry skin and poor skin turgor, and her lips are cracked and red. She appears to be very weak and states that she is very dizzy when she gets out of bed.

Describe the steps in planning nursing care.

Graders Info : The first step is priority setting to determine if any of the diagnoses represent life-threatening situations. Determine the overall expected outcome. Prioritize the problems based on Maslow's hierarchy of needs. List the problems and identify the cause of each. Include others in the plan.

Collaborate with family to identify any suggestions or interventions they may have noted in the past that were helpful. Meet with other members of the health care team for suggestions on planning the nursing care.

38. Give the priority nursing diagnosis statement for Mrs. James.

Graders Info : Fluid volume deficit related to excess vomiting and diarrhea 39. Identify nursing goals.

Graders Info : The fluid, electrolyte, and acid-base balance are restored and maintained. The cause of the fluid imbalance will be corrected (diarrhea).

40. List expected outcomes:

Graders Info : Vital signs will return to baseline normal. Normal skin turgor. Verbalization of need for and ingestion of increased fluids. Fluid and electrolyte balanced by discharge. Mucous membranes and skin moist and pink. No dizziness reported. Balanced intake and output. Soft, formed stools and no vomiting. Eating and retaining at least 50-75% of diet by discharge.

41. Which laboratory values are the most important when dehydration is present?

Graders Info :

Electrolytes: sodium, potassium, chloride, bicarbonate 42. The body's buffer system serves as a first line of defense against fluid and electrolyte imbalance.

Explain why.

Graders Info : The major minerals form salts that dissolve in the body fluids. The salts separate into ions, or charged particles. The ions can conduct electricity, thus the name electrolytes. The body cells determine where the salts go, and the movement of the salts, or electrolytes, controls the flow of fluids. Where the salt goes, the water follows. This action maintains the fluid-electrolyte balance in the body.

Chapter 10 Nutrition During Pregnancy and Lactation MULTICHOICE 1. ​What is a normal weight gain during pregnancy for an underweight woman?

(A) ​between 25 and 35 pounds (B) ​between 28 and 40 pounds (C) ​at least 40 pounds (D) ​no more than 35 pounds Answer : (D)

2. How many additional calories a day should a woman consume during the second and third trimesters?​ (A) ​second trimester an additional 240 calories, third trimester 350 calories (B) ​second trimester an additional 440 calories, third trimester 550 calories (C) ​second trimester an additional 340 calories, third trimester 450 calories (D) ​no extra calories are needed during pregnancy Answer : (C)

3. Which of the following nutrients does NOT need to be increased during pregnancy?​ (A) ​protein (B) ​vitamin C (C) ​iron (D) ​vitamin A Answer : (D)

4. Why is there an increased need for B vitamins during pregnancy?​ (A) ​for development of red blood cells (B) ​essential for development of infant's bones and teeth (C) ​to provide an increase of hemoglobin (D) ​essential for a fetus's collagen development

Answer : (A)

5. _____ is the condition when nausea persists and becomes so severe that it is life-threatening.​ (A) ​Parenteral gravidarum (B) ​Morning sickness (C) ​Hyperemesis gravidarum (D) ​Binge-purge gravidarum Answer : (C)

6. What two conditions can be relieved by eating high-fiber foods?​ (A) ​morning sickness and weight gain (B) ​hypertension and heartburn (C) ​hypertension and anemia (D) ​constipation and hemorrhoids Answer : (D)

7. ​How can heartburn be relieved?

(A) ​eating three meals a day (B) ​eating small, frequent meals (C) ​drinking three cups of milk a day (D) ​eating up to 25 g of fiber a day Answer : (B)

8. _____ is the craving for nonfood substances such as starch or clay.​ (A) ​Pico (B) ​Anemia (C) ​Pica (D) ​Picanemia Answer : (C)

9. ​Which nutrient is often deficient in women who are diagnosed with megaloblastic anemia?

(A) ​vitamin C (B) ​folate (C) ​iron (D) ​copper Answer : (B)

10. ​The ingestion of alcohol while pregnant can result in _____.

(A) ​weight gain (B) ​hypertension (C) ​spontaneous abortions (D) ​fetal alcohol syndrome Answer : (D)

11. The infant's sucking initiates the release of _____ (a hormone), which causes the ejection of milk into the infant's mouth.​ (A) ​oxytocin (B) ​aldosterone (C) ​insulin (D) ​prolactin Answer : (A)

12. During lactation, approximately how many extra calories are recommended daily for the first 6 months?​ (A) ​300 (B) ​400 (C) ​500 (D) ​1,000 Answer : (C)

13. Which vitamin, in excess, can cause birth defects?​

(A) ​vitamin C (B) ​vitamin E (C) ​vitamin A (D) ​vitamin D Answer : (C)

14. Which of the following are pregnant adolescents particularly prone to?​ (A) ​gestational diabetes (B) ​weight gain (C) ​pregnancy-induced hypertension (D) ​abruptio placentae Answer : (C)

15. ​What is the approximate number of calories in an ounce of human milk?

(A) ​10 calories (B) ​20 calories (C) ​30 calories (D) ​40 calories Answer : (B)

16. A nursing mother's use of caffeine may cause the following in her infant.​ (A) ​abnormal growth (B) ​blindness (C) ​irritability (D) ​fatigue Answer : (C)

17. The U.S. Public Health Service and the March of Dimes recommend that all women of childbearing age take a multivitamin or _____ of folic acid daily.​ (A) ​800 µg

(B) ​800 mg (C) ​400 mg (D) ​400 µg Answer : (D)

18. The need for _____ increases during pregnancy because of the increased blood volume during pregnancy.​ (A) ​calcium (B) ​iron (C) ​zinc (D) ​selenium Answer : (B)

19. Pregnancy-induced hypertension is characterized by _____.​ (A) ​hyperemesis gravidarum (B) ​pica (C) ​proteinuria (D) ​eclampsia Answer : (C)

20. ​Anemia may be caused by _____ deficiency.

(A) ​iron (B) ​folate (C) ​protein (D) ​zinc Answer : (C)

21. Macrosomia refers to birthweight of over _____ pounds.​ (A) ​7 (B) ​8

(C) ​9 (D) ​10 Answer : (C)

ESSAY 22. Weight gain during pregnancy is natural and necessary for the infant to develop normally and the mother to retain her health. Describe the recommended weight gain. Include variations for these conditions: adolescent, obesity, multiple infants, underweight, and each trimester. Correlate with the number of additional calories needed to achieve the desired gain.​

Graders Info : Average size: 25-35 lb gain; underweight: 28-40 lb gain; twin birth: 35-45 lb gain; obesity: 15 lb minimum; adolescent: more than 25-35 lb (approximately); first trimester: 2-4 lb, no additional calories; second and third trimesters: 1 lb per week, 340 calories daily for the second trimester and 450 calories daily for the third trimester.​ 23. Discuss four priority nutritional concerns for the pregnant woman. Include nursing interventions to relieve the symptoms.​

Graders Info : Nausea: Eat dry crackers or dry toast before rising; eat small, frequent meals; avoid foods with offensive odors; avoid liquids at mealtime.Constipation and hemorrhoids: High-fiber diet; daily exercise; drink 13 glasses of liquid per day; respond immediately to the urge to defecate.

Heartburn/indigestion: Eat small, frequent meals; avoid spicy or greasy foods; avoid liquids with meals; after eating wait at least 1 hour before lying down; wait at least 2 hours before exercising.

Excessive weight gain: Eliminate all food items that are not on the MyPyramid; bake, broil, or boil rather than frying; use fruits and custards made with fat-free milk; encourage raw vegetables as snacks; eliminate empty calorie foods.​

24. Describe the physiology associated with pregnancy and anemia. Compare iron deficiency anemia and folate deficiency anemia.​

Graders Info : Iron deficiency: During pregnancy, the increased volume of blood creates the need for additional iron for the hemoglobin for this blood. If the need is not met by the diet or by iron stores in the body, iron deficiency anemia develops. This is treated by a daily iron supplement.Folate deficiency: A form of megaloblastic anemia that can occur during pregnancy, it is characterized by too few red

blood cells and by large, immature red blood cells. The need for folic acid increases dramatically when new red blood cells are being formed.

25. Discuss the concerns that a pregnant teenager will have.​

Graders Info : The teen mother is still in need of nurturing herself. Economic needs for financial support. Social need to be a member of the teen group. Psychological need to meet love, belonging, and safety and security needs. To be an active member of a group. Prenatal health care. Infant care. Nutritional counseling to fulfill the nutritional needs of her own body. Nutritional counseling to meet infant's dietary need.​ 26. List the benefits of breastfeeding.​

Graders Info : Breast milk contains the right amount of lactose, water, fatty acids, and amino acids for brain development, growth, and digestion. No infant would be allergic to the mother's milk; however, there may be a reaction to something the mother eats. Human milk has 100 ingredients not found in formula. Breastfed infants have a lower incidence of ear infections, diarrhea, allergies, and hospital admissions. It is a source of antibodies to diseases such as pneumonia, bronchitis, influenza, German measles, botulism, and staphylococcal infections. Good for jaw development and growth of straight, healthy teeth because it is harder to get milk out of a breast than a bottle. The process creates an emotional attachment between mother and child. It aids in removing excess weight from mother and stimulates return of uterus to prepregnant state. Breast milk is economical, always the right temperature, and readily available.​ 27. Describe the physical characteristics of an infant born with fetal alcohol syndrome.​

Graders Info : Physical characteristics may include a small head, short eye slits, a flat midface, and a thin upper lip.

There is usually a growth deficiency, placing the child in the lowest 10th of age norms.​

TRUEFALSE 28. ​It is recommended that pregnant women should always drink an additional 6 oz of fortified milk per day. _________________________ (A) True (B) False

Answer : (B)

29. During pregnancy, the mother needs additional calories, vitamins, and minerals. It is advisable for the mother to take extra amounts of all vitamins and minerals. _________________________​ (A) True (B) False Answer : (B)

30. Nausea associated with pregnancy, or morning sickness, is a benign condition. _________________________​ (A) True (B) False Answer : (B)

31. Smoking during pregnancy may affect the intellectual and behavioral development of the fetus as it grows up. _________________________​ (A) True (B) False Answer : (A)

32. Women with smaller-sized breasts will be unable to produce enough milk to satisfy an infant. _________________________​ (A) True (B) False Answer : (B)

33. Research has shown that a lack of an intake of folate during pregnancy may result in neural tube defects for the baby. _________________________​ (A) True (B) False Answer : (B)

34. During pregnancy, most of the weight gain occurs during the first trimester of pregnancy.

___________________ (A) True (B) False Answer : (B)

35. A pregnant adolescent should gain the same weight as a mature woman of the same size. _____________________​ (A) True (B) False Answer : (B)

36. ​Overweight women should not lose weight during pregnancy. _________________________ (A) True (B) False Answer : (A)

37. When the mother drinks alcohol, it enters the fetal blood stream in the same concentration as it does the mother's. ______________________​ (A) True (B) False Answer : (A)

ESSAY 38. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

"How long do the experts recommend breastfeeding? I want to go back to work and I don't think I could do that pumping at work."

Graders Info : "The American Academy of Pediatrics recommends breast milk for the first 6-12 months of life. Some

women are not able to do that and it would be perfectly acceptable for you to breastfeed the child for any time period you desire. A beginning with breast milk would be a great beginning."​ 39. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

"If I breastfeed, will I have to be on a special diet?"​

Graders Info : "No, your dietary needs will be met if you continue as you are doing now, eating a nutritious diet that is adequate for calories, vitamins, and minerals."​ 40. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

"How many extra calories a day will I need to breastfeed?"​

Graders Info : The Institute of Medicine suggests an increase of 500 calories a day for the first 6 months of breastfeeding and 400 calories a day for 7-9 months. This is less than the actual need because it is assumed that some fat has been stored during pregnancy and can be used for milk production. The precise number of calories the mother needs depends on the size of the infant and its appetite and on the size and activities of the mother.​ 41. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

"If I eat all those additional calories, how will I ever lose all of the extra weight I have gained?"​

Graders Info : "Studies have shown that if you choose nutrient-dense foods, you will gradually lose the weight.

There may be a significant weight loss in the first month of lactation."​ 42. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

"Will I have to stop drinking coffee if I breastfeed?"​

Graders Info : ​"Excessive consumption of caffeine during lactation may cause irritability and wakefulness in the infant."

43. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

"Are there other important contraindications to breastfeeding that I need to know?"​

Graders Info : ​"Alcohol reduces the amount of milk produced. Caffeine causes irritability and wakefulness in the infant. Women who smoke produce less milk. Smoking exerts harmful effects on infants and mothers. Women who test positive for HIV should not breastfeed their infants. Breastfeeding mothers should not take oral contraceptives. It reduces the volume and the protein content of the milk. Other drugs may affect the infant and should be evaluated by the physician."

44. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

"Tell me why I should breastfeed." ​

Graders Info : "An infant grows faster the first year than at any other time. Their growth reflects their nutritional well-being. Breast milk excels as a source of nutrients for the young infant. With the exception of vitamin D and fluoride, breast milk provides all the nutrients a healthy infant needs for the first 4-6 months of life. Breast milk offers the infant protection against infection from viruses, bacteria, and other pathogens that cannot be achieved any other way. Breastfed children are less likely to develop stomach and intestinal disorders and middle ear infections, and are less likely to develop wheezing." ​ 45. M ​ s. Jayce, 6 months pregnant with her first child, visits you at the clinic. She wants to bottlefeed her baby; however, some coworkers have told her it is much better to breastfeed. She wants your opinion and has several questions for you to answer.

Ms. Jayce states, "Well, you have given me a lot of information to think about. I will continue to think about this. If my labor is not very difficult, I'll probably be able to make up my mind then." What is the appropriate response from the nurse? ​

Graders Info : "Ms. Jayce, I have only given you some general information about breastfeeding. There are some predelivery preparations you must make. I am going to refer you to a lactation specialist who can

prepare you for successful lactation, if that is your choice." ​ 46. You are assigned to complete nutritional assessments of pregnant women at a family planning clinic. After the examinations and interviews are completed, you will meet with the women as a group to answer questions or to begin prenatal education. You will need to identify the women who are at nutritional risk during pregnancy. ​ List risk indicators for which to be alert. ​

Graders Info : Women who ordinarily consume an inadequate diet; are lactose intolerant; are carrying multiple fetuses; smoke cigarettes or use other tobacco; use alcohol or illegal drugs; are underweight or overweight; gain excess weight; have an insufficient weight gain; lack nutritional knowledge; are economically deprived (poverty); are adolescents or teenagers; have a preexisting chronic illness; have had frequent pregnancies; have low hemoglobin and hematocrit. ​ 47. You are assigned to complete nutritional assessments of pregnant women at a family planning clinic. After the examinations and interviews are completed, you will meet with the women as a group to answer questions or to begin prenatal education. You will need to identify the women who are at nutritional risk during pregnancy. ​ Identify the components of a nutritional assessment. ​

Graders Info : Review of the health records; physical exam; laboratory analyses; interview to determine usual food and beverage intake, food allergies or intolerances, usual medications taken, adequacy of income to determine availability of food, medical history, cultural influences on dietary intake (religious or ethical), presence of any nutrition-related discomforts of pregnancy (morning sickness, constipation, heartburn, etc.), presence of or history of eating disorders, and obstetric or gynecological factors that impact the nutritional status ​ 48. You are assigned to complete nutritional assessments of pregnant women at a family planning clinic. After the examinations and interviews are completed, you will meet with the women as a group to answer questions or to begin prenatal education. You will need to identify the women who are at nutritional risk during pregnancy. ​ Identify some common nutrition-related outcomes. ​

Graders Info : The woman will achieve an appropriate weight gain during pregnancy; consume appropriate nutrients; use nursing measures to cope with nutrition-related discomforts; avoid consuming alcohol, illegal drugs, caffeine, and tobacco; prepare for successful breastfeeding or bottlefeeding.​

49. You are assigned to complete nutritional assessments of pregnant women at a family planning clinic. After the examinations and interviews are completed, you will meet with the women as a group to answer questions or to begin prenatal education. You will need to identify the women who are at nutritional risk during pregnancy. ​ Describe the role of the nurse versus that of the registered dietitian in prenatal dietary education. ​

Graders Info : The nurse can adequately educate the mother in making food choices and meal planning during pregnancy and lactation. Registered dietitians, however, may need to educate women in planning dietary modifications for women on special therapeutic diets. The registered dietitian can also calculate the patients specific calorie needs during the pregnancy based on height, weight, age, activity, weight gain needed by trimester, and so on. ​ 50. You are assigned to complete nutritional assessments of pregnant women at a family planning clinic. After the examinations and interviews are completed, you will meet with the women as a group to answer questions or to begin prenatal education. You will need to identify the women who are at nutritional risk during pregnancy. ​ Several women in the group are members of varied cultures. Identify potential dietary problems associated with the different cultures. ​

Graders Info :

​

Chinese: Use of large amounts of grease in cooking; limited use of milk and milk products; diet often low in protein and calories; use of soy sauce, which is high in sodium.Polish: Sodium in pork, sausage, and pickles; limited fruits and raw vegetables; large consumption of sweets; and a tendency to overcook vegetables.

Italian: Tendency to overcook vegetables; limited use of grains; high use of olive oil; and insufficient servings from milk groups.

Hispanic: Limited meats, milk, and milk products; average use of sugar; and large amounts of grease or lard.

Japanese: Excess use of sodium from soy sauce, pickles, salty seaweed, and monosodium glutamate (MSG); and insufficient use of milk.

African American: Extensive use of frying foods with shortening or oils; high consumption of gravies, salt pork, bacon drippings, or lard; limited milk; and excess intake of sugars.

Chapter 11 Nutrition During Infancy MULTICHOICE 1. How should infants' meal times be scheduled?

(A) three times a day (B) every 2 hours (C) three meals, two snacks a day (D) feed on demand Answer : (D)

2. By 6 months of age, a baby's weight can _____.

(A) remain unchanged (B) double (C) triple (D) quadruple Answer : (B)

3. Burping helps prevent _____.

(A) gas (B) regurgitation (C) air bubbles (D) gagging Answer : (B)

4. Infants under the age of 1 year should avoid regular cow's milk because it _____.

(A) is harder to digest than the mother's milk (B) can cause infectious diseases (C) doesn't contain any protein (D) is not readily available Answer : (A)

5. What may happen when a baby is regularly put to bed with a bottle in its mouth?

(A) Tooth decay may result (B) Saliva increases and may cause choking (C) The infant will reject breakfast (D) Gas and regurgitation Answer : (A)

6. With what microorganism can honey be contaminated?

(A) Salmonella (B) E. coli (C) C. perfringens (D) C. botulinum Answer : (D)

7. What foods listed below should not be offered to babies?

(A) fruit juice (B) nuts (C) bananas (D) chocolate Answer : (B)

8. What is the best food for a premature infant?

(A) whole milk (B) breast milk (C) 2% milk (D) infant formula Answer : (B)

9. _____ is an inherited disease affecting the exocrine glands.

(A) Cystic fibrosis

(B) Galactosemia (C) Diabetes (D) HIV Answer : (A)

10. What are some effects of untreated galactosemia?

(A) hypertension and deafness (B) anemia and constipation (C) diarrhea, vomiting, and edema (D) hypertension, diarrhea, and vomiting Answer : (C)

11. What is the dietary recommendation for an infant with galactosemia?

(A) three cups of milk a day (B) high-calorie dairy foods, for example, ice cream and milk shakes (C) elimination of milk from diet (D) milk in moderation Answer : (C)

12. Which liver enzyme is missing in infants with phenylketonuria?

(A) phenylalanine hydroxylase (B) phenylalanine hydrochlorase (C) phenylalanine ketonase (D) ketonase Answer : (A)

13. Congenital disabilities that prevent normal metabolism of specific nutrients are called _____.

(A) nutritional mutations (B) amniocentesis (C) failure to thrive

(D) inborn errors of metabolism Answer : (D)

14. Which disease is characterized by low weight for height; slow development of physical skills such as rolling over, sitting, and standing; and delayed social skills such as smiling or playing peeka-boo?

(A) phenylketonuria (PKU) (B) maple syrup urine disease (MSUD) (C) galactosemia (D) failure to thrive Answer : (D)

15. It is recommended that infants up to 6 months of age have _____ of protein per kilogram of weight per day.

(A) 0.8 g (B) 2.2 g (C) 1.56 g (D) 2.0 g Answer : (B)

16. Synthetic milk is commonly made from _____.

(A) rice (B) soybeans (C) goat's milk (D) artificial proteins Answer : (B)

17. Breast milk or formula should be the major food source for an infant until what age?

(A) 4-6 months (B) 1 year (C) 2 years

(D) 6-8 months Answer : (B)

18. Infants have _________ water per pound of body weight than adults.

(A) more (B) less (C) the same (D) Answer : (A)

19. When introducing solid foods to an infant's diet, _____ is usually introduced first.

(A) soft fruits (B) pureed vegetables (C) finely ground meat (D) cereal Answer : (D)

ESSAY 20. What are outcomes that ensure that the infant is receiving sufficient nutrition and calories from breastfeeding?

Graders Info : There are six or more wet diapers a day. There are one or two mustard-colored bowel movements daily. The breast becomes less full during nursing.

21. Describe correct positioning and burping techniques, with rationale, for feeding the infant.

Graders Info : Cuddle and hold the infant in a semi-upright position during feeding. This positioning is believed to decrease the occurrence of middle ear infections. During and after the feeding, the infant should be positioned upright and burped to release gas in the stomach and to help prevent regurgitation.

22. State instructions for preparing formula for infant feeding.

Graders Info : Serve at room temperature, or warmed. To warm the formula for feeding, place the bottle in a saucepan of warm water or a bottle warmer. The bottles should be shaken occasionally to warm the contents evenly. Do not use a microwave to warm the formula because the milk can heat unevenly and burn the infant's mouth. The temperature of the milk can be tested by shaking a few drops on one's wrist. The milk should feel lukewarm. Do not put the infant to bed with a bottle. That could cause tooth decay or protrusion of the upper teeth.

23. An infant with galactosemia who is fed lactose-free formula will have all its nutritional needs met. As the infant grows to become an adult, what type of nutrient supplements will be needed?

Graders Info : Calcium, vitamin D, and riboflavin 24. Describe the type of disability called inborn errors of metabolism.

Graders Info : These are congenital metabolic disabilities that infants may be born with. They prevent the normal metabolism of specific nutrients. This type of disability is caused by mutations in the genes. These disabilities may cause death at an early age, risk damage to the central nervous system, intellectually disabled, or retarded growth. Early diagnosis of these inborn errors, combined with diet therapy, increases the chances of preventing retardation. Hospitals test newborns for some of these disorders as a matter of course.

25. How is an infant's readiness for solid foods demonstrated?

Graders Info : Readiness for solid food is demonstrated by:​ 1. the physical ability to pull food into the mouth rather than pushing the tongue and food out of the mouth.

2. a willingness to participate in the process 3. the ability to sit up with support 4. having head and neck control 5. need for additional nutrients demonstrated by drinking more than 32 oz of formula or nursing 810 times in 24 hours 6. infant is at least 4 months old

26. Babies differ in the amount of food they eat from day to day. How will an infant let you know

they are full?

Graders Info : Babies will let you know they are full by:​ playing with the nipple on a bottle or breast looking around and no longer opening their mouth to solid food falling asleep while eating playing with food and not eating

TRUEFALSE 27. It is preferable to feed an infant on a schedule. _________________________ (A) True (B) False Answer : (B)

28. During the first year, the normal child needs half as many calories per kilogram as the adult requirement. _________________________ (A) True (B) False Answer : (B)

29. Breast milk provides all the nutrients needed by the infant except iron. _________________________ (A) True (B) False Answer : (B)

30. Babies differ in the amount of food they eat from day to day. An infant will let you know when they are full. _________________________ (A) True (B) False Answer : (A)

31. Human milk supplies the infant with sufficient vitamin C. ________________________ (A) True (B) False Answer : (A)

32. Excessive amounts of vitamin A can damage the infant's kidneys. _______________________ (A) True (B) False Answer : (B)

33. Mother's milk provides the infant with permanent immunity to many infectious diseases. _____________________ (A) True (B) False Answer : (B)

ESSAY 34. Maryanne, a 23-year-old mother of two children, is at the clinic for their checkup. Zachary is 7 months old and Lucia is 18 months old. Zachary weighed 8 lbs 4 oz at birth and now weighs 18 lbs.

Lucia weighed 7 lbs 10 oz at birth and now weighs 20 lbs. When the nurse commented on the weight of both children, Maryanne said that she was small and petite like Lucia when she was a child. ​ Further discussion revealed that Maryanne was breastfeeding Lucia when she found out she was pregnant again. The pregnancy was confirmed when Lucia was 2 months old, and at that time she stopped breastfeeding. She had a difficult time converting Lucia to a bottle and she says she just began to feed her more solid food than the bottle. Lucia seems to be withdrawn from the situation.

She is sitting quietly at a small table, virtually ignoring all of the activities in the room, and playing with an infant rattle. Her mother says Lucia "is the best baby because she plays for hours in her room by herself." She says that at one time she was concerned because Lucia was so slow in learning to walk. "After she learned to walk at 16 months, she seemed to do much better and became more active." ​ When Maryanne was questioned about her support system, she stated that her husband left when he found out she was pregnant with Zachary. Her parents are both dead and her only relative is an elderly aunt who is in a nursing home. She says she visits her aunt as much as she can with the two children.

The physician has made a diagnosis of failure to thrive. The mother does not understand why the

nurse and the doctor are so concerned about Lucia's weight. Tell Maryanne about the usual weight gain of infants.

Graders Info : A baby doubles its birth weight by 6 months and triples it by the end of the first year.

35. What additional information does Maryanne need to know about solid food for infants?

Graders Info : Introduction of solid foods should not begin before the age of 4 to 6 months.

36. What assessment data is most important?

Graders Info : Weight, delayed walking, and her social withdrawal.

37. How can you account for the underweight condition and the psychosocial withdrawal of Lucia?

Graders Info : Failure to thrive causes delayed physical, mental, and social development due to malnutrition or a disturbance from maternal-child interaction.

38. List three goals to be used for planning care for Lucia and her family.

Graders Info : To correct nutritional deficiencies and achieve body weight for height and age. Educate caregiver regarding the child's nutritional requirement. Restore mother-infant bonding and nurturing.

39. List nursing interventions that may be used to achieve nutritional goal attainment.

Graders Info : Select age-appropriate foods. Use acceptable carbohydrate additives. Multivitamin supplementation.

Limit empty calorie sources and sweetened juices. Nonfat dry milk may be added to whole milk to increase caloric density. Maintain schedule for feeding.

40. What factors for Maryanne have contributed to Lucia's failure to thrive?

Graders Info : Loss of her husband. Second pregnancy too soon. Lack of any support system. Economical demands for single parent with two infants. Cessation of breastfeeding when Lucia was 2 months old. Inability of Lucia to take the bottle. Introduction of solid foods too early. Lucia's awareness of the new infant, who takes her mother's time.

41. Is Lucia's failure to thrive classified as organic or nonorganic? Why?

Graders Info : Nonorganic, which means unrelated to disease and usually a result of psychosocial factors, such as inadequate nutritional information in a parent, disturbance in maternal-child attachment, or a deficiency in maternal care.

42. Ms. Newby just delivered her first baby yesterday. As Ms. Newby is getting ready for her discharge today, the nurse tells her that she will need to bring her baby back to the outpatient lab tomorrow for his phenylketonuria (PKU) test. Please make the appropriate responses to Ms. Newby's questions.

Ms. Newby has asked you, "What is a PKU test?"

Graders Info : "Phenylketonuria is a condition in which infants lack the liver enzyme phenylalanine hydroxylase, which is necessary for the metabolism of an amino acid, phenylalanine. If the condition is present and is not treated, infants become hyperactive, begin seizures between 6 and 18 months, and become intellectually disabled."

43. The mother asks you why they did not do the test as soon as the birth occurred, just to make sure it was detected in time.

Graders Info : "The infant has to have an amount of protein in the body, so that when it is broken down, the amino acid will not be metabolized. The protein comes from breast milk or formula."

44. The PKU test was positive and the physician diagnosed the infant with PKU. Ms. Newby states, "If the protein is only in milk products, it should not be too hard to watch the diet."

Graders Info : "Except for fats and sugars, there is some protein in all foods. Some of that protein is phenylalanine,

so the diet will need to be carefully planned for a growing infant and child."

Chapter 12 Nutrition During Childhood and Adolescence MULTICHOICE 1. The approximate weight gain during the second year of a child's life is _____.

(A) 2 pounds (B) 5 pounds (C) double the birth weight (D) triple the birth weight Answer : (B)

2. Between the years of 1 to 2, a child's recommended fat intake should _____.

(A) be no more than 30 g a day (B) be no more than 30% of total calories a day (C) not be limited (D) be between 10% and 20% of total calories a day Answer : (C)

3. A good example of a nutritious snack for a child under the age of 4 would be _____.

(A) grapes (B) peanuts and popcorn (C) hard candy (D) cheese and crackers Answer : (D)

4. Whom do adolescents typically prefer to imitate?

(A) their parents (B) their teachers (C) their peers (D) media personalities Answer : (C)

5. Pre-diabetes and type 2 diabetes mellitus, rarely seen before in children, are now being diagnosed in children as young as 10 years of age. Which of the following factors is/are related to the diagnosis?

(A) premature birth (B) exercise patterns (C) lack of fiber in diet and poor bowel habits throughout childhood (D) nutrition, exercise, and weight Answer : (D)

6. What is a treatment option for a person with anorexia nervosa?

(A) put food in front of them (B) as a family, try to eat all foods to show they do not make one fat (C) keep constant track of their eating habits (D) provide family and individual counseling Answer : (D)

7. What process changes sugars and starches into alcohol?

(A) alcoholism (B) homogenization (C) fermentation (D) pasteurization Answer : (C)

8. Which of the following conditions is associated with cancer of the throat and esophagus?

(A) alcoholism (B) sedentary lifestyle (C) diabetes (D) hypertension Answer : (A)

9. Which is a consequence of marijuana use?

(A) loss of weight (B) cardiac irregularities (C) leading to the use of other drugs (D) depression Answer : (C)

10. What vitamin needs to be increased if a person decides to smoke on a regular basis?

(A) vitamin B12 (B) vitamin D (C) vitamin C (D) vitamin E Answer : (C)

11. What drug causes heart, breathing, and blood pressure rates to increase?

(A) tobacco (B) marijuana (C) cocaine (D) methamphetamine Answer : (D)

12. An athlete needs additional _____ for energy metabolism.

(A) water (B) vitamin C (C) fats (D) caffeine Answer : (A)

13. Athletes need greater quantities of which minerals?

(A) sodium and potassium (B) sodium and phosphorus

(C) magnesium and sodium (D) copper and magnesium Answer : (A)

14. Which vitamin increases the utilization of iron in the body?

(A) vitamins B (B) vitamin C (C) vitamin A (D) vitamin K Answer : (B)

15. Which of the following is NOT accurate when families eat meals together?

(A) Children do better in school.

(B) Children are healthier.

(C) Children have greater self-esteem.

(D) Children will have greater risk taking behaviors.

Answer : (D)

16. A child's calorie needs depend on which of the following?

(A) body size and activity level (B) type of diet (C) taste preferences (D) availability of food Answer : (A)

17. How often should a child have a snack?

(A) never (B) every 1-2 hours (C) every 2-3 hours (D) every 3-4 hours

Answer : (C)

18. The typical diet of a teenager contains too much _____.

(A) milk (B) saturated fat (C) calcium (D) protein Answer : (B)

19. Generally speaking, fast foods are not high in _____.

(A) fat (B) sodium (C) calories (D) fiber Answer : (D)

20. Smoking increases the risk of _____.

(A) heart disease (B) cirrhosis (C) anorexia nervosa (D) none of the above Answer : (A)

ESSAY 21. Describe the rate of growth and the appetite of a child between the ages of 1 and 3 years.

Graders Info : As the child ages, the rate of growth slows, as demonstrated by only a 5-pound gain during the second year of life. Young children are often more interested in the environment than in eating, which accounts for the decreased appetites. From ages 1 to 3, their legs grow longer and they

develop a larger muscle mass and lose the baby shape. They begin to walk and talk and to feed themselves.

22. A child's relationship to food and basic eating habits develop early in childhood. Support this statement.

Graders Info : The caregiver's goal is to feed children age-appropriate food that meets nutrition needs and do this in a way that allows adequate support and encouragement. Micromanaging a child's eating or providing little support or chaotic feeding methods can increase emotional and physical problems such as irritability, depression, anxiety, fatigue, and illness. Because children learn partly by imitation, learning good eating habits is easier if parents role model those habits. Nutritious foods should be available at mealtime as well as snack time. Meals should include a wide variety of foods to ensure good nutrient intake.

23. Describe how growth is assessed in children.

Graders Info : Growth charts from the Center for Disease Control and Prevention (CDC) have been used to track growth of infants since 1977. In the United States, it is recommended that pediatricians, dietitians, nurses, and parents track the growth of children ages 0-2 with the World Health Organization (WHO) growth standards and use the CDC growth charts for children ages 2 and older. The growth charts measure stature-for-age, weight-for-age, and body mass index and consist of a series of percentile curves that illustrate the distribution of these measurements in children.

24. In addition to the physiological factors, describe other factors that may impact the child's food choices and nutritional status.

Graders Info : The child's intake may be impacted by additional factors that include food texture (they like crisp textures), temperature (do not like hot foods), odor and flavor (should be mild), or appearance (do not usually like gravies or sauces), and they like foods that are familiar to them. The atmosphere at mealtime also greatly affects the child's appetite.

25. What is the basis for the importance of fiber in the diet of a child? Why is it important to monitor the fiber intake for children?

Graders Info : Fiber is often lacking in children's diets due to a marketplace that is flooded with refined, processed foods. Fiber is needed for bowel health and regularity as well as maintenance of healthy cholesterol levels. Fiber ideally needs to come in natural forms: beans, whole grains, fruits, and vegetables.

These foods contain a mix of different fibers as well as key vitamins, minerals, and healthful plant chemicals, or phytochemicals. Some food products sold today have added fiber and may be useful in boosting fiber to the recommended intake level providing individuals strive for the natural forms first.Fiber needs for children by age: ​ 1-3 = 19 g ​ 4-8 = 25 g ​ 9-13 males = 31 g ​ 14-18 males = 38 g ​ 9-18 females = 26 g ​ It is important to monitor fiber intake in children because data suggests consumption falls short in children. As children get older, fiber may be reduced due to decrease in breakfast consumption, increased meals away from home, increase in snacking, increase in fried foods, increase in portion sizes, increase in sweetened beverages, and decrease in dairy products. ​

26. Discuss strategies for introducing new foods to children.

Graders Info : New foods should be introduced gradually, in small amounts, and as attractively as possible.

Allowing the child to assist in purchasing and preparing a new food is a good way of arousing interest in the food and a desire to eat it.

27. Discuss how some medications commonly taken by children can have an impact on their appetite and weight.

Graders Info : ​Certain medications (psychostimulants) used to treat attention deficit and hyperactivity disorder (ADHD) in children cause marked decrease in appetite. In practice, parents of the medicated ADHD child often see a compromised appetite especially at the lunch meal, when the medicine is most active. Parents may need to dose the medication after breakfast and serve a larger dinner. These children may often need a "third meal" before bed. Parents should keep plenty of healthy snacks on hand and offer a balanced diet with nutritious, higher-calorie foods and drinks. ​ On the other end of the spectrum, children and adolescents who take some of the newer generation of antipsychotic medications for mood stabilization and behavior issues have increased appetite.

Users of those medicines risk rapid weight gain and metabolic changes that could lead to diabetes, hypertension, and other illnesses. Some children on those medicines were recorded to have an average weight gain of 1-1.5 pounds a week. Doctors believe, however, these drugs still have their place in behavioral health as they can spare children from psychological suffering. Practitioners are

learning, however, that they must be prescribed more cautiously and that the benefits must be weighed against the risks. ​ ​

28. Explain why calorie requirements for adolescent boys tend to be greater than for adolescent girls.

Graders Info : Boys are generally bigger, tend to be more physically active, and have more lean muscle mass than do girls.

TRUEFALSE 29. An inadequate supply of calcium in the early years may result in a child who is shorter and less intellectually able. _________________________ (A) True (B) False Answer : (B)

30. An obese child needs a snack after school. _________________________ (A) True (B) False Answer : (A)

31. Childhood obesity has been rising steadily. Fifty-eight percent of children are considered obese today. _________________________ (A) True (B) False Answer : (B)

32. From ages 1 to 10, as a child grows, calorie needs decrease but nutrient needs increase. _________________________ (A) True

(B) False Answer : (A)

33. Whole milk is recommended for children 2 years and older. ____________________ (A) True (B) False Answer : (B)

34. The Academy of Pediatrics states that energy drinks are safe for children and adolescents. _______________ (A) True (B) False Answer : (B)

35. Eating disorders such as anorexia nervosa and bulimia are only seen in female adolescents. ________________ (A) True (B) False Answer : (B)

ESSAY 36. Chandra, a 12-year-old female, has recently been diagnosed with childhood type 2 diabetes. Her mother has brought her in for nutritional counseling. She weighs 145 lbs and is 5′3″ tall. Chandra is having difficulty maintaining the dietary regimen. She tells you that her friends are eating candy, chips, hamburgers, French fries, and lots of other "good foods." She doesn't want to be "different" from her friends. She and her mother have several questions that need answers.

Her mother asks, "Why did Chandra develop this condition? What did I do wrong?"

Graders Info : You must explain to her how it tends to be inherited, but more importantly, describe to her the childhood habits that lead to adult health problems, such as type 2 diabetes or heart disease: childhood obesity, lack of exercise, inadequate fiber intake, lack of nutritional knowledge regarding food portions, using food as rewards or celebrations, water needs, and the use of healthy snacks.

Discuss at length the parallel increase in childhood diabetes related to the increase of childhood obesity.

37. Describe to them the dietary controls that could prevent a child from developing unhealthy adult health behaviors.

Graders Info : Calcium intake at the dietary requirement level especially until age 30; fat intake as recommended by the American Heart Association at 7% saturated fats, 8% polyunsaturated, 15% monounsaturated, and total fat equal to or less than 30% of the daily calories; fiber intake of 26 g is adequate for a 12-year-old female; water intake of 1 mL for every calorie needed for their body weight.

38. What steps can you take to aid this family in planning a lifestyle for Chandra? Children with childhood type 2 diabetes and their parents will gain useful insight and increased nutritional knowledge with referral to additional health professionals. Acquaint them with those that will be of value.

Graders Info : Exercise trainer, certified diabetic educator, dietitian, diabetic nurse specialist, group therapy with peers who have a similar situation 39. In addition to a meal plan for diabetes, describe the additional need for nutrients Chandra will have, according to the recommended daily requirements.

Graders Info : Except for vitamin D, the needs increase drastically at the onset of adolescence. Girls need more iron than do boys. Vitamins D, C, and B12, calcium, phosphorus, and iodine are the same for both sexes. The remaining nutrients are increased more for boys than girls.

40. Discuss the stresses that impact Chandra's dietary intake.

Graders Info : Adolescents prefer to imitate peers who like low nutrient density foods, such as candy, sodas, chips, and other snack foods. Eating habits are affected by busy schedules, part-time jobs, sports activities, and social activities. Other factors can be the lack of an adult to prepare nutritious food when hungry and lack of time to eat. Adolescents need advice about food choices, but usually resent the advice. Numerous physical changes are occurring in their bodies. The need for independence prevents them from accepting advice or dietary suggestions. Sexual and social pressures affect dietary choices. The increased growth rate of the adolescent results in an enormous appetite.

41. Chandra wants to try out for the tennis team. Her mother has discouraged the activity because she thinks Chandra is "too sick." State goals related to client/family education for this scenario.

Graders Info : Will accept teaching provided. Will demonstrate understanding of the disease and its therapy. Will demonstrate understanding of dietary planning. Will demonstrate understanding of the importance of an exercise program.

42. Discuss the parameters of the nutritional needs of Chandra, childhood type 2 diabetes, and the impact on her performance as an athlete.

Graders Info : Needs additional water due to loss of water through perspiration. Needs diet to include 50-55% carbohydrates of the total, fats 30%, and protein 10-15%. Protein needs are not increased by physical activity. Needs increase for B vitamins, thiamine, riboflavin, and niacin for energy metabolism. The amount of sodium and potassium needed is increased due to losses from perspiration. Females need a sufficient intake of iron. Meal planning should be done according to MyPlate. A pregame meal should be eaten 3 hours before the event and should consist of carbohydrates and small amounts of protein and fats. Concentrated sugars should be avoided.

43. What are some additional age-appropriate physical activities you could suggest to help Chandra expend extra calories on a daily basis?

Graders Info : Take stairs instead of elevators, walking, swimming, inline skating, skateboarding, rope climbing, dancing, martial arts.

44. Nerissa's parents are concerned about her weight. At age 15, Nerissa is 5′5″ tall, and 1 year ago she was 28 pounds overweight. She entered an exercise program, went on a calorie reduction diet, and lost 25 pounds. Now, it seems as if Nerissa is obsessed with diet and exercise. She has reduced her caloric intake to fewer than 1,000 calories per day, and exercises several times a day. Her mother's efforts to talk her into eating more have been to no avail. The school nurse has asked Nerissa's mother to come in for a conference. The nurse asks her to explore some of the reasons for the initial overweight problem.

What are some factors that can worsen an adolescent's weight problem?

Graders Info : Overweight children are often the center of classmates' jokes and can develop diminished selfesteem. This consequently can exclude them from social life, which can further alienate an adolescent. Spending time alone, watching television, finding comfort in food, and a low self-esteem

compound the condition.

45. Generally, adolescent girls have dietary deficiencies. The weight loss that Nerissa has already had and the eating habits she has now will compound these deficiencies. What are the poor eating habits that can result in nutrient deficiencies?

Graders Info : Imitate peers who are eating low nutrient density foods such as potato chips, sugary sodas, and candy. Adolescents' eating habits can be seriously affected by busy schedules, part-time jobs, athletics, social activities, and the lack of an available adult to prepare nutritious food when adolescents are hungry or have time to eat.

46. Discuss the four primary symptoms of anorexia nervosa.

Graders Info : 1. Failure to maintain body weight at or above a minimally normal weight for age and height; usually 85% of expected weight.

2. Intense fear of weight gain or being fat, even though underweight 3. Disturbance with body weight or shape 4. Loss of menstrual periods in girls and women post-puberty

47. Nerissa's mother asks about the treatment for anorexia.

Graders Info : A strong, trusting relationship needs to be developed between the client and the health care professional. The client should realize that body changes and some weight gain are normal during adolescence. Teach the client that diet therapy is important to understand the need for nutrients and calories. Family and individual counseling helps everyone understand the problem. Medical monitoring by health care professionals is important. The situation requires time and patience from all involved.

48. Give nursing diagnosis statements for Nerissa and her family.

Graders Info : Altered nutrition: less than body requirements related to self-imposed starvation. Body image disturbance related to altered self-perception. Altered family coping related to ambivalent family

relationships and lack of understanding of Nerissa's feelings of unworthiness.

49. State goals for the anorexic adolescent and her family.

Graders Info : The adolescent will normalize eating behaviors. The adolescent will develop realistic views of her body and the intake of food. The adolescent will develop alternate methods to deal with the interpersonal relationships that contribute to the cause of anorexia. The family will gain knowledge to better deal with the adolescent with anorexia. The adolescent and the family will have an adequate support system. The adolescent and the family will conform to the therapeutic program.

50. List nursing interventions to deal with the negative interpersonal feelings that the adolescent has developed.

Graders Info : Maintain a kind and caring manner, yet be firm when caring for the child. Offer continued support and reassurance throughout the struggle of the child. Encourage participation in activities that strengthen self-esteem. Encourage socialization with peers.

51. List evaluation measures to determine if the nursing interventions are effective.

Graders Info : Determine weight. Interview the adolescent regarding eating habits and intake. Observe the adolescent's behavior and interview her regarding her attitudes, concerns, and behavior.

Chapter 13 Nutrition During Adulthood MULTICHOICE 1. Which mineral is needed in higher quantities by women throughout the childbearing years?

(A) calcium (B) copper (C) iron (D) magnesium Answer : (C)

2. What are the recommended protein needs for adults over the age of 25?

(A) 0.65 g per kilogram of body weight (B) 0.06 g per kilogram of body weight (C) 0.8 g per kilogram of body weight (D) 0.08 g per kilogram of body weight Answer : (C)

3. What is the current calcium requirement for adults aged 19 to 50?

(A) 1,000 mg/day (B) 1,500 mg/day (C) 2,000 mg/day (D) unlimited Answer : (A)

4. At what age does bone loss usually begin?

(A) between ages of 25 and 35 (B) between ages of 35 and 40 (C) after the age of 50 (D) after the onset of menses Answer : (B)

5. At what age does the caloric requirement in adults usually begin to decrease?

(A) after the age of 20 (B) after menses (C) after the age of 25 (D) after retirement Answer : (C)

6. What is the most common cause of being overweight?

(A) genetics (B) environment (C) energy imbalance (D) disease Answer : (C)

7. One pound of weight gain equals how many calories?

(A) 2,500 (B) 2,000 (C) 3,000 (D) 3,500 Answer : (D)

8. The onset of rheumatoid arthritis usually occurs between the ages of _____ _____.

(A) 30 and 50 (B) 60 and 70 (C) 20 and 30 (D) 50 and 60 Answer : (A)

9. Growth is usually complete by the age of _____.

(A) 18

(B) 25 (C) 22 (D) 40 Answer : (B)

10. Young adulthood ranges from about __________ years of age.

(A) 20 to 35 (B) 18 to 40 (C) 18 to 25 (D) 25 to 45 Answer : (B)

11. All of the following are related to determining caloric requirements EXCEPT __________.

(A) amount of lean muscle mass (B) activity levels (C) BMI (D) food preferences Answer : (D)

12. Researchers have found a ______-style diet may be linked to improvement of rheumatoid arthritis symptoms.

(A) Mediterranean (B) Caribbean (C) Asian (D) European Answer : (A)

13. As the body ages, what tends to occur?

(A) bone density and metabolism increase (B) lean muscle mass increases

(C) fat decreases (D) bone density and metabolism decrease Answer : (D)

14. Because of decreased metabolism, the calorie requirement decreases by what percent every decade after age 20?

(A) 2% (B) 15% (C) 10% (D) stays the same Answer : (A)

15. Excessive amounts of phosphorus can cause osteoporosis by _____.

(A) increasing body fat (B) speeding bone loss (C) decreasing lean muscle mass (D) increasing fatigue Answer : (B)

16. Clients who treat arthritis symptoms with regular aspirin use may need additional _____.

(A) calcium (B) vitamin C (C) fiber (D) iron Answer : (D)

17. Most Americans ingest _____ the amount of salt needed each day.

(A) half (B) one-fourth (C) 10 times

(D) 2-6 times Answer : (D)

18. Because they (it) can thin the blood, _____ should not be taken at the same time as blood clotreducing medications.

(A) antioxidant vitamins (B) calcium (C) iron (D) vitamin D Answer : (A)

19. After age 65, it may be advisable to modify one's daily protein intake to _____ g per kilogram of body weight.

(A) 0.8 (B) 0.9 (C) 1.0 (D) 1.1 Answer : (C)

20. Which of the following is NOT a reason for poor nutrition in an elderly person?

(A) poor dentation (B) depression (C) fad diets (D) poor appetite Answer : (C)

ESSAY 21. In general, people who are concerned about nutrition should make changes in food sources of several substances. List those.

Graders Info : Limit fats, cholesterol, sugar, salt, and calories, and increase fiber.

22. Many Americans ingest too many fats, sugar, salt, and high-caloric foods and too little fiber and other nutrients. What is the primary reason for that?

Graders Info : These food sources are selected because of convenience and flavor rather than nutritional content.

23. Being overweight is a precursor for several health problems. List those.

Graders Info : Diabetes mellitus, hypertension, poor risks for surgery, shorter lives, tendency to social and emotional problems 24. What are the common causes or factors that contribute to being overweight?

Graders Info : Genetics, hypothyroid, energy imbalance in the form of excess calories 25. Osteoporosis is becoming a common occurrence in the young to middle adulthood age groups. A healthy diet is very important in the care of this condition. A diet rich in what nutrients is thought to help prevent osteoporosis?

Graders Info : Calcium, vitamin D, magnesium, and fluoride 26. The middle period of life ranges from 40 to 65 years old. State the caloric need and the rationale for this age range.

Graders Info : Physical activities typically begin to decrease, resulting in lowered kilocalorie requirements. There are seldom young children to care for, and the strenuous activities of a job may be delegated to the younger workers. They may tire more easily and exercise may decrease. Appetite and food intake may not decrease, resulting in weight gain.

27. Describe some common food-drug interactions.

Graders Info : Dairy products should not be taken within 2 hours of taking the antibiotic tetracycline. Persons taking Coumadin or warfarin should avoid vitamin K food sources or antioxidant vitamins, as they counteract the action of the blood thinners.

28. List causes of anorexia in older adults.

Graders Info : Grief, loneliness, boredom, difficulty in chewing, dementias, Alzheimer's disease, decreased income, physical disability, inadequate cooking facilities 29. More than 80% of people over the age of 65 have one or more chronic diseases. Current research emphasizes the role of nutrition in preventing or relieving these conditions. Discuss the role of nutrition in the treatment of the elderly with chronic disease.

Graders Info : Nutrition effects are cumulative over many years and the effects of a lifetime of poor eating habits cannot be reversed overnight. Prevention of chronic disease may not be possible; however, the use of good nutrition to help stabilize a condition is possible. Good nutrition habits should begin as a child to prevent the diseases of the elderly.

30. Describe the conditions that may lead to difficulties in food selection and preparation in older persons.

Graders Info : Decreased income, lack of transportation, physical disability, and inadequate cooking facilities may cause difficulties in food selection and preparation.

TRUEFALSE 31. The most common cause of overweight is lack of exercise. _________________________ (A) True (B) False Answer : (B)

32. An individual who overeats by 200 calories per day will gain one pound per month.

_________________________ (A) True (B) False Answer : (B)

33. Kilocalorie requirements decrease after age 25; however, nutrient requirements do not. _________________________ (A) True (B) False Answer : (A)

34. Bone loss begins slowly, around age 50-60, and leads to osteoporosis. _________________________ (A) True (B) False Answer : (B)

35. Middle-aged people may tire more easily than they did when they were younger. Therefore, they may get less sleep than when they were younger. ___________________ (A) True (B) False Answer : (B)

36. After menopause, the iron requirement for women is the same as for men. __________________ (A) True (B) False Answer : (A)

37. Two glasses of milk a day nearly fulfill the calcium and vitamin D requirements for adults from age 19 to 50. __________________________ (A) True (B) False

Answer : (B)

38. A woman's need for adequate sources of iron or iron supplements continues throughout the life span. _________________________ (A) True (B) False Answer : (B)

39. Estrogen loss that occurs after menopause contributes to osteoporosis. _________________________ (A) True (B) False Answer : (A)

40. The Daily Recommended Intake of basic nutrients decreases with age. _________________________ (A) True (B) False Answer : (B)

ESSAY 41. Mrs. Leonas, 5′5″ and 185 pounds, has been instructed by her physician to lose 35 pounds. As the nurse, you will assist her in planning her care. Her cholesterol level is 590. She says she rarely eats fatty foods and exercises three times a week. She describes her usual diet as this: Breakfast Lunch Dinner 2 toast grilled chicken salad beef 6-8 oz 1-2 scrambled eggs low-fat salad dressing 2 vegetables 6 oz juice iced tea w/Sweet-n-Low 2-3 dinner rolls w/margarine coffee 8-10 crackers medium baked potato 2-3 T jelly fruit mid-afternoon snack butter and sour cream 2 slices bacon medium size dessert diet cola What are the three basic components of an assessment?

Graders Info : Nutritional history, physical examination, and diagnostic and laboratory data

42. List assessment data to determine defining characteristics for validating the nursing problem.

Graders Info : Weight, height, triceps skinfold, blood glucose level, weight gain, sedentary lifestyle, and lack of a planned exercise program; eats when bored 43. One aspect of assessment will involve evaluation of Ms. Leonas's current diet. Ms. Leonas believes her current diet is adequate. What can you tell her about her cholesterol level and her current diet? For what conditions is she at risk in relation to her cholesterol?

Graders Info : She is at very high risk for complications of elevated cholesterol or fats, such as coronary artery disease, hypertension, and atherosclerosis. She needs to make changes in her diet to reduce the intake of cholesterol to fewer than 200-300 mg per day. Total fat intake should be less than 30% of the total calories consumed. She needs to reduce her high fat meats and added saturated fats in her diet. She needs to be on a weight loss program and an exercise program.

44. Ms. Leonas asks you why the physician cannot order her a drug to reduce her elevated cholesterol, rather than her going on a strict diet. How would you respond?

Graders Info : As a general rule, physicians prefer a trial of diet therapy before prescribing drugs to lower blood lipid amounts. It is always preferable to reduce cholesterol in the diet verses taking a medication that may also have side effects. It is also encouraged that people continue to choose foods low in fat and cholesterol even if on cholesterol lowering medications.

45. List expected outcomes or short- and long-term goals.

Graders Info : The client will verbalize a desire to lose weight; acknowledge factors that have contributed to being overweight; understand some of the foods that she has eaten in the past are high in fat and cholesterol; improve her nutrition habits and eat a well-balanced diet; participate in an exercise program at least three times per week; lose 1 to 2 pounds weekly.

46. List interventions to assist in meeting the goals or the expected outcomes.

Graders Info : The client will meet with a dietitian or nurse educator who will have the client do a 24-hour recall of

her diet; develop, with the client, a meal plan that includes preferences; have client keep a 3-day log of her intake; evaluate the client's determination to adhere to the diet.

47. Mary has a fractured wrist. She is 54 and states she is in excellent health. She lives alone, but her daughter, who lives next door, does her grocery shopping and runs errands for her. Mary says she does not get out much. She prefers a sedentary lifestyle. She enjoys watching television, talking on the phone with her friends, and playing cards once a week with her friends, who gather at her home. Laboratory tests reveal that her calcium level is very low.

Mary asks you why her calcium level is low. Your response should include facts and incidence about osteoporosis. Include reasons for bone loss in women.

Graders Info : Adults lose bone mass as they grow older. After menopause, women lose bone mass. It is important to increase the amount of calcium, vitamin D, magnesium, and fluoride consumed during this time.

There are genetic and environmental factors that can contribute to osteoporosis as well.

48. Why is osteoporosis more common in women than in men? Include comparison between men and women and the consumption of calcium.

Graders Info : Men are able to consume more calories than women. Therefore, they may be able to consume more calcium. Women's bone mass is much lower than that in men, because most women have a smaller body size. Bone loss begins earlier in women than men.

49. Mary asks if there is anything she can do to prevent further bone mass loss.

Graders Info : Maintain an adequate intake of calcium and a moderate weight-bearing exercise, such as walking, running, or dancing, which are more effective than swimming or stretching. Working muscles pulls weight on the bones.

50. How much calcium does Mary need to take in per day?

Graders Info : The recommended dietary intake of calcium for women ages 51-70 is 1,200 mg per day.

51. Mary asks you about food sources for calcium.

Graders Info : Milk, yogurt, cheese, sardines, salmon, calcium fortified orange juice, and dark green, leafy vegetables 52. Mary tells you she does not like milk, so she will plan on purchasing some calcium supplements from the grocery store. How do you respond?

Graders Info : Foods with calcium offer additional benefits that are not available in the supplements. Vitamin D enhances the absorption of calcium, which is not always available in the supplement. Yogurt, sardines, salmon, and cheese are excellent sources of calcium in addition to milk. There are some fortified foods that offer large amounts of calcium, such as orange juice and bread.

53. Louise has been admitted to the nursing home. She is very unhappy and refuses most of the care provided at the home. Her fluid intake for the past 4 days has averaged 1,150 mL in 24 hours. You realize this is inadequate, and the multidisciplinary team is planning her care to increase her fluid intake.

What are 24-hour hydration requirements?

Graders Info : 1,000-3,000 mL of fluid daily or approximately 1 mL per calorie consumed 54. List conditions that an inadequate fluid intake may cause.

Graders Info : Constipation, urinary tract infection, urinary incontinence, dehydration 55. Why are elderly at high risk for dehydration?

Graders Info : Diminished thirst perception and other physical, cognitive, speech, mobility, and visual impairments 56. Write a nursing diagnosis statement for Louise.

Graders Info : Fluid volume deficit: related to lack of intake from appetite loss or refusal to eat

57. List adverse symptoms of dehydration for the elderly.

Graders Info : Fatigue, hypotension, increased pulse rate, decreased pulse volume and pressure, decreased skin turgor, change in mental status such as confusion, increased body temperature, dry mucous membranes, and altered serum sodium 58. List nursing interventions to correct or replace fluid losses.

Graders Info : Establish 24-hour replacement needs. Note preferences of fluids and foods that are of high fluid content. Provide nutritious diet via appropriate route. Provide IV fluids as ordered. Maintain accurate intake and output. Calculate 24-hour fluid needs. Weigh daily. Provide fluids throughout the day (different types of beverages). Monitor coffee intake (acts like a diuretic). Monitor laboratory data: serum electrolyte, blood urea nitrogen, hematocrit, sodium.

59. Louise's lack of appetite may lead to a medical condition associated with a lack of protein, as well as deficiencies in other nutrients. Discuss this.

Graders Info : The elderly often consume diets deficient in vitamins C, D, B6, and B12, folate, calcium, zinc, iron, calories, and protein. Lack of calories and protein may cause protein-energy malnutrition (PEM).

They often dislike food in facilities, may have difficulty chewing high-protein food sources, have depressed appetites and chewing or swallowing problems, or may be lonely and depressed; drugs may dull appetite.

Chapter 14 Weight Management Across the Life Cycle MULTICHOICE 1. When using BMI, which parameters define overweight?

(A) below 18.5 (B) 18.5-24.9 (C) 25.0-29.9 (D) 30.0 or higher Answer : (C)

2. What does BMI stand for?

(A) body measured index (B) body muscle index (C) body muscle indention (D) body mass index Answer : (D)

3. Visceral fat is fat located in the _____.

(A) buttocks (B) abdominal cavity (C) breast (D) upper thigh Answer : (B)

4. Which hormone is released from the stomach and signals the hypothalamus that it's time to eat?

(A) leptin (B) ghrelin (C) insulin (D) lecithin Answer : (B)

5. Obesity is more prevalent in _____________.

(A) immigrant families (B) families in poverty (C) single-parent families (D) minority families Answer : (B)

6. Research has documented there are many benefits to losing what percentage of body weight?

(A) 1-2% (B) 3-5% (C) 5-10% (D) 10-15% Answer : (C)

7. Regardless of which type of eating pattern is chosen for weight loss, ___________ change is absolutely required.

(A) metabolic (B) physical (C) behavior (D) psychological Answer : (C)

8. Which of the following is NOT a behavior change strategy for weight loss?

(A) Keep a record of food intake and activity.

(B) Set your specific, realistic goals.

(C) Change your surroundings to avoid overeating.

(D) Reward yourself with food.

Answer : (D)

9. Which hormone receives signals from fat and the intestine to make you feel full so eating will stop?

(A) leptin (B) ghrelin (C) insulin (D) lecithin Answer : (A)

10. Which of the following is NOT a core principle of motivational interviewing?

(A) expressing empathy (B) rolling with resistance (C) mandating progress (D) developing discrepancy Answer : (C)

11. Which of the following behaviors does NOT contribute to one becoming overweight or obese?

(A) eating breakfast (B) not eating with family (C) low intake of fruits and veggies (D) sweetened beverage intake Answer : (A)

12. Which of the following is NOT a health consequence of obesity?

(A) coronary heart disease (B) insulin resistance and type 2 diabetes (C) hypertension (D) anorexia Answer : (D)

13. _____ can be caused by inadequate consumption of nutritious food because of depression, disease, or poverty.

(A) Anorexia

(B) Underweight (C) Bulimia (D) Hyperthyroidism Answer : (B)

14. All of the following play a role in weight regulation EXCEPT _____________.

(A) genetics (B) environment (C) lifestyle (D) education Answer : (D)

15. How much of the population consumes a diet low in vegetables, fruits, dairy, and oils?

(A) 50% (B) 75% (C) 10% (D) 25% Answer : (B)

16. What percentage of U.S. adults report that they engage in NO regular physical activity?

(A) 10% (B) 20% (C) 30% (D) 40% Answer : (D)

17. Which measurement can be used with BMI to assess disease risk?

(A) wrist circumference (B) hip circumference (C) waist circumference

(D) height Answer : (C)

18. A BMI of _____ refers to a healthy weight.

(A) below 18.5 (B) 18.5-24.9 (C) 25.0-29.9 (D) 30.0 or higher Answer : (B)

ESSAY 19. Describe the distribution of fat as an indicator of possible health problems.

Graders Info : Abdominal fat is associated with a greater risk for hypertension, coronary heart disease, type 2 diabetes, and certain types of cancer than if the fat is in the thighs, buttocks, and hips. Pear-shaped bodies have lower risk for disease than the apple-shaped body. Measuring waist circumference can detect risk of disease even in a person of healthy weight.

20. Discuss body mass index (BMI) in relation to health risks.

Graders Info : BMI measures weight in relation to height and shows that health risks increase at higher levels of overweight and obesity. Additionally, even when within the healthy BMI range, weight can also indicate risks for adults. The BMI ranges are for adults only. It should also be noted that BMI does not show the difference between fat and muscle. It may inaccurately predict health problems in a person with large muscle mass such as a body builder or football player.

21. Discuss recommendations for healthy weight loss. Include calorie requirements and nutrient requirements.

Graders Info : It is recommended that no more than 1 to 2 pounds of weight should be lost in 1 week and that it can be accomplished by reduction of weekly calorie by 500-1,000 calories per day. This can be done

by decreasing calories consumed or by increasing calories burned via exercise. It is important to consume a diet that is high in fruits, vegetables, high-fiber grains, heart healthy proteins, such as seafood, beans, very lean poultry, low-fat dairy, nuts, seeds, and a small amount of oil. Special attention should also be shown to portion size.

22. Discuss the use of weight loss medications. Who are they prescribed for and how do they work?

Graders Info : Prescription weight loss drugs are approved only for those clients that have a BMI above 30, or a BMI of 27 and above with associated diseases such as hypertension, type 2 diabetes, or dyslipidemia.

Appetite suppressants, approved by FDA, are meant only to be used short term. They include phentermine, phendimetrazine, and diethylpropion. Orlistat (Xenical) is now sold over the counter and known as Alli. This drug reduces the body's ability to absorb fat from food by one-third. It can be viewed as a fat blocker, as it inhibits lipase. This drug is meant to be used in tandem with a reduced calorie, low-fat diet, along with exercise and a daily multivitamin. Orlistat may cause intestinal discomfort, diarrhea, and leakage of oily stools (especially if a higher fat food item is eaten).However these reactions are usually mild and temporary.

23. Compare the physiology of a Roux-en-Y gastric bypass (RYGB) with that of an adjustable gastric band (AGB).

Graders Info : Adjustable gastric band (AGB). A small bracelet-like band is placed around the top of the stomach to restrict the size of the opening from the throat to the stomach, thereby reducing food intake. The size of the opening can be controlled via a balloon inside the band.Roux-en-Y gastric bypass (RYGB).

Food intake is limited as surgeons create a small pouch for the stomach. This pouch is then connected to a different part of the intestine (bypassing the stomach, duodenum), thereby changing the way food is absorbed. The pouch the surgeons create is only about the size of a walnut.

24. Discuss some of the reasons for the growing increase in childhood obesity.

Graders Info : Children today lead different lives than their parents or grandparents. Children used to play outside for hours on end, coming inside only to receive nourishment. Now neighborhoods may be less safe and outside play is limited. The walks to school have been replaced by car or bus rides. Gym class and after school sports activities have been subject to program cuts. Researchers know that only 42% of children ages 6-11 obtain the recommended 60 minutes per day of physical activity and only 8% of adolescents achieve this goal. Afternoons and evenings are filled with "screen" time-TV, video games, the Internet, and texting. The average media time a day for a child is 7.5 hours. Rushed families no longer cook as many freshly prepared meals. Snacking between meals is now the norm and pantries become "fair game" at any time. Portion sizes have grown and more and more families are eating away from home. Researchers have used the term "toxic" to describe the food

environment in America.

25. Discuss the dangers of being underweight.

Graders Info : While staying lean may be advantageous, being truly underweight could have its risks. Underweight status may be the result of a medical condition and/or compromised nutrition intake. Underweight is seen in anorexia, depression, those with cancer and a variety of other conditions. It is also possible for individuals to be naturally thin due to heredity, but still have inadequate nutrition. It can be the result of tissue wasting, poor absorption of nutrients, infection, excessive activity, or hyperthyroidism. Those who are underweight may have weaker immune systems. They may have lower muscle mass, compromised bone status and substandard nutrition stores.

TRUEFALSE 26. Regulation of eating occurs primarily in the stomach. _________________________ (A) True (B) False Answer : (B)

27. ​Subcutaneous fat is the accumulation of fat under the skin and around the organs in the body and correlates more with health risks such as cardiovascular disease and type 2 diabetes. _________________________ (A) True (B) False Answer : (B)

28. Regardless of the type of diet consumed, weight loss will not occur unless the individual modifies eating habits through behavior change. _________________________ (A) True (B) False Answer : (A)

29. One of the limitations of BMI is that it may overestimate body fat in older persons and others who have lost muscle. _________________________ (A) True

(B) False Answer : (B)

30. According to the American Council on Exercise, acceptable body fat percentages for women are between 30 and 35%.

(A) True (B) False Answer : (B)

31. BMI is determined by dividing weight in kilograms by the height in meters. ____________________ (A) True (B) False Answer : (B)

32. The most immediate consequence of overweight as perceived by the children themselves is social discrimination.

(A) True (B) False Answer : (A)

ESSAY 33. A 17-year-old, Sabrina, is concerned with her weight gain of 10 pounds over a 2-month period.

Her parents are both extremely overweight. She has asked the nurse if she should expect to inherit obesity.

Describe the risk factors associated with childhood obesity.

Graders Info : Currently, one in three children in America is overweight or obese. Overweight adolescents have a 70% chance of becoming overweight adults. This increases to 80% if one or more parent is overweight or obese. African American and Hispanic children have a higher rate of obesity. Nine out of ten states with the highest obesity are in the South, which also correlates to poverty rates.

Sedentary lifestyle and unhealthy eating habits are risk factors for children developing obesity.

Skipping breakfast, low fruit and vegetable intake, sweetened beverage intake, excessive TV/media

time, low physical activity, not eating together as a family, parental restriction of palatable foods, and parental criticism of weight all put children more at risk.

34. Although she is not at this time above the weight recommendations for her height, Sabrina has several of the risk factors for obesity. What nursing plan should be used to treat her?

Graders Info : Nursing care should be directed toward prevention measures. Answers may vary. Examples could be encouraging 60 minutes of activity daily, eating breakfast daily, encouraging three to five fruits and vegetables a day, encourage water instead of sweetened beverages, and decrease TV/media time.

35. List assessment data to be collected.

Graders Info : Baseline characteristics: weight, lab or diagnostic findings, caloric intake, economic status (for use when planning foods), perception of the plan, cultural or religious dietary restrictions, beliefs in relation to misinformation or misconceptions, measurement of fat, etc.

36. List desired outcomes or evaluation criteria.

Graders Info : Demonstrate actual, continued weight loss with maintenance of optimal health status. Verbalize desire to achieve weight loss. Verbalize understanding of interventions to adhere to diet.

Demonstrate behaviors and lifestyle changes to obtain desirable weight loss, including eating patterns, food quantity and quality, and an exercise program.

37. List nursing interventions in order of priority.

Graders Info : a. Identify factors that have contributed to the weight gain, including review diary of foods ingested; determine how she perceives food and the act of eating; determine previous dietary history; calculate total calorie intake; review daily activity and exercise; monitor for negative feedback.b.

Establish weight program. Set goals for weekly weight loss. Record vital statistics. Work with dietician to create diet plan. Discuss eating habits that contribute to behaviors of overeating.

Monitor drug regimen. Encourage involvement in planned activity program of choice. Provide positive reinforcement or encouragement for efforts and actual weight loss. Promote self-esteem.

Identify ways to manage stress/tension during meals. Discuss strategies to deal appropriately with feelings instead of overeating. Recommend weighing only weekly. Refer to community support group. Encourage buying personal items as a positive reward for reaching weekly or monthly goals.

Encourage a decision to lead an active life and to control dietary patterns. Offer support and understanding.

​

38. Ms. Janie, age 88, has been admitted to the emergency room with malnutrition. She has been living at home, alone. A neighbor brought her to the emergency room. When she missed seeing Ms. Janie for several days, she went to check on her and found her lying on the floor. The neighbor stated that for some time Ms. Janie has had little income. She also has appeared to have difficulty ambulating and grasping objects.

The primary assessment goal is ______________.

Graders Info : to determine the cause of the malnutrition 39. List causes of malnutrition.

Graders Info : Inadequate nutritional intake; excessive activity; tissue wasting of certain diseases; poor absorption of nutrients; infection; hypertension 40. Describe the optimal way to increase caloric intake for an underweight individual.

Graders Info : High-calorie (at least 500 extra calories per day for 1 pound of weight gain per week), nutritious snacks between meals, or serving several small meals a day rather than just three meals. Some patient will also need extra vitamin or mineral supplements if they are not absorbing foods well or if they have food intolerances.

41. List foods to be avoided in a high-calorie diet.

Graders Info : The foods not recommended on a high-calorie diet would be ones that add too much bulk, fiber, or water content to the diet, thereby filling up the individuals without providing a high amount of energy. Items to limit when desiring a high-calorie diet would be salads, broth-based soups, raw vegetables, ultra-high-fiber cereals, and light or diet products made with artificial sweeteners. Too much water use also would fill someone up, especially if drank before a meal.

42. List some of the complications that may result from an inadequate nutritional status.

Graders Info : Decrease in energy; decrease in immune response; decrease in the healing rate; decrease of muscle tone; increased risk of tissue breakdown; increased fatigue; increased cognitive impairment 43. List possible reasons for Ms. Janie's deficient nutritional status, as well as for that of other geriatric clients.

Graders Info : Lack of teeth or dentures to chew certain foods limits diet. Change in taste often results in anorexia.

Economic status affects ability to purchase nutritious food. Lack of companionship at mealtime decreases appetite and motivation to prepare food.

44. Give a nursing diagnosis statement for Ms. Janie.

Graders Info : Nutrition: altered, less than body requirements related to inadequate intake due to inability to provide economically and to physically prepare food 45. List nursing interventions related to diet modifications.

Graders Info : Increase protein, carbohydrates, and calories. Use appetite stimulants and flavoring agents.

Encourage use of sugar/honey in drinks. Avoid foods that cause intolerances or increase gastric motility. Limit fiber in the diet. Minimize odors or unpleasant sights at mealtime. Perform oral care prior to meals. Ensure adequate fluid intake. Give small, frequent feedings.

Chapter 15 Diet and Pre diabetes and Diabetes MULTICHOICE 1. _____ is the name for a group of serious and chronic disorders affecting the metabolism of carbohydrates.

(A) Diabetes mellitus (B) Hyperglycemia (C) Diabetes insipidus (D) Ketonuria Answer : (A)

2. _____ includes 5% of all diabetes cases.

(A) Type 1 diabetes (B) Type 2 diabetes (C) Gestational diabetes (D) Diabetes insipidus Answer : (A)

3. Approximately _____ of type 2 diabetes clients are overweight.

(A) 85% (B) 65% (C) less than 50% (D) 95% Answer : (A)

4. What is the recommended carbohydrate intake for diabetics?

(A) 40-50% of total calories (B) no more than 30% calories (C) intake should be based on individual needs (D) 15-20% of total calories

Answer : (C)

5. Which of the following may be more helpful for a client with type 1 diabetes?

(A) limit fat intake to less than 10% of daily calories (B) eat small meals plus two or three snacks per day (C) exercise 2 days a week for 35 minutes (D) increase carbohydrate intake to 70% of daily calories Answer : (B)

6. When increasing one's fiber intake, one must also increase _____ intake.

(A) fat (B) carbohydrate (C) water (D) protein Answer : (C)

7. Which condition may result when clients do not eat the prescribed diet, yet still continue to take the prescribed meal-time insulin?

(A) hyperglycemia (B) ketosis (C) hypoglycemia (D) hypertension Answer : (C)

8. Which of the following statements is correct?

(A) Type 1 diabetes clients are advised not to exercise.

(B) Clients with type 2 diabetes must have injections daily to control blood glucose levels.

(C) For type 1 diabetes, insulin is often given in two or more injections daily.

(D) A hypoglycemic episode can lead to a high blood glucose level.

Answer : (C)

9. Which method of diet therapy is most commonly used for diabetic clients?

(A) carbohydrate counting (B) exchange lists (C) diet modification (D) meal planning Answer : (B)

10. Which of the following would be an appropriate recommendation for a client with gestational diabetes?

(A) avoid fat intake (B) avoid protein intake (C) avoid concentrated sugars (D) avoid preservatives Answer : (C)

11. How is fiber considered a therapeutic tool in the meal plan for a client with diabetes?

(A) slows the release of insulin from the pancreas (B) inhibits fat absorption (C) lowers blood glucose (D) eliminates the need for exogenous insulin in clients with type 1 diabetes Answer : (C)

12. Which of the following is the leading cause of blindness in the United States?

(A) retinopathy (B) hyperglycemia (C) infections (D) neuropathy Answer : (A)

13. This type of diabetes, formerly classified as juvenile-onset, occurs suddenly in children and young adults, requiring insulin injections and a carefully controlled diet.

(A) type 2 (B) type 1 (C) gestational (D) pre-diabetes Answer : (B)

14. When hyperglycemia occurs in the body, cellular changes result in three classic symptoms. What are they?

(A) weight loss, fatigue, vomiting (B) polydipsia, polyphagia, glucagon production (C) nausea, vomiting, diarrhea (D) polydipsia, polyuria, glycosuria Answer : (D)

15. What is recommended daily protein intake for the client with diabetes?

(A) no specific amount (B) 15-20% (C) 25% (D) at least 40% Answer : (A)

16. What hormone helps release energy by converting glycogen to glucose?

(A) estrogen (B) glucagon (C) insulin (D) glycogen Answer : (B)

17. What does polyphagia mean?

(A) excessive appetite

(B) excessive thirst (C) excessive urination (D) reduced appetite Answer : (A)

18. Low blood pH resulting from ketone collection in the blood is known as _____.

(A) ketonemia (B) ketoacidosis (C) ketonuria (D) acidosis Answer : (B)

19. Diabetes can cause all of the following EXCEPT _____.

(A) blindness (B) heart disease (C) kidney disease (D) hearing loss Answer : (D)

ESSAY 20. Describe why hyperglycemia occurs.

Graders Info : When there is an inadequate production of insulin, or the body cannot use the insulin it produces, glucose cannot enter the cells and accumulates in the blood, causing hyperglycemia.

21. A symptom of diabetes mellitus is polydipsia, or excessive thirst. Why does this occur?

Graders Info : When hyperglycemia occurs, the glucose cannot enter the cells and accumulates in the blood. The

body draws water from the cells to the blood in an attempt to equalize the concentration. The loss of the cellular fluid causes the client to experience polydipsia.

22. Describe the process of ketone production and its consequences.

Graders Info : An untreated client with diabetes is unable to metabolize carbohydrates for energy. Excessive fats are broken down to be used for energy, and consequently the liver produces ketones from the fatty acid metabolism. The fats are broken down rapidly, allowing ketones to collect in the blood. The ketones are acids that lower the blood pH and result in ketoacidosis.

23. List the nutrition goals for clients with type 2 diabetes.

Graders Info : Maintain healthy glucose levels, maintain normal blood pressure, and maintain healthy lipid levels.

Also, because approximately 80% of type 2 clients are overweight, these clients may be placed on weight reduction diets to help achieve blood glucose levels that are within acceptable range. Thus, monitoring their weight loss also becomes part of their therapy.

24. What are the goals for the treatment of diabetes?

Graders Info : Control blood glucose levels, provide optimal nourishment, and prevent symptoms and delay the complications of the disease.

25. What factors can predispose one to type 2 diabetes?

Graders Info : A family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, older age, physical inactivity, and race and ethnicity can predispose one to type 2 diabetes.

26. Discuss the prevalence of diabetes in the United States.

Graders Info : According to the American Diabetes Association, 29.1 million people in the United States have diabetes. An estimated 18.8 million people have been diagnosed with the disease with 8.1 million going undiagnosed. There are approximately 86 million people with pre-diabetes. There were 1.7 million new cases of diabetes in people 20 years old and older diagnosed in 2010 (American Diabetes

Association [ADA]).

27. What are the expected lab results for someone with pre-diabetes?

Graders Info : Pre-diabetes is usually detected during diabetes screenings. A fasting glucose between 100 and 125 mg/dl, an A1C of 5.7-6.4%, or an OGTT (oral glucose tolerance test) 2-hour blood glucose of 140-199 mg/dl can indicate the presence of pre-diabetes.

TRUEFALSE 28. The method of diet therapy most commonly used for diabetic clients is that of counting carbohydrates. _________________________ (A) True (B) False Answer : (B)

29. Exercise helps the body use glucose by increasing insulin receptor sites and stimulating the creation of glucagon. _________________________ (A) True (B) False Answer : (A)

30. Diabetes is a metabolic disease caused by improper functioning of the liver that results in inadequate production of insulin. _________________________ (A) True (B) False Answer : (B)

31. Neuropathy is the buildup of fatty substances inside the artery walls that can reduce blood flow and is a major cause of death among diabetic clients. _________________________ (A) True (B) False Answer : (B)

32. Gestational diabetes occurs in the 24-28th week of pregnancy. _________________________ (A) True (B) False Answer : (A)

33. Polyuria is defined as excess sugar in the urine. __________________ (A) True (B) False Answer : (B)

34. Type 2 diabetes is usually managed with insulin. ___________________ (A) True (B) False Answer : (B)

35. Pre-diabetes is the precursor to type 2 diabetes.

(A) True (B) False Answer : (A)

ESSAY 36. Jana, age 45, has been diagnosed with diabetes. She was adopted when she was 2 years old and has no family history with which to identify a genetic connection.

What data are used to validate the condition?

Graders Info : Fasting blood sugar, oral glucose tolerance test, serum insulin, postprandial blood sugar, hemoglobin A1C, and self-blood-glucose monitoring 37. List the most common symptoms of diabetes.

Graders Info : Hunger, thirst, nausea, weakness, fatigue, headache, blurry vision, pruritus, cold extremities, cramping pain in calves and feet during walking or exercise, decreased sensation to pain and temperature in feet, numbness and tingling of the lower extremities, weight loss, frequent infections, and slow healing cuts and sores 38. Jana is very concerned about her ability to plan her meals and to adhere to the plan. How can you reassure her?

Graders Info : Explain to her the basics of diabetes meal planning. The importance of eating a healthy well balanced meal, not skipping meals, keeping a close eye on portion sizes, and decreasing her consumption of highly concentrated sweets such as regular sodas, juices, and desserts. Refer her to a diabetes education program or a dietitian. Encourage her to attend a local support group. Be continually reassuring.

39. With the condition hyperglycemia, there is an abnormal presence of glucose in the bloodstream.

How does the body rid itself of the excess glucose? How can this cause additional complications?

Graders Info : The abnormal concentration of glucose in the blood of clients with diabetes draws water from the cells to the blood. When hyperglycemia exceeds the renal threshold, the glucose is excreted in the urine, this is known as glycosuria. With the loss of the cellular fluid, the client experiences polyuria (excessive urination), and polydipsia (excessive thirst) typically results. If this continues long term, it could damage the kidneys and lead to a complication known as nephropathy. Nephropathy is the number one leading cause for the need for kidney dialysis.

40. Medical treatment of diabetes focuses on what topics?

Graders Info : Education, monitoring, meal planning, medication, exercise, standards of care, and prevention of complications.

41. List goals to assist with making life changes to improve metabolic control.

Graders Info : Provision of adequate calories for maintaining reasonable weight. Achieve optimal serum lipid levels.

Maintenance of as near the normal blood glucose levels as possible. Prevention and treatment of acute complications, such as hypoglycemia, and long-term effects such as renal disease, neuropathy, hypertension, and cardiovascular changes.

42. What is the goal or expected outcome for diet therapy for a diabetic client?

Graders Info : To achieve normal blood glucose levels as evident by an A1C of less than 7% (this is the target goal for A1C recommended by the American Diabetes Association) 43. What are the goals for medical nutrition therapy for diabetes?

Graders Info : The goals are (1) control blood glucose levels, (2) provide optimal nourishment for the client, and (3) prevent symptoms and thus delay the complications of the disease.

44. Describe the benefits of exercise.

Graders Info : Exercise promotes proper utilization of glucose, improves the functioning of the cardiovascular system, and will increase the client's feeling of well-being.

45. Differentiate gestational diabetes from type 1 diabetes.

Graders Info : Type 1 diabetes is characterized by the inability of the pancreas to produce insulin and typically occurs by age 30. Gestational diabetes has its onset between weeks 24 and 28 of pregnancy. A woman's body is still producing insulin; however, the pregnancy hormones produced by the placenta are causing insulin resistance.

46. Discuss glucose and insulin production for the fetus during pregnancy.

Graders Info : Adjustments in the maternal metabolism allow for nutrition of both the mother and the fetus.

Glucose is transported across the placenta to meet energy needs for the fetus. The amount is directly proportional for both the mother and the fetus. Insulin does not cross the placenta. By the 10th week of gestation, the infant secretes an adequate amount of insulin. Therefore, when gestational diabetes occurs, mom cannot metabolize the glucose, but the baby can. If left untreated, this can lead to a large birth weight baby.

47. Describe the changes that occur in the second or third trimester that result in gestational diabetes.

Graders Info : The mother develops hyperglycemia as a result of the hormones produced by the placenta. This causes decreased tolerance to glucose, increased insulin resistance, decreased hepatic stores, and the increased production of glucose. Control of hyperglycemia is crucial for the well-being of the infant.

48. Infants of mothers who have had diabetes are prone to hypoglycemia immediately after birth.

Describe the cause of this.

Graders Info : Because of the hyperglycemic state of the mother and the proportional increase for the fetus, the newborn infant responds by secreting large amounts of insulin. Within 30-60 minutes after birth, the infant becomes hypoglycemic because of the effects of the fetal hyperinsulinism and the rapid utilization of glucose after birth.

49. Describe dietary management for gestational diabetes.

Graders Info : It is imperative that the mother understand the importance of maintaining normal blood glucose levels. Divide daily calorie intake among three meals and two to four snacks, depending on individual needs. The dietitian should determine total calories. Take vitamins and iron as prescribed.

Avoid foods that include concentrated sugars. Eat meals regularly; never skip meals or breaks. Eat a nutritious bedtime snack to prevent an early morning rise in glucose levels. Eat foods high in fiber.

Avoid alcohol and not more than 16 oz of caffeine is recommended. Formulate a dietary plan with the client.

50. Formulate nursing diagnosis statements for Mary.

Graders Info : Deficient knowledge: related to diabetic pregnancy and management of care. Risk for injury to fetus: related to inadequate management of condition by the mother. Anxiety or fear: related to powerlessness, body image disturbance, situational low self-esteem, or altered role performance.

51. Describe the management of gestational diabetes if meal planning alone does not bring glucose levels to target.

Graders Info : The majority of cases of gestational diabetes are able to manage with nutrition intervention alone. If,

however, glucose levels do not meet target, then medication may be necessary. The only oral medications used in pregnancy are metformin and glyburide. If insulin is needed, it can be dosed as a long-acting basal insulin alone or a combination of basal and meal-time insulin.

Chapter 16 Diet and Cardiovascular Disease MULTICHOICE 1. What are some modifiable risk factors for atherosclerosis?

(A) diet and lifestyle (B) diabetes mellitus (C) heredity (D) age Answer : (A)

2. What is the desirable blood cholesterol level recommended by the American Heart Association?

(A) 200 mg/dl (B) 200-239 mg/dl (C) 240 mg/dl (D) 300 mg/dl Answer : (A)

3. Which of the following represents a diet low in saturated fat?

(A) whole milk and oatmeal (B) bacon, lettuce, and cheese hamburger (C) fish and chips (French fries) (D) turkey and tomato sandwich with pretzels Answer : (D)

4. Which of the following foods contains a high amount of cholesterol?

(A) egg yolks (B) peanuts (C) soft margarine (D) olive oil Answer : (A)

5. How is sodium a contributory factor in hypertension?

(A) It causes fluids to move too quickly to the kidneys, which puts extra pressure on the blood vessels.

(B) It acts as a diuretic and causes a loss of body fluids.

(C) An increased intake of sodium causes fluid shifts in the body, which puts extra pressure on the blood vessels.

(D) An increase of sodium dilates blood vessels.

Answer : (C)

6. All of the following are sodium-containing products EXCEPT ____.

(A) MSG (B) baking powder (C) baking soda (D) flour Answer : (D)

7. What does the Food and Nutrition Board recommend for daily sodium intake?

(A) 7 mg per day (B) 2,300 mg per day (C) 500 mg per day (D) 5 g/day Answer : (B)

8. Which product listed below contains sodium and is used to bleach certain fruits and vegetables and is also used as preservative in some dried fruit?

(A) sodium benzoate (B) sodium propionate (C) sodium sulfite (D) disodium phosphate Answer : (C)

9. What is the general term for vascular disease in which arteries "harden"?

(A) atherosclerosis (B) arteriosclerosis (C) cardiovascular disease (D) myocardial infarction Answer : (B)

10. What is the name of the condition in which blood flow, and thus oxygen and nutrients, to the tissues is reduced?

(A) ischemia (B) angina pectoris (C) hyperlipidemia (D) hypertension Answer : (A)

11. When the lumen narrows and a blood clot forms, what could occur?

(A) ischemia (B) atherosclerosis (C) cardiovascular disease (D) myocardial infarction Answer : (D)

12. Atherosclerosis is defined as ____.

(A) hardening of the arteries resulting in reduced blood flow (B) reduced blood supply to arteries and veins (C) the inner lining of arteries through which oxygen is delivered and waste is removed (D) a form of arteriosclerosis affecting the intima of the artery walls Answer : (D)

13. Blood flow that is blocked from tissues that are located some distance from the heart is called ____.

(A) cerebrovascular accident (B) angina pectoris (C) thrombus disease (D) peripheral vascular disease Answer : (D)

14. Which of the following foods should be limited on a low-cholesterol diet?

(A) whole milk (B) potatoes (C) chicken (D) enriched bread Answer : (A)

15. All of the following statements about atherosclerosis are true EXCEPT ________.

(A) arteries become thickened (B) begins in adulthood (C) caused by an inflammatory process (D) plaques develop within the artery walls Answer : (B)

16. _____ tend to reduce serum cholesterol.

(A) Unsaturated fats (B) Saturated fats (C) Triglycerides (D) Lipids Answer : (A)

17. The primary treatment for hyperlipidemia is _____.

(A) medical nutrition therapy (B) statin medications

(C) exercise (D) weight loss Answer : (A)

18. How long does it take for a client to adjust to a heart healthy diet?

(A) 2-3 months (B) 1-2 weeks (C) 2-3 weeks (D) 1-2 months Answer : (A)

19. Hypokalemia refers to a low level of _____ in the blood.

(A) ​sodium (B) ​potassium (C) ​chloride (D) ​none of the above Answer : (B)

ESSAY 20. Discuss the formation of plaque.

Graders Info : Plaque deposits are made from fats, cholesterol, and other substances, which accumulate over time thickening and weakening artery walls. The plaques develop within rather than on the artery wall and are driven by an inflammatory process. The plaque reduces the size of the lumen, resulting in a decreased amount of blood flow to the tissues. The reduced flow prevents an adequate supply of nutrients and oxygen from reaching the tissues.

21. Differentiate low-density lipoproteins (LDL) from high-density lipoproteins (HDL).

Graders Info :

LDLs carry most of the cholesterol to the cells, which contributes to atherosclerosis. HDLs carry cholesterol from the tissue to the liver for excretion from the body. HDLs are considered "good" cholesterol, and LDLs are considered "bad."

22. Discuss potential causes and risk factors for cardiovascular disease.

Graders Info : Hypertension, hyperlipidemia, smoking, obesity, diabetes mellitus, males, heredity, personality type, ability to handle stress, and sedentary lifestyle 23. Discuss the impact of fiber on cholesterol levels.

Graders Info : Medical research studies have concluded that water-soluble fiber binds with substances containing cholesterol and prevents their reabsorption into the blood. The recommendation for total fiber per day is 38 g for men and 25 g for women. Research published by the National Institute of Health shows that people who increased their soluble fiber intake by 5-10 g each day had about a 5% drop in their LDL (bad) cholesterol. If a client is able, a level of 10-25 g of soluble fiber is preferred.

24. Discuss the use of sodium and salt by the general population. Include consumption, recommended dietary amount (RDA), and food sources.

Graders Info : A recommendation from the Food and Nutrition Board is that for adults the daily intake of sodium be limited to no more than 2,300 mg, with a safe minimum of 500 mg/day. Certain ethnic groups, such as African Americans with new onset of HTN and those already diagnosed with HTN, should limit sodium to 1,500 mg/day. The average adult consumes as much as 3,400 mg/day. Meat, fish, poultry, dairy products, and eggs all contain a substantial amount of sodium naturally. Water can contain varying amounts of sodium, and over-the-counter medications, prepared dinners, soft drinks, snacks, and canned foods also contain sodium.

25. List and define the four blood pressure categories.

Graders Info : Normal-less than 120/less than 80 mm Hg Prehypertension-120-139/80-88 mm Hg Stage 1 hypertension-140-159/90-99 mm Hg Stage 2 hypertension-160/100 mm Hg 26. Compare and contrast primary and secondary hypertension.

Graders Info : Primary, or essential, hypertension refers to hypertension with an unknown cause. Primary hypertension accounts for 90% of hypertension cases. The remaining 10% of cases of hypertension are secondary hypertension. Secondary hypertension is caused by another problem. Some causes of secondary hypertension include kidney disease, problems with the adrenal glands, and use of oral contraceptives.

27. The Dietary Approaches to Stop Hypertension (DASH) plan has been shown to reduce high blood pressure. A core component of this plan is to increase consumption of fruits and vegetables. How many servings of fruits and vegetables per day are encouraged on this plan? List four potassium-rich fruits and vegetables.

Graders Info : The DASH plan recommends 8-12 servings of fruits and vegetables each day, depending on calorie intake.

Potassium-rich fruits: apricots, oranges, bananas, avocados, cantaloupe, dates, figs, raisins, honeydew melon, grapefruit, kiwifruit, peaches, pineapple, prunes, strawberries Potassium-rich vegetables: asparagus, broccoli, cabbage, green beans, pumpkin, squash, tomatoes, spinach, potatoes, sweet potatoes, yams

TRUEFALSE 28. In severe cases of edema, it is possible for a client to adhere to a diet that is totally salt-free. _________________________ (A) True (B) False Answer : (B)

29. Cholesterol is found only in animal tissue. _________________________ (A) True (B) False Answer : (A)

30. The client who is taking diuretics should be screened for hypokalemia. _________________________ (A) True

(B) False Answer : (A)

31. Rheumatic fever is a contributing factor for a myocardial infarction. _________________________ (A) True (B) False Answer : (A)

32. Recent research indicates that fats are a primary factor in the development of hypertension. _________________________ (A) True (B) False Answer : (B)

33. The newest guideline for potassium intake is 2,500 mg per day to lower blood pressure. _____________________ (A) True (B) False Answer : (B)

34. The sodium in tap water is consistent from one area to another. ___________________ (A) True (B) False Answer : (B)

ESSAY 35. James, age 54, had a myocardial infarction 2 days ago. Initially, he was nauseated and then he became very thirsty.

After the initial attack, what diet will James be given?

Graders Info :

He will be given nothing by mouth (NPO) for several hours until his condition is stable. If nausea remains after the period of shock, IV infusions are given to prevent dehydration. A liquid diet will be recommended for the first 24 hours, followed by a low-cholesterol, low-sodium plan.

36. James is extremely thirsty. Discuss the rationale for this.

Graders Info : After the attack, the client is in shock, which causes a fluid shift within the cells, resulting in a severe thirst.

37. Discuss the goal and recommendations for the dietary management of James. State nursing interventions to obtain that goal.

Graders Info : The goal is to allow the heart to rest and heal. Nursing interventions include the following. Foods should not be extreme in temperatures, hot or cold. The diet should be easy to chew and digest, with little roughage. Chewing and the activity of the gastrointestinal tract necessary for metabolism of fiber cause extra work for the heart. Types of fats will be limited. Energy needs are based on the individual. Sodium and caffeine will be restricted.

38. What is the nutritional treatment for hyperlipidemia?

Graders Info : Reduce the amount and types of fats (especially saturated fats) and often the calories. When fats are decreased, there is usually a reduction of cholesterol and saturated fats ingested and a loss of weight, which is necessary to treat hyperlipidemia.

39. James's cholesterol level is 720. Low-density lipoproteins (LDLs) are high and high-density lipoproteins (HDLs) are low. Discuss the implications of this.

Graders Info : LDLs carry most of the cholesterol to the cells, where it contributes to atherosclerosis. HDLs carry cholesterol to the liver for excretion. James has a low amount of HDL. He should be on a low-fat, low saturated fat, and low-cholesterol diet. He will also most likely need medication to help control his cholesterol levels.

40. Discuss the implications of smoking for James.

Graders Info :

Cigarettes contain nicotine, which contributes to the constriction of the narrowed arteries that supply blood flow. Smoking also contributes to the changes in the arteries, making them less flexible and harder.

41. Search the Internet to find the guidelines compiled by the American Heart Association for cholesterol intake. List them.

Graders Info : Adult diets should contain less than 200 mg of cholesterol per day. Fats should provide no more than 25-35% of calories. Saturated fats should make up no more than 7% of the total, polyunsaturated fats should not exceed 8%. Trans fats should be limited to less than 1% of total daily calories.

42. James is discharged on day five, in good condition with a plan to decrease cholesterol in his diet.

He returns for a checkup in 3 months to find out his cholesterol level is 625. The physician plans to order a cholesterol-lowering drug: simvastatin (Zocor) or atorvastatin (Lipitor). Research these drugs for potential food-drug interactions. Identify the interactions.

Graders Info : Lipitor may increase serum digoxin levels, oral contraceptive levels, and the effects of warfarin.

Zocor interacts with grapefruit and its juice, and these should be avoided.

43. Ed, age 52, has 3+ edema and a B/P of 180/98. He is 5′10″ and weighs 275 lbs. Ed is in midmanagement at a new manufacturing company. He has to be very energetic and self-motivated to maintain the demands of his job. Ed, divorced, lives alone and often eats on the run at fast-food places or eats soup, sandwiches, frozen dinners, or salad at home. He says his only vices are "smoking and eating."

What predisposing factors have increased Ed's risk for hypertension?

Graders Info : Stress at work, weight, personality type, lifestyle, eating habits, lack of exercise, and history of smoking all increase Ed's risk for hypertension.

44. The physician has ordered a diuretic for Ed. What foods need to be added to his diet? Why?

Graders Info : Ed needs to increase fruits and vegetables that are high in potassium to replace the potassium lost from the action of the diuretic.​ ​ Fruits: oranges, bananas, prunes, apricots, avocados, cantaloupe, dates, figs, raisins, honeydew melon, grapefruit, kiwifruit, peaches, pineapple, and strawberries

​ Vegetables: asparagus, broccoli, tomatoes, green beans, squash, pumpkin, spinach, potatoes and sweet potatoes, and cabbage ​ ​

45. The dietitian calculated Ed's recommended body weight. What type of diet may be ordered for Ed?

Graders Info : Calorie-restricted, sodium-restricted, and potassium-rich 46. How has Ed's current diet affected his condition?

Graders Info : His diet is excessive in calories, fats, and sodium with little fiber, fruits, or vegetables. Frozen and processed foods are extremely high in sodium.

47. Compile a list of foods or condiments that are high in sodium.

Graders Info : Salt, baking powder, baking soda, cheese, preservatives containing forms of sodium, potato chips, other types of snack chips, canned soups, frozen dinners, canned foods, dried, breaded, smoked, or canned fish or meats, salt-topped crackers or breads, salad dressings, catsup, soy sauce, bouillon, processed meats, and many other types of processed foods 48. Ed is not happy with the sodium restrictions in his diet. How can you teach Ed the importance of adhering to this diet and instruct him in ways to make foods tasteful, without added salt?

Graders Info : It is important for Ed to realize he must conform to the sodium restrictions for the rest of his life. It can be a gradual reduction to allow his taste to adjust. Flavor can be added with numerous herbs, spices, and other flavorings. Advise him in the practice of reading labels for salt content.

Chapter 17 Diet and Renal Disease MULTICHOICE 1. Name two end products of protein metabolism.

(A) urea and uric acid (B) vitamin D and vitamin K (C) lecithin and uremia (D) creatinine and aldosterone Answer : (A)

2. Kidneys make the final conversion of what vitamin?

(A) vitamin D (B) vitamin C (C) vitamin K (D) vitamin E Answer : (A)

3. Vitamin D may be added and phosphorus limited in a renal client's diet in order to prevent _____ (softening of the bones due to excessive loss of calcium).

(A) osteomalacia (B) osteoporosis (C) gynecomastia (D) periodontal disease Answer : (A)

4. What vitamin supplement should not be given to renal clients because the blood level of this vitamin tends to be elevated in uremia?

(A) B (B) A (C) C

(D) D Answer : (B)

5. A client on hemodialysis requires how much protein per kilogram of body weight?

(A) 1.5 g of protein (B) 2 g of protein (C) 1.2 g of protein (D) 1.8 g of protein Answer : (C)

6. _____ is/are usually restricted to 1,500 to 2,500 mg a day for dialysis clients.

(A) Potassium (B) Calcium (C) Protein (D) Fats Answer : (A)

7. Milk is normally restricted to 1/2 cup per day for dialysis clients because it is high in what?

(A) calcium (B) protein (C) fat (D) potassium Answer : (D)

8. A typical renal daily diet is sometimes referred to as "80-3-3," meaning what?

(A) 80% protein, 3% fats, 3% carbohydrates (B) 80 g of carbohydrates, 3 g of fat, 3 g of protein (C) 80 g of protein, 3 g of sugar, 3 g of fat (D) 80 g of protein, 3 g of sodium, 3 g of potassium Answer : (D)

9. If there was substantial bone loss before a kidney transplant, additional calcium and _____ may be necessary following the transplant.

(A) potassium (B) carbohydrate (C) phosphorus (D) fat Answer : (C)

10. Large amounts of _____ are helpful in diluting urine for the treatment of renal stones.

(A) fats (B) fluids (C) proteins (D) carbohydrates Answer : (B)

11. _____ is a condition in which protein wastes that should have been excreted are instead circulating in the blood.

(A) Acute renal failure (B) Oliguria (C) Uremia (D) Nephritis Answer : (C)

12. Energy needs for the client with renal disease should be fulfilled with _____.

(A) carbohydrates and proteins (B) carbohydrates (C) proteins (D) carbohydrates and fats Answer : (D)

13. _____ is the condition when urinary output is less than 500 mL/day.

(A) Cystic fibrosis (B) Oliguria (C) Acute renal failure (D) Renal stones Answer : (B)

14. Approximately how many liters of urine are excreted per day?

(A) 10 L (B) 5 L (C) 1.5 L (D) 15 L Answer : (C)

15. Which of the following are among the functions of the kidneys?

(A) secrete certain hormones, dilute electrolytes (B) excrete hormones, recycle electrolytes (C) maintain volume of body fluids, dilute electrolytes (D) secrete certain hormones, excrete wastes Answer : (D)

16. _____refers to the hardening of the renal arteries.

(A) Nephritis (B) Glomerulonephritis (C) Nephrosclerosis (D) Nephrolithiasis Answer : (C)

17. Hemodialysis is done for 3 to 5 hours how many times each week?

(A) 1 (B) 3

(C) 5 (D) 6 Answer : (B)

18. _____ is a condition in which stones develop in the kidneys.

(A) Nephrolithiasis (B) Polycystic kidney disease (C) Nephritis (D) Nephrosclerosis Answer : (A)

19. Renal stones are classified according to their _____.

(A) location (B) composition (C) size (D) shape Answer : (B)

20. The specific amount of protein allowed in a dialysis patient's diet is calculated according to ___________.

(A) BUN and creatinine (B) length of dialysis treatment (C) height and weight (D) glomerular filtration rate and weight Answer : (D)

ESSAY 21. Describe the function and the action of the kidneys.

Graders Info : The kidneys excrete wastes, maintain volume and composition of body fluids, and secrete certain hormones. This includes filtering blood and cleansing it of waste and recycling other, usable substances that are necessary components of body fluids, so that they are constantly available.

22. Renal disease is a lifelong struggle and a challenge. Describe some of the feelings that may complicate management of the condition.

Graders Info : Anger and depression often occur and the client may have an unwillingness to learn anything about the condition that is in control of the client's life. Diet therapy is very complex and may serve to lower self-esteem. Fear of death and dealing with the grieving process is very much a part of life.

Clients grieve for the loss of normal body function, loss of a kidney, and the fear of death. They may also grieve for loss of roles within the family or work situation.

23. The use of salt substitutes is not recommended for clients with renal disease. Why?

Graders Info : Hyperkalemia tends to occur in end stage renal disease. Salt substitutes replace sodium with potassium. This adds excess potassium in the diet.

24. Describe the protein intake in clients with renal disease.

Graders Info : There must be sufficient fat and carbohydrates for energy needs. If not, the body must use the ingested protein for energy. This increases the work of the kidneys because protein increases the amount of nitrogen waste the kidneys must handle. The diet should be limited to 40 g protein daily, with sufficient fat and carbohydrates to meet the energy needs.

25. Describe the diet for clients who are on hemodialysis.

Graders Info : Protein requirement is 1.2 g per kilogram of body weight. Potassium is restricted to 2,000-4,000 mg.

Milk is restricted to 1/2 cup daily because of the potassium and protein it contains. Usually watersoluble vitamins, vitamin D, calcium, and iron are supplemented. Vitamin A should not be given because the blood level of Vitamin A tends to be elevated in uremia.

26. Discuss the role of calcium in formation of calcium oxalate stones.

Graders Info : Recent studies provide no support for the theory that a diet low in calcium can reduce the risk of calcium oxalate stones (renal stones). In fact, higher dietary calcium intake may decrease the incidence of renal stones for most people.

27. Discuss the etiology of renal diseases.

Graders Info : Kidney disorders can be initially caused by infection, degenerative changes, diabetes mellitus, high blood pressure, cysts, renal stones, or trauma. When these conditions are severe, renal failure may develop.

TRUEFALSE 28. The kidney is solely responsible for maintenance of fluid balance, acid-base balance, and electrolyte balance. _________________________ (A) True (B) False Answer : (A)

29. The body normally excretes about 2,000 mL of urine per day. _________________________ (A) True (B) False Answer : (B)

30. When the kidneys are unable to adequately eliminate nitrogenous waste from the body, a urinary tract infection occurs. _________________________ (A) True (B) False Answer : (B)

31. Kidney failure is reversible with appropriate diet and hemodialysis. _________________________ (A) True (B) False

Answer : (B)

32. Polycystic kidney disease is a relatively rare, hereditary disease. _________________________ (A) True (B) False Answer : (A)

33. Each kidney contains approximately 100,000 working parts called nephrons. ___________________ (A) True (B) False Answer : (B)

34. Hemodialysis is the removal of waste products from the blood by injecting the flushing solution into the abdomen and using the client's peritoneum as the semipermeable membrane.

(A) True (B) False Answer : (B)

35. Sodium and carbohydrates may be restricted after kidney transplant.

(A) True (B) False Answer : (A)

ESSAY 36. Hazel is in renal failure. She weighs 98 pounds and is 5′5″ tall, and has shaky movements. She lives alone in an elderly-adult housing apartment. She has no transportation to the clinic for dialysis that has been ordered three times per week. Hazel has been admitted to a skilled nursing facility to enable treatment. She typically eats less than 25% of each meal.

Describe hemodialysis.

Graders Info :

The blood is diverted through an access to the client's circulatory system, which routes blood through the artificial kidney, or dialyzer, for removal of wastes, fluids, and electrolytes, and then the blood is returned to the client's body. Hemodialysis is usually done 3 times a week for 3-5 hours at a time.

37. State nursing diagnosis statements for Hazel and explain the validity of each.

Graders Info : Hazel has ineffective role performance related to chronic illness and treatment side effects. She is no longer able to live alone and provide for her own needs. She was not able to arrange for her care to include trips to the dialysis center, and home dialysis was not an option. Hazel has learned about ineffective tissue perfusion related to risk of disconnection of the vascular access device. She knows the device must remain in her arm and she is very apprehensive about dislodging it and, as she states, "bleeding to death." Hazel needs to be assured that qualified staff will be monitoring the connection and the perfusion so that no harm will come to her.

38. State nursing interventions for Hazel.

Graders Info : Reinforce explanation of dialysis procedure.

Explain dietary restrictions thoroughly.

Maintain asepsis and universal precautions.

Monitor weight closely.

Schedule fluid intake within restrictions.

Monitor for signs of fluid and electrolyte imbalance.

Assess the access site for signs of infection and adequate circulation.

Do not take blood pressure or perform venipuncture on arm with access site.

Skin care frequently to remove urea deposits.

Encourage verbalization of self-concept.

Assist in identifying personal strengths.

Assist client and family members with clarifying expected roles and role changes.

Provide diversions and adequate rest periods.

Monitor for orientation levels.

39. Why has the physician ordered Epogen®?

Graders Info : It is a biological response modifier to stimulate red cell production to treat anemia.

40. You are encouraging Hazel to eat more of her lunch. She says to you, "What difference does it make? I'm going to die anyway." What should be your initial response?

Graders Info : "What do you think is going to happen to you?" You should answer with a leading question to encourage a discussion with her.

41. Describe the diet during dialysis.

Graders Info : Client may need additional protein to make up for the losses during dialysis. Potassium is restricted.

Fluids are restricted and supplementation may be needed for water-soluble vitamins, vitamin D, calcium, and iron.

42. Hazel's dietary intake is inadequate. How can you get her to eat more?

Graders Info : If she is not eating because she does not have the desire to live, spend additional time with her to make her value her self-worth. Including her in the planning of her nursing care will make her feel more valuable, and as a contributing member of society. Encourage visits with her family.

Encourage her to take day trips with her family. Let her plan her meals and accommodate her likes and dislikes. Serve her appealing foods. Include her family in her care planning.

43. Glen comes to the emergency room with severe pain in his flank area. He is 54 and very active and states, "I am never sick, what could be wrong with me?" His color is pale, and the skin is moist and clammy. The doctor has diagnosed Glen with a kidney stone.

What are the incidence and prognosis of a kidney stone?

Graders Info : Kidney stones occur in about 1 million people each year in the United States. Majority are men.

Stones often occur only once, although in some cases they may reoccur several times.

Reoccurrences are preventable. Stones form when stone constituents become concentrated in the

urine and form crystals that grow. It is a very painful, though rarely fatal, condition.

44. Describe why stones are painful.

Graders Info : Stones that are small may easily pass through the ureters and out of the body in the urine. Large stones cannot pass easily through the ureters, and when they move they produce a sharp, stabbing pain. The pain usually starts in the back and intensifies as the stone follows the path of the ureter down the abdomen toward the groin. Once in the bladder, pain subsides.

45. What is the dietary regimen for prevention of kidney stones?

Graders Info : Increase fluid intake to dilute the urine and reduce the risk of stone formation. The fluids should be mostly water, and at least 2 L must be consumed daily.

46. Discuss the most common types of stones and the dietary therapies of each.

Graders Info : Calcium oxalate stones require limiting intake of foods high in oxalates: spinach, rhubarb, beets, nuts and peanuts, chocolate, tea, wheat germ, wheat bran, soy beans and soy milk, dry beans, and sweet potatoes. Avoid megadoses of vitamin C supplements, pyridoxine, thiamine, and magnesium, as they raise urinary oxalate concentrations.Uric acid stones require a purine-restricted diet that limits red meat, particularly organ meats, anchovies, sardines, and meat extracts. A diet of no more than 100 g of protein per day is advised, and alcohol intake is limited.

Cystine stones form as a result of an inherited disorder of amino acid metabolism. Dietary restrictions limit the foods with the amino acid methionine, or an alkaline-ash diet is recommended; increased fluids are encouraged.

Struvite stones are treated with a low-phosphorus diet.

Chapter 18 Diet and Gastrointestinal Disorders MULTICHOICE 1. Which of the following organs are considered primary organs of the gastrointestinal tract?

(A) mouth, small intestine, large intestine (B) mouth, liver, stomach (C) pancreas, gall bladder, kidney (D) heart, lungs, stomach Answer : (A)

2. _____ is a condition of discomfort in the digestive tract.

(A) Esophagitis (B) Hiatal hernia (C) Dyspepsia (D) Peptic ulcer Answer : (C)

3. How can dyspepsia be related to a physical cause?

(A) overeating (B) diabetes (C) stress (D) prolonged eating times Answer : (A)

4. Acute esophagitis is caused by _____.

(A) ingesting an irritating agent (B) intubation (C) hiatal hernia (D) peptic ulcer Answer : (A)

5. _____ is a condition in which a part of the stomach protrudes through the diaphragm into the thoracic cavity.

(A) Esophagitis (B) Hiatal hernia (C) Dyspepsia (D) Peptic ulcer Answer : (B)

6. How can the symptoms of a hiatal hernia be eliminated?

(A) eating three large meals daily (B) eliminating fat in the diet (C) eating small, frequent meals (D) eliminating vegetables from the diet Answer : (C)

7. Which food can cause the lower esophageal sphincter to relax?

(A) milk (B) banana (C) chocolate (D) oatmeal Answer : (C)

8. Which bacteria are sometimes associated with a peptic ulcer?

(A) Myocardium bacterium (B) Helicobacter pylori (C) E. coli (D) Listeria monocytogenes Answer : (B)

9. How are antibiotics useful in treating peptic ulcers?

(A) inhibit gastric secretion (B) break down the cells that compose the ulcer (C) kill the bacteria (D) neutralize any excess acid Answer : (C)

10. How is cimetidine useful in treating peptic ulcers?

(A) inhibits gastric secretion (B) breaks down the cells that compose the ulcer (C) kills the bacteria (D) neutralizes any excess acid Answer : (A)

11. What is the protein diet recommendation for a client with a peptic ulcer?

(A) no more than 0.8 g of low-fat protein per kilogram of body weight (B) 1-1.5 g of low-fat protein per kilogram of body weight (C) no less than 0.8 g of low-fat protein per kilogram of body weight (D) 2-2.5 g high-fat protein per kilogram of body weight Answer : (A)

12. Diet therapy for clients with diverticulitis may begin with _____.

(A) low-residue diet (B) clear-liquid diet (C) high-fiber diet (D) low-fat diet Answer : (B)

13. What is a characteristic of a high-fiber diet?

(A) 20-30 g soluble fiber (B) 30 g or more of soluble fiber

(C) 30 g or more of insoluble fiber (D) 30 g or more of dietary fiber Answer : (D)

14. After the bowel has been allowed to rest and heal and the acute phase of diverticulitis is over, a _____ diet is given.

(A) low-residue (B) high-fiber (C) low-fiber (D) full liquid Answer : (B)

15. The liver is of major importance in the process of metabolism. Which of the following functions is NOT performed in the liver?

(A) Bile is stored (B) Cholesterol is synthesized (C) Bile is synthesized (D) Fats are converted to lipoproteins Answer : (A)

16. Hepatitis A is occurring more frequently than in years past. It is transmitted through _____.

(A) contaminated drinking water, food, or sewage (B) blood and body fluids (C) blood and body fluids and contaminated drinking water, food, or sewage (D) blood, blood products, and body fluids Answer : (A)

17. What is the name of the intestinal disorder characterized by little pockets in the sides of the large intestine?

(A) diverticulitus (B) pancreatitis

(C) diverticulosis (D) ulcerative colitis Answer : (C)

18. The process of providing all nutrients intravenously is called _____.

(A) enteral nutrition (B) IV nutrition (C) total parenteral nutrition (D) liquid nutrition Answer : (C)

19. People who have celiac disease would eliminate what food from their diet?

(A) barley (B) rice (C) corn (D) popcorn Answer : (A)

20. How many grams of fiber would someone following a low-residue diet consume each day?

(A) 5-10 (B) 15-20 (C) 25-35 (D) 20-25 Answer : (A)

21. Gastroesophageal reflux can cause _____.

(A) hiatal hernia (B) diverticulosis (C) pancreatitis (D) esophagitis

Answer : (D)

ESSAY 22. Describe the treatment for peptic ulcers.

Graders Info : Antibiotics are given to kill the bacteria, and cimetidine is given to inhibit the acid secretion in the stomach and thus helps to heal the ulcer. Antacids are prescribed to neutralize the excess acid. Rest and counseling help the client learn to deal with the pressure and stress that are sometimes associated with the disease.

23. What type of diet and lifestyle changes should be encouraged for a client with peptic ulcers?

Graders Info : A low-fat diet with a moderate amount protein is adequate. It should have vitamin and mineral supplements. If there has been any loss of blood associated with the condition, the protein should be increased to 1-1.5 g per kilogram of body weight. Spicy foods may be eaten as tolerated. Coffee, tea, and other caffeine-containing foods should be avoided, as they stimulate gastric secretions. Alcohol and medications with aspirin irritate the mucous membrane of the stomach. Cigarette smoking decreases the secretion of the pancreas enzymes that buffer the gastric acid in the duodenum. A well-balanced diet of three meals a day consisting of foods that do not irritate the client is generally recommended.

24. State food sources of fiber, and state the purpose of fiber in the diet.

Graders Info : Fiber is found in plants, such as the outer shells of corn kernels, strings of celery, seeds of strawberries and citrus fruits. Fiber becomes the solid part of feces and is made of undigested and unabsorbed parts of food, connective tissue in animal foods, dead cells, and intestinal bacteria and their products.

25. List medical conditions that require high-fiber and low-fiber diets.

Graders Info : A high-fiber diet is used to prevent diverticulosis, constipation, hemorrhoids, and colon cancer. It is useful for the treatment of diabetes and atherosclerosis. Low-fiber diets are used in cases of severe diarrhea, diverticulitis, ulcerative colitis, and intestinal blockage.

26. Describe the symptoms of ulcerative colitis and Crohn's disease.

Graders Info : Bloody diarrhea, cramps, fatigue, nausea, anorexia, malnutrition, and weight loss are among the symptoms of both conditions. The diarrhea will also cause alterations in the electrolyte, fluid, vitamin, and mineral levels in the body, as well as loss of iron and protein that are needed to repair the ulcers of the conditions.

27. How have food manufacturers marketed the gluten-free diet? For what conditions should the gluten-free diet really be used?

Graders Info : Marketing strategies have led people to believe that the gluten-free diet can result in weight loss, improve overall health, and act as a cure for common ailments. However, there is no evidence that replacing a gluten-containing food with a gluten-free food will help someone lose weight. Consuming fewer cakes, cookies, and dinner rolls (products that contain gluten) reduces calorie intake that will lead to weight loss. It is the reduction of calories that yields weight loss, not eliminating gluten from the diet. Gluten-free diets may often be suggested for managing autism, irritable bowel syndrome, and ADHD, but research shows mixed results. The only condition where a totally gluten-free diet is necessary is for celiac sprue disease. Those with gluten sensitivity may benefit from an elimination diet to determine if symptoms can resolve from decreasing gluten intake.

28. For someone who has Celiac disease, what are some of the gluten-containing grains that would need to be avoided and what are the gluten-free grains and starches that would be safe?

Graders Info : Gluten-containing grains to avoid: barley (including malt extract, beer, and ale), rye, wheat (all types of wheat flour and products made with wheat, bran, germ, starch), spelt, triticale, and farroGlutenfree grains and starches: rice, wild rice, millet, amaranth, arrowroot, corn, flax, buckwheat, soy, teff and flours made from nuts, beans, seeds, potato, tapioca, and sorghum

TRUEFALSE 29. Clients with an ileostomy have a greater need for monitoring and replacing fluids and electrolytes than do those with a colostomy. _________________________ (A) True (B) False Answer : (A)

30. Celiac disease is a disorder characterized by malabsorption of virtually all nutrients and is caused by recurrent diverticulitis. _________________________ (A) True (B) False Answer : (B)

31. The liver is of major importance in the body, because all nutrients are absorbed and then transported to the liver. _________________________ (A) True (B) False Answer : (B)

32. Hepatitis has become a social disease, as all forms are transmitted by blood, blood products, body fluids, or sexual intercourse. _________________________ (A) True (B) False Answer : (B)

33. Diet therapy for pancreatitis is intended to reduce stimulation of pancreatic enzymes. The type of diet used is a liquid diet consisting mainly of carbohydrates because they have the least stimulating effect. _________________________ (A) True (B) False Answer : (A)

34. In children with untreated Celiac disease, growth is compromised. ____________________ (A) True (B) False Answer : (A)

35. Gastrointestinal problems are always psychological in origin. ____________________ (A) True

(B) False Answer : (B)

36. Peptic ulcers occur in both the stomach and the duodenum. ____________________ (A) True (B) False Answer : (A)

ESSAY 37. Jessie has been admitted to the hospital with cirrhosis. She is a 65-year-old widow who is an alcoholic. Jessie is very malnourished. She weighs 98 pounds and is 5′5″ tall. She says she stopped drinking 6 months ago because it "hurt her stomach very bad" when she drank.

Besides her lack of appetite, why is she malnourished? How has her liver disease contributed to her nutritional status?

Graders Info : The liver is responsible for absorption and use of nutrients as well as for storing iron, copper, zinc, magnesium, fat-soluble vitamins, and the B vitamins. It also synthesizes bile and stores it in the gallbladder. It changes simple sugars to glycogen and provides glucose to the body cells. It converts fats to lipoproteins and synthesizes cholesterol.

38. What is the most common cause of cirrhosis?

Graders Info : Alcohol abuse 39. What type of diet will Jessie be on?

Graders Info : Protein of 0.8-1 mg per kilogram per day and 25-35 calories per kilogram per day.

40. If Jessie develops ascites, what dietary changes will be made?

Graders Info : Protein will be restricted to 35-40 g per day. Sodium and fluids may be restricted. If there is bleeding in the esophagus, fiber may be restricted. Several small feedings will be used rather than three regular meals a day.

41. Liver cells can regenerate. Why is this not true in Jessie's case?

Graders Info : Repeated insults to the liver destroy, inflame, and produce hepatic insufficiency. Repeated insults cause scarring that decreases the ability to regenerate. As the scar tissue increases, the organ will atrophy.

42. What pathology results in edema and ascites in the late stages of cirrhosis?

Graders Info : Reduced synthesis of protein reduces the blood's ability to regain needed fluids. The decrease in volume causes the brain to signal the adrenal cortex to increase the secretion of aldosterone, which stimulates the kidney to retain sodium and fluid. The normal liver inactivates the hormone aldosterone and prevents accumulation of excess fluid. The diseased liver allows its effect to continue, and there is an excess of aldosterone, which stimulates the kidney to retain sodium and fluids, resulting in ascites and edema.

43. Laura is a 34-year-old mother of three children. She has cholecystitis with cholelithiasis. She is to have surgery to remove the stones and the gallbladder.

Describe the incidence of cholecystitis.

Graders Info : It occurs more in women, in Native Americans, and whites. It occurs more in obese people, pregnant women, those with diabetes, multiparous women, and women who use birth control pills.

44. Describe the pathology of cholecystitis.

Graders Info : Stone formation causes an obstruction and prevents bile from leaving the gallbladder, thus trapping the bile, which acts as an irritant. The irritant causes cellular infiltration of the gallbladder wall, and an inflammatory response causes the gallbladder to enlarge and become edematous. If there is vascular occlusion and bile stasis, the lining of the gallbladder becomes necrotic. There is danger of rupture of the gallbladder and spread of infection to the hepatic duct and liver.

45. Describe the signs and symptoms of cholecystitis.

Graders Info : There is indigestion and pain that may be severe, localizes in the right upper quadrant of the epigastric area, and may radiate to the right scapular area. There is also flatulence, anorexia, nausea, vomiting, and diaphoresis. There may be a low-grade fever and elevated leukocyte count, mild jaundice, stools that contain fat, clay-colored stools, and dark amber urine.

46. Many cases are treated with laparoscopic surgery. After this type of surgery, what type of diet will be ordered?

Graders Info : Oral liquids may be given the first evening, followed by a light meal. Upon discharge, the client should be told to try small amounts of foods that previously caused discomfort and gradually eliminate those that continue to do so. Usually a regular diet can be resumed without difficulty.

47. How can the nurse determine if Laura is ready to begin to eat food?

Graders Info : By auscultation of bowel sounds to determine if peristalsis has resumed

Chapter 19 Diet and Cancer MULTICHOICE 1. What is the term used for cancerous tumor? ​ (A) neoplasm​ (B) benign growth (C) cachexia (D) carcinogen Answer : (A)

2. When cancer cells spread to new tissue sites in the body, they are said to _____. ​ (A) neoplasia (B) metastasize (C) resection (D) neoplasm Answer : (B)

3. _____ is the study of cancer. ​ (A) ​Gerontology (B) Carcinology (C) Oncology (D) Neurology Answer : (C)

4. ​ Which of the following foods is associated with the prevalence of cancer?

(A) bacon (B) ​legumes (C) ​chicken (D) ​olives Answer : (A)

5. What is an example of a phytochemical? ​ (A) ​ gluten (B) ​ legumes (C) ​ phenols (D) ​ roots Answer : (B)

6. Research shows what amount of cancer cases could be prevented by lifestyle changes? ​ (A) ​ three-fourths (B) ​ two-thirds (C) ​ one-half (D) ​ one-third Answer : (D)

7. What is one of the first indicators of cancer? ​ (A) ​ cough (B) ​ weight loss (C) ​ headaches (D) ​ nausea Answer : (B)

8. What is the term used to describe dry mouth? ​ (A) dysphagia (B) xerostomia (C) cachexia (D) hypoalbuminemia Answer : (B)

9. ​ Which of the following statements is correct?

(A) Lower doses of drugs are better for clients who cannot eat normally.

(B) Clients on high-protein and high-calorie diets tolerate the side effects of drugs better than do other clients.

(C) Weight gain is a major problem for a client with cancer.

(D) A cancerous tumor causes the body to metabolize at a slower rate.

Answer : (B)

10. What type of diet is recommended for a cancer client who has chewing difficulty? ​ (A) ​ liquid diet (B) ​ soft diet (C) ​ low-residue diet (D) ​ high-fiber diet Answer : (B)

11. What type of diet is recommended for a cancer client with diarrhea? ​ (A) ​ liquid diet (B) ​ soft diet (C) ​ low-residue diet (D) ​ high-fiber diet Answer : (C)

12. What is the appropriate caloric recommendation for a cancer client? ​ (A) ​30-35 calories per kilogram of body weight (B) 35-40 calories per kilogram of body weight (C) ​40-45 calories per kilogram of body weight (D) ​45-50 calories per kilogram of body weight Answer : (A)

13. How much protein is recommended for a cancer client with a good nutritional status? ​ (A) 0.5 g of protein per kilogram of body weight (B) ​0.8-1 g of protein per kilogram of body weight

(C) ​1-1.2 g of protein per kilogram of body weight (D) 1.3-2 g of protein per kilogram of body weight Answer : (C)

14. Cachexia is defined as _____. ​ (A) ​ abnormally low amounts of proteins in the blood (B) ​ anorexia combined with dysphagia (C) ​ a malignant carcinogen (D) ​ severe malnutrition and body wasting Answer : (D)

15. The effects of cancer on the host are determined by the _____. ​ (A) ​size of the tumor (B) amount of carcinogens in the usual diet (C) ​location of the tumor (D) treatment of the tumor Answer : (C)

16. What is the most common type of skin cancer? ​ (A) ​ melanoma (B) ​ squamous cell (C) ​ basal cell (D) ​ neoplasm Answer : (C)

17. What is the deadliest form of skin cancer? ​ (A) melanoma (B) basal cell (C) squamous cell (D) neoplasm

Answer : (A)

18. What is the term for abnormally low amounts of protein in the blood? ​ (A) hypoalbuminemia (B) proteinemia (C) ​hypoglycemia (D) marasmus Answer : (A)

19. Malnourished clients need how much protein per kilogram of bodyweight? ​ (A) ​ 0.8-1.0 (B) ​ 1.0-1.2 (C) ​ 1.3-2.0 (D) ​ 2.0-2.5 Answer : (C)

20. During chemotherapy and radiation treatments, it is advised that patients do not take greater than 100% of the Daily Value for which supplements?

(A) iron (B) protein (C) calcium (D) antioxidants Answer : (D)

ESSAY 21. Describe the nutritional needs of the cancer client. ​

Graders Info : The nutrient and calorie needs are greater than prior to the onset of cancer. Cancer increases the metabolic rate and tissue must be healed and rebuilt. An increase in protein is necessary. ​

22. Anorexia is a major problem for cancer clients. List ways to encourage eating. ​

Graders Info : Time the chemotherapy to occur 2 to 3 hours before and after meals.Take a diet history to plan meals that may be more appetizing.

Serve favorite foods, prepared familiarly and served attractively.

Serve a soft diet if chewing is a problem.

High-protein and high-calorie diets are best.

Cold foods may be more appealing than hot foods.

Milk, cheese, eggs, and fish may be more appealing.

Sugar may need to be added to fruits and juices.

Several small meals may be better tolerated than three large meals.

Nutritionally rich meals should be served earlier in the day because the person is less tired and may have a better appetite at that time.

High-calorie and high-protein liquid drinks should be served between meals so as not to reduce a client's appetite at mealtime. ​

23. Families with a genetic predisposition to cancer should take certain precautions. List those. ​

Graders Info : Environmental carcinogens should be carefully avoided and medical checkups made regularly. Avoid radiation from X-rays, sun, or nuclear waste; avoid chemicals from food or water, or those that touch the skin regularly or are breathed in from tobacco smoke or asbestos. Avoid foods that are believed to be carcinogenic. If they must smoke or drink, they should do so in moderation. Seek counseling and genetic testing.​ 24. Phytochemicals are substances that occur naturally in plant foods and are thought to be anticarcinogenic agents. Give examples and food sources. ​

Graders Info : Flavonoids, phenols, and indoles are phytochemicals. Fruits and vegetables have an abundance of them. Legumes such as soybeans, dried beans, and lentils contain vitamins, minerals, protein, and fiber that may protect against cancer. ​ 25. Some foods contain substances that may protect against cancer. List those. ​

Graders Info : Fiber helps protect against colorectal cancer. Vitamin C-rich foods may protect against cancers of the stomach and esophagus. Carotene and vitamin A-rich foods protect against cancers of the lung,

bladder, and larynx. ​ 26. Discuss the nutrition-related effects of radiation treatment to the head and neck. ​

Graders Info : Radiation of the head or neck can cause a decrease in salivary secretions, which causes dry mouth (xerostomia) and difficulty in swallowing (dysphagia). It can also cause damage to the taste buds and could also affect taste and smell, causing loss of appetite and weight loss. This reduction in saliva also causes tooth decay and sometimes the loss of teeth. Severe weight loss from not eating enough can also result from radiation therapy. Radiation reduces the amount of absorptive tissue in the small intestine. In addition, it can cause bowel obstruction or diarrhea. ​ 27. In protecting against cancer, what is the most important principle of nutrition? Explain. ​

Graders Info : The most important principle is moderation. An occasional serving of bacon or buttered popcorn or wine is not likely to cause cancer, but the regular, excessive use of carcinogenic foods may contribute to cancer. Vitamins that are thought to prevent cancer should be ingested in foods that naturally contain them. Excessive intake of vitamin supplements can be harmful. For example, abnormally large amounts of vitamin A can cause bone pain and fragility, hair loss, headaches, and liver and skin problems. ​

TRUEFALSE 28. Phytochemicals, or anticarcinogenic agents, can be obtained by eating nine or more servings of protein-rich foods in 1 day. _________________________ ​ (A) True (B) False Answer : (B)

29. Appropriate amounts of protein-rich foods are essential for the maintenance of a healthy immune system. _________________________ ​ (A) True (B) False Answer : (A)

30. Sarcomas involve bone, muscles, cartilage, and fatty or fibrous tissue. _________________________ ​

(A) True (B) False Answer : (A)

31. Lymphomas develop from white blood cells and affect bone marrow and the spleen. _________________________ ​ (A) True (B) False Answer : (B)

32. Melanoma originates in the cells that produce melanin and is almost always fatal.__________________ (A) True (B) False Answer : (B)

33. The hepatitis B and HPV vaccines can be considered anticancer vaccines. _________________________ ​ (A) True (B) False Answer : (A)

34. Cancer is the leading cause of death in the United States. ___________________ ​ (A) True (B) False Answer : (B)

35. The nutrient and calorie needs of the cancer client are lower than they were before the onset of the disease. ​ (A) True (B) False Answer : (B)

36. Anorexia is a major problem of cancer clients. ____________________ ​ (A) True (B) False Answer : (A)

ESSAY 37. Jennie, age 34, had squamous cell carcinoma diagnosed 2 years ago. It began as a scar on the side of her face resulting from a car accident, when she was a child. She became concerned and visited her doctor when it began to turn reddish-purple. A biopsy confirmed the diagnosis and that it was malignant. She underwent surgical removal of the lesion and a portion of the area around her mouth. Cosmetic repair will be done when the cancer growth has ceased. ​ Postoperatively, Jennie has pain when she chews, smiles, laughs, or talks. The doctor has ordered pain medication as needed. What side effect from narcotics affects nutrition? List measures to relieve the problem. ​

Graders Info : Constipation. Add high-fiber foods and liquids, especially juices, to the diet. Find out favorite liquids to increase intake. ​ 38. Jennie, age 34, had squamous cell carcinoma diagnosed 2 years ago. It began as a scar on the side of her face resulting from a car accident, when she was a child. She became concerned and visited her doctor when it began to turn reddish-purple. A biopsy confirmed the diagnosis and that it was malignant. She underwent surgical removal of the lesion and a portion of the area around her mouth. Cosmetic repair will be done when the cancer growth has ceased. ​ What part of the body does squamous cell carcinoma affect and what usually causes it? ​

Graders Info : Squamous cell carcinoma affects the squamous cells that are in the upper layer of the skin. Most cases arise from chronic exposure to sunlight but may also occur where skin has been injured-burns, scars, or long-standing sores. ​ 39. Jennie, age 34, had squamous cell carcinoma diagnosed 2 years ago. It began as a scar on the side of her face resulting from a car accident, when she was a child. She became concerned and visited her doctor when it began to turn reddish-purple. A biopsy confirmed the diagnosis and that it was malignant. She underwent surgical removal of the lesion and a portion of the area around her mouth. Cosmetic repair will be done when the cancer growth has ceased. ​ Describe the role of nutrition for a cancerous condition. ​

Graders Info : Several nutrients are believed to protect against some types of cancers. Nutrition, especially protein, can boost the immune system and helps to prevent protein energy malnutrition. Nutrition is not a cure, nor even a treatment for cancer, but it does play a supportive role in maintaining a healthy state. ​ 40. Jennie, age 34, had squamous cell carcinoma diagnosed 2 years ago. It began as a scar on the side of her face resulting from a car accident, when she was a child. She became concerned and visited her doctor when it began to turn reddish-purple. A biopsy confirmed the diagnosis and that it was malignant. She underwent surgical removal of the lesion and a portion of the area around her mouth. Cosmetic repair will be done when the cancer growth has ceased. ​ What nutritional conditions result from use of radiation? ​

Graders Info : Anorexia, damage to teeth and jaws, esophagitis, difficulty swallowing, mouth ulcers, nausea, reduced salivary secretions, taste alterations, and vomiting. ​ 41. Jennie, age 34, had squamous cell carcinoma diagnosed 2 years ago. It began as a scar on the side of her face resulting from a car accident, when she was a child. She became concerned and visited her doctor when it began to turn reddish-purple. A biopsy confirmed the diagnosis and that it was malignant. She underwent surgical removal of the lesion and a portion of the area around her mouth. Cosmetic repair will be done when the cancer growth has ceased. ​ What nutritional conditions result from use of chemotherapy? ​

Graders Info : Abdominal pain, anorexia, mouth ulcers, nausea, taste alterations, vomiting ​ 42. Jennie, age 34, had squamous cell carcinoma diagnosed 2 years ago. It began as a scar on the side of her face resulting from a car accident, when she was a child. She became concerned and visited her doctor when it began to turn reddish-purple. A biopsy confirmed the diagnosis and that it was malignant. She underwent surgical removal of the lesion and a portion of the area around her mouth. Cosmetic repair will be done when the cancer growth has ceased. ​ People who feel they are making little progress in curing the cancer often turn to unproven therapies. Describe the nutritional components of the therapies. Describe the outcome of most of these cases.

Graders Info : Follow a diet that restricts specific foods. Take vitamins or minerals in megadoses. Use herbal

remedies. Answers may vary. ​

Chapter 20 Foodborne Illness Allergies and Intolerances MULTICHOICE 1. Another name for a disease-causing agent is ____. ​ (A) ​pathogen (B) antibody (C) ​antigen (D) invader Answer : (A)

2. Which bacteria is found in ready-to-eat foods such as hot dogs and luncheon meat? ​ (A) Cryptosporidium (B) ​Escherichia coli (C) Clostridium perfringens (D) Listeria monocytogenes Answer : (D)

3. Which organism can be transmitted via contaminated water, unpasteurized milk, or raw ground beef products? ​ (A) Cyclospora cayetanensis (B) ​Escherichia coli (E. coli) (C) Clostridium perfringens (D) Listeria monocytogenes Answer : (B)

4. What is the most effective way to control E. coli? ​ (A) ​ store foods below 40°F (B) ​ cook ground beef to 160°F (C) ​ keep foods above 140°F (D) ​ keep foods below 0°F

Answer : (B)

5. Which bacteria can be found in milk? ​ (A) ​ Salmonella (B) ​ Listeria monocytogenes (C) ​ Shigella (D) Staphylococcus aureus Answer : (B)

6. What is the most common microorganism found in seafood? ​ (A) ​ Salmonella (B) ​ Listeria monocytogenes (C) ​ Shigella (D) Staphylococcus aureus Answer : (A)

7. Which microorganism produces toxins? ​ (A) ​ Staphylococcus aureus (B) ​ Shigella (C) ​ Salmonella (D) ​ Escherichia coli Answer : (A)

8. Which temperature range inhibits the growth of bacteria?

(A) above 140°F or below 40°F (B) ​between 40° and 140°F (C) ​above 165°F (D) ​below 165°F Answer : (A)

9. What substance in molds has the ability to cause cancer? ​ (A) ​spores (B) ​toxins (C) aflatoxins (D) mycotoxins Answer : (C)

10. How should beef be cooked to be rid of all parasites? ​ (A) ​cook to 160°F (B) ​freeze below 40°F (C) cook to 170°F (D) keep internal temperature to 140°F Answer : (A)

11. What disease is caused by protozoa? ​ (A) ​ cancer (B) ​ diabetes (C) ​ rickets (D) ​ dysentery Answer : (D)

12. Cross-contamination occurs ____. ​ (A) when two microorganisms are ingested together (B) ​when two or more pathogens are produced from a microorganism (C) ​when noninfected food is prepared with equipment that has been used to prepare infected foods (D) ​when two or more people become sick Answer : (C)

13. What is the generalized term for a substance that causes hypersensitivity? ​ (A) pollen

(B) ​allergen (C) urticaria (D) pathogen Answer : (B)

14. Which type of food poisoning can affect the mucous membrane in the digestive tract? ​ (A) neurotoxin (B) pathogen (C) bacteria (D) enterotoxin Answer : (D)

15. ​ Which bacteria have spores that are extremely heat resistant and must be boiled for 6 hours before they will be destroyed?

(A) Clostridium perfringens (B) Campylobacter jejuni (C) Clostridium botulinum (D) Listeria monocytogenes Answer : (C)

16. Which bacteria can cause hemorrhagic colitis? ​ (A) ​Clostridium perfringens (B) Campylobacter jejuni (C) Clostridium botulinum (D) Escherichia coli Answer : (D)

17. Which bacteria can be found in the intestinal tract of humans and can be avoided by good hygiene of food handlers? ​ (A) Salmonella (B) Campylobacter jejuni

(C) Shigella (D) Listeria monocytogenes Answer : (C)

18. Which microorganism can be found on human skin and in infected cuts and pimples? ​ (A) Staphylococcus aureus (B) Campylobacter jejuni (C) Clostridium botulinum (D) Salmonella Answer : (A)

19. A(n) ____ is an altered reaction of the tissues of some individuals to substances that are usually harmless to other individuals. ​ (A) allergen (B) allergy (C) toxin (D) insecticide Answer : (B)

20. ​ Food-related illnesses caused by Clostridium perfringens can be prevented by ____.

(A) thoroughly washing fruits and vegetables (B) pasteurization of milk (C) ​ensuring that meat and poultry are thoroughly cooked (D) keeping hot foods at or above 140°F Answer : (D)

21. Which of the following could cause typhoid fever? ​ (A) Salmonella (B) Listeria monocytogenes (C) Shigella

(D) Staphylococcus aureus Answer : (A)

22. Food poisoning caused by spores is the rarest and the most deadly of all food poisonings. Which of the following explains this? ​ (A) Spores have a thick protective shell that allows them to survive in unfavorable conditions.

(B) Spores are resistant to all antibiotics.

(C) The symptoms occur within 30 minutes of ingestion of the food with spores.

(D) Spores are double cells. This allows one cell to "escape" when the spore is attacked.

Answer : (A)

23. Which of the following bacteria is believed to be one of the most prevalent causes of diarrhea? ​ (A) ​Campylobacter jejuni (B) Clostridium botulinum (C) Listeria monocytogenes (D) Salmonella Answer : (A)

24. Which bacteria is called the "cafeteria" or "buffet" germ? ​ (A) ​ Cyclospora cayetanensis (B) ​ Clostridium perfringens (C) ​ Campylobacter jejuni (D) ​ Clostridium botulinum Answer : (B)

25. Which organism is commonly found in contaminated soil, food, and water as well as in recreational water sources? ​ (A) Escherichia coli (B) Campylobacter jejuni (C) Clostridium perfringens (D) Cryptosporidium

Answer : (D)

26. Symptoms of salmonellosis typically begin from ____________ hours after eating. ​ (A) ​1-2 (B) 12-72 (C) ​6-48 (D) 12-36 Answer : (B)

27. Food poisoning can result from ingesting all of the following EXCEPT ____.

(A) cleaning agents (B) insecticides (C) thoroughly washed foods (D) poisonous plants Answer : (C)

ESSAY 28. State the goal of the elimination diet and describe the process. ​

Graders Info : Goal: To define the offending foods of the client's allergies. Goal: To enable the client to lead a healthy, normal life, within the limitations of food allergies. For several weeks, the client does not eat any of the positively reacted foods. Once the allergic symptoms have subsided, the other foods are added back to the diet at a rate of one every 4 to 7 days. The foods most likely to be allergens are added last, until an allergic reaction occurs. This enables the allergen to be specifically pinpointed. ​ 29. Compare and contrast Clostridium botulinum and Clostridium perfringens. Include source, signs and symptoms, prevention, and prognosis. ​

Graders Info : C. botulinum: found in/on soil, water, plants, and intestinal tracts of animals and fish; the spores of

these bacteria can divide and produce toxin in the absence of oxygen. They can be produced in sealed containers such as cans, jars, and vacuum-packaged foods; signs and symptoms 18-36 hours later include double vision, speech difficulties, inability to swallow, and respiratory paralysis; take care with home canning; 10 minutes of boiling destroys toxin; can be fatal in 5-10% of cases.C. perfringens: found in/on food standing on buffets or steam tables for long periods, soil dust, sewage, and intestinal tracts of animals; signs and symptoms begin within 6-24 hours and include nausea, diarrhea, and inflammation of stomach and intestine; keep hot foods hot (>140°), cold foods cold (< 40°); bacteria destroyed by cooking; lasts 24 hours with complete recovery unless complicated by other medical conditions. ​

30. Describe the reason for the resistance of pathogens with spores. ​

Graders Info : Spores are single cells that have the ability to develop into a new organism. The wall of the spore is thick, protective, heat-resistant, and difficult to penetrate. They must be boiled 6 hours to destroy the spore, which also destroys the food source. ​ 31. Most foodborne illnesses occur because of the ignorance or carelessness of people who handle the food. List some preventive measures and guidelines toward the same. ​

Graders Info : Clean food preparation surfaces and equipment. Dishes to hold uncooked meat, poultry, fish, or eggs must be washed before cooked foods are placed on them. Wash hands after blowing nose or using toilet. Wear gloves if small cuts are present on the hands. Cover foods and store to prevent dust, insects, and animals from contaminating. Do not use water from unknown sources. Refrigerate foods promptly. Thaw frozen foods in the refrigerator. Test food workers to confirm they are not carriers.

Select foods carefully: packages and jars should be sealed properly; cans should not bulge; no mold present; discard food with unusual look or odor. Use only pasteurized milk and dairy products. ​ 32. One substance that causes food poisoning is mold. Describe the allergic reactions to molds, the symptoms, and preventive measures. ​

Graders Info : The growth of molds results in spores that cause respiratory problems or allergic reactions. Some molds have symptoms that include abdominal pain, vomiting and diarrhea, liver and skin damage, or cancer. Mold should never be eaten or purchased. The green, fuzzy part that is seen with the naked eye contains spores and should never be smelled. ​ 33. List the population groups most likely to become very ill or die from food poisoning. ​

Graders Info : Young children, pregnant women, the elderly, and those with compromised immune systems are more likely to become very ill or die from food poisoning. ​

TRUEFALSE 34. An altered reaction to a specific food that does not involve the immune system is called a(n) allergy. _________________________ ​ (A) True (B) False Answer : (B)

35. The primary treatment needed for most foodborne illness is replacing lost fluids and electrolytes to prevent dehydration. _________________________ ​ (A) True (B) False Answer : (A)

36. All allergic reactions to food are always immediate. _________________________ ​ (A) True (B) False Answer : (B)

37. Food allergies among children increased by 10% between 1997 and 2011. _________________________ ​ (A) True (B) False Answer : (B)

38. All microorganisms in the environment are harmful. _______________________ ​ (A) True (B) False Answer : (B)

39. Contaminated food always looks, smells, or tastes different from non-contaminated food. ___________________ ​ (A) True (B) False Answer : (B)

40. It is thought that as many as one in two Americans may experience food poisoning each year. ________________________ ​ (A) True (B) False Answer : (B)

41. The toxin produced by Clostridium botulinum can be produced in sealed containers. __________________ ​ (A) True (B) False Answer : (A)

ESSAY 42. Ms. Moulette has a 7-year-old son who is in remission with lymphoid leukemia. She brings him to the clinic today with vomiting and diarrhea. It is determined that he has food poisoning. Although Jake does recover readily, his mother is very apprehensive about a recurrence. She requests a list of different types of organisms and the symptoms she needs to be alert for, as well as a list of preventive guidelines. ​ Prepare a worksheet for her, stressing that knowledge of pathogenic names will be irrelevant if she adheres to the guidelines for prevention of foodborne illnesses. ​

Graders Info : The student should make a handout of foodborne illness guidelines and symptoms of which to be aware. The table will be similar to Table 20-1 in the text. ​ 43. Brian, age 12, has food poisoning. His mother describes the buffet-style restaurant they had eaten in the previous night. Brian became ill about 2 hours after eating. He has severe diarrhea, vomiting that has stopped at present, and a low-grade temperature of 100.2°F orally. His cheeks are flushed, skin is hot and dry, skin turgor is fair, and lips are dry and cracked. ​

Devise a nursing care plan for Brian. Include assessment data to observe, nursing diagnosis, goals, and nursing interventions. ​

Graders Info :

​

Assessment data to observe: general appearance and behavior, poor skin turgor, decreased urinary output, sunken fontanel (in infant), decreased weight, increased pulse and respiration, decreased blood pressure, prolonged capillary refill.Nursing diagnosis: altered nutrition-less than body requirements related to diarrhea losses and inadequate intake; fluid volume deficit related to excessive GI losses in stool or emesis.

Goals: child will maintain adequate hydration as evidenced by absence of above symptoms; child will maintain appropriate nutrition for age as evidenced by eating and retaining foods; child will not spread the infection to others; the family will receive appropriate support and education, especially home care and prevention.

Nursing interventions: administer rehydration liquids, beginning with small amounts and gradually increasing to a regular diet; administer IV fluids as ordered; strict intake and output; weigh daily; assess vital signs, skin turgor, mucous membranes, mental status; discourage intake of carbonated beverages, fruit juices, and gelatin (these are high in carbohydrates, low in electrolytes, and have a high osmosis level); instruct family in providing appropriate therapy, monitoring intake and output, and assessing for signs of dehydration.

Chapter 21 Nutritional Care of Clients with Special Needs MULTICHOICE 1. Extra ____ is needed for wound healing, tissue building, and blood regeneration.​ (A) ​vitamin B (B) ​protein (C) ​vitamin D (D) ​carbohydrate Answer : (B)

2. ​ Which vitamins, along with zinc, are essential for wound healing in surgery clients?

(A) ​vitamins B and E (B) ​vitamin K and folic acid (C) ​vitamin D and thiamine (D) ​vitamins A and C Answer : (D)

3. When a client is on complete bed rest, what special preparations are required? ​ (A) ​give client opportunity to use the bedpan and wash their hands before the meal is served (B) ​keep the client in a lying-down position (C) keep quiet during mealtime (D) the food must be cut up into small pieces Answer : (A)

4. What vitamin(s) is (are) essential for proper clotting of the blood in surgery clients? ​ (A) vitamin B (B) vitamin K (C) vitamin D (D) vitamins A and C Answer : (B)

5. In general, what is the only thing given to most clients during the first 24 hours after major surgery? ​ (A) intravenous solutions (B) ​high-protein foods (C) high-fat foods (D) ​vitamin supplements and fluids Answer : (A)

6. If clients are unable to feed themselves, how should the "feeder" place food in the client's mouth? ​ (A) on the tip of the tongue (B) ​on the center of the tongue (C) ​toward the back of the mouth (D) toward the front of the mouth Answer : (C)

7. What is the name of the condition that can occur after gastric surgery and is characterized by dizziness, weakness, cramps, vomiting, and diarrhea? ​ (A) ​opportunistic infection (B) dumping syndrome ​ (C) ​hyperglycemia (D) hypoglycemia Answer : (B)

8. What is the term for the instrument used to tube feed through the nose and into the stomach? ​ (A) ​nasal tube (B) ​gastric tube (C) nasogastric tube (D) esophageal tube Answer : (C)

9. An ostomy surgically created into the stomach is a(n) _____. ​

(A) gastrostomy (B) jejunostomy (C) hysterectomy (D) esophagostomy Answer : (A)

10. Clients who are able to digest and absorb nutrients are given a commercial formula containing intact proteins, carbohydrates, and fats that require digestion. What is the term for this formula? ​ (A) modular formula (B) hydrolyzed formula (C) polymeric formula (D) elemental formula Answer : (C)

11. What are some conditions that can cause a decline of the sense of taste? ​ (A) vitamin deficiencies (B) dysphagia (C) high sugar intake (D) mineral deficiencies Answer : (D)

12. Name the term for the provision of nutrients intravenously. ​ (A) parenteral nutrition (B) internal nutrition (C) enteral nutrition (D) gastrointestinal nutrition Answer : (A)

13. All of the following are needed immediately after a client sustains serious burns EXCEPT _____.

(A) ​fluids

(B) ​electrolytes (C) ​proteins (D) ​glucose Answer : (D)

14. What factor is related to weight loss in the AIDS client? ​ (A) ​Medication used to treat AIDS destroys the protein stores.

(B) Appetite and the body's ability to absorb nutrients are decreased.

(C) ​Depression decreases the appetite and causes lethargy.

(D) Fever increases the metabolism and burns the extra calories.

Answer : (B)

15. If the client begins to choke while being fed, what is the first action to take? ​ (A) ​help the client sit up straighter (B) offer water to wash down the food (C) go look for help (D) ​suction the client Answer : (A)

16. Constipation can be caused by all of the following EXCEPT _____.

(A) inadequate fiber (B) too much fluid (C) inactivity (D) medication Answer : (B)

17. What is the preferred method for feeding the postsurgical client? ​ (A) ​ orally (B) ​ via nasogastric tube (C) ​ parenterally

(D) ​ intravenous solution Answer : (A)

18. What complication can develop in bedridden clients? ​ (A) ​ peptic ulcer (B) ​ gastric ulcer (C) ​ pressure ulcer (D) ​ stomach ulcer Answer : (C)

19. It is estimated that the majority of people over age 85 have at least _____ chronic disease(s). ​ (A) one (B) two (C) three (D) four Answer : (A)

ESSAY 20. Describe the hypermetabolic response and its impact on the body's homeostasis. ​

Graders Info : The hypermetabolic response is a self-protective response to physical stress. The body signals the endocrine system. Energy output is increased. Catabolism occurs, which is the rapid breakdown of energy reserves to meet the demand of the stress. The catabolism pulls reserves that are needed for wound healing and tissue maintenance. Proteins, fats, and minerals are lost. When the stressful condition includes hemorrhage and vomiting, the loss is compounded. ​ 21. What vitamins and minerals are used prior to surgery to improve nutritional status, and what are their functions? ​

Graders Info : The B vitamins are needed for the increased metabolism, vitamins A and C are for wound healing,

and zinc is needed for wound healing. Vitamin D is for the absorption of calcium and vitamin K for proper blood clotting. Iron is for blood building, calcium and phosphorus to support bone health, and other minerals for maintenance of acid-base balance and electrolyte and fluid balance. ​ 22. Describe symptoms and pathology of the dumping syndrome. ​

Graders Info : After gastric surgery, the dumping syndrome may develop. Within 15-30 minutes after eating, dizziness, weakness, cramps, vomiting, or diarrhea may occur because the food moves too quickly from the stomach into the small intestine. ​ 23. Describe alternate enteral feeding methods when the oral route cannot be used. ​

Graders Info : Enteral nutrition includes feedings that bring the nutrients directly into the digestive system. These alternate methods include the following: Nasogastric-a tube through the nose into the stomach or small intestine Gastrostomy-creation of a surgical opening into the stomach Jejunostomy-creation of a surgical opening into the jejunum ​

24. Describe protein-energy malnutrition (PEM) and the prognosis when experienced by an AIDS client. ​

Graders Info : This is referred to as HIV wasting syndrome. Infections and other physical problems increase the metabolic rate and the nutrient and calorie needs. In addition, the appetite and the body's ability to absorb nutrients are decreased. Hypoalbuminemia and weight loss occur. The insufficient amounts of protein and calories damage the immune system and death soon follows. ​ 25. In relation to mealtime, what important information should be added to the client's chart? ​

Graders Info : The kinds and amounts of foods refused, the time, the type of diet, and client's appetite should be recorded to provide an ongoing record of nutritional history. The doctor may request a calorie and protein count to determine the types of foods eaten. ​ 26. Acute or chronic illness or surgery can devastate one's nutritional status. Describe the effects. ​

Graders Info : Fever, nausea, fear, depression, chemotherapy, and radiation can destroy appetite. Vomiting, diarrhea, chemotherapy, radiation, and some medications can reduce or prevent absorption of nutrients. When undergoing diagnostic or surgical procedures, the person has food and fluid restrictions. These restrictions, with reduced nutrient and calorie intake, occur at a time when the nutritional status could have a major impact on the prognosis. ​ 27. Define xerostomia and discuss its causes. How can xerostomia be alleviated? ​

Graders Info : Xerostomia means dry mouth and can be caused by disease or medications. Drinking water, eating frequent small meals, and chewing sugar-free gum or sucking on hard candies may be helpful. ​

TRUEFALSE 28. Intravenous solutions are used when clients cannot take foods orally. They provide protein. _________________________ ​ (A) True (B) False Answer : (B)

29. Parenteral nutrition is the provision of nutrients via an ostomy into the stomach or jejunum. _________________________ ​ (A) True (B) False Answer : (B)

30. When feeding clients who are unable to feed themselves, the nurse should sit on the bed so the client will not feel that the nurse is in a hurry. _________________________ ​ (A) True (B) False Answer : (B)

31. In preparation for gastrointestinal surgery, a high-residue diet may be ordered for a few days prior to surgery in order to aid in cleansing the colon. _________________________ ​

(A) True (B) False Answer : (B)

32. One reason weight reduction is desirable prior to surgery is that fatty tissue tends to retain the anesthetic longer than other tissue. ___________________ ​ (A) True (B) False Answer : (A)

33. Bowel sounds indicate that perstalsis has returned. ___________________ ​ (A) True (B) False Answer : (A)

34. If a client has dysphagia, he or she should drink beverages with a straw to prevent aspiration. _________________________ (A) True (B) False Answer : (B)

ESSAY 35. Why is it recommended to clients to lose weight prior to surgery? ​

Graders Info : Excess fat is a surgical hazard because the extra tissue increases the chances of infection, and the fatty tissue tends to retain the anesthetic longer than do other tissues. ​ 36. Describe postsurgery nutritional care. ​

Graders Info :

The diet plan is to provide calories and nutrients in amounts sufficient to fulfill the increased metabolic needs and to promote healing. Protein is the priority nutrient to build and repair tissue, control edema, avoid shock, resist infection, and transport fats. Protein of 1.5-2.0 g/kg a day may be necessary. Additional vitamins and minerals are also needed. ​ 37. Describe the progression of a postoperative diet. ​

Graders Info : When peristalsis returns, ice chips may be given. If the ice is tolerated, a clear-liquid diet can follow.

In the first 24 hours, intravenous fluids supply nutrition, vitamins, electrolytes, and dextrose. In normal cases, when peristalsis returns, the diet is advanced to a full liquid diet; a soft or, dependent on the type of surgery, a low-residue diet will precede a return to the regular diet. ​ 38. Rosa, age 84, is unable to care for herself at home. She had a stroke 6 months ago and is in the nursing home. She requires total care by the nursing staff. ​ Why is Rosa at high risk for pressure ulcers? ​

Graders Info : Change in mobility status, incontinence, and poor appetite that will result in a compromised nutritional status ​ 39. Rosa, age 84, is unable to care for herself at home. She had a stroke 6 months ago and is in the nursing home. She requires total care by the nursing staff. ​ What feeding techniques should the nurse be aware of prior to feeding Rosa? ​

Graders Info : Small amounts of food should be placed toward the back of the mouth. Use a slight pressure on the tongue with spoon. Allow the client to help as much as possible by holding the bread, finger foods, and drink (if not too hot). If choking occurs, help her sit up. Do not give food or water while choking.

Be aware of choking and the potential need for the Heimlich maneuver. Keep the mouth as clean as possible. ​ 40. Rosa, age 84, is unable to care for herself at home. She had a stroke 6 months ago and is in the nursing home. She requires total care by the nursing staff. ​ The elderly often have poor appetites, and that is a factor in the development of protein-energy malnutrition. What can the nurse do to make mealtimes more attractive? ​

Graders Info :

Serve food attractively with colorful garnish. Arrange utensils conveniently. Serve foods at proper temperatures. Allow client to use the bathroom or bedpan and wash before eating. Have the room well ventilated and the unit neat. Remove unpleasant odors and sights from view. Have pleasant conversation while eating. If client feeds selarrange tray with all items in reach. Cut food that needs it, butter bread, and add condiments. ​ 41. Rosa, age 84, is unable to care for herself at home. She had a stroke 6 months ago and is in the nursing home. She requires total care by the nursing staff. ​ How can the nurse improve the client's nutritional status? ​

Graders Info : A thorough nutritional assessment should be done on a regular basis. All staff needs to be alert for the signs of malnutrition. If there are complaints about the food, the nurse should check it out immediately. The client and family will need reassurance about the client's condition, will need information about nutritional needs, and will need personal attention for all concerns, and the client may want different foods that can be served within the diet plan. Allow the client to choose favorite foods. ​ 42. Rosa, age 84, is unable to care for herself at home. She had a stroke 6 months ago and is in the nursing home. She requires total care by the nursing staff. ​ Constipation is a problem for the elderly. List nursing measures to facilitate regular bowel patterns. ​

Graders Info : Increase fiber, fluids, and exercise 43. Rosa, age 84, is unable to care for herself at home. She had a stroke 6 months ago and is in the nursing home. She requires total care by the nursing staff. ​ The senses of smell and taste decline with age, and appetite may diminish. List some of the causes of sensory alterations, and nursing interventions to improve appetite. ​

Graders Info : Diminished senses can be caused by medications, disease, mineral deficiencies, or dry mouth. The use of condiments (that are allowed by diet), spices, herbs, salt, or sugar may give some flavor.

Drinking water, frequent small meals, or chewing sugar-free gum or candy may trigger some taste and increase appetite. ​ 44. Rosa, age 84, is unable to care for herself at home. She had a stroke 6 months ago and is in the nursing home. She requires total care by the nursing staff. ​ Rosa has developed anemia. State causes and dietary recommendations. ​

Graders Info : Anemia develops due to inadequate protein. The lack of meat could be due to lack of financial resources to purchase meats or the physical inability to prepare the foods. A factor for many of the elderly is the inability to chew meat from loss of teeth or loose-fitting dentures. The client who is anemic may complain of fatigue, confusion, and depression. ​ 45. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ Give a nursing diagnosis statement in relation to nutrition. ​

Graders Info : Imbalanced nutrition: risk for less than body requirements related to hypermetabolic state from the burn, inadequate intake, and protein catabolism 46. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ Susan is becoming dehydrated. Her B/P is 90/46, pulse 112, and respirations 32. Her urinary output for the past 24 hours is 100 mL. She is in burn shock. Describe the pathology that has resulted in these symptoms. ​

Graders Info : The loss of the skin surface leads to enormous losses of body fluids, electrolytes, and proteins. A protective mechanism in the body shifts the water from other tissues to the site of the burn, to compensate for the fluid loss. Unfortunately, this further reduces the blood volume and cellular fluids, which in turn lowers blood pressure and other vital signs and decreases urinary output.

Additionally, the heart can no longer supply enough blood to perfuse the vital organs, thus the decreased urine output. ​ 47. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ When does the greatest need for fluids occur? Why? ​

Graders Info : The greatest fluid loss occurs within the first 12 hours. The shift of the fluids, proteins, plasma, and electrolytes to the burn site puts the entire body in a state of dehydration. ​ 48. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​

Describe the hypermetabolic state associated with a burn. ​

Graders Info : The hypermetabolic condition is present until the burn is healed. It is in response to the increased metabolism from the body's need to repair and build new tissues. There is an enormous need for energy, accompanied by an increased need for calories and protein. ​ 49. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ Nutrition is of primary importance for a burn client. List some vitamins and minerals that have an impact on the healing process. ​

Graders Info : Vitamin C and zinc are needed for healing. The B vitamins are necessary for the metabolism of extra minerals. Vitamin A is needed for the immune system and the epithelial tissues. ​ 50. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ Susan has a poor appetite and drinks little fluid. Maintaining fluid balance is of utmost importance.

The physician orders enteral nutrition via nasogastric tube. Why did the doctor choose the nasogastric method? ​

Graders Info : Nasogastric tube insertion does not require the minor surgical procedure that the other enteral feeding methods do. The surgical procedure would increase the demands on the body for healing.

The prognosis for recovery of Susan's appetite is good; therefore, the tube could be removed before the 6-week limit. ​ 51. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ Compare the three methods for administering tube feedings. ​

Graders Info : Continuous feedings are administered during a 16-24-hour time period, preferably with a pump.​ Intermittent feedings are administered during either daytime or at night. If the client eats food, the tube feedings would be given at night, so that solid foods could be eaten during the day. ​ Bolus feedings are divided into six servings that are given over a 15-minute time span, followed by a

bolus of 25-60 mL of water. ​

52. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ One of the major complications of tube feedings is aspiration. Define aspiration and nursing measures to prevent the occurrence. ​

Graders Info : Aspiration occurs when some of the formula enters the lungs, and it may then cause pneumonia.

Keep the head of the bed elevated at all times. Turn client from side to side; check placement of the tube prior to giving medications, formula, or water flushes or any substances via the tube. If in doubt about correct placement of the tube, it should be checked with an X-ray to decrease the possibility of aspiration. ​ 53. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ List some of the complications that occur with tube feedings. ​

Graders Info : Aspiration pneumonia, a clogged feeding tube, constipation, dehydration and electrolyte imbalance, diarrhea, cramps and distention, hyperglycemia, nausea and vomiting, and skin irritation around the site 54. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ Nausea and vomiting have begun. What nursing interventions can be done to relieve or prevent further attacks? ​

Graders Info : Check gastric residual, slow administration rate, provide adequate fluids, and use continuous feeding techniques. ​ 55. Susan, age 42, has been burned over 30% of her body, including face, neck, arms, and chest, from a chemical explosion at work. ​ The feeding tube has become clogged. What measures are indicated? ​

Graders Info : Give drugs orally when possible, or by injection, or the intravenous route. Flush tube with at least 30 mL of warm water or saline before and after giving any drug through the tube. Dilute sticky or thick fluids prior to administration. Crush tablets to a fine powder and mix with water before administration. ​